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Biomedical subjects

P Clarenbach

Publications and source records attributed to P Clarenbach.

At least 19 recordsLinked to original sources

Early signs of cognitive deficits among human immunodeficiency virus-positive hemophiliacs.

A total of 181 human immunodeficiency virus (HIV)-seropositive hemophiliacs and 28 hemophilic controls were evaluated by psychometric tests and by electroencephalogram (EEG). Patients were classified from stages 1-6 according to the immunological criteria of the Walter Reed staging system. Statistical analysis of psychometric data showed an effect of the stage of the disease on test performances, indicating a decline in attention, accumulation of perceptual interferences, decline in visuoperceptual speed and visuomotor response speed and reduced verbal memory performance, especially in stage 6 patients. Comparison of performance levels with normative test data already revealed cognitive deficits in about 20-30% of the patients in stages 2-5. As regards verbal memory, especially learning and recognition of new verbal information were impaired. In contrast, there was no significant deficit for nonverbal memory processing. Compared with the controls, patients exhibited an increasing number of abnormal EEG findings in stages 2-6. As a conclusion, in the stages before acquired immunodeficiency syndrome (AIDS) develops, EEG findings as well as psychometric findings indicate central nervous system involvement of AIDS in about 20-30% of cases, whereas in full-blown AIDS there is a marked increase to 80%. Besides a more general deficit of attention and psychomotor speed as is seen in subcortical dementia, there is evidence for a particular verbal learning disorder, suggesting additional selective impairment of the brain.

AIDS Dementia Complex

Problems in performing a double-blind multicenter study using a hypnotic in private practice.

1. The procedure described--the immediate data transfer and entry system (ITES)--is suitable to improve the quality of data collected in multicentre studies in private practice. 2. The results of the study show that regarding influence on sleep quality and daytime well-being the non-benzodiazepine Z is significantly superior to placebo and slightly superior to the benzodiazepines F and T. 3. The advantage of Z treatment is the better daytime well-being after taking the hypnotic for sleep induction the night before. 4. This study shows that a quality standard equal to that in clinical practice may be achieved in private practice.

Adolescent

Cerebral sarcoidosis presenting as supranuclear gaze palsy with hypokinetic rigid syndrome.

A 31-year-old man with histologically documented pulmonary sarcoidosis developed a severe hypokinetic rigid syndrome with a supranuclear gaze palsy following recurrent lymphocytic meningitis and occlusive hydrocephalus. Magnetic resonance imaging (MRI) showed multiple hyperintense foci in the CNS, not detectable by computed tomography (CT). Long-term steroid therapy led to clinical complete remission.

Adolescent

Gabapentin augments whole blood serotonin in healthy young men.

It has been previously demonstrated that gabapentin, a gamma-amino butyric acid analogue, inhibits monoaminergic neurotransmitter release from rabbit caudate nucleus slices and from rat cortex. In humans this drug has been shown to have anti-epileptogenic activity. Serotonin may act as an inhibitory neurotransmitter and its interaction with blood platelets is thought to reflect its central actions. We investigated sleep stages, whole blood serotonin levels, and serum melatonin in healthy men after the administration of gabapentin. With increasing serum gabapentin levels six healthy subjects showed an increase in sleep stages 3 and 4 and in whole blood serotonin (P less than 0.05) Serum melatonin levels were not influenced. On account of these results we speculate that gabapentin modulates the release of serotonin from blood platelets. The increase in peripheral serotonin points paradigmatically to an increase in the bioavailability of serotonin which may account for the increase in sleep stages 3 and 4.

Acetates

EEG discharges in WR 1-5 HIV-seropositive hemophiliacs.

Human immunodeficiency virus (HIV)-seropositive patients show involvement of the central and/or peripheral nervous system. We present here the results of electroencephalographic (EEG) findings in stage WR 1-5 HIV-seropositive hemophiliacs from a total of 184 who attended our clinic prior to October 1987.

Brain

Endocrine profile of a long-acting somatostatin derivative SMS 201-995. Study in normal volunteers following subcutaneous administration.

The pharmacokinetics and the endocrine profile of a new low molecular somatostatin derivative, SMS 201-995, were investigated in a group of 35 normal subjects. Clearance studies (n = 6) for this peptide showed a prolonged half-life in plasma, 113 min, following single sc injections of 50 or 100 micrograms. Arginine stimulation tests (n = 6) were conducted immediately and 180 min after sc injection of 50 micrograms of SMS 201-995. The stimulatory effect of arginine on GH and insulin was counteracted by the peptide at the P less than 0.001 and P less than 0.02 significance level, respectively. Delayed arginine stimulation revealed a persistent blockade of the GH release (P less than 0.02), whereas a recovery of the insulin response was observed. Plasma glucagon increments following a standard protein meal (n = 10) were significantly (P less than 0.001) inhibited by previous sc injection of 50 micrograms of SMS 202-995. Pretreatment with 50 and 100 micrograms of SMS 202-995 sc (n = 9) inhibited (P less than 0.001) the stimulatory effect of TRH (200 micrograms iv) on TSH without modifying basal levels. The injection of 100 micrograms/h during sleep completely abolished the nocturnal GH peak in 4 volunteers. No rebound rise after decline of the suppressive action on GH was recorded in any of the trials. Safety chemistries and blood coagulation studies remained normal and no side-effects or untoward reactions were recorded throughout the investigation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Effect of clonidine and yohimbine on sleep in man: polygraphic study and EEG analysis by normalized slope descriptors.

An all-night polygraphic study of sleep was carried out in 6 healthy volunteers acutely medicated with clonidine (225 micrograms), yohimbine (15 mg), a combination of both drugs or with placebo at random order under simple blind conditions. The conventional scoring of sleep stages was extended by an on-line analysis of the EEG according to Hjorth. Clonidine, an agonist at alpha2 receptors, induced increases of the stages 2 and 3 + 4 but a decrease of REM sleep; the reduction of the parameters mobility and complexity during non-REM sleep signified synchronization of the EEG. Yohimbine, an antagonist at the same receptor sites, enhancing noradrenaline release, increased stage 1 and REM sleep, but decreased the stages 2 and 3 + 4; increases of mobility during REM and non-REM sleep signified desynchronization. The combined treatment with clonidine + yohimbine reduced REM sleep, but not as extensively as clonidine alone; the Hjorth parameters were without significant alterations compared to placebo. The physiological hypotonia was enhanced by clonidine and the combined treatment with clonidine + yohimbine. These results favour the hypothesis of a noradrenergic facilitation of REM sleep.

Adult

[Arthralgia and neurologic deficit. A differential diagnostic review].

The diagnostic classification of arthralgia and non-characteristic neurological deficit is a challenge for the neurologist and the internist if both symptoms arise simultaneously or in combination. Diseases with the combined appearance of both symptoms are grouped into those with early and more or less simultaneous onset, those starting with arthralgias followed by neurological deficits, neurogenic arthropathies, and those presenting both symptoms as complications of ongoing internal disease. A diagnostic procedure is set out and recommended.

Arthritis

Simultaneous clinical manifestation of subependymoma of the fourth ventricle in identical twins. Case report.

At the age of 22 years, identical twin brothers simultaneously developed symptoms of intracranial pressure. Radiological investigation revealed cerebellar midline tumors with occlusive hydrocephalus of the third and lateral ventricles. At operation, subependymomas with identical histological features were found in the fourth ventricle in both twins. This is the first report of subependymomas in identical twins. The clinical data suggest that this tumor type is of maldevelopmental origin.

Adult