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Biomedical subjects

R W Fincham

Publications and source records attributed to R W Fincham.

10 recordsLinked to original sources
PubMed1992

Parkinsonism treatment: Part III--Update.

OBJECTIVE: The purpose of this review is to update clinicians with recent advances in the management of parkinsonism, including drug therapy, transplantation, and diet. DATA SOURCES: Pertinent articles were obtained from an English-language literature search using MEDLINE (1970-1991), Index Medicus (1987-1991), Current Contents (1990), and bibliographic reviews of review articles. Index terms included parkinsonism, selegiline, pergolide, vitamin E, and transplantation. Fifty-five articles (representing 85 percent of the complete literature search) were selected by multiple reviewers for their contribution to the stated purpose. Emphasis was placed on double-blind, placebo-controlled, and randomized studies. Data from cited articles were examined by multiple reviewers for support of their stated hypothesis and were included as background for justification of major points in this article; critical studies were abstracted in more detail. RESULTS: New therapeutic measures have been added to the treatment of parkinsonism. Selegiline, a monoamine oxidase inhibitor type B, has shown beneficial results, especially in early stages. Pergolide, a dopamine agonist, may be an efficacious alternative to bromocriptine resistance or intolerable adverse effects. Vitamin E may have protective antioxidant properties, but very few clinical data are available. Fetal tissue transplantation needs continued research and remains very controversial. Diet modification may maximize the results of therapy with exogenous dopamine therapy. CONCLUSIONS: Clinicians should familiarize themselves with new alternatives for the management of parkinsonism in order to be reliable consultants for both professional and lay persons.

Antioxidants↗
PubMed1979

Electroencephalographic absence status with minimal behavior change.

Difficulty in correlating EEG abnormalities with clinical seizures is emphasized in this case report of an epileptic patient with electrical status epilepticus and normal behavior. In addition, the usefulness of dichotic listening tests in the identification of subtle perceptive and expressive impairments is illustrated in this same patient at a time of noncompliance with anticonvulsant therapy.

Adult↗
PubMed1979

Decreased phenytoin levels in antineoplastic therapy.

A case history is reported illustrating the difficulties which may be encountered in maintaining seizure control in patients being treated with antineoplastic therapy. The maintenance of therapeutic serum levels of phenytoin during combined cis-platinum and bleomycin sulfate therapy suggests an absorptive defect, possibly related to damage of the intestinal mucosa. This defect did not appear to alter the absorption of primidone or phenobarbital, since increased dosages were not necessary to maintain these drugs within therapeutic ranges.

Adult↗
PubMed1976

Use of phenytoin serum levels in a case of status epilepticus.

Serum anticonvulsant determinations made possible the identification of an unusual cause of status epilepticus and assisted with appropriate therapy in an epileptic patient with second-degree burns. The seizures were associated with a serum phenytoin concentration of 3.5 mug per milliliter. This suboptimal concentration of drug developed despite continuation of the patient's customary oral dose of phenytoin led to the conclusion that the unexpected decrement in serum anticonvulsant concentration was related to an experiment in absorption of that drug, possibly caused by the concurrent administration of oral oxacillin.

Adult↗
PubMed1975

Alexia with left homonymous hemianopia without agraphia. A case report with autopsy findings.

Unusual findings at autopsy prompted this case report of a patient with the syndrome of alexia without agraphia. The expected disconnection of the left angular gyrus from both visual cortices was not found at postmortem examination. Multiple cerebral metastases were identified, but none were present in the presumed pathways connecting the left occipital lobe and the left angular gyrus.

Autopsy↗
PubMedDate not supplied

Phenytoin pharmacokinetics: before and after folic acid administration.

Phenytoin (PHT) exhibits linear and Michaelis-Menten pharmacokinetics. PHT decreases serum folate; the vitamin folic acid (FA) is hypothesized to be a cofactor in the metabolism of PHT. The depletion of serum folate may explain the unpredictability of measured total serum PHT concentrations and time to steady state as compared with the Michaelis-Menten predictive calculations. We examined PHT pharmacokinetics before and after FA supplementation in 13 healthy male volunteers. The study was divided into two phases. Phase I determined V(max) (mg/day) and Km (micrograms/ml) of PHT to calculate PHT doses needed for the second phase. Phase II was a four-way cross-over study to examine the effect of 1 and 5 mg FA on total serum PHT concentrations 1 microgram/ml less and 5 micrograms/ml greater than the subject's Km, Km - 1 and Km + 5, respectively. Predicted versus measured total serum PHT concentrations, t90% (days to steady state), and the effect of FA were calculated for Km - 1 and Km + 5 before and after 1 or 5 mg FA. The measured total serum PHT concentration was always greater than the calculated concentration (p less than 0.05), and t90% was always longer than the calculated t90% (p less than 0.05) for Km - 1 before FA (all subjects decreased serum FA); the same was observed for Km + 5. If folate is assumed to be a cofactor in PHT metabolism, these results are expected, because depletion of the vitamin would indicate less folate to drive the metabolism of PHT, resulting in higher total serum PHT concentrations and longer time to reach steady state.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗