[Sarcoidosis of the nervous system].
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Biomedical subjects
Publications and source records attributed to T Sand.
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Seven patients with acute chemical meningitis after metrizamide myelography are described. Five of the cases occurred within a time span of two months. Clinical and cerebrospinal fluid findings in the acute stage of the illness were similar to findings in acute bacterial meningitis. Possible causes of this complication are discussed.
The latency distributions of normal brain-stem auditory evoked potential (BAEP) components elicited by condensation (C) and rarefaction (R) clicks at 10 and 50 Hz were found to be double- or multi-peaked for II (10 and 50 Hz), III (50 Hz), IV (10 and 50 Hz) and V (10 Hz). A bifid component III was found in 3.5% (10 Hz) and 7.4% (50 Hz) of BAEPs. A bifid II and triple IV/V configuration were occasionally noted. The prevalences of the different IV/V complex configurations were significantly dependent upon click phase and rate. These results suggest that several subcomponents might participate in the generation of the single BAEP components and that a single generator may contribute to different BAEP components in different subjects. Early subcomponents between I and II (Ib) were found in 13% of 10 Hz BAEPs and 27% of 50 Hz BAEPs (P = 0.002) and the latency distribution of Ib seemed to be bimodal. Ib/I relative amplitude frequently increased with 50 Hz stimulation. We suggest that the generator of Ib is partially cochlear (CM) and partially neural (equivalent to N2 of the ECochG-AP) in origin. The existence of subcomponents must be recognized in clinical use of BAEPs both to avoid misinterpretation and to decrease the normal variability in monophasic click evoked BAEP studies.
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A Norwegian family with asymmetrical scapuloperoneal atrophy is described. Chronic, aching shoulder pain, slight proximal and distal sensory dysfunction, and atrophy of the extensor digitorum brevis muscle occurred in some individuals. The proband had slightly impaired sensory conduction velocity, and his father exhibited impaired position sense and a vibration threshold asymmetry. EMG and muscle biopsy findings were equivocal. The syndrome is probably of neurogenic origin. It may be classified as a variant of Davidenkow's syndrome.
The effect of the phase of the click stimulus and its relation to the stimulus repetition rate on the brain-stem auditory evoked potentials (BAEPs) was investigated in 43 normal subjects, with condensation (C) and rarefaction (R) clicks of 10 and 50 Hz rate, using a piezoelectric headphone . The distribution of C and R latencies for component I seemed to be bimodal, probably reflecting (at least) two subcomponents in I separated by about 0.20 msec. C clicks tended to evoke the first and R clicks the second subcomponent. Condensation clicks gave significantly shorter absolute mean latencies for components I, IN, II, III, IIIN , IV and VI (10 Hz) and components IN, II, III, IIIN and IV (50 Hz). The V/I relative amplitude means were not influenced by phase, but increased with rate. Standard deviations were greatest for component IV latencies and increased only insignificantly with the higher repetition rate. A significantly smaller number of IV components was identified with R as compared to C clicks. Increasing the stimulus rate to 50 Hz detected wave IV in 12 of the 18 records where R clicks failed to identify IV with 10 Hz stimulation. The importance of the stimulus characteristics is discussed and some suggestions for clinical use of BAEP are made.
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The clinical value and prevalences of three primitive reflexes, i.e. the palmomental, the snout, and the corneomandibular, were examined in 30 institutionalized patients with Down's syndrome and the results were compared with those in a control group. The prevalence of palmomental reflex was clearly higher, i.e. 47% (31,63) in DS as compared to 7% (2,16) in controls (confidence limits, P = 0.9, is given in the parenthesis) (P = 0.0001). The prevalences of the snout reflex in the DS and control group were estimated to be 14% (5,29) and 0% (0,6) respectively (P = 0.02). The corneomandibular reflex was found unreliable in DS, mainly because of lack of cooperation. Neither the palmomental nor the snout reflex correlated well with the degree of mental retardation. No correlation of reflex incidence with age was demonstrated for the palmomental reflex. The prevalence of the snout reflex in DS patients less than 35 years was estimated to be 0% (0,18). This is significantly (P less than 0.05) less than the prevalence of 29% (10,54), found in the group older than 35 years of age. The possible value of the snout reflex as a sign of dementia in Down's syndrome is discussed.
TRH inhibits gastric secretion, gastric motility, and pancreatic enzyme secretion in man. We measured TRH immunoreactivity (TRH-IR) in mucosal and transmural biopsies from different parts of the stomach, pylorus, duodenum, and pancreas in patients undergoing surgery or gastroscopy. TRH-IR was found in pancreas (range, 1.64-3.27 pg TRH/mg protein) and in mucosa of the fundus (13.3 +/- 2.0 pg TRH/mg protein), antrum (22.5 +/- 4.5 pg TRH/mg protein), and duodenum (35.5 +/- 6.4 mg TRH/mg protein). Low levels of TRH-IR were found in transmural biopsies from fundus, antrum, and pylorus (range, 0.45-0.87 pg TRH/mg protein). Chromatography of gastrointestinal tissue extracts on a cation exchange column resulted in two different TRH-IR peaks, one eluted at pH 3.5 and the other eluted at pH 7.4. The peak at pH 7.4 corresponded to synthetic TRH. The presence and the action of TRH in human gut indicate a physiological role of TRH in the gastrointestinal tract in man.
The effect of beta-adrenergic receptor stimulation with isoproterenol and blockade with propranolol on the release of gastric inhibitory polypeptide (GIP) and insulin was investigated in seven healthy volunteers. In the control experiment, the concentration of GIP in plasma increased from 30.1 (18.9-58.8) to 77.2 (44.2-121) pM after 30 g oral glucose. The concentration of insulin in serum increased from 7 (4-12) to 34 (13-76) mU/l. During infusion with isoproterenol, plasma GIP increased from 29.9 (25.7-39.1) to 47.1 (37.2-83.8) pM and insulin from 9 (5-15) to 37 (16-72) mU/l before oral glucose. After oral glucose, further increases of GIP to 111 (68.8-171) pM and of insulin to 103 (33-131) mU/l were observed. When propranolol was given in addition during this beta-receptor stimulation, plasma GIP after glucose increased to 82.2 (49.7-145) pM and serum insulin to 61 (9-133) mU/l. An isoproterenol-induced increase in the concentration of GIP and insulin was thus counteracted by propranolol. This strongly indicates that not only the insulin release but also the entero-insular axis as a total is influenced by beta-adrenergic mechanisms.
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The endocrine response to severe physical strain including lack of sleep has been investigated in army personnel during a combat course of 5 days' duration. The thyroxine (T4) concentration in serum increased during the first 24 h, and then declined at a rate corresponding to a halflife of 7.6 days and on day 6 had reached the lowest level, 55 ng/ml. Triiodothyronine (T3) displayed a similar pattern, although an increase during the first 24 h could not be demonstrated. Within 48 h after the course T4 had returned to normal, whereas the serum level of T3 was significantly below the level before the course (p less than 0.05). The serum level of TSH was suppressed during the course. The serum level of prolactin was significantly suppressed and growth hormone was markedly elevated during the course with a significant negative correlation (r=-0.6) between the two. In agreement with a previous report, there was a rapid and sustained suppression of the serum level of testosterone to a mean level of 1.1 ng/ml on day 5. Short periods of sleep (3--6 h) were shown to be effective in reversing the changes described in this paper, especially for growth hormone, prolactin, and testosterone.
Thyrotrophin releasing hormone (TRH) tests were performed at 4 or 8 weeks intervals, after the initiation of anti-thyroid treatment in 15 patients with Graves' disease. All TRH test were negative as long as the serum levels of thyroxine (T4) and triiodothyronine (T3) were elevated, and normalization of the serum levels of these hormones always occurred before the response to iv TRH was restored. In 13 patients the time from the patients for the first time were registered as biochemically euthyroid varied from 0-9 months (mean 3.1 months), before TRH response was restored. Two patients were still TRH non-responsive at the end of the study, even though they had been biochemically euthyroid for as long as 17 and 18.5 months. The TRH test, therefore, is not helpful in the evaluation of the effect of anti-thyroid treatment in patients with Graves' disease. There was an increase in the serum level of (TSH) from 3.4 +/- 0.3 (SEM) to 4.3 +/- 0.5 (SEM) ng/ml (P less than 0.05), and a decrease in the serum level of total T4 from 19.4 +/- 1.1 (SEM) to 5.8 +/- 0.8 (SEM) microng/100 ml in 13 patients from the first examination until the last time they were examined before restored TRH response. This finding shows that the pituitary gland has retained its ability to synthesize and secrete TSH even though no TSH could be released by iv TRH. In 6 TRH non-responsive patients with Graves' disease, serum TSH levels were suppressed from 2.5 +/- 1.2 (SEM) ng/ml before the administration of a single dose of 3 mg T4 orally, to 0.9 +/- 0.2 (SEM) ng/ml, 7 days after the T4 administration. Thus, the negative feed-back effect on the pituitary gland of the thyroid hormones is operating in these patients. This finding indicates that the TRH non-responsiveness in euthyroid patients with Graves' disease is not due to pituitary depletion of TSH, since the negative feed-back effect of the thyroid hormones is operating normally.
We studied the respiration and glucose utilization of suspensions of cultured lymphocytes. Respiration was measured by a couloximetric method using closed systems without a gas-suspension interface. The sensitivity of the method allowed measurements during a time interval of less than 1 hr. We found that the respiration of lymphocytes was strongly density dependent over the range of 10(8)-10(3) cells/ml. Oxygen utilization per cell increased 100-fold with 1000-fold dilution of the cell suspension. Glucose utilization showed little density dependence. We showed that the phenomenon was not due to nutrient depletion, pH shifts, accumulation of lactic acid, nor damage of cells during the dilution. Since in our experiments a gas-liquid interface was absent, the previously suggested explanation of gas diffusion as a limiting factor has been excluded. The experiment was best explained by regulation of respiration by humoral factors produced by the cell suspension.
Two groups of 4 rabbits were immunized according to the method described by Vaitukaitis et al. (1971). One group was given 55 mu g (900 IU) FSH/animal and the other 100 mu g (o.5 IU) TSH/animal. Two highly specific antisera against FSH and one specific antiserum against TSH were obtained. The FSH antisera showed affinities towards LH and TSH of 0.13 and 0.25% respectively as compared to that of FSH. The TSH antisera showed affinities towards LH and FSH of 2.2 and 1.7% respectively as compared to that of TSH. The specific antisera showed no or minor affinities towards the LH-alpha subunit and they were sufficient specific to be used in the radioimmunoassay of serum from pregnant women without pre-absorption with HCG. Scatchard plots showed the association constants of the FSH antisera to be 1.3 times 10-11 and 1.2 times 10-11 1/mol respectively, and the association constant of the TSH antiserum to be 6 times 10-10 1/mol. All 3 antisera showed high titers.
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