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W H Jost

Publications and source records attributed to W H Jost.

At least 73 records · Page 4Linked to original sources
PubMed1996

[Blood pressure adaptation and hormone regulation in Parkinson patients following orthostasis].

OBJECTIVE: To determine whether abnormal orthostatic regulation commonly occurs in patients with Parkinson's disease (PD) and is caused by an abnormal catecholamine release (especially of noradrenaline). PATIENTS AND METHODS: Blood pressure and catecholamine concentration were measured after 10-min recumbency and 1, 3, 5, 7 and 9 min after standing up in 46 patients with PD (15 women, 31 men: mean age 64.3 +/- 11.7 years). Results were compared with those in a group of 27 healthy controls (eight women, 19 men; mean age 60.7 +/- 10.8 years). RESULTS: Among PD patients there were marked hypotonic circulatory reactions, associated with decreased catecholamine concentration and heart rate adaptation; an abnormal orthostatic regulation occurred in 30 patients. In 22 patients noradrenaline concentration changed by less than 200 pg/ml in the 9th min after standing up, while a decreased hormonal release was noted in only four of the controls, all of whom had normal orthostatic regulation. In PD patients the lowest adrenaline rise was always associated with an extremely high fall in blood pressure. Changes in mean blood pressure correlated positively with the rise in noradrenaline. There was no demonstrable correlation between medication for PD, age of patient and the duration or severity of the disease. CONCLUSION: Abnormal orthostatic regulation occurs more frequently in PD than in healthy persons and is associated with changes in noradrenaline release. This suggests multisystem degeneration as a cause of PD.

Adaptation, Physiological↗
PubMed1996

[Electrophysiologic diagnosis in erectile dysfunction].

So far, electrophysiological examinations have rarely been used in the diagnosis of erectile dysfunction (ED) mainly because the methods available only allow somatic neuron pathways to be examined whose relevance for the mainly autonomically controlled crection is evaluated differently. At present, impaired penile nerve supply as the possible cause of ED can only be evaluated through neurophysiological screening of the somatic and autonomic pathways of the pelvic floor, and not just by one simple method. Diagnosing ED should include testing of motoric efferences through electroneurography of the pudendal nerve and electromyography of the external anal sphincter and the urethral sphincter. Sensitive afference is tested with somatosensory evoked potentials of the pudendal nerve. New methods that are available for the examination of autonomic pathways are the penile sympathetic skin response and the EMG of the corpus cavernosum. Together with the other electrophysiological examinations, they allow neurogenic causes to be determined and differentiate not only between central and peripheric lesions, but also between acute and chronic changes. Prognosis can also be estimated. A crucial diagnostic deficit is the fact that it is still not possible to test the parasympathetic system directly.

Autonomic Nervous System↗
PubMed1996

[Urinary incontinence in patients with Parkinson syndrome].

Disturbances of micturition are very common in Parkinson's disease. Hence, we assessed 50 patients (22 female, 28 male, average age: 59.8 years) by means of the Gaudenz score. In 31 cases (62%) normal findings were obtained. Urge incontinence was diagnosed in 13 cases (26%) and stress incontinence in 5 patients (10%). One patient had both urge and stress incontinence. All patients with stress incontinence were female.

Aged↗
PubMed1996

[Value of electromyography in diagnosis of incontinence].

Electromyography (EMG) of the pelvic floor musculature is only carried out as a routine method in few clinics. There is a lack of standard patient groups and, correspondingly, standardized values do not exist. Close cooperation between proctologists and neurologists is the exception. Some surgeons use the EMG to evaluate muscular defects (mapping), however sonography is a less invasive method to detect these lesions. It is the real domain of the EMG to provide qualitative and quantitative evidence of neurogenic lesions, which means that it allows to differentiate between central and peripheral as well as between acute and chronic lesions. It also enables the experienced neurophysiologist to estimate the prognosis and to give an expert opinion. Optimum utilization of the method is only possible with interdisciplinary cooperation.

Anal Canal↗
PubMed1995

[Blood pressure and hormonal regulation in active and passive orthostasis].

UNLABELLED: The procedure using a tilt-table is far better standardized and less dependent on the patient's compliance compared to the active manoeuvre of standing up. The object of this study is to detect to what extent results are comparable concerning hormonal regulation and the adaptation of blood pressure. In 20 males (59.1 +/- 10.9 years), without any evidence of central nervous disorder, we measured the systolic, diastolic and the median blood pressure, heart frequency and hormone levels (noradrenaline, aldosterone, renin) at rest and over 10 minutes in the upright position after actively or passively (by tilt-table) assuming an orthostatic posture. The blood pressure showed little change after the patient sat upright himself, whereas the passive manoeuvre caused a significant decline of systolic blood pressure lasting over the entire sampling period. The adaptation of hormone levels and heart frequencies, however, showed no significant differences. Renin and aldosterone rose in both examinations. Noradrenaline showed an increase of 100% after active assumption of orthostatic posture and 80% using the tilt-table. Hence in patients who are passively brought into the upright position there is no increased noradrenaline output to stabilize blood pressure. This points to the fact that orthostatic circulatory mechanisms are not sufficiently brought into play after the non-physiological passive manoeuvre. IN CONCLUSION: (1.) the tilt-table compared to active orthostatic posture provides better standardized conditions; (2.) there are no significant differences in hormone levels; and (3.) maneuvering patients into an upright position provides a greater risk of fainting due to a pathological fall in blood pressure.

Aged↗
PubMed1995

[Disorders of autonomic regulation in Parkinson syndrome].

Ever since the first description of Parkinson's disease, it has not only been associated with the classical triad of akinesia, rigor and tremor but also with autonomic regulation disorders. However, the studies published on this subject show differing and partly contradictory results. A large number of studies demonstrate a distinct autonomic disorder. On the other hand there are authors who question an affliction of the autonomic nervous system and others who attribute the autonomic disorder to Parkinson specific medication. To make matters worse, the various pathogeneses of Parkinson's syndrome within the patients collectives have not been sufficiently differentiated and nomenclature of the multisystem degeneration was handled in different ways. Taking our examinations of the various autonomic functions and the underlying literature into critical consideration, we come to the conclusion that regulation disorders of the cardiovascular system, gastrointestinal and urinary tract, as well as sweat and thermoregulation are often seen in the idiopathic Parkinson's disease. In our opinion the idiopathic Parkinson's syndrome must be attributed to the multisystem degenerations. Autonomic dysfunction occurs in different intensities in the disease.

Antiparkinson Agents↗
PubMed1995

[Bladder dysfunctions in encephalomyelitis disseminata--drug and interventional therapeutic options].

Patients with disseminated encephalomyelitis have various urological presentations, ranging from pollakisuria to urge incontinence. After detailed evaluation (neuro-urological examination, urodynamic investigation) drug therapy and various interventional methods must be adapted to the individual manifestations. Patients with detrusor hyperreflexia are treated with oral anticholinergic agents (oxybutynin, trospium chloride, propiverine). Patients with urinary retention are recommended to be managed with clean intermittent (self)-catheterisation. The various interventional therapeutic options (bladder denervation, electrostimulation, local treatment with botulinum toxin) and the surgical therapy (sacral deafferentation and anterior root stimulation, bladder neck closure and cystostomy, sphincterotomy or augmentation cystoplasty) must be reserved for special cases.

Cholinergic Antagonists↗
PubMed1995

[Disorders of eye movement in amyotrophic lateral sclerosis--report of 2 patients].

BACKGROUND: Amyotrophic lateral sclerosis (ALS), a neurodegenerative disorder of unknown origin, was thought to spare the extraocular muscles. Extraocular involvement has recently been reported to occur in the late stages of ALS following respiratory insufficiency. CASE REPORT: We report on two patients with ALS who were referred for screening of oculomotor impairment in ALS. Orthoptic examination in a 64-year-old woman with peripheral ALS revealed retraction of the upper eye lids as well as impaired abduction and upgaze in both eyes, developing prior to respiratory insufficiency. A 50-year-old man with bulbar ALS was found to have bilateral impairment of upgaze as well as a negative Bell's phenomenon. Horizontal pursuit was interrupted by compensatory saccades, vertical fixating saccades were slightly hypometric. These oculomotor changes were also seen prior to respiratory insufficiency. CONCLUSION: These findings provide further evidence of early oculomotor involvement in ALS, e.g. prior to respiratory failure and prior than previously suspected. Oculomotor impairment may occur in both the peripheral and the bulbar type of ALS.

Amyotrophic Lateral Sclerosis↗
PubMed1995

Penile sympathic skin response in erectile dysfunction.

Penile sympathic skin response (PSSR) was measured in 20 normal patients and in 46 patients with erectile dysfunction (ED). PSSR could be registered in 80% of normal patients. The latencies were 1,100-1,600 ms. In patients with ED, latencies were 1,240-3,640 ms. A reproducible normal latency of PSSR (< 1,600 ms) indicates a normal sympathic innervation of the penis. Long latencies (> 1,800 ms) indicate neuropathy of unmyelinated nerval fibers. The loss of a reproducible answer however allows no exact diagnostic information. PSSR is a useful diagnostic test for detecting neuropathy of unmyelinated nerval fibers as a possible cause of ED.

Adult↗
PubMed1995

[Sympathetic skin response in Parkinson syndrome].

Several tests of cardiovascular and gastrointestinal function have been approved for the diagnosis of autonomic regulation dysfunction in Parkinson's disease. In the present study we compared the diagnostic value of the sympathetic skin response (SSR) with the established methods. Ninety percent of the 20 patients we examined (10 women, 10 men, 46 to 80 years) showed pathological results in the cardiovascular function test. Fifty-five percent had a prolonged colon transit, indicating a gastrointestinal dysfunction. We saw pathologically prolonged latencies of the SSR in 35% of the patients, 55% had borderline results. Three of the 20 patients had pathological results in all of the functions examined. Half of the patients had two pathological results, whereas 7 patients were pathological in only one of the three examinations. We were unable to establish any correlation between the SSR and other results, and we also found no relationship between prolonged SSR and the duration of the disease.

Aged↗
PubMed1995

Eye movement in amyotrophic lateral sclerosis: a longitudinal study.

Eye muscles and the sphincter muscles of the bowel and bladder were formerly thought to be spared in amyotrophic lateral sclerosis (ALS), a neurodegenerative disorder. As frequent subclinical impairment of the anal sphincter muscles in ALS has recently been reported, We suspected an earlier and more frequent, if subclinical, involvement of the oculomotor system than hitherto described. Starting in 1993, we repeatedly studied oculomotor involvement in eight patients with (ALS) using routine orthoptic examination techniques as well as electro-oculographic recordings of ocular movements. Three patients had consistently normal clinical examinations but progressive changes in electro-oculography (EOG). Three patients showed intermittent impairment of eye movements with normal EOG (one patient) or with progressive changes on EOG examination. In two patients, both clinical examination and EOG were progressively pathologic. These findings provide further evidence of early oculomotor involvement, e.g., prior to respiratory failure, in ALS than previously suspected. Since EOG changes seemed to be detectable in all but one patient, EOG changes may allow earlier, subclinical detection of impaired eye movement and thus reveal even an increased frequency of oculomotor impairment in ALS. Due to the heterogeneity of ALS the number of patients examined to settle finally the question of oculomotor involvement in ALS needs to be increased. Newly developed software will allow further interpretation and comparison of more data and, thus, should offer further help in detecting early changes.

Adult↗
PubMed1994

Surface versus needle electrodes in determination of motor conduction time to the external anal sphincter.

Patients were referred to our neurophysiological department in order to investigate anorectal function. By the means of magnetic stimulation the total motor conduction can be determined. Only patients with normal latency of the pudendal nerve and normal EMG of the external anal sphincter were examined. Stimulation was carried out above the motor cortex with a MO between 80 and 100%. The recording was carried out in 22 patients with concentric needle electrodes and in the other 18 patients with surface electrodes. The mean latency in the group with surface electrodes was 19.4 ms (SD 1.7), and in the group with needle electrodes 23.4 ms (SD 4). Our results suggest, that in magnetic stimulation above the motor cortex and recording with a concentric needle electrode, the range and the mean was higher than with surface electrodes. In our opinion surface electrodes are preferable to needle electrodes in determining motor conduction time to the external anal sphincter.

Adult↗
PubMed1994

Are heart rate responses reproducible in the tilt-table test?

Measurement of blood pressure and heart rate in active orthostasis has proven to be effective in the diagnosis of autonomic regulatory dysfunctions. The following study was carried out in order to clarify to what extent reproducible heart rate reactions also occur in passive orthostasis. 61 people with normal results in five standardized tests were examined. All 61 test persons had individually differing courses of heart rate. After an initial increase of frequency an almost straight line results from a superimposed projection of the graphs. In 20 of these cases the tilt-table test was repeated in order to detect intra-individual regularities. Even when the test was repeated, no reproducible intraindividual heart rate reactions occurred. And here as well, projection of the graphs produced an almost straight line. We could not find any quotient, such as the 30/15 ratio in active orthostasis, during our tests with the tilt-table.

Adult↗