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PubMed2006

Safety and efficacy of donepezil in African Americans with mild-to-moderate Alzheimer's disease.

BACKGROUND: African Americans have a higher incidence and prevalence of Alzheimer's disease (AD) than whites but have been underrepresented in clinical trials, including studies of cholinesterase inhibitors. PURPOSE: The purpose of this 12-week, open-label study was to evaluate the efficacy and safety of donepezil in African Americans with mild-to-moderate AD. METHODS: Efficacy was assessed via the Mini-Mental State Examination (MMSE), Clinician's Interview-Based Impression of Change-Plus interview with the patient and caregiver (CIBIC-Plus) and Fuld Object Memory Evaluation (FOME), a measure that has been validated for use with elderly African Americans. RESULTS: Significant improvements were observed in cognition (MMSE), global function (CIBIC-Plus) and memory (all four subscales of the FOME). Donepezil was well tolerated; 51% of patients experienced adverse events, most commonly diarrhea (5.6%), hypertension (5.6%) and urinary tract infection (4.8%). CONCLUSIONS: These results suggest that donepezil is effective and safe in treating African Americans with mild-to-moderate AD, and support the value of FOME in assessing efficacy in AD trials in diverse populations.

Black or African American↗

PubMed1991

[Etiology, pathophysiology and clinical significance of hereditary fructose intolerance].

Due to repeatedly described incidents in patients with undiscovered hereditary fructose intolerance, the application of fructose and sorbit-containing parenteral solutions is a topic vehemently discussed. This paper presents a survey of the literature dealing with the inborn defect of fructose-1-phosphate aldolase. The physiology and pathophysiology of fructose metabolism are described as well as the clinical appearance and diagnostic possibilities. The acute course of a fructose incompatibility is determined by a threatening decrease in the blood glucose level, which is attributed to the inhibition of several enzymes of glycolysis and gluconeogenesis by an intracellular accumulation of fructose-1-phosphate. Within hours a global functional breakdown of organs, which normally have the enzyme, occurs. The impairment of the liver function finds expression in a severe coagulopathy, the damage of the kidney leads to anuria. In chronic oral fructose supply, damage of the liver and small intestinal mucosa with corresponding gastrointestinal symptoms determine the clinical course. Concerning diagnosis, contrary to the liver biopsy and the fructose tolerance test, the mucosal biopsy with determination of fructose-1-phosphate aldolase activity has the advantage of greater specificity and is better tolerated by the patient. A total abstinence to fructose and sorbitol-containing solutions is not considered to be necessary when the rarity of the illness is taken into account and certain precautions are taken. These include a specific anamnesis of nutrition as well as a total abstinence from fructose and sorbitol in infants and in the unconscious patient. For clinical routine a simple fructose tolerance test is suggested.

Chromosome Aberrations↗

PubMed1991

[Diagnostic significance of urinary endothelin concentration].

We investigated plasma Endothelin concentration (s-ET) and urinary Endothelin concentration (u-ET) in eleven patients undergoing subtotal esophagectomy through r-thoracal and abdominal approach for esophageal cancer (nine men and two women). S-ET and u-ET, sodium excretions fraction (FENa), free-water clearance (CH2O, uric NAG Index, creatinine clearance rate (Ccr), primary water balance (PWB) and primary sodium balance (PNB) were measured during the perioperative period till the 7th day. Urinary Endothelin concentration in the postoperative 3 and 6 hours, and the 2nd postoperative day were significantly higher than preoperative value. No significant values were obtained in plasma Endothelin Highly significant correlations were obtained between urinary Endothelin concentration and FENa, CH2O, PWB and PNB. Furthermore, u-ET was well correlated with s-ET. We concluded that the measurement of u-ET may be useful as an indicator of renal tubular function and global renal functions with high sensitivity.

Adult↗

PubMed1991

Stress echocardiography for detection of coronary artery disease.

Stress echocardiography is a relatively new technique that combines cardiovascular stress with echocardiographic imaging for the diagnosis of coronary artery disease. It is based on the hypothesis that stress-induced ischemia will result in regional wall motion abnormalities that can be detected by two-dimensional echocardiography or abnormalities of global function that can be detected with Doppler ultrasound. Its accuracy for detecting coronary artery disease is high enough to allow for clinical use. In such a role it has added value to the analysis of the routine electrocardiogram and symptoms during exercise. In the patient unable to exercise, pharmacological stress with the use of dobutamine or dipyridamole are realistic alternatives. In addition to the diagnosis of coronary disease, stress echocardiography can be used to demonstrate recovery of function after interventions and to assess prognosis after myocardial infarction.

Coronary Disease↗

PubMed1990

[Evaluation of tolerability and efficacy of a nabumetone preparation in the treatment of patients with rheumatoid arthritis].

In an open uncontrolled trial 30 patients (4 males, 26 females) aged 43-70 years suffering from active rheumatoid arthritis (diagnosis based on American Rheumatoid Association criteria) were treated with nabumetone (one 1 g capsule daily per os). Symptoms were evaluated according to subjective and objective parameters (spontaneous resting pain, night pain, pain during movement. Huskinsson's visual analogic scale, Ritchie's articular index, hand grip, duration of morning stiffness; number of joints involved, global function capacity, Lee index); an overall improvement was observed. In view of the prevalence of positive judgements, nabumetone may be considered a valid resource for symptomatic management of active rheumatoid arthritis. Treatment had to be withdrawn in four cases: for gastrointestinal side effects in 3 cases, slight erythema in one case, often accompanied by increasing severity of the painful symptoms. Tolerability both general and local was considered good.

Adult↗

PubMed1990

Simulated left ventricular aneurysm and aneurysm repair in swine.

Patch reconstruction of left ventricular aneurysm may be superior to linear closure, but this hypothesis has not been tested experimentally. Accordingly, six anesthetized domestic pigs were instrumented to measure regional left ventricular wall thickening, stroke volume, systolic left ventricular pressure, and myocardial oxygen consumption. With total bypass and cardioplegia, a 6 by 8 cm Dacron patch was inserted into the anteroapical left ventricle. Simulations were as follows: left ventricular aneurysm, patch open; patch reconstruction, 50% patch plication; standard repair, ventriculotomy edges approximated. Global function, from stroke work (stroke volume x integral of left ventricular pressure)-left ventricular end-diastolic pressure curves, was depressed in all three simulations compared with control. A tendency for stroke work to be greater for standard repair than for left ventricular aneurysm and patch reconstruction at higher preloads was not statistically significant. Mechanical efficiency, from stroke work/myocardial oxygen consumption (joules per milliliter oxygen per beat), was 2.43 +/- 0.52 (mean +/- standard error of the mean) (control), 2.22 +/- 0.94 (standard repair), 1.27 +/- 0.39 (patch reconstruction), and 1.09 +/- 0.37 (left ventricular aneurysm) (no significant differences). Regional work was calculated as regional left ventricular wall thickening x integral of left ventricular pressure. The slope of the regional work-end-diastolic wall thickness relation decreased in the posterior wall 14.0 +/- 2.9 (control) versus 8.4 +/- 2.0 (left ventricular aneurysm), 6.9 +/- 1.4 (patch reconstruction), and 7.4 +/- 1.4 (standard repair) (p less than 0.05). In the anterior wall, contractility did not change significantly (7.4 +/- 1.2, control; 7.8 +/- 2.7, left ventricular aneurysm; 5.0 +/- 0.4, patch reconstruction; and 5.3 +/- 0.4, standard repair). Decreased end-diastolic wall thinning anteriorly suggested tethering. These results in the normal left ventricle suggest that patch ventriculoplasty is of no greater benefit than linear repair. Either repair may impede function of adjacent myocardium through restriction of regional diastolic lengthening.

Animals↗

PubMed1990

[Three-dimensional analysis of the regional contractility of the normal and the cardiomyopathic left ventricle using cine-magnetic resonance imaging].

The left ventricular regional contractile pattern, global function and mass of normal subjects and patients with idiopathic dilated cardiomyopathy was compared using cine magnetic resonance imaging (MRI) in a short-axis imaging plane. Left ventricular ejection fraction and mass were 64.3 +/- 2.5% and 115 +/- 10 g in normal hearts and 23.5 +/- 3.1% and 194 +/- 20 g in dilated cardiomyopathic hearts (p less than 0.001 and p less than 0.002). Left ventricular end-diastolic wall thickness was homogeneous in normal hearts except for the posterior wall at the basal level, which was significantly thinner compared to the anterolateral wall and the septum (p less than 0.02). End-diastolic wall thickness in the cardiomyopathic group was significantly more heterogeneous and was thinner at the apical compared to the basal level (p less than 0.02) as well as in the segment of the posterior compared to the anterolateral and septal wall (p less than 0.005 and p less than 0.03). In normal hearts, left ventricular end-systolic wall thickness was progressively greater from base to apex for the anterolateral (p less than 0.01) and posterior wall (p less than 0.02) and the septum (p less than 0.02). Such a uniform gradient of end-systolic wall thickness was not present in hearts with dilated cardiomyopathy. It was even reversed for the anterolateral wall with decreasing thickness from base to apex (p less than 0.03). Left ventricular mean systolic wall thickening increased progressively from base to apex (p less than 0.005) in normal hearts, whereas there was no significant gradient from base to apex in hearts with dilated cardiomyopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

[The acute hemodynamic effects of the new vasodilating beta blocker carvedilol in comparison with combined administration of nifedipine and propranolol in patients with coronary heart disease].

The acute hemodynamic effects of carvedilol, a new vasodilating betablocker, were assessed in comparison to the response to nifedipine or a combination of nifedipine and propranolol in patients with coronary artery disease. Either 5 mg carvedilol, 2 mg nifedipine or 2 mg nifedipine + 5 mg propranolol (N + P) were administered intravenously in a not randomized study within 30 min to 10 patients for each drug. Carvedilol reduced (comparable to the effect of N + P) the left ventricular afterload with a decrease of AOPm of 12.6%, p less than 0.001 (N + P -11.8%, p less than 0.001) and systemic vascular resistance of 9.1%, p less than 0.02 (N + P -10.0%, p less than 0.01) and no change of cardiac index. Single treatment with nifedipine leads to a reflex increase of heart rate which could not be observed after carvedilol or N + P as a result of the betablocking properties of carvedilol and propranolol. Therefore, the rate-pressure-product at rest was unchanged after nifedipine but decreased significantly after carvedilol (-10.9%, p less than 0.01) and N + P (-12.4%, p less than 0.01). Negative inotropic effects were significantly lower after carvedilol, with a 6.3% (p less than 0.05) decrease of LV dP/dtmax, compared to N + P (-12.0%, p less than 0.01). Since preload, afterload, and heart rate changes were equal in both groups negative inotropic effects can be compared on the base of dP/dtmax changes. The acute hemodynamic effects (vasodilation without reflex tachycardia, negative inotropic effects) of the new vasodilating betablocker carvedilol are comparable to a combined treatment with nifedipine and propranolol in patients with coronary artery disease and well preserved left ventricular global function.

Carbazoles↗

PubMed1988

[Results of surgically treated chronic anterior laxities. Apropos of 251 cases reviewed with a minimum follow-up of 3 years].

Two hundred and fifty one chronic anterior laxities operated by intra-articular plasty using a free knee-cap tendon and by the Lemaire extra-articular procedure were reviewed with a minimum 3 year follow-up. Eighty-three per cent of the patients obtained a global functional result excellent or good, eight per cent fair and nine per cent poor. Clinical examination disclosed 24% equivocal pivot shifts and 4% true jerks in internal rotation. Most of the patients, at the check-up clinic, underwent a radiographic and dynamic examination, thereby allowing evaluation of postoperative arthrosis and residual anterior laxity in extension. Frontal radiographs of the knee on unilateral weight-bearing showed 29% joint remodelling, 16% "prearthrosis" and 8% arthrosis. These radiological modifications were most often medial femoro-tibial, they were highly correlated with the patient's age at the time of operation, with the state of the medial meniscus and with the residual laxity in extension. The residual anterior laxity in extension measured on the dynamic radiographs was, on average, 9 mm, i.e. an average difference of 5 mm in relation to the healthy knee; it was highly influenced by the pre- or peroperative treatment of the medial meniscus. Indications of precautions to be taken are defined and suggestions are drawn up whereby residual laxity in extension may be limited.

Adolescent↗

PubMed1987

Regulation of metabolite fluxes and concentrations in living cells and organisms.

A quantitative framework for the analysis of metabolic control depends on the recognition of input and output fluxes occurring in steady-state systems in which the concentrations of intermediates are constant--the fluxes and concentrations peculiar to a given steady state are determined by the catalytic components of the system. Control of the variables is a global function shared among the components in a complex pattern, for reasons which are evident when the detailed properties of such systems are analysed. Such properties include circuit design and a host of factors affecting the sensitivity of catalytic components to substrates and effectors.

Cell Membrane Permeability↗

PubMed1987

[Value of bifocal stereotaxic destruction in case of dyskinesia in patients with a motor deficit of cerebral origin].

Authors report a study concerning 12 dyskinetic patients with cerebral palsy. The clinical pre-operative examination shows that many signs and symptoms are associated: volitional and postural dyskinesia, athetosis and dystonia, pyramidal deficit and spasticity. Talairach's stereotactic methodology has been used for bifocal (VPL thalamic nucleus and internal pallidum) Yttrium 90 implantation. After stereotactic bifocal lesions, involuntary movements have been reduced in 45.5% of cases and have disappeared in 27% of cases. Impairment of previous motor deficit has been observed in 3% of cases; volitional and postural dyskinesia seems to be the most curable symptomatology. Clinical results in athetoid involuntary movements and dystonia are less rewarding. Because of important anatomical modifications often observed cerebral palsy patients, the authors stress the interest of individual acute neurophysiological study and discuss about the stereotactic targets and the modalities of destruction. They insist upon the necessity of rigorous selection of indications based on acute clinical examination in the perspective of improvement of global functional capacities.

Adolescent↗

PubMed1987

[Adolescence. The problem of identity and development of the self].

This is a contribution to the description of the birth and development of the feeling of identity, such as organized by the genesis of the authentic self, which in sociology is called the value system of young people. My clinical experience suggests that this development, which is spread over two decades, goes through two phases: formation of basic identity; formation of sexual identity. They are integrated into the total self-identity at the end of adolescence. The basic identity organizes the intra-psychic structuration by the internalization of the super ego, after the oedipal phase. I use the term Ego-identity to define this phase of global functioning. The constitution of the authentic self is evidence of this integration.

Adolescent↗

PubMed1985

[Value of plethysmographic methods as a means of monitoring arteriopathies].

Plethysmography provides an original solution to the study of arteriopathy, complementing other non-invasive investigational methods. The different fields of application are discussed, and the diagnostic and prognostic value of each of them outlined. Methods used include: pulsed plethysmography, measurement of segmental pressures, hyperemia test, irrigraphy and measurement of segmental blood flow. Principal advantages of the technique are undoubtedly the evaluation of global function, monitoring of therapy and, to some degree, prediction of course.

Arterial Occlusive Diseases↗

PubMed1981

[Substance P].

Substance P is present in numerous organs (salivary glands, trachea, pancreas, kidneys, bladder and prostate) and in various parts of the central and peripheral nervous system, notably substantia nigra, hypothalamus, pineal body and dorsal horn of the spinal cord. It is a potent stimulant of salivary secretion and intestinal motility, a vasodilator in muscles and fatty tissues and an inhibitor of insulin release. Its main role, however, lies in the transmission of pain, where it seems to act as neuromodulator. Released when nociceptive fibers are activated at the same time as the fast-acting neuromediator, it enhances and prolongs the effects of the latter. Opiates inhibit its release. In addition, substance P is present in the excitatory neurones of the corpus striatum-substantia nigra pathway, which also has GABA-containing inhibitory neurones, and this pathway is known to modulate the dopaminergic nigra-striatum pathway. The global function of substance P, therefore, seems to keep the central nervous system in a state of alert through activation of the cerebral cortex and assistance in the transmission of pain.

Animals↗

PubMed1983

[Epileptic absences. Studies on the structure, pathophysiology and clinical course of the seizure].

The temporal structure of absence symptoms of 59 patients--investigated by subtilized polygraphic video documentation technique--discloses a global functional scheme of motor activity directed from cranial parts of the body--like the ocular region--towards caudal parts. In analogy to the Jacksonian march of partial elementary motor seizures these findings are interpreted as a march of generalizing seizure activity of absence type. Its recognition allows to understand many motor as well as so-called "automatic" absence symptoms as correlated elements of a general organization plan. The development of a nuclear-layer model explains the fact, that in short-lasting absences often only ocular symptoms occur whereas in long lasting absences oral automatisms or motor activities of the extremities as well as gestural automatisms become manifest. New techniques of intensive seizure monitoring are carried out during therapy in patients with absences.

Automatism↗

PubMed1978

[Angiographic studies on regional contraction behavior of the left ventricle in the acute phase of myocardial infarction].

Quantitative angiocardiographic examinations concerning the regional contraction of the left ventricle in 16 patients with acute myocardial infarction were performed. In comparison to a control group of 6 healthy male patients the determination of the speed of the medium regional shortening (MVRF) of 12 different ventricle segments resulted in typical findings deviating from the normal. On the second day after beginning of the infarction in the area of the myocardium affected by an acute infarction there existed as a rule severe hypokinetic and akinetic disturbances of the contraction (13 times), only in three cases slight paradoxical movements of the ventricular wall (dyskinesias) could be observed. The average speed of shortening of all segments together (MVRF) excellently represents the momentary global function of the ventricle. It comprises in the same way acutely and chronicly disturbed areas as well as also the function of regions of the myocardium which are not disturbed. MV/RF and systolic ejection fraction (SEF) show statistically a highly significant correlation of r = 0,797 (p less than 0.001). On the basis of the findings got considerations are performed concerning a proved differential therapy in the acute stage of the myocardial infarction.

Angiocardiography↗

PubMed1995

The successful pharmacological treatment of adolescents and young adults with borderline personality disorder: a preliminary open trial of flupenthixol.

Borderline personality disorder is a significantly disabling disturbance often arising in adolescents or young adults. In the absence of demonstrated effective treatments in this population, this open prospective study evaluated the effect of low dose (3 mg per day) flupenthixol in 13 rigorously diagnosed adolescents with borderline personality disorder. Therapeutic outcome over eight weeks of treatment assessed across measures of impulsivity, depression/dysphoria, general psychopathology and global functioning showed significant improvement in all spheres. These findings suggest that low dose flupenthixol may have a role to play in the short-term treatment of this population.

Adolescent↗

PubMed1994

[Femoral osteotomy for severe hip osteoarthritis: an actuarial analysis of results].

INTRODUCTION: In cases of severe hip osteoarthritis in young patients, the intertrochanteric osteotomy can delay total hip arthroplasty. The main advantage of the osteotomy is to preserve the bone stock. The main disadvantages are the lasting postoperative invalidity and the varying longterm success rate. Our aim was to quantify these disadvantages using survivorship analysis. MATERIAL AND METHODS: The study included 64 patients (65 osteotomies) ranging from 16 to 68 years. The osteotomies were performed between 1975 and 1987. The osteoarthritis was stage III or IV, with a joint space less than 50 per cent. Osteoarthritis was primitive in 25 cases and secondary in the others. The osteotomy always included a medial displacement of the shaft according to the principle of Mac Murray's procedure, but also 22 cases (33.8 per cent) had a varus angulation and 19 (29.2 per cent) a valgus angulation. The preoperative pain score according to the Merle d'Aubigné (MDA) grading was 2.6 (1 to 4) and the global functional score was 11.1 (5 to 15). The patients were reviewed in 1991 and examined clinically and radiographically. RESULTS: The results of the 65 cases were distributed into 3 groups: -29 cases having reached the follow-up without difficulty, -7 patients were lost for follow-up examination, 6 of these latter than 9 years, -29 patients taking osteotomy failure as a pain lesser than the 3 MDA score. The postoperative delay to obtain the best functional result was 6 to 24 months (mean: 13.65). This result ranged from 5 to 17 MDA score (mean: 15) with pain ranging from 2 to 6 (mean: 5). The survivorship analysis curve showed 67.5 +/- 19.5 per cent survival for all osteotomies to the interval of 9-10 years. There were 3 types of results: -3 early failures (4.6 per cent) one because of a deep infection, -in 7 cases, after a short initial functional improvement, there was a progressive degradation leading to failure in 3.7 years (2 to 6 years), -55 cases with a lasting period of functional improvement, 26 osteotomies leading to failure in 3.5 to 15 postoperative years and, 29 cases having reached the follow-up (7 to 16 years mean 10 years). There was radiographic improvement of the osteoarthritis increasing the joint space in 59 cases (90.7 per cent). There was no radiographic improvement in the 6 other cases, including the 2 functional failures. The functional degradation appeared parallel to the radiographic degradation leading to a decrease of joint space to 90 per cent. We tested differences between various groups using Log Rank test. We found no difference in survival between the 3 different types of osteotomy. DISCUSSION: The results of this study can help to choose between intertrochanteric osteotomy and THA in the case of severe osteoarthritis. The best functional result of the osteotomy is in one postoperative year, with a mean MDA score of 15 and a mean pain score of 5. It appears that we do not predict the duration of functional improvement, the patient has 2/3 chances that this improvement reaches 10 years.

Actuarial Analysis↗