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PubMed2006

Medicinal marijuana use: experiences of people with multiple sclerosis.

OBJECTIVE: To describe medical marijuana use from the perspectives of patients with multiple sclerosis. DESIGN: A qualitative, descriptive design was used. Participants discussed their medicinal marijuana use in one-to-one, semistructured interviews. SETTING: Interviews were conducted at a time and place convenient to participants. PARTICIPANTS: Six men and eight women with multiple sclerosis participated. METHOD: Potential participants identified themselves to the researcher after receiving an invitation in a mailed survey. Eligibility was confirmed, and purposive sampling was used to recruit subjects. A range of issues emerged from the interviews. Interviews and data analysis continued until saturation occurred. MAIN FINDINGS: Descriptions fell into three broad areas: patterns of use, legal or social concerns, and perceived effects. Consumption patterns ranged from very infrequent to very regular and were influenced by symptoms, social factors, and supply. Legal concerns expressed by most respondents were negligible. Social concerns centred on to whom use was revealed. The perceived benefits of use were consistent with previous reports in the literature: reduction in pain, spasms, tremors, nausea, numbness, sleep problems, bladder and bowel problems, and fatigue and improved mood, ability to eat and drink, ability to write, and sexual functioning. Adverse effects included problems with cognition, balance, and fatigue and the feeling of being high. Although participants described risks associated with using marijuana, the benefits they derived made the risks acceptable. CONCLUSION: Further research is needed to clarify the safety and efficacy of marijuana use by patients with multiple sclerosis. If evidence of benefit is seen, medicinal marijuana should be made available to patients who could benefit from it. Until then, discussing medicinal marijuana use with patients will be awkward for health professionals.

Adult↗
PubMed1986

Rehabilitation in progressive supranuclear palsy: case report.

Progressive supranuclear palsy (PSP) is a distinct clinicopathologic entity characterized by supranuclear ophthalmoplegia, pseudobulbar palsy, axial dystonia in extension, and subcortical dementia. Although relatively rare, PSP is disabling, thus rehabilitation techniques and management are indicated in nearly every case. This report describes the neurologic presentation, rehabilitation management, and outcome of treatment of a patient with PSP during a 12-month period. The patient required thorough neuromuscular, neuropsychological, speech, swallowing, vision, and social service evaluations prior to the implementation of a rehabilitation program. Therapeutic rehabilitation techniques focused on limb coordination activities, tilt board balancing, ambulation activities, and activities to improve route finding and visual scanning ability. Prism lenses were introduced to compensate for deficits in vertical eye movements. Treatment improved the patient's functional status. Later, as the patient's neurologic status deteriorated, it became necessary to educate the family and caretakers in the ongoing rehabilitation management of the patient.

Bulbar Palsy, Progressive↗
PubMed1980

Statistical inference and the design of clinical trials.

According to the likelihood principle of statistics, a decision to stop or otherwise alter a clinical trial can be made on the basis of accumulating information without losing the ability to draw inferences from the results of the trial. In particular, balanced, randomized designs are not necessary. The probability that a particular treatment is the best among those in the trial can be calculated after each patient response, and may suggest that the treatment should be used predominantly in the next stage of the trial. Doing so results in more effective treatment of the patients in the trial while sacrifacing some of the information on the other treatments. Not doing so results in equal information on the treatments but sacrifices effective treatment. There are many trials in which compromise is possible between these antagonistic consequences.

Clinical Trials as Topic↗
PubMed1997

Evaluation of quality of life and symptoms after translabyrinthine acoustic neuroma surgery.

OBJECTIVE: This study aimed to describe the consequences of acoustic neuroma surgery in terms of symptoms and quality of life. STUDY DESIGN: This study was a retrospective case review. SETTING: The surgery was conducted in Uppsala, Sweden. PATIENTS: A consecutive sample of acoustic neuroma patients operated on between 1988 and 1994. INTERVENTION: All patients had been operated on with the translabyrinthine technique. MAIN OUTCOME MEASURES: A questionnaire was constructed including questions about the surgery and symptoms. The House and Brackmann scale was used for grading facial function and the Brackmann and Bars scale was used for self-assessment of facial function. RESULTS: Follow-up data were collected by a postal questionnaire sent out and returned by 141 patients, which yielded a 90% response rate. Normal to moderately impaired facial function (House I-III) was evident in 85.2% of patients, although residual facial problems were reported. Most considered hearing to be worse after surgery (80%), and tinnitus was found in 60% of the sample. Balance problems (45%), dizziness (19%), and headache/pain (22%) were also reported. Work ability was affected in 23%, and 37% reported a continued need for medical consultations, mainly because of facial problems and pain. Most (89%) were pleased with the preoperative information. CONCLUSIONS: This study showed that few patients with acoustic neuroma had experienced negative social consequences after surgery. Although not linked to the operation, residual symptoms were reported that may necessitate further rehabilitation.

Adult↗
PubMed1976

[Measurement of kidney concentrating ability in children with nonrenal glycosuria].

In non-renal (diabetic) glucosuria we did not find any statistically real relations between the concentration of glucose in the urine and cryoscopically measured osmolality in children with healthy kidneys. The close negative correlation of the conductance of the urine to the concentration of glucose is not only to be explained by changes of the viscosity, but is an expression of an increased re-absorption of sodium as a result of a compensatory hyperaldosteronism. In renal insufficiency the electrolytic conductibility of the urine is lower than the borderline area of the normal, even when under influence of the glucose excretion the osmolality of the urine is still to be found normal. Thus also on the conditions of a considerable glucosuria we can further judge the concentrating ability of the kidney in diabetes mellitus with the help of the measurement of the conductance of the urine.

Adolescent↗
PubMed1997

The effect of Tai Chi Quan and computerized balance training on postural stability in older subjects. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies on Intervention Techniques.

BACKGROUND AND PURPOSE: This study explored whether two exercise programs would affect the ability to minimize postural sway of 72 relatively inactive, older subjects who participated in the Atlanta FICSIT trial. SUBJECTS: Subjects were randomly assigned to (1) a computerized balance training group, (2) a tai chi group, or (3) an educational group serving as a control for exercise. Each group consisted of 24 members. METHODS: All subjects were evaluated under four postural conditions before, immediately after, and 4 months following their respective interventions, each of which was given over 15 weeks. RESULTS: Platform balance measures revealed greater stability after training among subjects in the balance training group but little change in stability among subjects in the tai chi and educational group. Subjects in the tai chi group were less afraid of falling after training compared with subjects in other groups with similar covariates. CONCLUSION AND DISCUSSION: Unlike computerized balance training, tai chi does not improve measures of postural stability. Because tai chi delayed onset to first or multiple falls in older individuals, this effect does not appear to be associated with measures of enhanced postural stability. Tai chi may gain its success, in part, from promoting confidence without reducing sway rather than primarily facilitating a reduction in sway-based measures.

Accidental Falls↗
PubMed1994

Bile salts determine leukotriene B4 synthesis in a human intestinal cell line (CaCo-2).

The ability of a human colonic epithelial cell line (CaCo-2) to synthesize leukotriene B4 (LTB4) in response to bile salt stimulation was examined, as was the dependency of such stimulation on the hydrophobic-hydrophilic balance of the bile salts. We demonstrate for the first time in this human intestinal epithelial cell line the ability of bile salts to stimulate synthesis of LTB4. CaCo-2 cell monolayers were incubated with a series of bile salts ranging in concentration from 0.5 microM to 1 mM. This resulted in a dose- and hydrophobicity-dependent increase in LTB4 synthesis. Hydrophobic bile salts (glycine and taurine conjugates of lithocholate and deoxycholate) caused LTB4 synthesis to be stimulated 27% and 35%, respectively, above control levels. In contrast, hydrophilic bile salts (glycine and taurine conjugates of ursodeoxycholate) increased LTB4 synthesis only 11.2% and 16.1%. Under basal conditions pretreatment with dexamethasone significantly inhibited bile salt-induced LTB4 synthesis by 38% compared to control. With more hydrophobic bile salts, chenodeoxycholate and deoxycholate, dexamethasone inhibited LTB4 synthesis to levels significantly below those observed with dexamethasone under basal conditions. Unlike A23187 calcium ionophore-induced LTB4 synthesis, bile salt-induced stimulation of LTB4 synthesis was not found to be dependent on the presence of extracellular calcium. Variations in bile salt stimulation of LTB4 by intestinal epithelial cells could be important in modulating cellular responses. The synthesis of chemotactic factors, such as LTB4, by the human colonic adenocarcinoma epithelial cell line now needs to be extended to normal human intestinal epithelium, as it may play a role in many of the functional disturbances which characterize intestinal inflammatory conditions.

Adenocarcinoma↗
PubMed2006

Improvements in muscle-tendon properties are beneficial to balance in multiple sclerosis.

A 63-year-old male was diagnosed with multiple sclerosis (MS) two years prior to this investigation. We hypothesized that compromised postural balance in MS can be improved by training-induced alterations in muscle-tendon properties. Sixteen weeks of strength and balance training induced an increase in quadriceps and gastrocnemius muscle size, strength, central activation, muscle recruitment and tendon stiffness. Concomitantly, the ability to maintain postural stances was increased in both eyes-open and eyes-closed conditions. We concluded that improvements in muscle-tendon properties were accompanied by improved balance and a general feeling of well-being after training.

Humans↗
PubMed1994

Effects of sodium depletion on competition and summation between rewarding effects of salt and lateral hypothalamic stimulation in the rat.

The effect of sodium depletion on the value of lateral hypothalamic (LH) stimulation and on competition and summation between saline reward and LH reward was assessed. Sodium depletion did not alter curves relating the number of LH rewards earned per trial to the number of stimulation pulses per train, suggesting that negative sodium balance does not alter the reward value of the stimulation. In contrast, sodium depletion increased the ability of saline (0.9% NaCl) to compete with LH stimulation in a forced-choice preference test. Summation between the effects of the 2 rewards was also seen under sodium depletion. These findings imply that the rewarding effects of saline and LH stimulation are evaluated within a common system of measurement and that negative sodium balance modulates the value of the saline reward upstream from the point where the rewarding effects of saline and LH stimulation are combined.

Animals↗
PubMed2002

[Decreased ATP-synthesis ability of liver mitochondria in spontaneously hypertensive rats (SHR): role of calcium overload of the mitochondria].

It has been shown previously, that a decrease of ATP amount and changed balance of the other macroergic phosphates are observed in different tissues of spontaneously hypertensive rats (SHR) compared with the normotensive controls (WKY). The aim of the present study was to assess the ability of SHR liver isolated mitochondria to synthesize ATP and to clarify its dependence on extramitochondrial calcium concentration. Macroergic phosphate concentrations were measured by high performance liquid chromatography (HPLC). The present work shows for the first time, that SHR liver mitochondria initially differ from WKY ones by decreased (by 30%) ATP synthesis rate. Respiratory control coefficient and phosphorylation rate in SHR and WKY mitochondria change in different manner when extramitochondrial calcium concentration increases from 0 to 50 microM. When calcium concentration is increased up to 50 microM both parameters in WKY mitochondria are about one half compared with the condition when the medium does not contain calcium. In the conditions, when the medium contains 50 microM of calcium, complete uncoupling of oxidation and phosphorylation in SHR mitochondria is observed. Thus the decrease of ATP synthesis rate in SHR mitochondria in conjunction with reduced tolerance to calcium overload (by respiratory control coefficient and phosphorylation rate) in comparison with WKY may be considered as the main cause of cell energy deficiency, observed in experimental variant of primary arterial hypertension.

Adenosine Triphosphate↗
PubMed1995

The visual vertigo syndrome.

Neuro-otological and posturography findings in 15 patients with visually induced vertiginous symptoms (visual vertigo, VV) are reported. Most patients were considered to have peripheral vestibular disorders but one had cerebellar degeneration and another a brainstem stroke. Five patients showed abnormally large body sway induced by full-field visual motion stimulation; including the 2 patients with CNS disease. Four of these 5 patients had additional strabismic symptoms (diplopia, squint surgery and ocular muscle weakness). VV may occur if patients with balance disorders show high visual field dependence. The presence of additional CNS or strabismic symptoms, probably by reducing the ability to resolve conflicting visual stimuli, may lead to inappropriate postural reactions.

Adult↗
PubMed1991

The nutritional sensitivity of the diurnal cycling of body protein enables protein deposition to be measured in subjects at nitrogen equilibrium.

In adults in overall protein balance on intakes of protein equal to or greater than minimum requirements, the diurnal pattern of feeding and fasting results in cycling of body protein, with fasted losses and fed state gains of increasing amplitude with increasing habitual protein intake. Measurement of the slope of the fed state gain-intake relationship enables investigation of the ability of various patient groups to utilise dietary protein, without the need to impose negative nitrogen balance due to sub-maintenance protein intakes.

Journal Article↗
PubMed1993

Pro: midazolam is the sedative of choice to supplement narcotic anesthesia.

Having examined the options for adjuvant drug use during cardiac anesthesia, it becomes increasingly apparent that midazolam is "the drug" of choice and that supplementation with an opioid is an ideal adjuvant. In the hands of experienced cardiac anesthesiologists, the majority of the drugs discussed could provide adequate anesthesia with outcomes that would be difficult to distinguish, with the exception of awakening and time to extubation. Regardless of the inability to differentiate overall outcome, when comparing ease of providing complete "balanced" anesthesia, minimal cost increase, ease of use, hemodynamic stability, reliability of amnesia and ability to decrease narcotic requirement and allow early extubation, midazolam is a clear winner. Given as a continuous infusion or a bolus, potent opioids such as alfentanil, fentanyl or sufentanil enhance the amnestic and hypnotic effect of midazolam, decreasing the required dose. In addition, the combination of midazolam and narcotics decreases the catecholamine response that either one alone would produce. This removes the necessity of marked narcotic overdose required when narcotics alone are used. The result of this anesthetic combination is a technique that can be used in the majority of cardiac patients regardless of their ventricular performance, allowing options for earlier awakening, earlier extubation and decreased ICU stay. The goal of complete "balanced" anesthesia is best achieved with continuous infusions of midazolam and opioids. Accepting recall of intraoperative events as a necessary evil is unacceptable in the stable cardiac surgery patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Intravenous↗