Serial determinations of plasma dihydroxyphenylalanine (dopa) in 16 Parkinson's disease patients receiving levodopa showed a negative correlation between plasma dopa levels and disability scores among patients who exhibited daily fluctuations of signs and symptoms. This suggests that the amount of levodopa delivered to the brain from the periphery is of major importance in the production of the "on-off" phenomenon. A close relationship between plasma dopa levels and abnormal involuntary movements was present in six patients. In three a striking dissociation between control of Parkinson's disease and abnormal involuntary movements was present, suggesting that in some patients these two effects are mediated through different underlying mechanisms. Administration of levodopa in such a way as to prevent both high and low levels of dopa in plasma minimizes disability in Parkinson's disease and may lessen abnormal involuntary movements in patients with the "on-off" effect.
Abstract:Cerebrospinal Fluid in Cerebral Hemorrhage and Infarction• Cerebrospinal fluid (CSF) abnormalities were correlated with pathological diagnoses in 61 patients with autopsy-verified intracerebral hemorrhage or cerebral infarction. Lumbar punctures were performed within one week of onset of symptoms. The CSF color and red blood cell counts were the most useful CSF parameters in differentiating between intracerebral hemorrhage and cerebral infarction. In 75% of the patients with intracerebral hemorrhage, the CSF was either grossly bloody or xanthochromic; in 25%, the CSF was clear. In patients with cerebral infarction, the CSF was never grossly bloody; in two patients with hemorrhagic infarction, the CSF was xanthochromic. The CSF pressure, protein values and leukocyte counts were less useful in differentiating intracerebral hemorrhage from cerebral infarction. Cases with hemorrhagic infarction could not be separated from those with ischemic infarction on the basis of CSF analysis. In clear CSF, the polymorphonuclear neutrophilic leukocyte (PNL) counts were never greater than 20 per cubic millimeter. In xanthochromic or cloudy CSF, leukocyte counts, especially PNLs, were frequently elevated, occasionally to high levels.
The authors determined by fluorimetry the norepinephrine-epinephrine content (NE-E) of cerebral tissue from 38 cats, to ascertain whether constriction of hypersensitive arterial vessels by vasoactive agents in ischemic cerebral tissue could cause extension of cerebral infarcts and worsening of neurological deficits. Twenty-three cats had the left middle cerebral artery (MCA) occluded transorbitally, and 10 cats had sham operations. Five cats had only the surgical procedures necessary for obtaining tissue; mean NE-E content was 0.30 mug/gm (SD=0.041). For the other 33 cats, including those with sham operations, values were variable, ranging from 0.07 to 0.60 mug/gm. Low values usually were obtained for ischemic hemispheres 24 hours and 7 days after MCA occlusion, but at other times values could be high or low on either side. Many factors unrelated to tissue damage, including arterial manipulation, influence the catecholamine content of cerebral tissue.
Objectives: To assess whether outcome and first-monitored rhythm for patients who sustain a witnessed, nonmonitored, out-of-hospital cardiac arrest are associated with on-scene CPR provider group.Methods: A retrospective, cohort analysis was conducted in a suburban, heterogeneous EMS system. Patients studied were 219 years of age, had had an arrest of presumed cardiac origin between July 1989 and January 1993, had gone into cardiac arrest prior to ALS arrival, and had received CPR on collapse. First-monitored rhythms and survival rates were compared for two patient groups who on collapse either: 1) had received CPR by nonprofessional bystanders (BCPR) or 2) had received CPR by on-scene EMS system first responders (FRCPR).
Results
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