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  • 1
    ISSN: 1432-1440
    Keywords: Meningoencephalitis ; Mycobacterium avium intracellulare infection ; Mycobacterium avium intracellulare drug therapy ; AIDS
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A wide variety of pathologies afflicting the CNS is see in patients infected with the human immunodeficiency virus. We report the case of relapsing meningoencephalitis caused by Mycobacterium avium intracellulare (MAI) in a homosexual male with the acquired immunodeficiency syndrome in whom repeated use of polymerase chain reaction was required to detect MAI-specific DNA in the cerebrospinal fluid. Successful responses to early empirical antibiotic combination treatment, including the drugs clarithromycin and rifabutin, were demonstrated by clinical, EEG, and CSF improvement during an 8-month period. To our knowledge, this study presents the first known patient with the acquired immunodeficiency syndrome effectively treated for MAI meningoencephalitis and suggests that modern antimycobacterial combination therapy may improve the poor prognosis of CNS infections with nontuberculous myoobacteria.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Journal of neurology 246 (1999), S. 515-519 
    ISSN: 1432-1459
    Keywords: Key words Migraine attack ; 5-HT1B/1D agonists ; Analgesics ; Ergotamine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Migraine is a paroxysmal disorder characterized by attacks of headache, nausea, vomiting, photophobia, phonophobia, and malaise. This review summarizes new treatment options for therapy of the acute attack. Mild or moderate migraine attacks are treated with antiemetics followed by analgesics such as aspirin, paracetamol, nonsteroidal anti-inflammatory drugs, or antiemetics combined with ergotamine or dihydroergotamine. Sumatriptan, a specific serotonin (5-HT)1B/D agonist is used when attacks do not respond to ergotamine, or when intolerable side effects occur. The new migraine drugs zolmitriptan, naratriptan, rizatriptan, and eletriptan differ slightly in their pharmacological profiles, which translates into minor differences in efficacy, headache recurrence, and side effects. New drugs in migraine prophylaxis include cyclandelate, valproic acid and magnesium.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1106
    Keywords: Human posture-Short-medium-long-latency responses
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The functional role of short-, medium- and long-latency responses for the maintenance of upright posture was investigated in twenty healthy subjects standing on a platform which could be rotated in pitch around the subject's ankle joints. Tilting the platform toe-up evokes a stretch reflex in the triceps surae muscle (TS, latency 55–65 ms) and at higher speeds and amplitudes of platform displacement a medium-latency response (latency 108–123 ms). Both responses functionally destabilize posture, since they enforce the induced backward displacement of the body. Compensation of body displacement in this situation is achieved by a long-latency EMG response in the anterior tibial muscle (TA 130–145 ms). Platform movement toe-down elicits a rather small medium-latency response in TA (103–118 ms), but no short-latency response. A late compensatory response occurs in the triceps surae muscle (latency 139–170 ms). The mean latency of the late antagonistic EMG response was significantly shorter than that of a voluntary movement triggered by a somatosensory stimulus. Integrals of rectified EMG responses from the two muscles were linearly related to the amplitude and to a smaller degree to the velocity of platform displacement. The slope of this function (gain) varied depending on the direction of ankle displacement and the functional importance of the subsequent EMG responses. Destabilizing short- and medium-latency responses of the stretched muscle had a lower gain relative to amplitude than the late stabilizing response of the antagonist. This functionally adaptive modulation of gain was not seen in relation to the rate of platform displacement.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Experimental brain research 45 (1982), S. 126-132 
    ISSN: 1432-1106
    Keywords: Human posture ; Induced sway ; Visual stabilization
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Displacements of the center of foot pressure, the hip and the head were recorded in six subjects standing on a platform, sinusoidally tilting in pitch(anterior-posterior).Stimulusfrequenciesranged between 0.01 and 1 Hz. Stimulus amplitudes were 2, 4 and 6 °. With eyes open the displacements were minimal at 0.3 Hz. With eyes closed, however, induced sway was maximal at this frequency. The apparent lack of visual stabilization at the lowest frequency (0.01 Hz) might be attributed to a subthreshold velocity of the retinal image motion induced by the swaying body. A similar absence of visual stabilization at 1 Hz is assumed to indicate the limit of the working range of visual stabilization of posture. Independent of stimulus amplitude a phase lead of about 90 ° was found at 0.01 Hz. This decreased with increasing frequency up to a phase lag of 100 ° at the highest frequency (1 Hz). Head stabilization was generally more effective than hip stabilization. EMG recordings from the leg muscles suggest that with eyes closed the center of force is mainly stabilized by leg muscle activity, while with eyes open this stabilization is best, when vision allows for stabilization of body posture by intersegmental movements between head, trunk and legs.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-1106
    Keywords: Motion perception ; Spatial frequency ; Aubert-Fleischl phenomenon
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Apparent velocities of moving visual stimuli are known to be different depending on whether the subject pursues the stimulus (efferently controlled motion perception) or whether the eye is stationary and the image moves across the retina (afferent motion perception). Afferent motion perception of a periodic pattern or a moving single object causes overestimation of velocity (magnitude estimations) as compared to smooth pursuit. This socalled Aubert-Fleischl phenomenon is shown to depend on local temporal frequency stimulation on the retina caused by the repetitive passage of contrast borders of the moving periodic pattern. This is evidenced by the fact that for a given stimulus speed the amount of overestimation is a function of the spatial frequency of the pattern (or the angular subtend of a single moving object) and that the Aubert-Fleischl phenomenon is not observed if a single edge moves. Background characteristics seem not to influence the apparent velocity during smooth pursuit.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Experimental brain research 52 (1983), S. 423-428 
    ISSN: 1432-1106
    Keywords: Human posture ; Postural “reflexes” ; Change of latency
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The functional role of spinal and supraspinal EMG-responses for the maintenance of upright human posture was investigated in ten healthy subjects standing on a force measuring platform, which could be rotated in pitch around an axis aligned with the subject's ankle joint. Voluntary changes of body posture prior to the platform movement by leaning forward or backward led to a change in the amplitude and temporal organization of EMG-responses as compared to platform movements starting from a neutral position. Tilting the platform toe-up while leaning backward led to an increase of the latency of the short- and medium-latency responses in the triceps surae muscle and to a decrease of the latency of the stabilizing response in the anterior tibial muscle. Functionally, a cocontraction of both antagonistic muscles could be observed which partly compensated for the destabilizing action of the “reflex” response in the stretched triceps surae muscle. In analogy, leaning forward and tilting the platform toedown led to a cocontraction of the two antagonistic muscles. The observed changes of latencies of short-, medium-, and long-latency response show the functional variability of segmental and suprasegmental “reflex” mechanisms. EMG-activities, which are functionally destabilizing posture, can be suppressed or compensated by reflexive cocontractions of antagonists.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1432-1106
    Keywords: Child development ; Postural control ; Long-loop reflexes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Short (SL), medium (ML), and long (LL) latency EMG responses of leg muscles were recorded after perturbation of stance by means of a sudden toe-up tilt of a movable platform. 56 healthy children varying in age between 14 months and 15 years were investigated. All three responses were present when children were able to stand on the recording platform. The SL-response in the triceps surae muscle, which corresponds to the mono- and oligo-synaptic spinal stretch reflex, showed a decreasing latency up to the age of 5 years. This reflects the increasing peripheral nerve conduction velocity. The ML-response in the triceps surae muscle, which as the SL-response has no stabilizing effect in this experiment, showed somewhat delayed maturational changes. The LL-response in the relaxed anterior tibial muscle helps to restore upright posture even in the youngest children. Its maturational changes in terms of latency by far exceed the range that can be explained by the increase of peripheral and spinal conduction velocities. Its mechanisms of maturation, besides the biophysical optimalization of a polysynaptic network, may include learning in terms of selecting the shortest pathways by way of synaptic potentiation within structures involved in the supposedly transcortical pathway of the LL-response. Qualitative observations made during the trials showed that the pattern of postural adaptation changed with age, suggesting the development of additional intersegmental mechanisms.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1468-2982
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Alniditan is a new 5HT1D receptor agonist, belonging to a different chemical class from sumatriptan and other indole derivatives used or being developed for the treatment of acute migraine. In a multinational double-blind randomized parallel-groups dose-finding trial, alniditan was given subcutaneously in hospital to patients with migraine headache of moderate or severe intensity at doses of 0.8 mg (n = 44), 1.0 mg (n = 42), 1.2 mg (n=46) and 1.4 mg (n=39). Efficacy, tolerability and safety of each dose were compared with those of placebo (n =41 ). At 2 h after injection, headache was absent or mild in 83% and 82% of patients receiving alniditan 1.2 and 1.4 mg respectively compared with 39% for placebo (p0.002). Complete relief from headache was achieved in 72% (1.4 mg) Time to onset of relief decreased with increasing alniditan dose, and there was a dose-dependent reduction in headache recurrence rate: 25% of patients receiving 1.4 mg had responded by 15 min and headache recurred within 24 h in only 16% of the patients who initially responded to alniditan 1.4 mg, significantly less than for placebo (p=0.018). Alniditan was superior to placebo in reducing the associated symptoms of nausea, phonophobia and photophobia, and in increasing patients’ functional ability. The use of rescue medication was reduced when compared with placebo, and up to 87% of patients said that they would use the drug again if available. No clinically relevant cardiovascular effects were seen, nor consistent changes in clinical laboratory findings. Adverse effects, mainly head pressure, paraesthesia, and hot flushes, were reported by 34% of placebo-treated patients and up to 70% of patients receiving alniditan, but all doses were very well tolerated and no clear relationship with dose was established. Comparison with published findings suggests that alniditan 1.4 mg sc may have advantages over sumatriptan 6 mg sc in providing complete relief from acute migraine headache, and may be associated with fewer headache recurrences within 24h. Both of these suggestions warrant further and larger trials of alniditan in acute migraine.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1468-2982
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Sumatriptan is a potent and selective agonist at the vascular 5HT1 receptor which mediates constriction of certain large cranial blood vessels and/or inhibits the release of vasoactive neuropeptides from perivascular trigeminal axons in the dura mater following activation of the trigeminovascular system. The mode of action of this drug in migraine and cluster headache is discussed. On the basis of a detailed review of all published trials and available data from post-marketing studies, the efficacy, safety, tolerability and the place of oral and subcutaneous sumatriptan in the treatment of both conditions are assessed. A number of double-blind clinical trials have demonstrated that sumatriptan 100 mg administered orally is clearly superior to placebo in the acute treatment of migraine headache and achieves significantly greater response rates than ergotamine or aspirin. In other studies, 70 to 80% of patients receiving sumatriptan 6 mg sc experienced relief of migraine headaches by 1 or 2 h after administration, and patients consistently required less rescue medication for unresolved symptoms. Sumatriptan was also effective in relieving associated migraine symptoms like nausea and vomiting. Sumatriptan was equally effective regardless of migraine type or duration of migraine symptoms. Overall, approximately 40% of patients who initially responded to oral or subcutaneous sumatriptan experienced recurrence of their headache usually within 24 h, effectively treated by a further dose of this drug.In 75% of patients with cluster headache treated with sumatriptan 6 mg sc, relief was achieved within 15 min. Based on pooled study data, sumatriptan is generally well tolerated and most adverse events are transient. Adverse events following oral administration include nausea, vomiting, malaise, fatigue and dizziness. With the subcutaneous injection, injection site reactions occur in approximately 30%. Chest symptoms are reported in 3 to 5% but have been associated with myocardial ischaemia only in rare isolated cases. The recommended dosage of sumatriptan at the onset of migraine symptoms is 100 mg orally or 6 mg subcutaneously. The recommended dosage for cluster headache is 6 mg sumatriptan sc. Sumatriptan must not be given together with vascoconstrictive substances, e.g. ergotamines, or with migraine prophylactics with similar properties, e.g. methysergide. Sumatriptan should not be given during the migraine aura. It is contraindicated in patients with ischaemic heart disease, previous myocardial infarction, Prinzmetal (variant) angina and uncontrolled hypertension.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1468-2982
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Amitriptyline is the medication of first choice in the treatment of chronic tension-type headache. In 197 patients with chronic tension-type headache (87M and 110F with a mean age of 38 ±13 (18–68)) efficacy and tolerability of 60–90 mg amitriptylinoxide (AO) were compared with 50–75 mg amitriptyline (AM) and placebo (PL) in a double-blind, parallel-group trial consisting of a four weeks’ baseline phase and 12 weeks of treatment. The primary study endpoint was a reduction of at least 50% of the product of headache duration and frequency and a reduction of at least 50% in headache intensity. Statistics used were Fisher’s exact test and analysis of variance. No significant difference emerged between AO, AM and PL with respect to the primary study endpoint. Treatment response occurred in 30.3% of the AO, 22.4% of the AM and 21.9% of the PL group. A reduction in headache duration and frequency of at least 50% was found in 39.4% on AO, in 25.4% on AM and in 26.6% on PL (PAO-PL = .1384, PAM-PL = 1.000, PAO-AM = .0973). A reduction in headache intensity of at least 50% was found in 31.8% on AO, in 26.9% on AM and in 26.6% on PL (PAO-PL = .5657, PAM-PL = 1.000, PAO-AM = .5715). Trend analysis with respect to a significant reduction of headache intensity (p 〈 0.05) and the product of headache duration and frequency revealed a superior effect of AO. Adverse events occurred in 75.8% on AO, 82.1% on AM and 76.6% on PL (PAO-PL = 1.000, PAM-PL =.5188, PAO-AM = .4017). Neither depressive symptoms, measured by the SCL-90-R, nor study drug-related adverse events had any influence on the results.
    Type of Medium: Electronic Resource
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