Urodynamic analysis and treatment of male Parkinson’s disease patients with voiding dysfunction

Background Parkinson＇s disease （PD） is an extrapyramidal neurological disorder.Urinary symptoms are frequently present in patients affected by PD.Symptoms such as urgency,frequency,nocturia,and urge incontinence significantly impact the patient＇s quality of life.We attempted to investigate the urodynamic changes and treatment of male PD patients with voiding dysfunction by means of a review.Methods Comprehensive urodynamic examinations were performed in 141 male patients with PD associated with voiding dysfunction.Appropriate treatments were given to subgroups that were divided based on test results,and the changes in urodynamic parameters as well as the treatment efficacy were observed.Results Detrusor hyperreflexia without bladder outlet obstruction （BOO） was observed in 35 patients,who exhibited significant improvements in the international prostate symptom score （IPSS）,maximum flow rate （Qmax）,bladder volume at the first desire to void,post-void residual （PVR）,and bladder compliance.Detrusor hyperreflexia associated with BOO was observed in 59 patients.The patients exhibited significant improvements in IPSS,Qmax,PVR,and bladder compliance.Detrusor dysfunction without BOO was observed in 19 patients,for whom the IPSS and the bladder volume at the first desire to void were improved after treatment.Detrusor dysfunction with BOO was found in 28 patients,with no significant improvement in the urodynamic parameters after the treatment.Conclusions Urodynamic examination is recommended for male Parkinson＇s disease patients with voiding dysfunction.Early and effective treatment can improve the bladder function and quality of life of these patients.     

Neuropsychiatric disorders and cognitive dysfunction in patients with Cushing’s disease

Objective To review the main neuropsychiatric disorders and cognitive deficits in patients with Cushing's disease (CD) and the associated pathophysiological mechanisms underlying CD.These mechanistic d...     

Clinical course and cause of death in elderly patients with idiopathic Parkins on’s disease

Objective To improve the therapeutic and preventive measure for elderly patients (75 years and over) with idiopathic Parkinson’s disease (OEIPD). Methods Fifteen OEIPD patients were observed prospectively over a long period of time. Their diagnosis was confirmed by autopsy. Based on clinical and pathological data, the causes of death were analyzed.Results The mean clinical course in OEIPD patients was 6.2±3.6 years. The majority of the 15 patients were the akinetic type and the akinetic type with tremor (80.0%). In the late stages of disease (4.8±3.5 year), choking occurred in 12 OEIPD patients who received nasal feeding for an average of 4 months after the occurrence of choking. The most common complication in 12 patients was repeated pulmonary infections with an average rate of 2.9±1.9. The causes of death were bronchial pneumonia and shock induced by pulmonary infection (11 cases, accounted for 73.3%), acute myocardial infarction (2 cases), one case with cardiac rupture and one case with rupture of aortic aneurysm. Conclusions The clinical course was shorter in OEIPD patients. Levodopa therapy should be started early in OEIPD patients. Bronchial pneumonia and infectious shock constitute the major cause of death and choking was one of the main causes of aspiration pneumonia. Nasal feeding should be started as early as possible after the appearance of choking. Silent aspiration can be reduced by teaching the patient to protect the airway by ’supraglottic swallowing’.     

Parkinson’s disease therapy: treatment of early and late disease

Purpose To summarize the current strategies for the treatment of early and late Parkin son’s disease (PD).Data sources The presented guidelines are based on the review of the literature as well as th e author’s extensive experience with the treatment of 7000 patients with PD over the past 25 years.Results An analysis of reported data as well as personal experience suggest that while y oung patients seem to have a slower progression of the disease, they are at a hi gher risk for developing levodopa induced complications, such as motor fluctuati ons and dyskinesias. It is, therefore, prudent practice to delay levodopa thera py, particularly in younger patients, until the PD symptoms become troublesome a nd interfere with social or occupational functioning. Other strategies, such as the use of deprenyl, amantadine, trihexyphenidyl and dopamine agonists, should be employed before instituting levodopa therapy. Entacopone and dopamine agonis ts are useful in smoothing out levodopa related motor fluctuations. Surgical in terventions, such as pallidotomy and pallidal or subthalamic deep brain stimulat ion, are effective therapeutic strategies, but should be reserved only for patie nts in whom optimal medical therapy fails to provide satisfactory control of sym ptoms.Conclusion The medical and surgical treatment of patients with PD must be individualized an d tailored to the needs of the individual patient.     

Protective effects of Radix Astragalus on vascular endothelial Cells of patients with Binswanger’s disease

Objective: To compare the effects of Radix Astragalus (RA) on vascular endothelial cells in Binswanger’s disease (BD) patients with Radix Salviae miltiorrhizae (RSM).Methods: There were 37 patients with BD in the treated group and 37 healthy subjects in the control group. Thirty-seven patients were further randomly subdivided into two groups: RA group (19 patients) and RSM group (18 patients). Circulating endothelial cells (CEC) and the levels of endothelin-1 (ET-1), nitric oxide (NO) and malondialdehyde (MDA) in the blood of internal jugular vein which were examined before and after treatments.Results: When compared with those of the control group, CEC counts, ET-1 and MDA levels in plasma increased significantly, meanwhile serum NO concentration decreased significantly in the treated group. When compared with those of pretreatment, CEC counts, ET-1 and MDA decreased significantly and serum NO concentration increased significantly after treatment in RA group. There were no significant changes of these indices in RSM group after treatment.Conclusions: There are damage and dysfunction of vascular endothelial cells in patients with BD. RA injection is an effective drug to protect vascular endothelial cells of BD patients.     

Clinical study on treatment of Alzheimer’s disease from the viewpoint of Xin and Shen

Clinical Study on Treatment of Alzheimer’s Disease from the Vie wpoint of Xin and Shen@林水淼$Institute of Geriatrics, Shanghai TCM University!Shanghai @王健$Institute of Geriatrics, Shanghai TCM University!Shanghai @周如倩$Institute of Geriatrics, Shanghai TCM University!Shanghai @郁志华$Institute of Geriatrics, Shanghai TCM University!Shanghai…     

Depression in patients with Parkinson’s disease and the associated features

The study was aimed to examine the prevalence of depression in patients with Parkinson’s disease （PD） and identify its features. A total of 131 out-patients, diagnosed as having idiopathic PD in accordance with the United Kingdom Parkinson’s Disease Society Brain Bank criteria, were interviewed with questionnaire and evaluated by Mini-Mental State Examination （MMSE）, Unified Parkinson’s Disease Rating Scale （UPDRS）, Hohen ＆Yahr staging （H＆Y staging） and Hamilton Rating Scale for Depression （HRSD）. Patients were divided into three groups in terms of HRSD score： depression group, sub-threshold depression group and non-depression group. The clinical variables and symptom profiles were obtained and compared among the three groups. The results showed that 27 patients （20.6%） fell into the depression group, 71 （54.2%） into the sub-threshold depression group, and 33 （25.2%） into the non-depression group. There were no differences in age, gender or tremor score among the groups （P〉0.05）. Significant differences were found in duration of PD, UPDRS score, rigidity score and H＆Y stage between the sub-threshold depression group （or the depression group） and the non-depression group （P〈0.05）. Moreover, the clinical variables in the subthreshold depression group had the trend of increasing with the severity of PD and their values were similar to those in the depression group. Anhedonia, feeling of incapability, sleep disturbance, gastrointestinal symptoms and depressive moods were most common in the depression group. And these symptoms also were more common in the other two groups. It is concluded that depression and sub-threshold depression are common in PD and share similar clinical features. Furthermore, subthreshold depression might be the prodrome of depression and may develop into depression as the condition progresses.     

Pericardial devascularization combined with Latarjet’s innervation in the treatment of patients with

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Microarray-based analyses of monocytes from Chinese Uygur patients with Parkinson’s disease and cognitive impairment

Parkinson＇s disease （PD）, a complex neurodegenerative disease, is characterized by the loss of dopamine neurons in the substantia nigra ot the midbraln. PD patients have varying degrees of cognitive impairment （CI） that we term PD-CI. However, the etiology of these changes remains unexplained. We chose three Uygur male patients with PD-CI and three healthy controls of the same of nationality and sex to explore the pathogenesis of Xinjiang Uygur PD-CI using microarray-based gene expression profiling of monocytes.     

Clinical features and management of Crohn’s disease in Chinese patients

Background An increasing incidence of Crohn‘s disease has been found in China in recent years.Our study has been focused on evaluating the diversity of the clinical manifestations of Crohn‘ s disease in order to improve early diagnostic accuracy and therapeutic efficacy.Methods Thirty patients with active Crohn‘s disease were enrolled and their clinical data, including diagnostic and therapeutic results, were analyzed. Endoscopy combined with histological examination of biopsy specimens provided characteristic features of the disease. Transabdominal bowel sonography (TABS) was used for detecting intestinal complications. Nutritional supportive therapy was given to 20 subjects with active cases of the disease.Results Most patients were young adults with a higher proportion of females to males ( ratio: 1.14:1 ). The disease affects any segment or a combination of segments along with the alimentary tract(from the mouth to the anus). In this study, the colon and small bowel were the major sites involved.Recurrent episodes of abdominal pain in the right lower quadrant and watery diarrhea were the most common symptoms. Granulomas were identifiable in nearly one-third (30. 8%) of all biopsy specimens. In moderate cases of the disease, remission was achieved more quickly through the use of oral prednisone therapy than with SASP or 5-ASA. Beneficial effects on the host‘ s nutritional status were observed. Immunosuppressives were used on an individual basis and showed variable therapeutic effects. Sixteen patients had surgery due to intestinal obstruction or failure to respond to drug therapies. Rapid improvement after surgery was reported.Conclusion Endoscopy (with biopsy) and TABS were both crucial procedures for diagnosis. SASP (or 5-ASA) and prednisone were effective as inductive therapies. Azathioprine has demonstrable benefits after induction therapy with prednisone. Surgery, as an alternative treatment, provided another effective choice in selected patients.     

Apolipoprotein E genotype in patients with Alzheimer’s disease

Objective To explore the frequency and significance of ApoE gene polymorphisms in patients with sporadic Alzheimer’s disease (AD).Methods Single nucleotide polymorphisms of the ApoE gene were analyzed in 32 cases of AD and 26 controls, using PCR and gene sequencing.Results The single nucleotide polymorphism of ApoE gene 462C/G was significantly associated with AD (P<0.05).Conclusions The 462C/G polymorphism might be a specific genotype in Chinese patients with sporadic AD.     

Effects of lornoxicam combining with fentanyl on postoperative arrhythmia and platelet function in patients with coronary artery disease after abdominal surgery

Effects of lornoxicam combining with fentanyl on postoperative arrhythmia and platelet function in patients with coronary artery disease after abdominal surgery@王军$Dept Anesthesiol,Wuxi 1st Peop Hosp,Wuxi 214002     

Differential acetylcholine and choline concentrations in the cerebrospinal fluid of patients with Alzheimer’s disease and vascular dementia

Background An important aspect of Alzheimer’s disease (AD) is loss or impairment of cholinergic neurons. It is controversial whether there is a similar cholinergic impairment and cerebral deficit of acetylcholine (ACh) in the case of vascular dementia (VD). The purpose of this study was to explore the levels of ACh and choline (Ch) in the cerebrospinal fluid (CSF) of patients with AD and VD, and their possible relationship with cognitive impairment.Methods Twenty-two AD patients, twenty-two VD patients, and twenty normal controls were recruited and scored with a Mini-Mental State Examination (MMSE). CSF concentrations of ACh and Ch were measured using high-performance liquid chromatography with an electrochemical detector (HPLC-ECD) and the results were then compared to cognitive status.Results ACh concentrations in CSF of AD patients ［(10.7±5.1） nmol/L］ and VD patients ［(16.8±7.4） nmol/L］ were both significantly lower than in controls ［(34.5±9.0） nmol/L, t=10.67, P<0.001; t=6.91, P<0.001］. Both results correlated positively with MMSE scores (rs=0.88 and rs=0.85, respectively, P<0.01). The CSF concentration of Ch was significantly higher in VD patients ［(887.4±187.4） nmol/L］ compared to AD patients ［(627.6±145.1） nmol/L, t=6.4, P<0.001］ and controls ［(716.0±159.4） nmol/L, t=4.2, P=0.002］. CSF Ch concentration showed no difference between AD patients and normal controls, nor did it correlate with MMSE score in any of the three groups. Conclusions The positive correlation between ACh deficit and cognitive impairment suggests that ACh is an important neurotransmitter for memory. The similar decrease in ACh concentration in AD and VD patients may imply a similar pathogenesis for the process of cognitive impairment involved in these two disorders. The elevated CSF levels of Ch in VD patients compared to AD patients may be useful diagnostically. Cholinesterase inhibitors may be helpful not only for AD patients, but also for VD patients.     

Study of cochlear hydrops analysis masking procedure in patients with Meniere’s disease and otologically normal adults

Background  The cochlear hydrops analysis masking procedure (CHAMP) is a new diagnostic technique for Meniere’s disease (MD). But its value has not been well proven. This study aimed to evaluate the diagnostic value of CHAMP for MD.

Methods  CHAMP test was taken in three populations using the Auditory Evoked Potential system delivered by Bio-logic Systems Corporation: (1) otologically normal subjects; (2) patients clinically diagnosed with definite MD; (3) patients clinically diagnosed with probable and possible MD.

Results  According to the comparison between the normal and definite MD group, if the abnormal criterion of CHAMP was defined as latency delay less than 0.3 ms, then the corresponding sensitivity was only 52%. However, if the abnormal criterion was defined as latency delay between 0.6 and 3.8 ms, then a sensitivity of 93% and a specificity of 100% can be achieved. The complex amplitude ratio showed a significant overlap between normal and definite MD group. If the abnormal criterion was defined as a complex amplitude ratio less than 0.95, the corresponding specificity was only 50%. However, if the abnormal criterion was defined as less than 0.80, the corresponding sensitivity was 60%, and the specificity was 97%. If the abnormal criterion of CHAMP was defined as latency delay less than 0.6 ms or the complex amplitude ratio less than 0.80, CHAMP result can be obtained in all subjects with good sensitivity and specificity.

Conclusions  CHAMP can differentiate patients with Meniere’s disease from otologically normal subjects with high sensitivity and specificity. The recommended criterion of abnormal CHAMP was a latency delay less than 0.6 ms or a complex amplitude ratio less than 0.80.

     

Clinical efficacy and safety of chelation treatment with typical penicillamine in cross combination with DMPS repeatedly for Wilson’s disease

The aim of this study was to assess the clinical efficacy and safety of chelation treatment with penicillamine （PCA） in cross combination with sodium 2, 3-dimercapto-l-propane sulfonate （DMPS） repeatedly in patients with Wilson＇s disease （WD）. Thirty-five patients with WD were enrolled. They were administrated intravenous DMPS in cross combination with oral PCA alternately which was practiced repeatedly, all with Zinc in the meantime. During the treatment, clinical observations and 24-h urine copper excretion as well as adverse effects of medicines were recorded and analyzed. Although the incidence of adverse effects was not significantly different after either intravenous DMPS or oral PCA treatment, levels of 24-h urine copper tended to be higher after short-term intravenous DMPS than that of oral PCA. Adverse effects in the course of intravenous DMPS were mainly neutropenia, thrombocy- topenia, allergic reaction and bleeding tendency. As compared with oral PCA alone or intravenous DMPS alone, such repeated cross combination treatment could as much as possible avoid continued drug adverse effects or poor curative effect and had less chance to stop treatment in WD patients. Im- proved or recovered liver fimction in 71% of the patients, alleviated neurologic symptoms in 50% of the patients, and disappeared hematuria in 70% of the patients could be observed during the follow-up pe- riod of 6 months to 5 years after such combined chelation regimen. Chelation treatment repeatedly with oral penicillamine in cross combination with intravenous DMPS alternately could be more beneficial for WD patients to relieve symptoms, avoid continued drug adverse effects and maitain lifelong therapy.     

Effects of calcium antagonist nimodipine on patients with severe craniocerebral trauma

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Preliminary observation on treatment of patients with Japanese B encephalitis with monoclonal antibody

The monoclonat antibodies(McAbs)against Japanese B encephalitis virus for clinicaluse were prepared according to the standards of Food and Drug Administration(FDA,USA).Immediately after the diagnosis,the patients were given 10 mg of McAbs(IgG)in normal salineby intravenous drip plus intramuscular injection.The average febrifugal days of the McAb treat-ment group(55 cases),symptomatic treatment group(12 cases),ribavirin treatment group(17cases)and thymus peptides treatment group(7 cases)were 2.86,6.20,7.16 and 9.11d,respec-tively(P<0.05 or P<0.01).It is necessary to take the skin test before use of the McAbs andto give dexamethasone during the McAb treatment.