The passage of the vasopressin analogue, 1-deamino-8-D-arginine-vasopressin (DDAVP) into the cerebrospinal fluid (CSF) following intravenous (i.v.) administration was studied in human subjects. After ...i.v. injection of DDAVP, resulting in plasma levels exceeding normal plasma concentrations of vasopressin (AVP) by 100-fold, serial blood and ventricular CSF specimens were sampled during 2 h. Plasma and CSF were analysed by radioimmunoassay using two different AVP antisera: one specific against natural AVP and another cross-reacting 100% with DDAVP. No changes in the joint concentrations of DDAVP + AVP in CSF were found following i.v. infusion of DDAVP when compared with the concentration before the infusion. Neither was any difference between CSF concentrations of AVP and DDAVP + AVP observed at any sampling time following the i.v. DDAVP administration. Hence, it is concluded that no measurable amounts of DDAVP can be found in the CSF for up to 2 h after i.v. administration of the peptide, and that for all practical purposes a blood-CSF barrier to DDAVP exists.
From the city center of Copenhagen, almost 20,000 people, 20 years of age and older, were randomly selected for examination after age and sex stratification. The participation rate was 72%. 231 ...persons responded affirmatively to a questionnaire concerning cerebrovascular disease. After neurological examination the diagnosis was confirmed in 115 cases. Adjusted on the basis of the age distribution of the Danish population (1976) the prevalence rate was calculated to be 651/100,000 for men and 385/100,000 for women. The frequency of myocardial infarction and hypertension was significantly higher in the stroke patients than in the study population. The risk factors: cigarette smoking, serum-cholesterol, and high-density-lipoprotein concentration, showed no significant differences between the patients and the study population. 44% of the patients had had their stroke more than 5 years before the prevalence date. In 41% of the patients, residual neurological signs could not be demonstrated, while 59% of the patients had neurological deficits of varying severity. 30% of the surviving patients were in gainful work or managed domestic activities as they had done before the stroke. Nearly 1/2 of the severely disabled patients were independent in self care. The age group above 80 years was under-represented in this study.
The association between cerebral ischaemic attacks (CIA) and mitral valve prolapse (MVP) was investigated in a blinded study of 30 consecutive patients with cerebrovascular disease and 30 control ...patients matched by age, sex, and immediately apparent neurological signs. All patients were below the age of 40 years. Phonocardiography, motion-mode and two-dimensional echocardiography were performed at rest and during various manoeuvres. MVP demonstrated by all three diagnostic modalities was classified as definite and prolapse in at least one but not in all three tests were designated as ambiguous. Regarding the frequency of definite MVP, no statistically significant difference was demonstrated between patients with CIA (3%) and controls (0%). Ambiguous MVP was rather common in patients with cerebrovascular disease (13%) but equally frequent in control patients (20%). It is concluded that MVP does not appear particularly common in Northern Europe in younger patients with cerebral ischaemic events.
We measured the fluctuations in plasma pyridostigmine concentration from day to day on 3 consecutive days and hour to hour during 1 day in 11 myasthenic patients, by studying their usual dosage ...regime. Plasma pyridostigmine was measured by gas chromatography/mass spectrometry. The intraindividual day-to-day variation in plasma pyridostigmine levels was small. A highly significant relationship was found between the oral pyridostigmine dose and the area under the plasma concentration/time curve. The bioavailability of oral pyridostigmine was 3.6%, estimated by replacing one dose with an intravenous dose amounting to 1/30 of the oral dose. The relatively stable kinetic behavior of pyridostigmine is in contrast to the interpatient variability in dose requirement, indicating that monitoring of plasma pyridostigmine levels should be reserved for special cases.
Five patients with essential tremor were treated with increasing daily doses of propranolol. Tremor intensity was assessed after each propranolol dose had been given daily for a period of at least ...seven days. The evaluation was made 12 to 15 hours after the last propranolol ingestion. It included a semiquantitative clinical tremor evaluation and quantitative registration with an accelerometer. Electronic integration of the accelerometer curves gave an arbitrary measure of tremor intensity. Plasma propranolol concentration was determined at each tremor measurement. The reduction in tremor correlated with increasing propranolol doses, whereas plasma propranolol concentrations varied widely among individuals and could not be correlated with tremor reduction. Most of the patients had considerable diminution in tremor at low propranolol doses, often with an unmeasurable plasma propranolol concentration. Determination of plasma concentrations has little value in long-term treatment of essential tremor with propranolol. The dosage can be sufficiently guided by clinical evaluation of effect.
The initial clinical symptoms, the course of the disease, and the effect of corticosteroid treatment have been analyzed in a retrospective study of 63 patients with temporal arteritis or polymyalgia ...rheumatica. The relationship between the physical examination of the temporal regions, the ophthalmological examination, and biopsy from the temporal artery with respect to the diagnostic value were examined. Histological examination of biopsy specimens from the temporal artery in 58 patients revealed arteritis in 46. Half of the patients had only local symptoms from the temporal regions; one fourth presented such symptoms as well as myalgias, and one fourth had myalgias only. Patients presenting local symptoms of temporal arteritis as well as of myalgias had always had myalgias as the initial symptom and developed local symptoms of temporal arteritis 1-24 months later. Permanent reduction of vision occurred in 20% of the patients. Symptoms of generalized arteritis were observed in several patients. The overlapping of the clinical symptoms, the positive biopsy findings in patients with polymyalgia rheumatica as the only local symptom and the identical reaction to corticosteroid treatment support the conception of temporal arteritis and polymyalgia rheumatica as two manifestations of the same disease. The physical and the ophthalmological examinations were of limited diagnostic value. Positive biopsy findings were seen in 25 patients with noraml palpatory findings, and in 46 patients without eye symptoms the ophthalmoscopic examination revealed no signs of arteritis. If the first biopsy from the temporal artery is negative, biopsy from the contralateral temporal artery should be performed. Correctly timed corticosteroid treatment in adequate doses can prevent reduction of vision in giant-cell arteritis. The treatment is a long-term therapy, its average duration in the present study being more than two years.
