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Ferrari MD, James MH, Bates D, Pilgrim A, Ashford E, Anderson BA, Nappi G. Oral sumatriptan: effect of a second dose, and incidence and treatment of headache recurrences. Cephalalgia 1994; 14:330-8. [PMID: 7828190 DOI: 10.1046/j.1468-2982.1994.1405330.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Oral sumatriptan in a dose of 100 mg aborts about 60% of migraine attacks within 2 h, but the headache may recur within 24 h. We investigated: (i) the incidence of headache recurrence after oral sumatriptan (ii) whether a second tablet of sumatriptan at 2 h increases initial efficacy and/or (iii) prevents headache recurrence and (iv) whether a further tablet of sumatriptan treats headache recurrence. In a randomized parallel-group clinical trial, 1246 patients treated one to three migraine attacks (with or without aura), with 100 mg oral sumatriptan. Two hours later they all took a double-blind randomized second table of sumatriptan (group I) or placebo (group II). Patients who initially improved, but then experienced headache recurrence took a further double-blind randomized tablet of sumatriptan or placebo. Proportions of patients who improved from moderate/severe headache to mild/none were similar in groups I and III at 2 h (55 vs 56%) and 4 h (80 vs 77%). Incidences of headache recurrence (moderate/severe-any grade of headache) and median times to headache recurrence were also similar: 22-32% at 16 h in group I and 25-33% at 16.5 h in group II. Sumatriptan was superior to placebo in treating headache recurrence: 74 vs 49% (p = 0.017) in group I and 70 vs 30% (p = 0.0001) in group II. Thus, one-fourth of patients experience headache recurrence at about 16 h after successful treatment of a migraine attack with 100 mg oral sumatriptan. A second tablet of sumatriptan at 2 h does not increase initial efficacy and neither prevents nor delays headache recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)
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Bates D, Ashford E, Dawson R, Ensink FB, Gilhus NE, Olesen J, Pilgrim AJ, Shevlin P. Subcutaneous sumatriptan during the migraine aura. Sumatriptan Aura Study Group. Neurology 1994; 44:1587-92. [PMID: 7936279 DOI: 10.1212/wnl.44.9.1587] [Citation(s) in RCA: 120] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
This double-blind, placebo-controlled, multicenter, parallel-group study assessed whether subcutaneous sumatriptan administered during the migraine aura would prolong or modify the aura and prevent or delay development of the headache. One hundred seventy-one patients (88 receiving 6 mg sumatriptan, 83 receiving placebo) treated a single attack of migraine with typical aura at home, by self-injection. The median duration of aura following the first injection was 25 minutes for the sumatriptan group and 30 minutes for the placebo group (NS). The aura symptom profile was similar for the two treatment groups. The proportion of patients who developed a moderate or severe headache within 6 hours after dose administration was similar in the two groups--68% among those receiving sumatriptan and 75% among those receiving placebo (NS). Sumatriptan given during the aura did not prolong or alter the nature of the migraine aura and did not prevent or significantly delay headache development.
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Bates D. BOOK REVIEWS: Stroke: Populations, Cohorts, and Clinical Trials. Journal of Neurology, Neurosurgery and Psychiatry 1994. [DOI: 10.1136/jnnp.57.4.526-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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104
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Heald A, Bates D, Cartlidge NE, French JM, Miller S. Longitudinal study of central motor conduction time following stroke. 2. Central motor conduction measured within 72 h after stroke as a predictor of functional outcome at 12 months. Brain 1993; 116 ( Pt 6):1371-85. [PMID: 8293276 DOI: 10.1093/brain/116.6.1371] [Citation(s) in RCA: 174] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A longitudinal study was performed on 118 first-ever stroke patients to evaluate neurophysiological measurements of central motor conduction time (CMCT) in the period immediately following stroke as predictors of functional outcome and mortality at 12 months. Measurements of CMCT were made as described in the accompanying article (Heald et al., 1993, Brain, 116, 1355-1370), in which the following three groups of patients were recognized within 12-72 h after the onset of symptoms: normal response group, delayed response group and no response group. Neurophysiological and clinical investigations were commenced 12-72 h (designated as day 1) after the onset of symptoms and repeated at set time intervals up to 12 months. The subjects were examined neurologically and assessed using the Motricity Index for muscle strength, the Nine-hole Peg Test to measure manual dexterity, the Barthel Score for activities of daily living and the modified Rankin Scale for functional outcome. The duration of stay in hospital and the occurrence of stroke-related death were noted. During the first week following stroke, absence of responses correlated closely with the patient's symptoms and neurological observations of abnormal muscle tone and tendon reflexes. Correlations were made in the three groups of patients of functional scores at day 1 and at 12 months. Patients with normal CMCT had consistently higher scores throughout the 12 month period and achieved significantly better functional recovery. Patients with no responses showed poor performance in neurological and functional tests throughout the 12 month period. Patients with delayed CMCT had neurological and functional scores intermediate between those of the other two groups, but outcome at 12 months was similar to those in the normal response group. Where the threshold to cortical stimulation was abnormally high, functional outcome was generally poor. Mortality was highest in the group with absent responses and the survivors spent the longest period in hospital. In conclusion, the observation of normal or delayed CMCT at day 1 identifies a group of patients with a high probability of survival and functional recovery. The absence of responses to cortical stimulation at day 1 identifies a group of patients who are at high risk of poor functional recovery at 12 months and greater probability of stroke-related death during this period.
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Heald A, Bates D, Cartlidge NE, French JM, Miller S. Longitudinal study of central motor conduction time following stroke. 1. Natural history of central motor conduction. Brain 1993; 116 ( Pt 6):1355-70. [PMID: 8293275 DOI: 10.1093/brain/116.6.1355] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A 12 month longitudinal study has been performed on 118 subjects following first-ever stroke to determine changes in central motor conduction time (CMCT) to upper limb muscles. The responses to electromagnetic stimulation of the motor cortex and cervical motor roots were recorded bilaterally in the surface electromyograms of pectoralis major, biceps and triceps brachii and thenar muscles. The CMCTs obtained from these recordings in stroke patients have been compared with those obtained in 53 normal healthy subjects of a similar age. The first measurements were made within the immediate post-stroke period (12-72 h of the onset of symptoms) and repeated at set time intervals over 12 months. The first assessment of CMCT identified three groups: those with normal responses, delayed responses and absent responses. During the first 12 months following stroke various changes in CMCT occurred. Central motor conduction time may remain unchanged, delayed CMCT may return to normal and previously absent responses may reappear and be delayed or normal. Using electromagnetic stimulation of the motor cortex the thresholds for motor evoked responses in the different muscles were initially high and fell over 12 months.
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De Camilli P, Thomas A, Cofiell R, Folli F, Lichte B, Piccolo G, Meinck HM, Austoni M, Fassetta G, Bottazzo G, Bates D, Cartlidge N, Solimena M, Kilimann MW. The synaptic vesicle-associated protein amphiphysin is the 128-kD autoantigen of Stiff-Man syndrome with breast cancer. J Exp Med 1993; 178:2219-23. [PMID: 8245793 PMCID: PMC2191289 DOI: 10.1084/jem.178.6.2219] [Citation(s) in RCA: 208] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Stiff-Man syndrome (SMS) is a rare disease of the central nervous system (CNS) characterized by progressive rigidity of the body musculature with superimposed painful spasms. An autoimmune origin of the disease has been proposed. In a caseload of more than 100 SMS patients, 60% were found positive for autoantibodies directed against the GABA-synthesizing enzyme glutamic acid decarboxylase (GAD). Few patients, all women affected by breast cancer, were negative for GAD autoantibodies but positive for autoantibodies directed against a 128-kD synaptic protein. We report here that this antigen is amphiphysin. GAD and amphiphysin are nonintrinsic membrane proteins that are concentrated in nerve terminals, where a pool of both proteins is associated with the cytoplasmic surface of synaptic vesicles. GAD and amphiphysin are the only two known targets of CNS autoimmunity with this distribution. This finding suggests a possible link between autoimmunity directed against cytoplasmic proteins associated with synaptic vesicles and SMS.
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Bates D. Rationing by age: a short philosophical comment. HEALTH CARE ANALYSIS 1993; 1:153-4. [PMID: 10135593 DOI: 10.1007/bf02197109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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108
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Bates D. BOOK REVIEWS: Cardiac Surgery and the Brain. Journal of Neurology, Neurosurgery and Psychiatry 1993. [DOI: 10.1136/jnnp.56.11.1237-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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109
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Rodgers H, Aitken PD, French JM, Curless RH, Bates D, James OF. Alcohol and stroke. A case-control study of drinking habits past and present. Stroke 1993; 24:1473-7. [PMID: 8378949 DOI: 10.1161/01.str.24.10.1473] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE Previous studies have reported a U-shaped relation between alcohol consumption and stroke. Those studies have been criticized for failing to distinguish between lifelong abstainers from alcohol and those who have given up drinking. METHODS We examined current and previous drinking habits of 364 cases of acute stroke and 364 community-based control subjects matched for age, sex, and family practitioner. RESULTS Stroke patients were more likely to have been lifelong abstainers from alcohol than were the control subjects. The odds ratio (OR) or lifelong abstainers versus those who had ever drunk regularly was 2.36 (95% confidence interval [CI], 1.67 to 3.37). No relation was found between stroke and current nondrinkers. Current male heavy drinkers also had an increased risk of stroke (OR, 2.88; 95% CI, 1.08 to 2.31). CONCLUSIONS Lifelong abstention from alcohol is associated with an increased risk of stroke. Moderate alcohol consumption may protect against cerebrovascular disease.
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Newens AJ, Forster DP, Kay DW, Kirkup W, Bates D, Edwardson J. Clinically diagnosed presenile dementia of the Alzheimer type in the Northern Health Region: ascertainment, prevalence, incidence and survival. Psychol Med 1993; 23:631-644. [PMID: 8234570 DOI: 10.1017/s0033291700025411] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Potential cases of presenile dementia of the Alzheimer type (PDAT) in the Northern Health Region (estimated population aged 45-64, 655,800) were ascertained for the years 1979-86 from in-patient ICD-9 codes and other sources. An algorithm was applied to the casenote information to distinguish between Alzheimer-type and other forms of dementia. A search of the NHS central register was made to establish date and place of death. Estimates were made for patients with missing case records. The point prevalence rate for PDAT was estimated as 34.6 per 100,000 with an annual incidence of 7.2 per 100,000 in the 45-64 age range. These rates are compared with those reported in other studies. Five-year survival following diagnosis for incident cases of PDAT was 64% with a longevity quotient (LQ), the percentage of expected time actually survived, of 69%. There was no evidence of a more malignant course in PDAT when compared with survival in older patients with dementia of the Alzheimer type (DAT) in other studies. Sixty-six per cent of deaths occurred in hospital, 19% at home and 15% in residential homes.
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112
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Bates D. BOOK REVIEWS: Autonomic Failure: A Textbook of Clinical Disorders of the Autonomic Nervous System/Third Edition. J Neurol Psychiatry 1993. [DOI: 10.1136/jnnp.56.4.429-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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113
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Folli F, Solimena M, Cofiell R, Austoni M, Tallini G, Fassetta G, Bates D, Cartlidge N, Bottazzo GF, Piccolo G, De Camilli P. Autoantibodies to a 128-kd synaptic protein in three women with the stiff-man syndrome and breast cancer. N Engl J Med 1993; 328:546-51. [PMID: 8381208 DOI: 10.1056/nejm199302253280805] [Citation(s) in RCA: 187] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The stiff-man syndrome is a rare disease of the central nervous system characterized by progressive rigidity of the body musculature. Autoantibodies directed against glutamic acid decarboxylase are present in about 60 percent of patients with the syndrome. In this group, there is a striking association of the stiff-man syndrome with organ-specific autoimmune diseases, primarily insulin-dependent diabetes mellitus. METHODS We studied three women with the stiff-man syndrome and breast cancer, seeking autoantibodies directed against nervous system antigens in serum and cerebrospinal fluid by immunocytochemical techniques, Western blotting, and immunoprecipitation. RESULTS Autoantibodies directed against a 128-kd brain protein were found in two of the women with the stiff-man syndrome and breast cancer. These results led to a search for breast cancer in the third patient with the stiff-man syndrome, who also had autoantibodies. A small invasive ductal carcinoma was detected by ultrasonography and removed. Serum samples from all three patients were negative for autoantibodies directed against glutamic acid decarboxylase. Autoantibodies against the 128-kd antigen were not detected in control patients with the stiff-man syndrome without breast cancer or in patients with cancer who did not have the syndrome. Within the nervous system, the 128-kd autoantigen was localized in neurons and concentrated at synapses. CONCLUSIONS In a subgroup of patients with the stiff-man syndrome, the condition is likely to have an autoimmune paraneoplastic origin. The detection of autoantibodies against the 128-kd antigen in patients with this syndrome should be considered an indication to search for an occult breast cancer.
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Rodgers H, Aitken P, Murdy J, Curless R, French J, Bates D, James O. Alcohol and Stroke: A Case Control Study of Drinking Habits Past and Present. Age Ageing 1993. [DOI: 10.1093/ageing/22.suppl_2.p3-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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115
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Aitken P, Rodgers H, French J, Bates D, James O. Devising a Stroke Study - A Cautionary Tale. Age Ageing 1993. [DOI: 10.1093/ageing/22.suppl_2.p13-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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116
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Rodgers H, Aitken P, Spriggs D, Murdy J, French J, Bates D, James O. Stroke: A Case Control Study of Premorbid Handicap. Age Ageing 1993. [DOI: 10.1093/ageing/22.suppl_2.p3-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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117
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Aitken P, Rodgers H, French J, Bates D, James O. General Medical or Geriatric Unit Care for Acute Stroke? A Controlled Trial. Age Ageing 1993. [DOI: 10.1093/ageing/22.suppl_2.p4-c] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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118
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Abstract
In a case-controlled study into the risk factors for admission to hospital with stroke, 400 subjects and 400 age and sex-matched controls were recruited. All bar two subjects were followed until death or 6 months. Previous stroke and regular snoring (p = 0.0013 and p less than 0.0001 respectively) were the only two risk factors adversely to effect mortality. Transient ischaemic attack, ischaemic heart disease, hypertension, atrial fibrillation, diabetes mellitus did not significantly effect prognosis. An apparent beneficial effect of drinking alcohol and smoking became insignificant when the confounding influence of age was taken into account.
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Shaw PJ, Ince PG, Goodship J, Burn J, Slade J, Bates D, Medwin DG. Adult-onset motor neuron disease and infantile Werdnig-Hoffmann disease (spinal muscular atrophy type 1) in the same family. Neurology 1992; 42:1477-80. [PMID: 1641139 DOI: 10.1212/wnl.42.8.1477] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We describe a family in which infantile Werdnig-Hoffmann disease and adult-onset progressive muscular atrophy both occurred. The possibility of these two diseases developing within the same family by chance is unlikely, and several genetic hypotheses may be put forward to explain the association. We suggest that the molecular pathogenesis of these two subtypes of lower motor neuron degeneration may be linked. The genetic defect in the childhood spinal muscular atrophies has been mapped to chromosome 5q in close proximity to the microtubule-associated protein 1B locus. The association of diseases within this family suggests that chromosome 5q should also be studied in relation to adult-onset familial motor neuron disease.
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120
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Spriggs DA, Burn DJ, French J, Cartlidge NE, Bates D. Is bed rest useful after diagnostic lumbar puncture? Postgrad Med J 1992; 68:581-3. [PMID: 1437958 PMCID: PMC2399377 DOI: 10.1136/pgmj.68.801.581] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A randomized study of 110 patients undergoing their first diagnostic lumbar puncture was performed to compare the effect of immediate mobilization with 4 hours bed rest on the incidence of post lumbar puncture headache. There was no difference between the mobile (n = 54) and bed rest (n = 56) groups in the incidence of post lumbar puncture headache (32% versus 31%, respectively). We conclude that bed rest following lumbar puncture may be an unnecessary imposition on the patient, as well as on nursing staff.
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Rodgers H, Aitken PD, Bates D, James OF. Use of the myometer in assessing stroke patients--a cautionary tale. Disabil Rehabil 1992; 14:110-1. [PMID: 1600182 DOI: 10.3109/09638289209167082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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122
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Glenn AM, Shaw PJ, Howe JW, Bates D. Complicated migraine resulting in blindness due to bilateral retinal infarction. Br J Ophthalmol 1992; 76:189-90. [PMID: 1540572 PMCID: PMC504207 DOI: 10.1136/bjo.76.3.189] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Retinal migraine is not uncommon, but permanent sequelae in the anterior visual pathway are rare. We describe the case of a young woman in whom blindness developed over a six-year period due to recurrent episodes of migraine-related occlusions of a branch retinal artery.
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Spriggs D, Murdy JM, French JM, Bates D, James OW. Snoring - An Imprtant Factor for Risk and Prognosis of Storke. Age Ageing 1992. [DOI: 10.1093/ageing/21.suppl_1.p18-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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124
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Bates D. BOOK REVIEWS: McAlpine's Multiple Sclerosis 2nd Edition. J Neurol Psychiatry 1991. [DOI: 10.1136/jnnp.54.11.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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125
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Baxter P, Gardner-Medwin D, Bates D, Ragunathan L, Ingham HR. Encephalomyelitis with seroconversion to Listeria monocytogenes. Arch Dis Child 1991; 66:1080-1. [PMID: 1929521 PMCID: PMC1793033 DOI: 10.1136/adc.66.9.1080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A previously healthy girl recovered from a lymphocytic encephalomyelitis with brain stem involvement after antibiotic and steroid treatment. Cultures of blood and cerebrospinal fluid were negative, but she seroconverted to Listeria monocytogenes serotype 4. Antilisterial treatment should be considered in similar cases.
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126
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Bates D, Ruggieri P. Imaging modalities for evaluation of the spine. Radiol Clin North Am 1991; 29:675-90. [PMID: 2063000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The spine can be evaluated by a number of different imaging modalities. Although magnetic resonance imaging has assumed the dominant role in the diagnosis of spinal disease, the individual clinical situation still determines the procedure of choice. This review discusses the different imaging techniques and their currently accepted indications.
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128
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Bates D. BOOK REVIEWS: Neurobehavioral Aspects of Multiple Sclerosis. J Neurol Psychiatry 1991. [DOI: 10.1136/jnnp.54.6.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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129
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Bates D. BOOK REVIEWS: Vascular Brain Stem Diseases: Workshop on Vascular Brain Stem Diseases, Gutersloh, September 1988. J Neurol Psychiatry 1990. [DOI: 10.1136/jnnp.53.12.1113-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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130
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Shaw PJ, Allcutt DA, Bates D, Crawford PJ. Cauda equina syndrome associated with multiple lumbar arachnoid cysts in ankylosing spondylitis: improvement following surgical therapy. J Neurol Neurosurg Psychiatry 1990; 53:1076-9. [PMID: 2292702 PMCID: PMC488319 DOI: 10.1136/jnnp.53.12.1076] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A case of cauda equina syndrome with multiple lumbar arachnoid cysts complicating ankylosing spondylitis (AS) is described. The value of computerised tomography (CT) and magnetic resonance imaging (MRI) as a non-invasive means of establishing the diagnosis is emphasised. In contrast to previously reported cases the patient showed neurological improvement following surgical therapy. Surgery may be indicated in some patients, particularly when there is nerve root compression by the arachnoid cysts and when the patient is seen early before irreversible damage to the cauda equina has occurred.
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Gray CS, French JM, Venables GS, Cartlidge NE, James OF, Bates D. A randomized double-blind controlled trial of naftidrofuryl in acute stroke. Age Ageing 1990; 19:356-63. [PMID: 2285001 DOI: 10.1093/ageing/19.6.356] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
There is evidence to support the use of naftidrofuryl in acute stroke with claims of increased recovery, reduced fatality and reduced bed occupancy in patients treated with either oral or intravenous preparations. One hundred patients presenting with acute hemisphere stroke (less than 72 hours) were randomized to receive either a new oral formulation of naftidrofuryl or placebo on a double-blind basis. Treatment was given for a total of 12 weeks and patients followed for 26 weeks with serial neurological and functional assessments by a single observer. Cumulative fatality and hospital-bed occupancy were determined at each assessment interval. No significant difference was demonstrated in cumulative fatality, hospital-bed occupancy or recovery of motor function in patients treated with either naftidrofuryl or placebo. There is no evidence from this study to support the use of oral naftidrofuryl in acute stroke.
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Spriggs DA, French JM, Murdy JM, Bates D, James OF. Historical risk factors for stroke: a case control study. Age Ageing 1990; 19:280-7. [PMID: 2251961 DOI: 10.1093/ageing/19.5.280] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to determine the risk factors for admission to hospital with stroke by means of a case-control study recruiting age- and sex-matched controls from the local community. Four hundred pairs of patients and controls were recruited. Of historical factors, preceding cerebrovascular disease contributed the greatest odds of stroke (odds ratio 9.8). Taking prescribed medicines (odds ratio 2.6), regular snoring (odds ratio 3.2), smoking (odds ratio 1.7) and some factors in the family history were also significant risk factors.
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Nightingale S, Woo E, Smith AD, French JM, Gale MM, Sinclair HM, Bates D, Shaw DA. Red blood cell and adipose tissue fatty acids in mild inactive multiple sclerosis. Acta Neurol Scand 1990; 82:43-50. [PMID: 2239137 DOI: 10.1111/j.1600-0404.1990.tb01586.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The fatty acid profiles of phosphatidyl ethanolamine (PE) and phosphatidyl choline (PC) of the red blood cells of 30 patients with mild inactive multiple sclerosis (MS) and 30 healthy controls were studied by gas chromatography. The groups were well matched for factors likely to influence tissue lipid levels, including diet. The MS patients showed a significant reduction in PE eicosapentaenoic acid (p = 0.009) especially in women, and an increase in both PE dihomo-gamma-linolenic acid (p = 0.004) and PC stearic acid (p = 0.04). No reduction in linoleic acid was observed in either the PC or PE fractions of the MS subjects. A similar study of the fatty acid profile in adipose tissue in 26 MS and 35 healthy controls found no detectable eicosapentaenoic acid in either group. However, whereas docosahexaenoic acid was not detectable in any MS patient, 40% of the controls had measurable levels varying from to 0.1 to 0.3% of total estimated fatty acid (p = 0.0003). No reduction in linoleic acid in MS subjects was observed. Supplementation with oral fish body oil demonstrated that n-3 fatty acids were incorporated into red blood cells over 5 weeks and this occurred equally in MS and controls. The effects of oral supplementation on adipose tissue were studied after 1 and 2 years. Whereas many fatty acids such as linoleic acid were raised at 1 year, but did not rise subsequently, eicosapentaenoic acid and docosahexaenoic acid continued to rise through the 2-year period.(ABSTRACT TRUNCATED AT 250 WORDS)
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Gray CS, French JM, Bates D, Cartlidge NE, James OF, Venables G. Motor recovery following acute stroke. Age Ageing 1990; 19:179-84. [PMID: 2363378 DOI: 10.1093/ageing/19.3.179] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
There is little information available from which normal patterns of recovery from acute stroke can be ascertained. Most attention has been directed towards functional recovery in stroke patients but the neurological basis on which this occurs needs to be documented in a large cohort of patients. One hundred and fifty-seven patients admitted to hospital with a clinical diagnosis of acute stroke were examined daily for up to 28 days to determine the patterns of recovery of limb tone, power and reflexes. Changes in these variables during the first 28 days after stroke are described.
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135
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Gray CS, French JM, Bates D, Cartlidge NE, Venables GS, James OF. Recovery of visual fields in acute stroke: homonymous hemianopia associated with adverse prognosis. Age Ageing 1989; 18:419-21. [PMID: 2629493 DOI: 10.1093/ageing/18.6.419] [Citation(s) in RCA: 91] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
In a prospective study of 157 patients (median age 73 years) admitted to hospital within 72 hours of acute cerebral hemisphere stroke, there was clinical evidence of homonymous hemianopia (HH) as assessed by confrontation in 99 (63%). Patients were followed with serial neurological examinations for 28 days. Complete recovery of visual fields occurred in 14 (17%) of the 81 patients with a complete HH on admission and in 13 (72%) of the 18 patients with a partial HH on admission. Cumulative fatality at 28 days was greater in patients with a complete HH (49%), compared with patients with a partial HH (11%). These two patterns of recovery and outcome probably reflect the differing extent of cerebral damage in the two groups.
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136
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Gray CS, French JM, Bates D, Cartlidge NE, Venables GS, James OF. Increasing age, diabetes mellitus and recovery from stroke. Postgrad Med J 1989; 65:720-4. [PMID: 2616396 PMCID: PMC2429807 DOI: 10.1136/pgmj.65.768.720] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In a prospective study of 200 patients with acute stroke, blood glucose and glycated haemoglobin (HbA1) were measured within 72 hours of onset. Unrecognized hyperglycaemia as defined by a raised stable HbA1 more than two s.d. above the mean reference value and no previous history of diabetes was present in 27%. No correlation existed between patient age and admission blood glucose or HbA1 levels (r = 0.1). Cumulative mortality and recovery of limb function was assessed in the first 136 patients with carotid distribution events. Admission blood glucose greater than or equal to 8 mmol/l was shown to be associated with a significantly greater mortality at 4 and 12 weeks (P less than 0.05). Multivariate analysis with age, glucose, HbA1 as independent variables demonstrated that age was the only significant predictor for death at 4 weeks (P less than 0.05) but at 12 weeks both age and blood glucose were significant (P less than 0.05). In patients less than 65 years blood glucose was a significant predictor for death (P less than 0.05) but in patients less than or equal to 65 years HbA1 and not glucose was significantly (P less than 0.05). Patients greater than or equal to 65 years with HbA1 greater than or equal to 7.5% were significantly more likely to have a raised admission blood glucose. Hyperglycaemia on admission was not shown to influence recovery of limb function. Increasing age is of greatest importance in predicting mortality although blood glucose is of prognostic value especially in the young stroke patient.
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137
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Papiha SS, Boddy J, Roberts DF, Bates D. PHA-induced interferon in multiple sclerosis: association between gamma interferon and clinical and genetical variables. Acta Neurol Scand 1989; 80:145-50. [PMID: 2510455 DOI: 10.1111/j.1600-0404.1989.tb03857.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Gamma interferon (INF-gamma) production, after PHA stimulation of peripheral blood mononuclear cells, from multiple sclerosis (MS) patients with the acute remitting and chronic progressive forms, in attack and remission phases, and from normal controls, was studied by immunoradiometric assay. MS patients in all these 4 clinical states of disease produced less INF-gamma (log value range from 2.55 to 2.65). MNC from the total MS patients produced significantly low levels of INF-gamma compared to the control group (log values 2.60 vs. 2.82; P = 0.001). No association between the interferon production and antigens at any HLA locus (A, B, C, Dw and Bf) was found. There was no correlation between IFN-gamma production and age, sex, duration of disease, or disability index. However there was a slight tendency to negative correlation with the progression index of the disease. The results suggest that this lower IFN-gamma production in MS may be secondary to the disease, and the primary defect may be a severe reduction of the essential lymphocyte populations required for an effective lymphokine cascade to produce the normal immune response against infection.
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138
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Shaw PJ, Bates D, Cartlidge NE, French JM, Heaviside D, Julian DG, Shaw DA. An analysis of factors predisposing to neurological injury in patients undergoing coronary bypass operations. THE QUARTERLY JOURNAL OF MEDICINE 1989; 72:633-46. [PMID: 2608882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In a prospective study of 312 patients undergoing elective coronary bypass surgery we evaluated 50 preoperative, intraoperative and postoperative factors with the aim of identifying predisposing causes for perioperative neurological morbidity. Factors which showed a significant association with the development of neurological complications included the duration and severity of heart disease before surgery; the presence of extracoronary vascular disease; history of cardiac failure; history of diabetes; difficulty in terminating bypass; intraoperative mean arterial pressure levels of less than 40 mmHg; a large drop in haemoglobin level during surgery; prolonged stay in the intensive therapy unit after operation; and abnormalities of blood pressure control in the postoperative period. The significance of these findings is discussed and a comparison made with data available from previous studies.
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139
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Shaw PJ, Dale G, Bates D. Familial lysinuric protein intolerance presenting as coma in two adult siblings. J Neurol Neurosurg Psychiatry 1989; 52:648-51. [PMID: 2732736 PMCID: PMC1032181 DOI: 10.1136/jnnp.52.5.648] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Lysinuric protein intolerance (LPI) is an inborn error of metabolism which usually presents in infancy with failure to thrive and vomiting. Two patients are described who presented in adult life with hyperammonaemic coma due to LPI. Both had been underweight and had had intermittent gastrointestinal symptoms during childhood. They were of normal intellect and had maintained good health, until presentation in their thirties, by unconscious dietary protein avoidance. The diagnosis of LPI should be considered in patients who present with obscure relapsing coma associated with hyperammonaemia. Considerable clinical improvement may result from dietary protein restriction and citrulline supplementation.
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140
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141
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Bates D, Cartlidge NE, French JM, Jackson MJ, Nightingale S, Shaw DA, Smith S, Woo E, Hawkins SA, Millar JH. A double-blind controlled trial of long chain n-3 polyunsaturated fatty acids in the treatment of multiple sclerosis. J Neurol Neurosurg Psychiatry 1989; 52:18-22. [PMID: 2540285 PMCID: PMC1032650 DOI: 10.1136/jnnp.52.1.18] [Citation(s) in RCA: 111] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A trial of n-3 polyunsaturated fatty acids in the treatment of multiple sclerosis has been conducted over a 5 year period. Ambulant patients (312) with acute remitting disease were randomly allocated to treatment or placebo. Both groups were given dietary advice to increase the intake of n-6 polyunsaturated fatty acids and the treatment group in addition received capsules containing n-3 polyunsaturated fatty acids. Analysis of clinical outcome at the end of 2 years of treatment was made in terms of the duration, frequency and severity of relapses and the number of patients who had improved or remained unchanged. The results showed no significant difference at the usual 95% confidence limits but there was a trend in favour of the group treated with n-3 polyunsaturated fatty acids in all parameters examined.
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142
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Shaw PJ, Bates D, Kendall-Taylor P. Hyperthyroidism presenting as pyramidal tract disease. BMJ (CLINICAL RESEARCH ED.) 1988; 297:1395-6. [PMID: 3146377 PMCID: PMC1835103 DOI: 10.1136/bmj.297.6660.1395] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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143
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Gray CS, French JM, James OF, Bates D, Cartlidge NE. The prognostic value of haematocrit in acute stroke. Age Ageing 1988; 17:406-9. [PMID: 3239500 DOI: 10.1093/ageing/17.6.406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
One hundred and twenty-two consecutive patients admitted with acute stroke in a carotid distribution had venous blood taken for haematocrit (Hct), haemoglobin (Hb), white cell count (WCC) and urea estimations. Patients were followed for 12 weeks to determine the influence of haematocrit upon fatality. There were 96 patients aged greater than or equal to 65 years and 26 patients less than 65 years. No association could be demonstrated between Hct levels and fatality at 4 or 12 weeks. Regression analysis demonstrated that only increasing age (P less than 0.05) and a raised WCC (P less than 0.005) were independent factors significantly associated with fatality at both 4 and 12 weeks. In the elderly stroke patient (greater than or equal to 65 years) only WCC was significantly associated with fatality (P less than 0.005). Haematocrit levels are of no prognostic value for fatality in acute stroke. A raised white cell count is an important and independent prognostic factor for fatality at both 4 and 12 weeks following stroke.
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144
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Bates D, Schoup A. Telling our pastoral care story. CARE GIVER : JOURNAL OF THE COLLEGE OF CHAPLAINS 1988; 5:64-8. [PMID: 10290316 DOI: 10.1080/10778586.1988.10781535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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145
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Béliveau R, Bernier M, Giroux S, Bates D. Inhibition by phenylglyoxal of the sodium-coupled fluxes of glucose and phosphate in renal brush-border membranes. Biochem Cell Biol 1988; 66:1005-12. [PMID: 3190881 DOI: 10.1139/o88-115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The coupling of phosphate and glucose transport to sodium in brush-border membrane vesicles from rat kidney cortex was studied after chemical modification of arginine residues by phenylglyoxal. Phosphate (10 mM) and sodium (20 mM) uptakes were linear for 6 s and stimulated in the presence of their cosubstrate. The sodium:phosphate stoichiometry measured by a direct method was 1.74. Sodium-independent phosphate and glucose influx were found to be unaffected by phenylglyoxylation. Phosphate- or glucose-independent sodium influx also remained unaltered by the treatment. However, phosphate influx measured with sodium was inhibited by 69% and sodium influx measured with phosphate was inhibited by 40%. When these values were corrected for uncoupled fluxes, the sodium influx coupled to phosphate and the phosphate influx coupled to sodium were inhibited by 93 and 95%, respectively. Glucose influx measured in the presence of sodium was inhibited by 36% and sodium influx in the presence of glucose was reduced by 39%. When the values were corrected for diffusion, these inhibitions were 95 and 100%, respectively. We conclude that the coupling of phosphate and glucose to sodium fluxes by the renal carriers requires the participation of arginine residue(s) in the translocation process. Modification of this arginine by phenylglyoxal leads to a marked inhibition of coupling. These results suggest the implication of arginine residues in the molecular coupling for both glucose and phosphate sodium symporters.
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146
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Bates D. Brain Injury and Protection During Heart Surgery. J Neurol Psychiatry 1988. [DOI: 10.1136/jnnp.51.6.891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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147
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Bates D. Cerebrovascular Diseases. Fifteenth Research (Princeton) Conference. Journal of Neurology, Neurosurgery and Psychiatry 1988. [DOI: 10.1136/jnnp.51.6.892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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148
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Cox NH, Johnston SR, Marks J, Bates D. Extensive carbamazepine eruption with eosinophilia and pulmonary infiltrate. Postgrad Med J 1988; 64:249. [PMID: 2971936 PMCID: PMC2428823 DOI: 10.1136/pgmj.64.749.249] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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149
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Bates D. Neurological Disorders. (Treatment in Clinical Medicine series.). Journal of Neurology, Neurosurgery and Psychiatry 1988. [DOI: 10.1136/jnnp.51.1.161-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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150
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Barnes MP, Bates D, Cartlidge NE, French JM, Shaw DA. Hyperbaric oxygen and multiple sclerosis: final results of a placebo-controlled, double-blind trial. J Neurol Neurosurg Psychiatry 1987; 50:1402-6. [PMID: 3320274 PMCID: PMC1032548 DOI: 10.1136/jnnp.50.11.1402] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The long term results are reported of a trial involving 120 patients with chronic multiple sclerosis who were randomised to receive either 100% oxygen at 2 atmospheres absolute (ATA) for 90 minutes daily for 20 sessions or placebo therapy with air using a simulated compression procedure. The previous finding of subjective improvement in bowel/bladder function at the end of treatment was not confirmed by objective urodynamic assessment. The treatment did not alter disease progression as measured by the Kurtzke disability status scale nor did it alter the rate of acute relapse. There was less deterioration in cerebellar function at one year in the treated patients as measured by the Kurtzke functional systems scale. No other differences were found between the two groups. Psychometric tests and measurements of lymphocyte sub-populations showed no treatment related effects. Evoked potential studies showed no improvements but there was a significant reduction in amplitude of the visual evoked potential in the treated patients at the end of therapy. This might indicate a reversible degree of retinal damage induced by oxygen toxicity.
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