Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We have evaluated the analgesic effect of continuous intrathecal administration of midazolam in 4 patients using a three-level score (no change, amelioration, and marked improvement). The secondary effects of this drug were also investigated (sedation, nausea, vomiting, respiratory depression, urinary retention, motor dysfunction). In one patient midazolam was the only drug administered, whereas in three patients this drug was associated with morphine. In one patient with a peripheral arteriopathy, midazolam at a dose of 12 mg/day was unable to equal the analgesic effect achieved with 0.4 mg of morphine. The remaining three patients had carcinoma and received a continuous intrathecal perfusion of morphine at increasing daily doses up to 12; 4,8; and 6 mg/day, respectively without pain relief. In these patients the association of midazolam at respective doses of 9; 4-8; and 6 mg/day induced amelioration in one patient and marked improvement in the two other patients. Midazolam did not change the heart rate, respiratory rate, arterial blood pressure, nor body temperature. We believe that the analgesic effect of intrathecal administration of midazolam is due to its coupling with the ionophore complex GABA-spinal benzodiazepine that in turn produces an increment of the GABA amino butyric acid at this level.
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PMID:[Intrathecal administration of morphine, midazolam, and their combination in 4 patients with chronic pain]. 159 51

The case is described of a 40-year-old woman who presented with diffuse pain in both feet and a sensation of cold following a course of vigorous gymnastics. The pain was worse at night and did not improve with oral anti-inflammatory medication. The patient, a nurse, was not working due to a depressive state and had a prior history of psychopathology and depression in 1975 and 1984. She smoked 2 packs of cigarettes daily, and had been taking combined oral contraceptives (OCs) for 1 year. The clinical examination showed few findings. There was no edema and no change in the coloring of the feet. Arteriography confirmed the existence of an obstruction in the area of the deep femoral artery and a thromboectomy was performed. Predominantly nocturnal pain in the left foot continued after the operation, and an inability to completely raise the left leg while walking was observed. A left lumbar sympathectomy was done. Despite the 2 operations and extensive medical treatment with vasodilators, anticoagulants, and other medication, the pain and limp persisted and a cutaneous necrosis of the 1st and 5th left toes was observed. The pain persisted and the necrosis worsened with use of pain medication. Amputation was under consideration when improvement began to be noted. After 9 months the patient was again able to walk without a cane despite limping. The pain and signs of ischemia disappeared. This patient suffered from acute arteriopathy induced by smoking and OCs. It is rare for an ischemic syndrome of arterial origin to be responsible for these kinds of symptoms. A similar syndrome sometimes occurs after prolonged physical effort because of compression of the arteries caused by increased muscular volume. In the case described, an atherogenic process that had been relatively compensated was intensified by prolonged gymnastic exercise. Once underway the process was difficult to control despite attempts to clear the obstruction and a sympathectomy. Acute arteriopathy is rare in a young patient, but OCs and smoking have increased the risk in susceptible subgroups. Published works indicate that for OC users the risk of atherogenic accidents depends on the progestin dose, the associated estrogen dose, and on numerous extrinsic factors such as age, physical exercise, alcohol, and smoking. After 35, combined OCs should not be used if any risk factors, especially alcohol or smoking, are present. All pill users should be carefully followed. Triglyceride anomalies and imbalances of the ratio of high density lipoprotein to low density lipoprotein cholesterol should be ruled out.
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PMID:[An unusual compartment syndrome]. 361 6

The effects of the following vasoactive drugs: Bencyclan fumarate, Cetiedil citrate, Cinepazide maleate, Dihydroergocristine methane sulphonate, Nafthydrofuril acid oxalate, Papaverine hydrochloride, Piribedil monomethane sulphonate, Raubasine, Thymoxamine hydrochloride and Xanthinol nicotinate, in concentrations ranging between 0.001 - 2 mM, were tested on the compound action potentials led off from human isolated sympathetic ganglions. The experiments, carried out on 50 isolated lumbar ganglion preparations removed from 23 subjects with arteriopathy of the limbs, indicated that all the drugs are able to impair the synaptic transmission, although at different concentrations. These findings are in favour of the hypothesis that the vasodilatatory effects observed after therapeutic treatment of patients with vasoactive drugs are partially produced by the vasodilatation following the depression of the sympathetic nervous transmission.
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PMID:[Effect of various vasoactive drugs on synaptic transmission in the orthosympathetic ganglia in man]. 608 53

This paper reports a Swiss family affected by a cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) linked to chromosome 19q12. In three generations several members of this family had recurrent stroke-like episodes and, some developed subcortical dementia, migraine-like headaches, and depression. The clinically affected family members had multiple subcortical infarcts and diffuse leukoencephalopathy on MRI. Necropsy of one patient showed a distinctive non-amyloid and non-atherosclerotic angiopathy of small cerebral and leptomeningeal arteries with concentric depositions of a basophilic granular material replacing the smooth muscle cells of the media. Linkage analysis with five chromosome 19 markers spanning the estimated CADASIL interval showed the absence of any recombinant and positive Lod scores, highly suggestive of linkage of this condition to the CADASIL locus. CADASIL might be an underestimated cause of familial stroke and should be considered in the differential diagnosis of hereditary stroke.
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PMID:Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy: a clinicopathological and genetic study of a Swiss family. 762 27

A 62-year-old male patient, suffering from a hypertensive cardiopathy, an arteriopathy of the lower extremities and a type II insulin independent diabetes had a prothrombin time ratio R of 2.15 (therapeutic range: 2.1-1.45) during a daily treatment of 4-6 mg acenocoumarin. On admission to the psychiatric hospital for depression, a mianserin treatment was commenced, leading to a sharp modification in the PT ratio R, in effect that the acenocoumarin treatment had to be increased to keep R within the therapeutic range. The possible mechanism of this interaction between mianserin and acenocoumarin is discussed, taking into account the possible role of the comedicated amiodarone.
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PMID:Interaction between mianserin and acenocoumarin: a single case study. 803 74

Mental disorders due to cerebral microvascular disease have been known for over 100 years. Recently, an autosomal dominant form of cerebral arteriopathy (CADASIL) has been described in association with a Notch3 family gene on the short arm of chromosome 19. CADASIL causes subcortical lacunar infarction and dementia in over 80% of cases and depression in a large proportion of patients. Clinically, CADASIL may appear to be very similar to hypertensive microvascular disease (Binswanger's disease), a condition that is seen in the elderly. This article reviews the clinical, pathologic, and genetic features of CADASIL. CADASIL is of interest to neurologists and psychiatrists because it is the first syndrome of vascular dementia and depression with an identified gene. How the gene causes the widespread arteriopathy is not yet known. Insights gained from the study of CADASIL should help us better understand its etiology, as well as the options for treatment of the more common forms of microvascular disease seen in the elderly.
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PMID:CADASIL syndrome: a genetic form of vascular dementia. 987 28

Several studies confirm cognitive impairment and dementia to be increased after stroke in the elderly. Although not necessarily involving memory deficits, the frequency of cognitive impairments may occur in up to 30% of stroke survivors at 3 months. This impairment may be confounded by preexisting cognitive decline or dementia. By contrast, cognitive changes and dementia are widely recognized in familial forms of stroke, such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Several factors, including type of stroke, recurrent episodes, the site and laterality of the lesion(s), volume of cerebral infarction, medial temporal lobe atrophy, and coexistent neurodegenerative pathology predict the degree of impairment. Aphasia, diabetes mellitus, atrial fibrillation, and depression are listed among other biologic factors that further exacerbate cognition and affect long-term survival. There is no clear consensus whether genetic factors, such as the apolipoprotein E e4 allele or angiotensin converting enzyme gene polymorphisms, modify cognitive changes or stroke outcome. Although several neurotransmitter systems may be affected in post-stroke dementia, the amelioration of cholinergic function is a worthy target.
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PMID:Stroke and cognition. 1138

The phenotype and genotype of cerebral autosomal dominant arteriopathy and subcortical infarcts and leukoencephalopathy (CADASIL) in Caucasians have been well characterized, but CADASIL is less recognized in Asian populations. Here we investigated the first known Taiwanese family affected by CADASIL and identified an uncommon NOTCH3 mutation. The family had clinical manifestations in affected members including recurrent strokes, early dementia, and depression, but not migraine. A skin biopsy in the proband patient showed characteristic pathological findings of CADASIL on electron microscopy. Afterward, genetic analysis found an Arg332Cys mutation at exon 6 of NOTCH3. Neuropsychological evaluation showed vascular dementia in two of four affected people. Head MRI showed multiple infarcts in bilateral basal ganglia, thalami, periventricular white matter, external capsules, and brainstem, but involvement of the anterior temporal pole was found only in two people with milder symptoms. To our knowledge, the Arg332Cys NOTCH3 mutation at exon 6, which was identified in the studied family, has not been reported in Asian populations. Our findings emphasize the importance of genetic analysis of NOTCH3 for Asians with a phenotype typical of CADASIL.
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PMID:Arg332Cys mutation of NOTCH3 gene in the first known Taiwanese family with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. 1569 92

A DELETERIOUS ROLE OF STREPTOCOCCUS AGALACTIAE?: Introduction Screening strategies among pregnant women have decreased the incidence of group B Streptococcus, which causes severe neonatal infections. The incidence of these infections has increased among diabetic patients, however. OBJECTIVES: To specify the characteristics of diabetic foot infections in which surgical samples have isolated one or several germs including group B Streptococcus, study its risk factors and determine its course. Materials and methods We retrospectively evaluated the records of all patients admitted to the University Hospital of Geneva from January 1999 through October 2004, with diagnoses of severe foot infection (+/- osteomyelitis) documented during surgery. RESULTS: Twenty-five severe diabetic foot infections were identified, 21 with osteomyelitis. The most common risk factors were age older than 60 years (n=10), chronic renal failure (n=7), severe arteriopathy (n=6), and immune depression (n=2). Most lesions were classified as grade 3 or 4 of Wagner's classification. 80% of the surgical samples were polymicrobial. Blood cultures were positive in 4 patients, one in septic shock. Half the patients (n=13) underwent amputation, despite initially appropriate antibiotic treatment. No patients died but 3 relapsed. CONCLUSION: Group B streptococcal foot infections often occur in fragile patients with immune depression or severe arterial disease. Despite intensive antibiotic therapy and adequate debridement, amputation is often required in diabetic patients because of severe damage to the tissue and poor vascularization.
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PMID:[Severe Streptococcus agalactiae infection of the diabetic foot.] 1590 60

Most previously reported mutations in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) result in an odd number of cysteine residues within the epidermal growth factor (EGF)-like repeats in Notch3. We report here R75P mutation in two Japanese CADASIL families not directly involving cysteine residues located within the first EGF-like repeats. Probands in both families had repeated episodes of stroke, depression, dementia as well as T2 high-intensity lesions in the basal ganglia and periventricular white matter, but fewer white matter lesions in the temporal pole on MRI. These families provide new insights into the diagnosis and pathomechanisms of CADASIL.
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PMID:Two Japanese CADASIL families exhibiting Notch3 mutation R75P not involving cysteine residue. 1904 63


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