ceruletide and Spasm

To clarify the factors determining the amelioration of Meige's syndrome, changes of involuntary movements (IVMs) and functional disability, we examined 60 patients with Meige's syndrome during 5 years after the onset. On average, they showed gradual worsening of IVMs for approximately 2.1 years, then the IVMs ameliorated slowly. In many patients, blepharospasm appeared as the first symptom. Subsequent IVMs were seen in vicinity of the muscles of orbicularis oculi. Phasic involuntary contractions changed to tonic ones in some patients. Asynchrony of the IVMs in various facial or neck muscles may be originated from extensive pathological changes and high excitability in the brainstem. The factors determining the amelioration of functional disability are: (1) younger onset, (2) shorter duration from the onset to the period showing the worst symptoms, (3) mild IVMs when the symptoms were the worst, (4) shorter duration from the onset to the beginning of therapy, (5) synchrony of the IVMs between the muscles of orbicularis oculi and other muscles. Methylphenidate, trihexyphenidyl, and ceruletide showed a higher efficiency for IVMs than the other drugs. The drug therapy in Meige's syndrome should be started as early as possible.

Topics: Age of Onset; Blinking; Ceruletide; Electromyography; Female; Follow-Up Studies; Humans; Male; Meige Syndrome; Methylphenidate; Prognosis; Spasm; Trihexyphenidyl

Topics: Adult; Aged; Ampulla of Vater; Ceruletide; Common Bile Duct Diseases; Constriction, Pathologic; Diagnosis, Differential; Female; Humans; Intraoperative Period; Male; Middle Aged; Spasm; Sphincter of Oddi

Coordination of gallbladder and sphincter of Oddi and effect of cholecystectomy on biliary pressure physiology were investigated in 7 patients using an indwelling microtransducer catheter placed in the bile duct by duodenoscopy. Intramuscular morphine (0.2 mg/kg) to induce a sphincter of Oddi spasm produced no change before cholecystectomy but intravenous caerulein (0.1 microgram/kg) induced pressure elevation coincident with gallbladder contraction on echogram. After cholecystectomy, however, morphine caused a pressure rise and a coarse and irregular change of the tracings, which seemed attributable to sphincter of Oddi spasm. Caerulein promptly reduced the pressure and eliminated the irregularity. These results show (a) the sphincter of Oddi relaxes when the gallbladder contracts in response to caerulein and (b) the gallbladder acts as a pressure reservoir against the sphincter of Oddi spasm caused by morphine. The latter implies that the spasm of the sphincter of Oddi readily leads to a pressure rise if the gallbladder is absent, which may partly explain a development of postcholecystectomy syndrome.

Topics: Adult; Aged; Ampulla of Vater; Ceruletide; Cholecystectomy; Duodenum; Female; Gallbladder; Humans; Male; Manometry; Middle Aged; Morphine; Postoperative Period; Pressure; Spasm; Sphincter of Oddi

Topics: Adrenergic alpha-Antagonists; Animals; Atropine; Ceruletide; Female; Ganglionic Blockers; Gastrins; Histamine H1 Antagonists; Parasympatholytics; Peptides; Pylorus; Rats; Serotonin Antagonists; Spasm; Sympatholytics; Sympathomimetics