The speech-language pathologist's role in understanding the genetics of Van der Woude syndrome

A family report of three generations of Van der Woude syndrome (cleft lip or palate and lip pits) is presented to show that the speech-language pathologist may play an important role in identifying patients with this defect. Understanding the genetic basis of this syndrome and documentation of family history through pedigree analysis can be instrumental in identifying other family members potentially affected with speech disorders. Because the diagnosis of Van der Woude syndrome was made in one member of the family in the pedigree, three other family members who had never received previous diagnosis or treatment of their speech disorders were identified. Other family members were referred for genetic counseling. The concepts of autosomal dominant transmission, variable expression, incomplete penetrance, and the pedigree technique for recording family history are also presented.

Effect of intermittent endogenous hyperglucagonemia on glucose homeostasis in normal and diabetic man

Infusion of glucagon causes only a transient increase in glucose production in normal and diabetic man. To assess the effect of intermittent endogenous hyperglucagonemia that might more closely reflect physiologic conditions, arginine (10 g over 30 min) was infused four times to 8 normal subjects and 13 insulin-dependent diabetic subjects (4 of whom were infused concomitantly with somatostatin to examine effects of arginine during prevention of hyperglucagonemia). Each arginine infusion was separated by 60 min. Diabetic subjects were infused throughout the experiments with insulin at rates (0.07-0.48 mU/kg per min) that had normalized base-line plasma glucose and rates of glucose appearance (Ra) and disappearance (Rd). Basal plasma glucagon and arginine-induced hyperglucagonemia were similar in both groups; basal serum insulin in the diabetics (16+/-1 muU/ml, P < 0.05) exceeded those of the normal subjects (10+/-1 muU/ml, P < 0.05) but did not increase with arginine. Serum insulin in normal subjects increased 15-20 muU/ml with each arginine infusion. In both groups each arginine infusion increased plasma glucose and Ra. Increments of Ra in the diabetics exceeded those of normal subjects, (P < 0.02); Rd was similar in both groups. In normal subjects, plasma glucose returned to basal levels after each arginine infusion, whereas in the diabetics hyperglycemia persisted reaching 151+/-15 mg/dl after the last arginine infusion. When glucagon responses were prevented by somatostatin, arginine infusions did not alter plasma glucose or Ra.

CONCLUSIONS

Infusion of arginine acutely increases plasma glucose and glucose production in man solely by stimulating glucagon secretion; physiologic increments in plasma glucagon (100-150 pg/ml) can result in sustained hyperglycemia when pancreatic beta cell function is limited.

Epidermoid cyst in the brain stem. Case report

✓ A patient is reported with an epidermoid cyst of the brain stem, presenting as a progressive brain-stem mass, together with recurrent aseptic meningitis.

The usefulness of pretreatment DNCB in 85 patients with squamous cell carcinoma of the upper aerodigestive tract

Pretreatment DNCB skin testing and absolute lymphocyte counts were studied in 85 consecutive head and neck cancer patients. All patients were treated primarily with radiation therapy alone or combined radiation plus surgery. The results of DNCB testing and absolute lymphocyte counts were not sufficiently predictive of outcome, (no evidence of disease after 2 years) to be useful in making treatment decisions on an individual patient. This applied to the good prognosis (T1, T2, N0-N3) and poor prognosis (T3, T4, N0-N3) groups.

Factors affecting the incidence of wound infection in Neurosurgery

A prospective survey of wound infection in a continuous series of 357 patients undergoing operations at a neurosurgical unit was made. The incidence of wound infection was 4.7 percent. Causative organisms were isolated in only 29.4 percent of the clinically infected cases. The type of suture material used did not affect the infection rate and neither did the coincidental use of steroids in the high doses employed in neurosurgical practice. Re-exploration does not carry an increased risk of infection. Use of systemic or topical antibiotics or both was not found to confer any protection against wound infection.

Sump drainage: a palliative manoeuvre for the treatment of craniopharyngioma

A sump system was used as a palliative manoeuvre in the treatment of four cases of cystic craniopharyngioma. Percutaneous needling of the subcutaneous reservoir enabled the fluid contents of the tumour to be evacuated with considerable therapeutic effect. Radiotherapy was combined with this manoeuvre in two cases. The three successfully treated patients have been followed up for 3 1/2, five, and 5 1/2 years. The manoeuvre is not original. It is simple, safe, effective, even in the long term, and worthy of consideration in the treatment of a condition of acknowledged uncertain natural history and surgical difficulty.

Posterior fossa subdural haematomas

Traumatic posterior fossa subdural haematomas are rare and, while part of a major head injury, may give little warning of their presence. A definite proportion of cases will be well enough to exhibit progressive and recognizable posterior fossa signs that might include occipital headache, raised intracranial pressure, lateralized cerebellar or brain-stem signs, and a fracture of the occipital bone. These cases will be readily amenable to investigation and cure by evacuation of the causative haematoma.

Intrathoracic meningocele. Its development and association with neurofibromatosis

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