Benign osteoblastoma of a thoracic vertebra. Case report

A patient with osteoblastoma of the T-11 vertebral body presented with symptoms of spinal cord compression. Six weeks after an emergency laminectomy and subtotal removal, spinal computerized tomography disclosed residual tumor, which was totally removed via a combined anterior transthoracic approach and posterior laminectomy.

Supine metrizamide myelography: a technique for achieving excellent visualization of the thoracic cord and conus medullaris

The authors describe a supine positioning method for metrizamide myelographic studies, which results in excellent visualization of the thoracic cord and conus medullaris.

A double-blind comparison of flupenthixol decanoate and fluphenazine decanoate in the treatment of chronic schizophrenia

Sixty-four chronic stabilised schizophrenics were studied for 18 months in order to assess the possible difference in therapeutic effects and side effects between flupenthixol decanoate and fluphenazine decanoate. Although certain differences in the BPRS sub-scores in favour of flupenthixol were present at various stages in the study, there was no significant difference between the two drugs in the overall antipsychotic scores at the end of the assessment period; however, more patients on fluphenating required additional therpay for depression or anxiety during the trial period.

Cerebral arteritis in scleroderma

Central nervous system (CNS) involvement is rare in scleroderma unless there are concomitant abnormalities in renal or lung function or malignant hypertension. A 43-year-old woman with typical scleroderma developed subacute encephalopathy despite absence of the above abnormalities. Cerebral angiography demonstrated a focal arteritis. The patient improved while being given corticosteroids. We believe this case indicates that cerebral arteritis can occur in scleroderma.

Governing board and management staff attitudes toward community mental health center citizen participation

The present study investigated the attitudes and values of community and mental health center board and management staff of four Community Mental Health Centers and one mental health clinic toward the recent federal mandate calling for increased citizen involvement in center evaluation activities. Three related areas were address: (a) general attitudes toward citizen participation, (b) types of program-evaluation activities in which citizen input would be most useful; and (c) types of individuals who would best serve on citizen review groups. The results indicated that although board members are somewhat more optimistic about benefits received from citizen involvement, overall there was close agreement between the board and staff respondents in the three areas studied. These results were interpreted as substantiating the view that community mental health center boards typically reflect a provider orientation in their approach to mental health governance. A missing evaluation component in most centers is citizen participation as it reflects the values of its service consumers. It is advocated that only by developing consumer participation mechanisms will centers more readily achieve the goal of responsiveness to community needs.

Intracranial hemorrhage and infarction in anticoagulated patients with prosthetic heart valves

In 1 year 6 patients with prosthetic heart valves (PHVs) treated with anticoagulants suffered intracranial hemorrhage. In 4, hemorrhage occurred into the site of a recent non-hemorrhagic infarction. In the others, both of whom had endocarditis, hemorrhages probably occurred as the result of rupture of a mycotic aneurysm. Five patients were treated with warfarin, 1 with heparin. In all patients the level of anticoagulant activity was greater than 1.5 times control. Five patients were in atrial fibrillation; 1 was hypertensive. The diagnosis of intracranial hemorrhage was made and its location and extent accurately determined by computed tomography (CT). Three patients underwent surgery and 2 are alive with only minor neurological deficits. Among the 3 patients who did not undergo surgery 2 died and 1 is alive with a moderate neurological deficit. The management of PHV patients with use of anticoagulants is discussed in terms of the mechanisms involved in intracranial bleeding. Emphasis is placed on prevention of emboli, discontinuation of anticoagulants once non-hemorrhagic infarction has occurred and the primacy of CT scan in diagnosis when hemorrhage is suspected. The special problems of anticoagulation in the presence of endocarditis are also discussed.

[Stabilizing action of verapamil "in vivo" upon the membrane of heart lysosomes (author's transl)]

The effect of the verapamil upon the stability of the membranes of lysosomes isolated from rabbit hearts was studied by means of the acid phosphatase activity, the mapping enzyme of the cytoplasmic organelles. A dose of 2.5 mg of verapamil was injected endovenously in each animal. After homogenization of a sample taken from the lower end of the heart, the lysosomes were isolated by fractionated centrifugation and refrigerated at 2 degrees C. The lysosomal activity of non treated animals was 43.1 +/- 8.9x10(-1)mU/mg. The activity of lysosomes isolated from verapamil treated animals without previous treatment "in vitro" with digitonin was 8.7 +/- 1.6x10(-1)mU/mg and the activity of those with previous treatment of digitonin was 9.1 +/- 2.1x10(-1)mU/mg. The activity of lysosomes isolated from the control group and treated "in vitro" by digitonin was 193.9 +/- 40.5x10(-10)mU/mg. Consequently, the verapamil proved to have a strong capacity of protection of the lysosome membranes when "in vivo".

Cerebral manifestations of ergotism. Report of a case and review of the literature

A patient with diffuse and focal cerebral dysfunction was found to have absent peripheral pulses. Cerbral angiography revealed evidence of an arteritis with bilateral high grade carotid stenosis. When there was no laboratory confirmation of the arteritis, an iatrogenic etiology (ergotism) was suspected. This was later confirmed by the patient. The pertinent literature on ergotism is reviewed, and it is emphasized that ergotism may develop in patients on therapeutic doses of the drug.

[A case of metatropic dwarfism (author's transl)]

A case of metatropic dwarfism is presented. Particular reference is made to the differential diagnosis of this form.

Videodensitometry of cerebrospinal fluid pulsations

Roentgen videodensitometry (RVD) during myelography is described in 13 patients with a variety of intraspinal lesions. Abnormalities in the RVD tracing are discussed and correlated with the type of spinal canal obstruction. Intramedullary, intradural and extradural processes may be differentiated by RVD.

Daytime titers of testosterone, LH, estrone, estradiol, and testosterone-binding protein: acute effects of LH and LH-releasing hormone in men

Four normal 18-20 yr-old men were studied on 3 occasions, from 0830 h to 1500 h. The baseline for each study consisted of 3 or 4 measurements of the respective hormone obtained between 0830 and 0900 h. In the control studies mean testosterone (T) fell by 43% (P less than 0.01) during the final 30 min. The fall was gradual throughout the day and was significant by 1100 h (P less than 0.05). Administration of LH and LH-releasing hormone (LHRH) at 0900 h resulted in 9-fold (5 min) and 3-fold (30 min) higher concentrations of LH respectively. LH declined more slowly after LHRH. Titers of T rose to the 0830-0900 h mean 130 min after LH but were never significantly elevated; the occurrence of a significant drop in mean T was delayed for 70 min. After LHRH there was a nonsignificant 24% increase of the mean T followed by a slow decline; however, T did not fall significantly below the mean baseline level. In contrast, in 2 of the 4 subjects LHRH resulted in rises in T levels (P less than 0.05) above the basal titers. Testosterone-binding globulin (TeBG) mean titers showed no diurnal rhythm in the control studies. There were statistically significant elevations of mean TeBG 150 min after LH and 340 to 370 min after LHRH, as well as sustained increases during the final 30 to 210 min of 1 or 2 individuals in each group. The reason for these increases in TeBG is not presently known. Estrogen analyses performed in all studies on 2 of the subjects revealed: 1) afternoon titers of estrone were lower than baseline in all 6 studies, 2) there was no diurnal rhythm for estradiol in control studies, and 3) estradiol increased during the final 2.5 to 3 h after LHRH (P less than 0.01), but after LH it was not altered in 1 man and was lower in the other.