Benign autosomal dominant syndrome of neuronal Charcot-Marie-Tooth disease, ptosis, parkinsonism, and dementia

We present a kindred with a previously undescribed combination of neuronal Charcot-Marie-Tooth disease, ptosis, parkinsonism, and mild dementia. The propositus, a 72-year-old man, had pes cavus, peripheral neuropathy, ptosis, parkinsonism, hyperreflexia, orthostatic hypotension, central hypoventilation, and mild dementia. Peripheral electrophysiologic studies showed features of an axonal neuropathy. The electroencephalogram showed intermittent 2 to 4 Hz activity symmetrically in the hemispheres. Several family members in 3 generations had pes cavus, neuropathy, ptosis, parkinsonism, and dementia although not all of the features were consistently present. Survival past the 7th decade was common. Autopsy in 2 affected members revealed the neuropathy to be axonal in type and showed mild to moderate loss of anterior horn cells in the spinal cord and pigmentary loss with gliosis in the substantia nigra. This is a unique, benign, autosomal dominant syndrome which shows complete penetrance, variable expression, and both central and peripheral nervous system involvement.

Metastasizing thymoma and myasthenia gravis. Favorable response to glucocorticoids after failed chemotherapy and radiation therapy

Myasthenia gravis (MG) occurs in up to 44% of patients with thymoma. Thirty-three percent of these neoplasms are invasive but extrathoracic disease is rare. Recently, we saw a patient with MG and recurrent, metastasizing mixed lymphoepithelial thymoma, whose disease was resistant to combination chemotherapy and radiotherapy but who responded dramatically to treatment with daily glucocorticoids. Thus, therapy with daily glucocorticoids should be considered in the treatment of invasive or metastatic thymoma associated with MG, including when conventional surgery, radiotherapy, and chemotherapy have failed.

Peri-operative oxytetracycline in prophylaxis of surgical wound infections

Experience with peri-operative oxytetracycline coverage in prevention of wound infection following elective surgery is presented; of 150 cases included in control group 21 developed infection (14%), whereas only 4 of the study group (170 cases) had infection (2.5%). The importance of peri-operative antibiotic umbrella is emphasised and some of the shortcomings of recommended schedule is highlighted.

Stroke in young adults

Strokes in young adults are uncommon and often a diagnostic challenge. A retrospective study of strokes due to intracerebral hemorrhage, subarachnoid hemorrhage, or cerebral infarction was undertaken. We reviewed the medical records of 113 young patients aged 15-45 years who were admitted to the Medical Center Hospital of Vermont with a diagnosis of stroke between 1982 and 1987. This group comprised 8.5% of patients of all ages admitted for stroke, 2.3 times the proportion observed in the National Survey of Stroke. Nontraumatic intracerebral hemorrhage was diagnosed in 46 young patients (41%); the main causes included aneurysms, arteriovenous malformations, hypertension, and tumors. Subarachnoid hemorrhage was found in 19 young patients (17%); the majority were due to aneurysms. The remaining 48 young patients (42%) had cerebral infarction, the majority due to cardiogenic emboli and premature atherosclerosis. Mitral valve prolapse, the use of oral contraceptives, alcohol drinking, and migraine were infrequent sole causes of cerebral infarction in the absence of other risk factors. The case-fatality rate for this group of young patients with stroke was 20.4% compared with 23.9% for the National Survey of Stroke. Young adults with stroke deserve an extensive but tailored evaluation, which should include angiography and echocardiography.

Age at menarche in northwest Indian females and a review of Indian data

Data on menarcheal age were collected by a status quo method on a sample of 709 girls drawn from an urban Punjabi population of Chandigarh. Probit analysis provided a median age at menarche of 13.2 +/- 0.04 years with a standard deviation of 1.09. Menarche occurred in all cases between 10 and 16 years. Comparison with other Indian populations shows that populations at higher altitude and in peninsular India have a later maturation than the present sample.

Endogenous digoxin-like immunoreactive factor and digitalis-like factor associated with the hypertension of patients receiving multiple alkylating agents as part of autologous bone marrow transplantation

1. Hypertension is a complication of autologous bone marrow transplantation when therapy includes multiple alkylating agents. We have sought to identify the factors underlying this hypertension. We measured weight, serum creatinine, plasma renin activity, aldosterone and digoxin-like immunoreactive factor (DLIF), by digoxin radioimmunoassay, in 18 patients. Plasma catecholamines were also measured in five patients. 2. Of the 18 patients studied, 15 became hypertensive. The variable most consistently associated with these individuals' hypertension was DLIF activity which was increased in 14 of the 15 hypertensive patients (P = 0.055, Fisher exact test). Serum creatinine was increased at some point in seven of the 15 hypertensive patients, weight was increased in five and plasma renin activity and aldosterone were increased in one. Catecholamines were not increased in any of the five patients in which they were measured. 3. The association between changes in mean arterial pressure (MAP) and changes in DLIF for the group as a whole was assessed by analysing one data pair per patient, representing the maximal MAP. This correlation was significant (r = 0.75, P = 0.001). 4. Within individual patients, changes in MAP and changes in serum DLIF concentrations were significantly correlated (r greater than 0.50, P less than 0.05) in six of 15 hypertensive patients. 5. Digitalis-like factor (DLF) was measured by inhibition of (Na+,K+)-adenosine 5'-triphosphatase in five patients and DLF and DLIF were significantly correlated (r = 0.081, P = 0.0001). DLF and MAP were also significantly correlated (r = 0.59, P = 0.002). 6. This represents the first longitudinal study of the relationship between DLIF and blood pressure in hypertensive individuals, and the results suggest that DLIF may contribute to the increased blood pressure in some of these subjects.

Increases in plasma digitalis-like factor activity during insulin-induced hypoglycemia

Digitalis-like factor (DLF) appears to be widely distributed throughout the body, and has been specifically localized to the mammalian hypothalamus. In this study we monitored the DLF response to insulin-induced hypoglycemia in 11 normal males. Hypoglycemia was associated with a significant increase in serum DLF activity over basal values (40 +/- 5 pg digoxin Eq/ml, mean +/- SEM) at 60 min (83 +/- 8 pg digoxin Eq/ml) and 90 min (86 +/- 10 pg digoxin Eq/ml) following insulin administration (p less than 0.01). We measured the DLF response to insulin-induced hypoglycemia in other men after infusion of hypertonic saline (n = 8) or after oral water-loading (n = 8). Saline infusion (0.06 ml 5% saline/kg BW/min for 120 min prior to insulin infusion) or water loading (20 ml/kg BW over 60 min completed 30 min before insulin infusion) alone significantly increased serum DLF (saline: 21 +/- 5 to 60 +/- 18 pg digoxin Eq/ml, p less than 0.05; water: 18 +/- 11 to 49 +/- 15 digoxin Eq/ml, p less than 0.05). DLF activity was further significantly increased within each group 60 and 90 min after administration of insulin. In the group infused with hypertonic saline, insulin caused increases of serum DLF from 60 +/- 18 at time 0 to 170 +/- 17 pg digoxin Eq/ml at peak (p less than 0.01). Similarly, in the oral water-loaded group serum DLF increased from 49 +/- 15 at time 0 to 127 +/- 24 pg digoxin Eq/ml at peak (p less than 0.01) after they received insulin.2=

Odontometric asymmetry in Punjabi twins with special reference to methods for detecting spurious genetic variance

Bilateral human odontometric asymmetry generally shows very little genetic variance. In Indian twins, using the simplest methods, unusual levels of disproportionate monozygous similarity and/or dizygous dissimilarity for asymmetry, giving the appearance of significant genetic determinance, were found. Thus this dental asymmetry constituted an interesting test case for the application of more exact methods for the detection of zygosity bias; these invalidated the spuriously significant genetic variance ratios. Therefore the predominantly environmental influences on bilateral dental asymmetry are confirmed.

Genetic marker in juvenile diabetic retinopathy

Thirty five patients with insulin dependent diabetes mellitus (IDDM) were investigated for development of retinal microangiopathy by fluorescein angiography. HLA typing (A,B.C antigens) was done as a genetic marker. There was no statistically significant difference in the frequency of HLA antigens between patients without retinopathy (Gr.I) and with retinopathy (Gr.II) Frequency of various HLA antigens did not differ significantly in the mild and severe retinopathy groups or in comparison with controls. HLA B8 was significantly over represented in the patients of IDDM as a single group (GrI + II) when compared with controls (26% vs 8%). HLA profile was not a predictor of either the development or the severity of retinopathy in IDDM.

Age at menarche in relation to adult body size and physique

The relationship of early and late menarche with adult body dimensions has been studied on a sample of 147 young adult women drawn from an urban Punjabi population of Chandigarh and Ludhiana. The results indicate that girls with early menarche (age 10 to 11) have significantly smaller skeletal dimensions (both longitudinal and transverse) and more subcutaneous fat than those with average or late menarche. The girls with late menarche have on average more height for weight than early maturers. Results indicate that there is a biological determinant of the observed association between menarcheal age and fatness and adult body size.

Fluoride-induced changes in the tooth glycosaminoglycans: an in vivo study in the rabbit

Effect of high fluoride ingestion on the tooth matrix glycosaminoglycans was studied in rabbits administered 10 mg NaF/kg body weight orally at 24-h intervals for a period of 9 months. Fluoride-treated tooth showed a significant reduction in glycosaminoglycan content as compared to the normal tooth. Sephadex G-75 chromatography and DEAE-cellulose ion exchange chromatography revealed the presence of small molecular weight glycosaminoglycan molecules and an increase in the charge density heterogeneity in the sulphated glycosaminoglycans of the fluoride-treated rabbit tooth as compared to the controls. These changes may be related to the dedifferentiated tooth matrix and an increase in the dermatan sulphate content in the fluoride-treated tooth matrix reported earlier.

Comparison of a lactose-free cereal-based formula and cow's milk in infants and children with acute gastroenteritis

Sixty children less than 2 years of age suffering from mild acute gastroenteritis with less than 5% dehydration were randomly assigned to two different isocaloric feeding regimens, viz., a locally prepared milk-free formulation (group A) of rice, lentil, sugar, and coconut oil and a spray dried commercial cow's milk formula (group B). There were two treatment failures in group A and one in group B. The postintervention duration of diarrhea (days) in group A (11.0 +/- 10.0) was higher than in group B (7.6 +/- 10.8), but these differences were not significant (p greater than 0.05). The energy intake (kcal/kg/24 h) on postintervention day 4 was 78.7 +/- 31.7 in group A and 101.3 +/- 41.1 in group B (p greater than 0.05). The corresponding values for day 7 were 74.2 +/- 29.1 and 110.0 +/- 41.1, respectively (p less than 0.05). The mean weight gain (g/kg/24 h) between admission and the day of recovery in group A (2.0 +/- 4.2) was significantly lower (p less than 0.05) than in group B (5.8 +/- 7.8). Similar trends in weight gain were observed at days 4 and 7. These findings suggest that a cow's milk-based formula is well tolerated by majority of the infants with mild acute gastroenteritis after initial rehydration with ORS. The infants who were fed the milk-free cereal-based diet showed significantly less energy intake and gained weight less rapidly than those who were fed the cow's milk-based formula.

The status of sulphated isomers of glycosaminoglycans in fluorosed human teeth

Fluorosed human teeth have lower concentrations of glycosaminoglycan (GAG) disaccharides and an increased dermatan sulphate content. Teeth from subjects with a high fluoride intake have a higher ratio of 4-sulphated to 6-sulphated GAGs. Increased dermatan sulphate may be an important factor in the clinical manifestations of fluorosis.

Incidence of double occipital hair whorls in twins and singletons

A sample of 122 twin pairs and 166 singletons from the urban Punjabi population of Chandigarh was studied. The observed frequency of double occipital hair whorls was higher in twins than in singletons (P less than 0.01). The possible association between twinning and double occipital hair whorls is discussed.

Genetic variance estimates and familial resemblance for body size traits

To study genetic contribution to complex body size traits, the intrafamilial correlation and regression analyses along with twin study method have been used. The data are based on a sample of 45 MZ and 101 DZ twin pairs, their 125 singleton siblings, 104 fathers and 103 mothers in 146 Punjabi families living in Chandigarh, India. Twin study gives no evidence of inequality of means and variances between zygosities. Within-pair genetic variance ratios, correlations, regressions of offspring on midparent and single parent are all significant at 0.1%, thus indicating strong genetic component. Heritability estimates are higher for longitudinal body traits than the breadth dimensions. The resemblance of the children with the parents of either sex is not equal. Higher maternal influence is indicated for a number of body traits. The results on familial correlations do not support the hypothesis of sex-linked inheritance for any of the traits considered in this investigation. These results have been compared with those from other such studies.

Methods for eliminating interferences in digoxin immunoassays caused by digoxin-like factors

Endogenous, circulating digoxin-like immunoreactive factors (DLIF) are known to cross react with many antisera used in digoxin assays, complicating the quantification of serum digoxin. We have explored ways to decrease or remove the interference from DLIF in such assays. Prolonging the assay incubation from 30 to 60 min decreased apparent digoxin concentrations (attributable to DLIF) by an average of 68% in the digoxin radioimmunoassays studied. The serum protein-binding of DLIF was also exploited to remove them from serum. Ultrafiltration, performed as part of a simple centrifugation step, removed approximately 90% of the DLIF. Analytical-recovery studies with true digoxin also demonstrated ultrafiltration to be an adequate method (greater than 95% of digoxin was recovered) for routine clinical use. Heat- or acid-precipitation of protein removed DLIF less effectively. Appropriate incubation times and ultrafiltration can dramatically minimize or eliminate DLIF interference in digoxin immunoassays.

Methods for eliminating interferences in digoxin immunoassays caused by digoxin-like factors

Endogenous, circulating digoxin-like immunoreactive factors (DLIF) are known to cross react with many antisera used in digoxin assays, complicating the quantification of serum digoxin. We have explored ways to decrease or remove the interference from DLIF in such assays. Prolonging the assay incubation from 30 to 60 min decreased apparent digoxin concentrations (attributable to DLIF) by an average of 68% in the digoxin radioimmunoassays studied. The serum protein-binding of DLIF was also exploited to remove them from serum. Ultrafiltration, performed as part of a simple centrifugation step, removed approximately 90% of the DLIF. Analytical-recovery studies with true digoxin also demonstrated ultrafiltration to be an adequate method (greater than 95% of digoxin was recovered) for routine clinical use. Heat- or acid-precipitation of protein removed DLIF less effectively. Appropriate incubation times and ultrafiltration can dramatically minimize or eliminate DLIF interference in digoxin immunoassays.

Comparative genetic variance and heritability of dental occlusal variables in U.S. and Northwest Indian twins

Genetic variance analysis of 15 dental occlusal and arch variables is based on cross-cultural comparison of twin variances (U.S. Whites and Northwest Indian Punjabis). Both samples exhibit high genetic versus environmental partition of variance. However, monozygotes and dizygotes have unequal variance, which invalidates conventional genetic variance ratios. The pattern of environmental biases on the zygosities is quite different in the two groups. Revised estimates that acknowledge zygosity heterogeneity (hence unequal environmental influences) are generally much lower for occlusal traits, whereas arch size measurements are unaffected.