Evidence for the involvement of histamine in the antidystonic effects of diphenhydramine

Although diphenhydramine hydrochloride is known to eliminate or reduce the symptoms of dystonia in human patients with acute dystonic reactions and idiopathic torsion dystonia, its mechanism of action is still unclear. In the present study, we show that the antihistamine properties of diphenhydramine may contribute to its beneficial effects. Acute dystonic reactions were produced in rats with unilateral microinjection of haloperidol into the red nucleus as previously described. Similar to the pattern in humans, this effect could be attenuated by coadministration of diphenhydramine. Unilateral microinjection of histamine itself into the rat red nucleus produced dystonic postures (torticollis) in a dose-dependent manner, demonstrating that a histamine dysfunction could contribute to the pathophysiology of dystonia. The torticollis produced by histamine could be significantly attenuated with coadministration of the H1 antagonists diphenhydramine or pyrilamine or the H2 antagonist cimetidine. These effects are thought to be mediated through the red nucleus because significantly more torticollis was observed when histamine was injected into the red nucleus rather than surrounding mid-brain areas, the substantia nigra, or the lateral ventricle. The present data, taken together with studies in humans, suggest the involvement of histamine in some types of dystonia. Furthermore, the red nucleus and related motor pathways may have a more important role in dystonia than previously thought.

Orthopedic aspects of cervical spine disorders in children and adolescents

Literature on a variety of pediatric orthopedic diseases of the cervical spine is reviewed. Only new ideas, important papers, or reviews of current opinions on contemporary problems are discussed. A comprehensive review of all cervical spine disorders is not within the scope of this paper.

Spontaneous remissions in spasmodic torticollis

We reviewed the frequency of spontaneous remissions in spasmodic torticollis (ST). One hundred sixteen patients with idiopathic ST (72 F, 44 M) were examined. The age at onset ranged from 9 to 69 (mean, 38.1 +/- 1.3). Twenty-one patients (18%) were Jewish. Eleven patients (9%) had a history of familial dystonia. Remissions longer than 1 year unrelated to treatment were observed in 14 patients (12%) (9 F, 5 M). They occurred in the first year of ST in 13 patients (93%) and in the eighth year in 1. Duration of remissions ranged from 1 to 20 years (mean, 6.5 +/- 1.6). Two patients had three remissions, and another had two. The mean age at the onset of ST in patients with remission was 26.4 +/- 3.3 (SEM) and ranged from 9 to 49. The age at the onset in the patients without remissions was 39.7 +/- 1.4, ranging from 10 to 69 (p less than 0.01). In the remission group, 3 patients were Jewish (21%); in the non-remission group, 18 (18%) were Jewish. There was a familial history in 1 case with remission (7%) and in 10 cases (10%) without remission. Spontaneous remissions in the course of ST seem to be more frequent in patients with early onset, and they occur usually during the first year.

Outpatient management of pediatric surgical problems

A number of pediatric surgical problems commonly seen in the outpatient department or physician's office are reviewed. It is particularly important for the primary care physician to recognize the difficulty of accurate diagnosis in children and the advantage of sedation in improving patient cooperation. Hospitalization may be necessary for adequate observation, proper preparation for diagnostic studies, or safe treatment. Simple traumatic injuries or infections can usually be treated effectively without hospitalization if sound surgical principles are observed. Abdominal pain or rectal bleeding calls for a careful investigation for early signs of inflammatory disease or life-threatening lesions requiring surgical treatment.