Neuromyotonia. A mild case

A mild case of the syndrome of generalized, sustained, fine muscular twitchings and impaired relaxation after a vigorous contraction (but without a myotonic response), which is presumably due to peripheral motor nerve hyperactivity is described. In this case, generalized muscle stiffness, deformities of the hands and feet, excessive sweating and an increased basal metabolic rate were not present.

Preleukemia: hematological disorders prior to onset of leukemia

Published data on Japanese leukemia patients with a preleukemic hematological disorder were assessed. The reexamined cases were from the "Japona Centra Revuo Medicina" reported during the period from 1952 to 1971. Among preleukemic hematological disorders, hypoplastic anemia was the most frequently reported (41 of 62 cases). These "hypoplastic preleukemia" patients were rather elderly and terminated mostly in atypical myelocytic leukemia. The chief hematological feature of the hypoplastic preleukemia cases was the coexistence of a relative erythroid hyperplasia and a slight increase of myeloblasts in the bone marrow that was unusual in hypoplastic anemia. The presence of pancytopenia and hypocellular marrow with a relative erythroid hyperplasia combined with a slight increase of myeloblasts probably indicates hypoplastic preleukemia that terminates later in acute leukemia.

An electro-oculographic study of ocular bobbing and intermittent vertical oscillations occuring in the same patient

A surviving patient with two rare types of abnormal eye movements, typical ocular bobbing and subsequently developed intermittent vertical oscillations of the eyes, is described, and a follow-up series of electro-oculographic recordings of these eye movements is analyzed. It is suggested that these two types of vertical eye movements might have a common pathophysiological background and the activity of remaining functional oculomotor pathways may play an important role in their occurrence.

[Studies on the pudendal nerve. Part 4. A macroscopical observation of the branches of the pudendal plexus in dogs and cats (author's transl)]

The pudendal plexus and its branches of 20 dogs and 20 cats have been observed macroscopicaly. The main findings are summarized as follows: 1) The pudendal plexus in dogs is formed most frequently by the ventral rami of the first, second and third sacral nerves. 2) The bigeminal nerve of dogs and cats is formed respectively by the union of the ventral rami mentioned above. 3) The perineal nerve in dogs arises with one root from the bigeminal nerve and that of cats two roots, of which the main root arises from the points where the bigeminal nerve joins the asciatic nerve and the accessory one from the bigeminal nerve. 4) In dogs and cats the dorsal nerve of the penis or clitoris arises from the main trunk of the perineal nerve (Fig. 5, type IB) at an average rate of 57.5%. 5) In the dogs and cats, the inferior rectal nerve consists of two divisions; a division had the branches which are derived the perineal nerve to supply the skin around the anus and the other branches which arises from the muscular branch of the dorsal nerve of the penis or clitoris to supply the Sphincter ani externus. 6) The muscular branch of dogs and cats which is analogous to that of the perineal nerve in man, arises from the dorsal nerve of the penis or clitoris. 7) In dogs and cats the muscular branch to the Obturator internus is derived from the dorsal nerve of penis or clitoris. 8) The pelvic splanchnic nerve of dogs originates from the ventral rami of the first, second and third sacral nerves and that of cats from the ventral rami of the first and second sacral nerves. 9) In the posterior femoral cutaneous nerve in dogs, as well as in rats and rabbits, the lateral deviation of the origin from the sciatic to the perineal nerve is observed.

Pregnancy and childbirth in a true hermaphrodite

A rare case of pregnancy and parturition in a true hermaphrodite is reported. This patient, who was 25 years of age when first seen, had an ovotestis on the left and an ovary on the right gonad, with a karyotype of 46,XX. Following removal of the left ovotestis and surgical correction of the external genitalia, she married at the age of 31 and subsequently delivered a normal male child, karyotype 45,XY, by cesarean section.

Cellular responses to dental amalgam in vitro

Cytotoxicity of fine cut amalgam was persistent until 24 hours after trituration in vitro, whereas cytotoxicity of spherical amalgam diminished more quickly. Increasing mercury content in spherical amalgam increased cytotoxicity. Possible reactions for the diminution of cytotoxicity of amalgams with time are discussed.

[Early diagnosis and selection of operative approach for acoustic neuroma (author's transl)]

The recent advances of various diagnostic procedures made possible to detect intracanalicular neuroma in early stage. The operative results have been also greatly improved by transtemporal approach using surgical microscope and dental burr. In addition, the revised suboccipital approach contributed to obtain better operative results. Reviewing our clinical experiences with 15 cases operated from May 1969 to December 1971, appropriate combination of applicable diagnostic procedures and selection of operative method are discussed. Multiple audiologic examinations consisting of pure tone audiometry, speech discrimination, Békésy audiometry, alternate binaural loudness balance test, tone decay and uncomfortable lebel were performed in 11 cases. 9 of these cases manifested retrocochlear type of hearing loss. Spontaneous nystagmus and induced nystagmus, together with balance test, were evaluated for vestibular function. Bithermal caloric test disclosed unilateral canal paresis in all cases. In 13 cases, spontaneous nystagmus was observed. Analysis of optokinetic nystagmus using electronystagmography suggested tumor invasion to the brain stem and cerebellum. Tomography of the internal auditory canal showed abnormal findings in all cases. Cisternography with 2 ml of myodil was performed in 7 cases, all of which were diagnosed definitely by filling defect. Angiography showed abnormal vascular displacement with the tumor of size exceeding 3 cm in diameter. Translabyrinthine approach was performed in 5 cases. Suboccipital approach was applied in 6 cases. Combined approach of these two routes was used in 4 cases. 11 patients returned to their original work postoperatively. To obtain the correct diagnosis of acoustic neuroma in early stage, multiple audiologic examination are indispensable together with detailed vestibular function tests when the unilateral sensory neural hearing loss is suspected. Tomography of the internal auditory canal is also advisable as routine roentonologic study. If the clinical sign is confined to the 8th nerve only, myodil cisternography is useful, however, angiography is reliable in more advanced cases. When the tumor size is below 2 cm and signs of the spread to the brain stem, cerebellum or lower cranial nerves are lacking, translabyrinthine approach is indicated. Suboccipital approach is advisable for more advanced cases or undefinitive cases. Planning of combined approach of both routes is seemed to be not necessary in any case from our experience.