Epileptic Munchausen's syndrome: a form of pseudoseizures distinct from hysteria and malingering

A young woman with seizures and status epilepticus sought and obtained hospitalization in at least 25 hospitals in the province of Quebec between 1980 and 1987. She was thought to have uncontrolled epilepsy; her treatment led to intoxication with anticonvulsants and once to anesthesia for three consecutive periods of 7 days each. The nonepileptic nature of her attacks was proven and a diagnosis of Munchausen's syndrome made. She was transferred to a psychiatric center where she committed suicide. We found no documented cases of epileptic chronic factitious disorder in the literature.

[The effect of alcohol on the heart in chronic alcoholics]

48 asymptomatic alcoholics (mean age 31.2 years) with an average daily alcohol consumption of 287 g were studied about 45 h (mean) after the last ingestion of alcohol. M-mode echocardiography and 24-h long-term ECG recordings were performed. 24 of these patients were restudied after a mean of 12 days of abstinence using long-term ECG recording. All patients were in sinus rhythm. 44 of 48 patients demonstrated supraventricular premature beats. In three patients, there were ventricular pairs (1/24 h). Two further patients had ventricular triplets (1/24 h). Echocardiography demonstrated a significant enlargement of left atrial dimensions (LA: 39 +/- 3.8 mm), of the diameter of the left ventricular posterior wall (10 +/- 4.1 mm), and of the interventricular septum (12 +/- 1.7 mm) compared to control data in 24 'normals'. In addition, there was a significant increase in the derived left ventricular mass index (292 +/- 48.2 g). Left ventricular enddiastolic diameter was not significantly different. Laboratory tests showed pathologically elevated values of SGOT, SGPT, and gamma-GT whereas serum potassium was normal. During restudy of the long-term ECG after 12 days, complex ventricular arrhythmias were no longer detectable. In six patients, echocardiography was repeated after a mean of 110 days of abstinence. Three of these patients had had marginal left ventricular fractional shortening during the first study which was normalized at the repeat study. Our results show some degree of left ventricular dysfunction in some chronic alcoholics without clinical overt heart failure.

Haemoglobin Köln in Cape Town. A case report

A 7-year-old patient presented with an acute haemolytic episode. Investigation showed the presence of an unstable haemoglobin (Hb), identified as Hb Köln. No other members of the family were affected. This disorder has occasionally been seen as a spontaneous mutation. This is the first report of Hb Köln in a South African family, although other unstable Hb variants have been described.

Structure and function of a new hemoglobin variant, Hb meilahti (alpha 2 beta 2 36(C2)Pro----Thr), characterized by mass spectrometry

An abnormal hemoglobin was found by isoelectric focusing in the blood of a Finnish woman with erythrocytosis. Oxygen equilibrium curves of the patient's hemolysate indicated the presence of a variant with a very high oxygen affinity. Structural analysis was carried out by mass spectrometry. In the spectrum of the tryptic digest, an abnormal peptide was found at m/z1278 which corresponded to the mass number of the protonated molecular ion of beta T4 with 36Pro----Thr substitution. The structure was confirmed by the mass spectrum of the chymotryptic digest.

Preclinical safety testing of species-specific proteins produced with recombinant DNA-techniques. An attempt to transfer current experience into future testing strategies

Preclinical toxicity studies in animals with species-specific recombinant DNA products have now been performed for several years. An interim statement on the significance of these animal tests and their ability to predict adverse effects in humans therefore appears indicated, with the aim of deducing future testing strategies. The experience accumulated so far shows that the animal models have failed to predict adverse effects subsequently observed in man. Immunogenicity of these proteins further restricted the usefulness of standard toxicity tests. There is also increasing evidence that animal tests on the toxic potential of impurities contained in the products are markedly inferior in sensitivity to analytical and quality control methods. Thus, modified testing programs are proposed to demonstrate safety rather than target organ toxicity using rodents and small non-rodent species and restricted dosing; furthermore the study duration should be limited by the detection of immunogenic responses.

Haemoglobin gene frequencies in the Jamaican population: a study in 100,000 newborns

The gene frequencies of abnormal haemoglobins have been determined in a group of 100,000 Jamaican newborns screened over a period of 8 1/2 years. The population is predominantly of West African origin and the survey represents approximately one quarter of all island deliveries within the period of the study. The common beta globin chain abnormalities beta s and beta c occurred with gene frequencies of 0.055 and 0.019 respectively; beta thalassaemia was relatively rare. In contrast, alpha thalassaemia was quite common, occurring with a gene frequency of 0.183. In addition to these common abnormalities, the frequencies of 256 rare abnormal haemoglobins are described. This survey thus represents a complete and accurate documentation of the alpha and beta globin variants that occur in the Jamaican population.

Abscisic acid metabolism -vacuolar/extravacuolar distribution of metabolites

The biotransformation of abscisic acid (ABA) was studied in cell suspension cultures of Lycopersicon esculentum. The ABA was converted by the cells to phaseic acid, nigellic acid, dihydrophaseic acid, abscisic acid-β-D-glucopyranosyl ester (ABA-Glc) and other ABA and phaseic acid conjugates. Investigation of their cellular distribution showed that the conjugated forms were located only in the vacuoles whereas ABA and its acidic metabolites were found mainly in the extravacuolar fractions. Our results, together with a number of studies on the increase of ABA-Glc as a response to stress, allow us to propose that ABA-Glc is irreversibly compartmented in the vacuoles of plant cells.

Prenatal diagnosis of "dihydrobiopterin synthetase" deficiency, a variant form of phenylketonuria

Amniocentesis was performed at 19 weeks gestation in a mother who had previously delivered a boy with "dihydrobiopterin synthetase" (DHBS) deficiency. The amniotic fluid contained neopterin in high (136 nmol/l) and biopterin in very low concentrations (1.8 nmol/l). The activity of the phosphate-eliminating enzyme (PEE, also called 6-pyruvoyl tetrahydropterin synthase, substrate: 7,8-dihydroneopterin triphosphate) which is present in liver and erythrocytes and defective in DHBS deficiency, was measured in the erythrocytes of the family members. The fetal sample showed only 2% of the activity of healthy adult controls and was comparable with that of the affected sibling. Obligate heterozygotes had activities around 20% of the controls. Two fetal control samples showed even higher activities than adult erythrocytes, Sepiapterin reductase activities wer normal in all cases. At autopsy, PEE deficiency was confirmed in the liver of the fetus. We concluded that DHBS deficiency (and most probably also GTP cyclohydrolase I deficiency) can be diagnosed by metabolite measurements in amniotic fluid. PEE activity is measurable in erythrocytes, although the assay needs to be improved. Since maternal tetrahydrobiopterin does not cross the placenta, treatment of a tetrahydrobiopterin-deficient fetus with tetrahydrobiopterin in utero is not possible.

Litter parameters and spontaneous abnormalities in Himalayan rabbits

A joint study was undertaken in three testing facilities to evaluate cumulative background data of Himalayan rabbits. All litters were derived from control does. The conception rate was high (84.0-95.1%) but the average numbers of corpora lutea (7.9-8.7), implantation sites (6.5-7.5) and viable fetuses (5.8-6.9) were somewhat lower than that of most other strains of rabbit. Altogether 90 malformed fetuses (1.12%) and 425 fetuses with variations (5.27%) occurred among 8,060 virable fetuses.

Hepatic regenerative stimulator substance in the rabbit. Relation to liver regeneration after partial hepatectomy

The occurrence and activity of hepatic regenerative stimulator substance was investigated in the partially hepatectomized rabbit and related to biochemical and morphological parameters of liver regeneration. Male rabbits were 60% hepatectomized by excising the Spigelian, left lateral and left central lobes of the liver leaving the gallbladder in situ. [3H]Thymidine incorporation into DNA, the fraction of labelled hepatocyte nuclei, the fraction of mitoses and thymidine kinase activity rose from basal levels at 30-40 h after hepatectomy and increased up to 12-fold at 40-60 h. After 7 days, proliferation parameters returned to near prae-hepatectomy values and 82% of the initial liver mass was restored. Hepatic regenerative stimulator substance was biologically active when prepared from rabbit livers between 18-30 h after partial hepatectomy. At 12 and 30 h after intraperitoneal injection of the extract into normal rats, hepatic DNA synthesis was stimulated up to 2-fold in a dose-dependent fashion. The biological activity was protease-sensitive and thus depended on a protein component of the extract. The data demonstrate the existence of hepatic regenerative stimulator substance in regenerating rabbit liver and suggest that it is implicated in the regulation of liver growth after partial hepatectomy.

The myoglobin of rodents Proechimys guairae (casiragua) and Mus musculus (house mouse)

The amino acid sequences of the myoglobins of two rodents, the casiragua and the house mouse, have been determined. The myoglobin of casiragua differs from that of viscacha (another hystricomorph) at 6 positions. Mouse myoglobin differs from that of mole-rat (another myomorph) at 17 positions, whereas casiragua and mouse differ at 22 positions. Mouse myoglobin possesses several features unique among all known myoglobins (Gly 31, Cys 66, Thr 74 and Glu 113) and one substitution unique among known mammalian myoglobins (Glu 53).

A distant gene deletion affects beta-globin gene function in an atypical gamma delta beta-thalassemia

We describe an English family with an atypical gamma delta beta-thalassemia syndrome. Heterozygosity results in a beta-thalassemia phenotype with normal hemoglobin A2. However, unlike previously described cases, no history of neonatal hemolytic anemia requiring blood transfusion was obtained. Gene mapping showed a deletion that extended from the third exon of the G gamma-globin gene upstream for approximately 100 kilobases (kb). The A gamma-globin, psi beta-, delta-, and beta-globin genes in cis remained intact. The malfunction of the beta-globin gene on a chromosome in which the deletion is located 25 kb away suggests that chromatin structure and conformation are important for globin gene expression.

The first observation of Hb D Punjab beta zero thalassaemia in an English family with 22 cases of unsuspected beta zero thalassaemia minor among its members

A 36 year old local Englishman from Nuneaton was referred to hospital with suspected glandular fever. Relevant tests were negative and the symptoms subsided in due course. The finding of a hypochromic microcytic blood picture without iron deficiency led to the discovery that he was heterozygous for Hb D and beta thalassaemia. Hb D trait was established in the father of the proband and beta thalassaemia in his mother and a brother. The father's ancestors were miners who came to Nuneaton from Monmouthshire in the 19th century. The mother's ancestors have belonged to the indigenous population of Nuneaton and neighbouring Leicestershire since the 18th century. Twenty local members of her wider family also had thalassaemia. All thalassaemias had a low MCH and raised level of Hb A2. The Hb F level, however, was normal in five, demonstrating the independent segregation of genetic factors influencing the Hb F level in beta thalassaemia trait.

Studies on circulatory stability during bicarbonate hemodialysis with constant dialysate sodium versus acetate hemodialysis with sequential dialysate sodium

Eight stable patients on maintenance hemodialysis were studied while undergoing (a) acetate hemodialysis with a sequential dialysate sodium concentration from 147 to 137 mEq/L (SNa-HDA) and (b) bicarbonate hemodialysis with a constant dialysate sodium concentration of 140 mEq/L (HDB). Circulatory behavior was observed during both of these methods, and both were found to allow a high volume removal. However, as a consequence of the high sodium load during SNa-HDA, volume was shifted from the extra- to the intravascular space. This stabilizing effect on the circulation disappeared with the sequential decrease of dialysate sodium concentration (despite a constant plasma sodium concentration (despite a constant plasma sodium concentration of approximately 140 mEq/L), which was concomitant with a significant decline of the mean arterial blood pressure and an inadequate compensation of the metabolic acidosis. In contrast, a better circulatory response to comparable volume removal was found during HDB, expressed by a stable mean arterial blood pressure in the presence of well-balanced arterial acid-base values.

Hemoglobin Hofu associated with beta 0-thalassemia

A mild anemia (hemoglobin 9 g/dl) was found in a patient from Seville (Spain) with marked morphological abnormalities in the peripheral blood smear. The red cell osmotic fragility showed a mild resistance curve with a mean cell fragility (MCF) of 0.375% NaCl (normal = 0.450). Chemical Chemical and thermal instability test and search for inclusion bodies gave positive results. Hemoglobin electrophoresis at pH 8.9 revealed absence of Hb A, a major component of fast mobility (94%), and increased Hb F and Hb A2 levels (1.5% and 4.6%, respectively). The fast fraction, isolated and purified by means of cellulose acetate electrophoresis, precipitated in acid acetone and treated with urea 8 M and mercaptoethanol, revealed an anomalous beta chain. Trypsin-digested globin peptides were separated by high-voltage electrophoresis at pH 6.4 and ascendant chromatography. With differential staining, an extra peptide was detected in an unusual site, more anodic than alpha Tp4 but in lower position. Peptide map of the fast beta chain, stained with ninhydrin, and also for Tyr, confirmed the position of the new peptide and the absence of the usual beta Tp13. The new peptide, separated by high-voltage electrophoresis at pH 3.5, revealed absence of Val and the presence of an additional Glu residue, which should appear only in position beta 126. The diagnosis of Hb Hofu (alpha 2 beta 2 126 Val----Glu; H4) was reached, thus interpreting its increase and the absence of Hb A, as an association with beta o-thalassemia, producing a mild hemolytic anemia. Evidence was obtained that Hb Hofu is a mild unstable hemoglobin variant.

A critical comparison of the freehand razor-blade dissection method according to Wilson with an in situ sectioning method for rat fetuses

Two methods of dissecting rat fetuses are compared: the generally well-known freehand razor-blade dissection method according to Wilson and an in situ sectioning method (ISM). For this purpose the substance EGYT 1978 was used, which induces--inter alia--cardiovascular anomalies. Thirty-nine gravid rats were given either the test drug (EGYT 1978, 400 mg/kg body weight) or the vehicle orally from the 6th to the 15th day of gestation. The fetuses were assigned randomly to either dissection group. Both methods of examination revealed approximately the same number of anomalies per organ system. A comparison of the types of anomaly found showed, however, relevant differences in the nature of the changes revealed by the two methods. The in situ sectioning method was clearly superior to the freehand razor-blade dissection method for the detection of discrete anomalies of the cardiovascular system. We therefore recommend the in situ sectioning method as the method of choice for examining small fetuses from teratological experiments.

Homozygosity for the delta-chain variant haemoglobin A2' (HbB2) (delta 16 Gly----Arg)

A healthy 20-year-old woman, belonging to the Kgalagadi tribe of Botswana, has been found to possess a variant Haemoglobin A2 as her only minor haemoglobin component. Fingerprinting and amino-acid analysis have shown that it is Haemoglobin A2' (delta 16 Gly----Arg). The one parent available for study is heterozygous for the Hb delta A2' allele and the variant haemoglobin accounts for 3% of the total haemoglobin in the proband. It is reasoned that the proband is, therefore, homozygous for the Hb delta A2' allele. No haematological abnormalities were evident.

Haemoglobin Warwickshire (β5 [A2] Pro → Arg)

The blood of a 67-year-old Scotsman who was admitted to hospital with an abdominal carcinoma showed an abnormal red cell lysis in the oxidase channel of the Technicon H6000 analyser. This is seen regularly with Hb C and sometimes with Hb S and on further investigation a new haemoglobin variant--Hb Warwickshire--was found. When the family was examined, other examples were revealed. The haematological parameters were normal. Hb Warwickshire is mildly unstable and whilst in the absence of phosphates its oxygen dissociation does not differ from that of Hb A, a small fall of oxygen affinity is noted when phosphates are present.

The myoglobin of primates: the Night Monkey, Aotes trivirgatus (Cebidae, Platyrrhini, Anthropoidea)

The amino acid sequence of the myoglobin of the South American Night Monkey, Aotes trivirgatus, is identical to that of the marmoset (Callithrix jacchus [1]) except for residue 21 which is isoleucine in the marmoset, like in all other anthropoids, but valine in Aotes. Analysis of a possible pathway of the evolution of Aotes myoglobin using 18 known primate myoglobin sequences [2-5] supports the classification of the Night Monkey within Anthropoidea and Platyrrhini but it indicates that this species might be more closely related to the marmoset (family Callitrichidae) than to the family Cebidae as a member of which it is commonly classified.

Sickle cell anemia 35 years ago: reminiscence of early African studies

The author was a biochemist who, because he had experience in plasma iron estimations, became involved in the investigation of a hypochromic anemia in India during World War II. This led to another such study in Uganda after the war. There, an investigation of the incidence of sickling led to the discovery of overall differences between Hamitic-speaking tribes and the Bantu and Nilotes. A few exceptions could later be explained on the basis of the effect of malaria on sickling incidence. A mapping of the world distribution of sickle-cell and other hemoglobins followed, as well as a search for factors which cause the severity of sickle-cell anemia to vary. A most important lowering influence on this severity seems to be that of alpha-thalassemia. It is suggested that the high incidence of alpha-thalassemia type 2 (alpha/alpha alpha) in malarial regions is not related to malaria itself but to the beta-chain abnormalities which protect against malaria and therefore are frequent in the same populations. Alpha thalassemia in turn has a selective value because it lowers the pathological effect of sickle-cell anemia, as well as the consequences of Hemoglobin E and beta-thalassemia.

Ultrastructure of Anaulus creticus Drebes & Schulz with special reference to its reduced ocelli

The ultrastructure of the vegetative cell of the centric diatom Anaulus creticus Drebes & Schulz is described. Exhibiting the organic wall component (diatotepum) separated from the siliceous parts of the cell wall this species belongs to the diatom group with so-called split-walls [17]. A most interesting feature of the Anaulus cell is the horn region and its internal structure. As there is no silicified sieve-plate at the horn top but just a big hole sealed only by a thin diatotepum with a hexagonal meshwork, this wall structure is termed a "reduced ocellus". The inner part of the horn region is largely occupied by a conspicuous protoplasmic plug of proteinaceous nature. The possible function of this peculiar structure is discussed as well as new ideas about the role of the labiate process are provided.

Reflections on Freud's reaction to the death of his mother

Freud's reaction to the death of his mother as he reported it in letters to Ernest Jones and Sandor Ferenczi is discussed. The sense of liberation and the absence of grief which he emphasized is given some analytic consideration. An attempt is then made to gain an understanding of Freud's somewhat cryptic remark that a change in the "values of life" in the "deeper layers" will have occurred following his mother's death. His discussion of these concepts in Civilization and Its Discontents, which was published just before her death, is utilized. The question is raised of whether the death of his mother may have been related to the change in Freud's view of the significance of the preoedipal mother which he presented in "Female Sexuality," the first paper he wrote after her death.

Malignant hyperthermia in pigs: a search for abnormalities in Ca2+ binding proteins

Malignant hyperthermia occurs in man and pigs as a hereditary disorder notably as a complication of halothane-induced anaesthesia. It involves an abnormality in the metabolism of Ca2+. A search was made for abnormalities of calcium-binding proteins. Troponin C from normal pig muscle was found to differ in 2 of 159 amino acids from rabbit Tn C and 3 from man. No differences between normal and abnormal pig muscle were found. Two-dimensional electrophoresis of red cell calmodulin from normal and abnormal pigs also failed to demonstrate a difference.

Investigation of malignant hyperthermia: analysis of skeletal muscle proteins from normal and halothane sensitive pigs by two dimensional gel electrophoresis

Two dimensional gel analysis of skeletal muscles from normal pigs and from pigs which were homozygous for halothane sensitivity showed no obvious differences in the patterns of spots attributed to the major contractile proteins and glycolytic enzymes. In muscle from a sensitive pig which died of heat shock under anaesthesia there was a selective loss of glyceraldehyde-3-phosphate dehydrogenase and aldolase, presumably owing to proteolytic activity. The progressive loss of these enzymes under anaesthesia could contribute to the mechanism of heat production by diverting fructose 1,6 diphosphate into a futile cycle.

Haemoglobin LeporeBaltimore in a Spanish family

Description of the clinical, haematological and biochemical aspects of a new family with heterozygous haemoglobin LeporeBaltimore. Of the 6 members affected. 4 were totally asymptomatic. All of them showed morphologic features of heterozygous beta-thalassaemia. The levels of haemoglobin Lepore ranged from 12.2 to 15% (mean value: 13.7 +/- 1.1%). The analysis of the primary structure of the haemoglobin shows that crossing over takes place between amino acid 50 of the delta-chain and amino acid 86 of the beta-chain. This is the third family, to our knowledge, with haemoglobin LeporeBaltimore so far described.

[Wegener's granulomatosis: ocular manifestations, diagnosis and therapy]

As a chronic, focal, necrotizing granulomatous angiitis Wegener's granulomatosis mainly affects the upper respiratory tract, the lungs and kidneys. Various other organs may be affected including te eyes. Ocular manifestation of Wegener's granulomatosis may result from granulomatous sinusitis that has proceeded into the orbit causing nasolacrimal duct obstruction and proptosis, and affecting eye muscles as well as the optic nerve. Another possible picture is presented by focal vasculitis in the form of conjunctivitis, episcleritis, scleritis, uveitis and granulomatous vasculitis of the retina and optic nerve. In 13 patients out of 26 examined the eyes were found to be involved. The etiology of Wegener's granulomatosis is unknown. The prognosis of this generally lethal disease could definitely be improved by early treatment with cyclophosphamide in combination with glucocorticosteroids.