The clinical and psychological effects of pemoline in depressed patients--a controlled study

The clinical and psychological effects of pemoline were compared with placebo in a double-blind study of 20 depressed patients. Target symptoms were disturbances of concentration and memory, tension, depression, fatigue, decreased libido, anorexia and insomnia. The two groups were matched for their clinical picture, age, sex, and duration of illness. During the three-week study period the pemoline group received 50 mg daily. Significant differences in some clinical symptoms were found between the groups, but not in the performance of psychological tests, administered before and after the three-week study period. These differences proved the effectiveness of pemoline in combating symptoms of disturbances in concentration, memory, tension, depression and fatigue.

Treatment of Bell palsy with prednisone: a prospective, randomized study

Two hundred thirty-nine patients with Bell palsy were randomly distributed into prednisone-treated and control groups. Patients were followed until complete recovery or for 1 year. In the steroid-treated and control groups, respectively, incomplete recovery of facial strength occurred in 12 percent and 20 percent; motor synkinesis in 9 percent and 15 percent; autonomic synkinesis in 1 percent and 10 percent; and electromyographic evidence of severe denervation in 9 percent and 17 percent. The differences reached statistical significance only for autonomic synkinesis. In the total series recovery of facial strength was incomplete in 16 percent. Residual weakness was mild in 14 percent and moderate in 2 percent. No patient remained with severe weakness. Age, hyperacusis, and severity of the initial palsy were associated with an increased risk of poor outcome.

Short-term treatment in a general hospital following a suicide attempt

The authors discuss the value of short-term psychiatric treatment in the nonpsychiatric wards of a general hospital for patients who attempt suicide. During 1974 a total of 124 such patients were seen in the emergency room of Meir General Hospital in Kfar Saba, Israel. Following an initial psychiatric examination, 110 of the patients were admitted to the internal medicine or surgical wards. After further observation 30% were transferred to psychiatric hospitals, and the rest were treated in the general hospital's nonpsychiatric wards for an average of three days. There were no suicide attempts during hospitalization. The authors emphasize the usefulness of a short hospitalization to separate the patient from his traumatic home environment until his return to it becomes feasible.

A psychosomatic triad in a bipolar patient

A 56-year-old white male with a rare case of psychosomatic triad occurring during a single depressive episode is presented. The dynamics, course, and treatment are discussed. It is suggested that common psychosomatic mechanisms are interacting with the bipolar illness.

The value of phenobarbital in the child who has had a single febrile seizure: a controlled prospective study

A group of 355 children who were seen after a first febrile convulsion at the Kaiser Foundation Foundation Hospitals in Southern California from 1970 to 1975 were randomly assigned to three treatment groups-daily phenobarbital, "intermittent" phenobarbital given at the onset of fever, and no phenobarbital. We found that 42% had a relative with a febrile seizure and 16% a relative with an afebrile convulsion. 13% had seizures which were either lateralized or longer than ten minutes. Parents were unaware of the fever prior to the seizure in about 30% of the cases. In 81% the preseizure duration of fever was less than 24 hours. The mean follow-up was 28 months, with a range of 6 to 70 months. There was no significant difference in the recurrence rate between children receiving "intermitent" as compared with no phenobarbital. The recurrence rate in children receiving daily phenobarbital was significantly decreased compared to either of the other two groups. Severe recurrent febrile seizures occurred in no children on daily phenobarbital and in 4.4% of the children receiving either intermittent or no phenobarbital. Parental resistance, compliance, and reversible hyperactivity were the main problems encountered with the continuous phenobarbital regimen.

Assessment of intrauterine growth retardation by diagnostic ultrasound

In the first 1,000 cases referred to the Department of Diagnostic Ultrasound for Obstetrics and Gynaecology, 200 patients with singleton pregnancies were examined by this modality for possible intrauterine growth retardation (IUGR). Inclusion in this study was based on one or more of the following criteria: past history of IUGR, present clinical impression of IUGR, present high risk of developing IUGR, and unsuspected IUGR evidenced by diagnostic ultrasound. In 34 per cent of cases, serial examinations indicated that the date of confinement had to be recalculated. Ultrasound was in agreement with delivery results in 82 per cent of cases. Sixteen per cent of cases in this study resulted in growth-retarded infants. Ultrasound correctly diagnosed 70 per cent of these.

Corynebacterium diphtheriae endocarditis

Two patients with Corynebacterium diphtheriae endocarditis have been observed in the past ten years. Both cases occurred sporadically. In one case toxigenic C. diphtheriae caused endocarditis in an immunized child with congenital heart disease. The second patient developed rapidly progressive valve destruction caused by a nontoxigenic strain of C. diphtheriae. These cases illustrate that C. diphtheriae may produce endocarditis in addition to its previously described diseases spectrum.

Brain concentrations of phenytoin, phenobarbitone and primidone in epileptic patients

Plasma, brain, lumbar CSF, skeletal muscle, skin and bone concentrations of phenytoin, phenobarbitone and primidone have been measured in specimens from patients undergoing temporal lobectomy for chronic epilepsy. A good correlation was found between the plasma and brain concentrations of each drug. Similarly, a good correlation was found between the plasma and CSF concentrations of each drug. Assuming that CSF is an ultrafiltrate of plasma, the percentage of phenytoin, phenobarbitone and primidone which was unbound in plasma was 10-14%, 43% and 81% respectively. Skeletal muscle concentrations of phenytoin and phenobarbitone and the skin concentration of phenytoin, also correlated with the plasma concentrations, but the remaining tissues did not give significant correlations.

Outcome of surgery in 40 children with temporal-lobe epilepsy

Temporal-lobe epilepsy commonly has its origins in childhood, particularly when the lesion involved is mesial temporal (Ammon's horn) Sclerosis. Evidence suggests that this lesion is probably a common cause of chronic epilepsy in adults and that often it is probably the result of a severe febrile convulsion in infancy. 40 children, fifteen years of age and younger, who had an anterior temporal lobectomy were followed up for one to twenty-four years. The findings confirm those already established in adults, that the best results of surgery, not only in seizure relief but also in behaviour, are obtained when mesial temporal sclerosis is the lesion found at operation, and also indicate that a severe febrile convulsion in infancy is often the chief provocative factor in the development of epilepsy.

Glutamine production by the isolated perfused rat heart during ammonium chloride perfusion

Myocardial levels of ammonia, glutamate, and glutamine and the release of glutamate and glutamine were studied in the isolated perfused rat heart during perfusion with ammonium chloride, epinephrine, and conditions of anoxia or ischaemia. Perfusion for 15 min with effective ammonium chloride concentrations of 0.53, 0.71, and 2.06 mmol/l resulted in glutamine production of 1.34, 0.95, and 4.41 mmol with 15 min-1/200 dry weight compatible with the presence of glutamine synthetase in rat myocardium. Myocardial ammonium content was unchanged by perfusion with 0.53 and 0.71 mmol/l ammonium chloride, but was increased by 1.36 mumol with 15 min-1/200 mg dry weight by perfusion with 2.06 mmol/l ammonium chloride. Increased myocardial contents of ammonia and glutamine were not accompanied by depression of left ventricular pressure. Perfusion with epinephrine (0.20 mug/ml) resulted in an increased myocardial content of glutamine. Anoxia or ischaemia resulted in no changes in ammonia content, and no changes in glutamine or glutamate production. The net release of glutamine into the perfusate was about 10 times the net release of glutamate.

Cerebral arteriovenous malformation causing cardiac enlargement and epilepsy: correction after operation

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Solitary myeloma with peripheral polyneuropathy--recovery after treatment

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Asymmetrical hypertrophic cardiomyopathy simulating mitral stenosis

Hypertrophic cardiomyopathy usually involves the left ventricle more severely than the right, and when asymmetrical may produce the syndrome of idiopathic subaortic stenosis. Less commonly, clinical manifestations of inflow-tract obstruction predominate and produce a syndrome that may be mistaken for mitral stenosis, principally because of an apical diastolic rumbling murmur. The probability of this diagnostic error and the risk of a consequent unnecessary operation can be reduced by appreciating the significance of the clues to left ventricular disease revealed by the electrocardiogram and the chest roentgenogram. Furthermore, proper timing of the heart sounds differentiates the protodiastolic filling sound of cardiomyopathy from the opening snap of mitral stenosis. The correct diagnosis is established following ventriculographic and hemodynamic studies.

Treatment of lateral epicondylitis

Of the total number of injuries treated at the Lewisham Hospital Sports Medicine Clinic (Sydney), over a period of eighteen months, lateral epicondylitis constitutes approximately 1.4%. The 36 patients this figure represents received varying treatments, which are listed below. The overall results were as follows.

Cryptococcal spinal arachnoiditis

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Massive removal of small bowel during criminal abortion

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