Partial remission of hemiplegia and somatoparaphrenia through vestibular stimulation in a case of unilateral neglect

In a case of long lasting severe neglect resulting from a large right parieto-temporo-occipital infarct, vestibular stimulation produced a temporary reduction of the motor deficit and disappearance of the somatoparaphrenic delusion, in addition to the already reported improvement of extrapersonal and personal neglect and anosognosia. These data open new perspectives in the understanding of the neglect syndrome and of functional involvement of the parietal lobe in space representation.

Attitudes of patients after "genetic" termination of pregnancy

Twelve of 15 women who had had abnormal fetuses agreed to be interviewed after termination of the pregnancy. The survey showed that persistent adverse psychological and social reactions may be much commoner in patients undergoing termination of pregnancy for genetic rather than "social" indications. Adequate information and counselling before, and support after, termination of an abnormal pregnancy are essential if these women are to cope with the experience.

Vertigo and upside down vision due to an infarct in the territory of the medial branch of the posterior inferior cerebellar artery caused by dissection of a vertebral artery

A 48 year old woman developed an acute vestibular syndrome associated with upside down vision a few hours after minor cervical trauma. Magnetic resonance imaging showed an ischaemic lesion in the territory of the medial branch of the posterior inferior cerebellar artery. An arteriogram showed a dissection of the left extracranial vertebral artery.

First-aid for snake-bite: efficacy of a constrictive bandage with limb immobilization in the management of human envenomation

A herpetologist was bitten on the thumb by a common brown snake (Pseudonaja textilis). A constrictive bandage to impede lymphatic and capillary flow was applied, and the upper limb was immobilized. Two hours after the bite, there were no signs of symptoms of envenomation and venom (to a sensitivity of 0.5 ng/mL) was undetectable in serum and urine. Within five minutes of removal of the constrictive bandage, significant signs of envenomation developed, and serum and urine levels of venom rose significantly. The patient received two ampoules of brown-snake antivenom, and had recovered within six hours. No anaphylaxis of other allergic phenomena occurred, despite the fact that three other doses of antivenom had been administered in the preceding 36 months for prior elapid envenomation. By means of an experimental whole-mouse technique, and an enzyme-linked immunospecific assay (ELISA) system, the snake involved was shown to deliver 4.91 mg of venom in an average bite. A constrictive bandage properly applied to impede lymphatic and capillary flow, together with limb immobilization, is effective in the field management of human elapid envenomation.

Retinal and optic nerve findings in Goldenhar-Gorlin syndrome

Involvement of the posterior segment of the eye in Goldenhar-Gorlin syndrome is more common than is generally appreciated. We examined seven patients with this syndrome. Abnormalities included diminished visual acuity, tilted optic disc, optic nerve hypoplasia, tortuous retinal vessels, macular hypoplasia and heterotopia, microphthalmia and anophthalmia. In one case, pathologic study showed agenesis of the optic nerve. It is proposed that retinal, optic nerve and craniofacial abnormalities in this condition may reflect an asynchrony in the migration of the neural crest cells in the early stages of embryonal development.

Clinical validation of antidromic stimulation of the ring finger in early electrodiagnosis of mild carpal tunnel syndrome

Median and ulnar sensory distal latencies were measured antidromically on the fourth finger in 158 patients (224 hands) with suspected carpal tunnel syndrome (CTS), in 60 normal subjects (100 hands), and in 30 patients (30 hands) who suffered from paresthesiae due to a cervical spondylotic radiculopathy (CSR). The difference between these 2 latencies was less than 0.4 msec in all normals and patients with CSR, while in all of the patients with CTS it was more than 0.5 msec. Median sensory nerve conduction was significantly slower for the fourth than for the second finger in the CTS group, but not in controls. The difference between median and ulnar sensory distal latencies on the fourth finger proved to be the most sensitive of the tested parameters and was the only abnormal one in 20% of the clinically affected hands. The ring finger technique is a quick and easy procedure, which should be recommended in the early diagnosis of mild CTS.

IgE receptor type I-dependent tyrosine phosphorylation of phospholipid scramblase

To identify new effectors of IgE receptor (FcepsilonRI) signaling, we purified proteins from FcepsilonRI-stimulated RBL-2H3 rat mast cells on anti-phosphotyrosine beads and generated mouse monoclonal antibodies (mAb) against these proteins. Two mAbs bound to a protein that was identified as a new isoform of phospholipid scramblase (PLSCR) after screening an RBL-2H3 cDNA expression library. This isoform differed from PLSCR1 by the absence of an exon 3-encoded sequence and by an insert coding six QGPY(P/A)GP repeats. The PLSCR family of proteins is responsible for a redistribution of phospholipids across the plasma membrane. Although rat PLSCR is a 37-kDa protein, anti-phosphotyrosine immunoblots revealed the presence of 37-49 kDa phosphoproteins in the material immunoprecipitated with either anti-PLSCR mAb but not with unrelated monoclonal or polyclonal antibodies. Depletion of PLSCR resulted in the absence of these phosphoproteins. Additional experiments led to the identification of these phosphoproteins as phospho-PLSCR itself. Stimulation of RBL-2H3 cells upon FcepsilonRI engagement resulted in a dramatic increase in PLSCR tyrosine phosphorylation. A comparison of the relative amounts of phospho-PLSCR and nonphosphorylated PLSCR demonstrated that only a tiny fraction was thus modified, indicating a finely targeted involvement of PLSCR in FcepsilonRI signaling. Thus, this study reports the cloning of a new isoform of PLSCR, as well as the first observation that a member of the PLSCR family is a target for tyrosine kinases and is involved in signaling by an immune receptor. These findings open new perspectives on the role of phospholipid scramblases and to the mechanisms involved in their regulation.

Effects of Packaging Systems on the Natural Microflora and Acceptability of Chicken Breast Meat

The effect of 3 packaging systems on the spoilage microflora, objective color, and sensory characteristics of fresh commercial broiler chicken breast meat was investigated. Fresh skinless and boneless chicken broiler breasts were purchased from a local poultry processing plant and packaged in either (1) a conventional Styrofoam tray with polyvinyl chloride overwrap and absorbent pad, (2) a Styrofoam tray with polyvinyl chloride overwrap minus absorbent pad, or (3) a Fresh-R-Pax (FRP) container equipped with an absorbent liner-gel system. All packages were heat sealed and stored at 1.2 +/- 1 degrees C for 8 d. At each sampling period (0, 2, 4, 6, and 8 d), packages from each treatment were analyzed for Pseudomonas spp., psychrotrophic organisms, objective color, and sensory characteristics. In general, Pseudomonas spp. and psychrotrophic counts increased as storage time increased for all packaging systems. Color and overall appearance were similar (P >0.05) for all packaging systems. Although not significant, the off-odor scores for breast meat packaged in FRP were higher (P >0.05) after 6 and 8 d when compared with the breast meat packaged in a Styrofoam tray with polyvinyl chloride overwrap with or without an absorbent pad. Although the absorbent pad did not control microbial growth, it maintained aesthetic appeal by absorbing all visible moisture released from the meat during storage.

[Disulfiram (Esperal) toxicity. Apropos of 3 original cases]

Prescribed since 1948 to control chronic alcoholism, disulfiram may cause severe toxicity as report in three cases of acute motive axonal polyneuritis. Disulfiram toxicity may present different clinical aspects: 1) Cytolytic hepatitis with fatal evolution in 30% of cases (fulminant hepatitis), and full recovery for the other 70%. The onset of the symptoms usually occurs as early as 15 days to a maximum of 6 months (most within 2 months) after initiation of treatment. 2) Severe optic neuritis with full recovery in 2 months. 3) Peripheral neuropathy usually dose dependent, with different clinical presentations: polyneuritis with sensory, motor, or both deficits, and few cases of tetraplegia. 4) Encephalopathy frequently associated with one of the precedent symptoms, having a favorable outcome (probably resulting in inhibition of dopamine-beta-hydroxylase by disulfiram). The mechanism of toxicity (direct or idiosyncractic) remain unclear. Disulfiram has been used safely in millions of people since 1948, and we have only few cases reports of severe toxicity. From a practical point of view, treated patients should benefit by a neurological examination once a month, ophtalmological examination every 2 months, and hepatic enzymes monitored twice a month during the 2 first months. This is the price to prevent and to detect side effects of disulfiram therapy.

"I just cope from day to day": unpredictability and anxiety in the lives of women

Data are presented from in-depth interviews with 35 women in an industrial town in South Wales, U.K., many of whom were from low income households. The research aimed to explore women's own concerns about their health and the ways in which health problems affected their lives. This paper focuses on one prominent theme in these interviews: unpredictability. In particular, women described how their lives had become less predictable and amenable to control as a result of health problems--epilepsy, asthma, ME, anxiety, nerves and panic attacks, for example. Women's accounts are used to show how they experienced these problems, how they influenced women's self-identity and the ways in which women struggled to cope with the dreadful uncertainty that characterized their days. They often hid these problems, and the privacy of this aspect of their lives is striking. The data are set within the context of class and gender relations which diminish women's control over their lives and erode their self-esteem and sense of autonomy. Class and gender combine with ill health to create the conditions for women's sense of unpredictability and powerlessness. They can aggravate and provoke the health problems women described: women spoke of the challenges they faced in their roles as wives and mothers, the problems associated with widowhood, the loss of their jobs, the impact of unemployment and their efforts to cope with severe financial problems. In part, these provided them with a framework for understanding the uncertainty, anxiety, nerves and panic they experienced.

Myasthenia gravis in childhood and infancy. Usefulness of electrophysiologic studies

The diagnostic yield of electrodiagnostic tests was evaluated in 21 children with myasthenia gravis (MG). Twelve children had juvenile autoimmune MG, four had neonatal MG, four had congenital MG, and one had MG with arthrogryposis. Repetitive stimulation (RS) of the ulnar nerve was performed in every patient, sometimes with sensitization by ischemia. When the RS test was negative, the spinal or facial nerve was tested. In the group with neonatal MG, the RS test disclosed a significant decrement in 75% of the patients. Among the 17 other children, the overall percentage of positive RS tests was 88%. An ulnar nerve RS test was positive in 41% of them. Sensitization of ulnar nerve RS by ischemia improved the diagnostic yield to 66%. A spinal or facial nerve RS test was positive in seven of 10 patients. These results confirmed the diagnostic value of RS, with sensitization by ischemia, when necessary, in childhood MG whenever a careful technique is provided.

No association or linkage with HLA-DR or -DQ genes in South Indians with pulmonary tuberculosis

Studies of the HLA class II genes were performed in patients and multiple families with pulmonary tuberculosis from South India to seek any association of disease susceptibility with an individual allele or haplotype. TaqI RFLP analysis of HLA-DRB, -DQA and -DQB genes was done in 38 patients and 36 healthy control subjects. No significant association with any particular allele or haplotype was obtained. Linkage analysis performed in 12 families and haplotype sharing analysis in 9 families showed that the genetic susceptibility to pulmonary tuberculosis was not linked to the HLA region. The results suggest that the RFLP patterns of HLA class II genes DRB, DQA and DQB are not associated with susceptibility to pulmonary tuberculosis and that the genes controlling susceptibility or resistance may be located outside the HLA region.

Korsakoff's syndrome as the initial presentation of multiple sclerosis

A 37-year-old man presented with an acute amnestic syndrome of Korsakoff's type and an upper brain-stem oculomotor syndrome. After a moderate improvement with steroid therapy, he developed progressive behavioural changes due to a frontal lobe syndrome, in addition to motor and visual impairment. Memory performance was investigated on several occasions during an 11-year follow-up. Diagnosis of laboratory-supported definite multiple sclerosis was established and magnetic resonance imaging showed disseminated white matter lesions, especially in both medial temporal lobes. No other cause than multiple sclerosis was found for the amnestic syndrome. Among the rare cases of Korsakoff's syndrome in the course of multiple sclerosis, this is to our knowledge the first case in which a memory deficit was the initial manifestation of the disease.

Fulminant myasthenia gravis soon after initiation of acebutolol therapy

We report the case of myasthenia gravis in a 74-year-old woman, 2 weeks after acebutolol had been introduced as the sole treatment for systemic hypertension. The disease developed at a fulminant and fatal course despite drug withdrawal. The possibilities of coincidental association between the two events, triggering of a preexisting latent myasthenia gravis or full induction of the disease by acebutolol, are discussed.

Bombesin and nutrients stimulate release of CCK through distinct pathways in the rat

An isolated, vascularly perfused duodenojejunum model was developed in the rat to investigate the mechanisms involved in the release of cholecystokinin (CCK) by vascular bombesin (BBS) and luminal nutrients (LN). Immunoreactive peptides released into the portal vein effluent were measured with three antisera that were relatively CCK specific, gastrin specific, and cross-reactive to both CCK and gastrin, respectively. Bombesin (10(-7) M) provoked a biphasic release of CCK, consisting of a transient rise (approximately 700% above basal) followed by a sustained response (approximately 250% above basal). Gastrin accounted for less than 25% of the total immunoreactivity as measured with the nonspecific antiserum. The two phases of the CCK response were related to the dose of BBS in the range 10(-10)-10(-6) M, with a half-maximal effect at 10(-8) M BBS. Tetrodotoxin (TTX, 10(-6) M) reduced the second phase only (by 80%), whereas hexamethonium (10(-4) M) and atropine (10(-5) M) left the two phases unaltered. LN induced a prompt and well-sustained release of CCK (approximately 250% above basal) that was not affected by arterial TTX or atropine. These results demonstrate that BBS stimulated the release of CCK through both a direct pathway and an indirect, noncholinergic mechanism, while the effect of LN did not appear to involve intramural nerves.

A rare case of 68,XX triploidy diagnosed by amniocentesis

68,XX triploidy was found in the amniotic fluid cell culture of a 40-year-old patient. Elective termination of the pregnancy revealed a fetus with multiple congenital anomalies. While this case does show some common features with monosomy X, a greater similarity to the triploidy syndrome is observed.