Plasma 25-hydroxyvitamin D in pregnant Asian women and their babies

Plasma 25-hydroxyvitamin D (25-OHD) was measured in cord blood taken at delivery and in fasting blood taken from 44 Asian mothers in the first day of the puerperium. Blood was taken from the baby 48 h after delivery. Cord-blood samples were also taken at 43 non-Asian deliveries. Plasma 25-OHD concentrations in Asians were low at delivery; in 81% of the mothers and 36% of the babies plasma 25-OHD was in the osteomalacic range. Asian lower than concentrations in non-Asian controls. 4 Asian babies had vraniotabes and 1 had neonatal tetany. 1 non-Asian baby had craniotabes. A review of 3327 deliveries in 1978 confirmed that neonatal tetany was significantly more common in Asian babies (2.3%) than in non-Asian babies (0.3%). In 44 other Asian mothers supplements of 1000 units of vitamin D daily during pregnancy significantly increased plasma-25-OHD concentrations at delivery.

Active and passive characteristics of the canine cricothyroid muscles

Active and passive characteristics of the canine cricothyroid muscle were investigated through a series of experiments conducted in vitro and compared with their counterparts in the thyroarytenoid muscle. Samples from separate portions of canine cricothyroid muscle, namely, the pars recta and pars obliqua, were dissected from dog larynges excised a few minutes before death and kept in Krebs-Ringer solution at a temperature of 37 degrees C +/- 1 degrees C and a pH of 7.4+/-0.05. Active tetanic stress was obtained in isometric and isotonic conditions by applying field stimulation to the muscle samples through a pair of parallel-plate platinum electrodes and using a train of square pulses of 0.1-ms duration and 85-V amplitude. Force and elongation of the samples were obtained electronically with a dual-servo system (ergometer). The results indicate that the dynamic response of the canine cricothyroid muscle is almost twice as slow as that of the thyroarytenoid muscle. The average 50% tetanic contraction times for pars recta and pars obliqua were 84 ms and 109 ms, respectively, in comparison to 50 ms for thyroarytenoid. The examination of force-velocity response of this muscle indicates a maximum shortening velocity of 2 to 3 times its length per second, which is about half of the thyroarytenoid shortening speed. The passive properties of the pars recta and pars obliqua portions are similar to those of thyroarytenoid muscle.

Neurogenic benign fasciculations, pseudomyotonia, and pseudotetany. A disease in search of a name

We studied two patients with abnormal spontaneous muscular activity. The first had widespread fasciculations, painful spasms, delayed muscular relaxation, and hyperhidrosis. Improvement occurred after several years. The second case had generalized paresthesia, mild stiffness, a positive result from Trusseau's test, and was relieved by administration of carbamazepine. Both patients had abnormal conduction velocity. Examination of muscle biopsy specimens disclosed fiber type grouping and increased collateral ramification of motor axons. These observations exemplify symptoms and signs that resemble those of myotonia and tetany and occasionally occur in partial denervation. they provide additional evidence of the neurogenic nature of Isaacs-Mertens syndrome.

Environmental illness in athletes

This article examines environmental illness in athletes. Causes, symptoms, and treatment of heat-related illness, cold-related illness, and altitude-related illness are discussed.

Postmortem biochemical markers of experimentally induced hypomagnesaemic tetany in sheep

Hypomagnesaemic tetany was induced in non-lactating and lactating ewes by feeding them semi-synthetic low magnesium diets containing additional potassium chloride and citric acid. Aqueous and vitreous humour were sampled from one eye at the time of death (fresh) and from the second eye after the head had been stored at ambient temperature for 24 hours (24-hour). There were significant relationships between the concentrations of magnesium in cerebrospinal fluid and plasma and its concentrations in fresh aqueous humour and fresh vitreous humour. Magnesium concentrations of < 0.33 mmol/litre in fresh aqueous humour and < 0.50 mmol/litre in 24-hour aqueous humour were associated with severe hypomagnesaemia and tetany. However, the concentration of magnesium in aqueous humour is relatively unstable and, unless the time of death was known accurately, its interpretation would be difficult. Magnesium concentrations of < 0.60 mmol/litre in fresh vitreous humour and < 0.65 mmol/litre in 24-hour vitreous humour were associated with severe hypomagnesaemia and tetany in adult sheep. The concentration of magnesium in vitreous humour was relatively stable for up to 48 hours postmortem.

Hypocalcemic tetany in the newborn as a manifestation of unrecognized maternal primary hyperparathyroidism

Primary hyperparathyroidism (PHP) during pregnancy is a very rare event that increases maternal and perinatal morbidity and mortality. We present a case in which hypocalcemic tetany of the neonatal infant - caused by transient hypoparathyroidism in the child - finally revealed asymptomatic maternal PHP. An apparently healthy 30-year-old woman had an uneventful pregnancy and delivery. On the 15th postpartal day, the newborn developed hypocalcemic tetany. After receiving supplementation of calcium and vitamin D, the child developed without further pathological findings. Laboratory and radiological studies in the mother led to a diagnosis of maternal PHP. An adenoma of the right lower parathyroid gland was subsequently removed. The search for the cause of hypocalcemia in a newborn should not focus on the patient alone. Examining the apparently healthy mother and approaching the case in a multidisciplinary fashion may benefit both the child and the mother.

The effect of abnormal maternal plasma calcium levels on the offspring of rats

Study of the offspring from parathyroidectomized and hypercalcaemic rats showed that both high and low levels of maternal plasma calcium produced abnormalities in the offspring. Both groups of offspring had hypocalcaemia at birth which reverted to normal by the 7th day of life. All the offspring grew poorly compared with controls. The growth defect in the offspring of the hypocalcaemic rats was reversed if the offspring were reared by normal rats, and in the offspring of the hypercalcaemic rats was accompanied by abnormalities of the fur, including focal alopecia, which reverted to normal when the offspring were weaned on to a normal diet. The calcium concentration in the milk of the hypercalcaemic rats was higher than that in the milk of normal and parathyroidectomized rats.

In the rat the plasma and milk calcium levels in the mother appeared to be important in the aetiology of neonatal hypocalcaemia and growth. It is suggested that the estimation of the plasma calcium in the mother should become a routine procedure in the investigation of cases of neonatal tetany in infants.

Tetany, tetanus or drug reaction? A case report

An 8-year-old child was given perphenazine to prevent vomiting after surgery and developed an acute dystonic reaction; There were features of both tetany and tetanus without any of the classical features of extrapyramidal disturbance. The diagnostic difficulties are discussed. The reaction was treated successfully with i.v. diazepam. The prescribing of anti-emetics after surgery is examined critically with special reference to children.

Toxoplasmosis. Historical review, direct diagnostic microscopy, and report of a case

A case of congenital toxoplasmosis diagnosed by the detection of Toxoplasma gondii organisms in the ventricular fluid of a living patient, confirmed by mouse inoculation, is reported. The subject of toxoplasmosis is reviewed historically, especially in regard to cases diagnosed by direct microscopic examination of cerebrospinal or ventricular fluids. Although several such cases have been reported in the world medical literature, an extensive survey failed to reveal such a case previously reported in the United States.

[Standardization of the electromyographic tetany test in the diagnosis of normocalcemic tetany: the 10-minute Trousseau test in patients and healthy humans]

Eighteen adult patients with typical history and signs of normocalcemic tetany (hyperventilation syndrome) and 18 age- and sex-matched controls were submitted to a provocation test for tetany. This consisted of 10-min ischemia of the right arm produced by suprasystolic cuff compression at the upper arm (Trousseau test) and a postischemic electromyographic recording from the right interosseous I muscle. Postischemic repetitive discharges were found in all patients and predominantly consisted of multiples of 5 times and more. These discharges lasted 8 min on the average. Of the normal controls, as many as 16 subjects (88.8%) also exhibited tetanic discharges. However, these preferred a lower number of repetitions, such as doublets or triplets. Both number of repetition and duration of postischemic tetanic activity were significant parameters discriminating between patients and controls (2P less than 0.001), as was the cumulative total number of spontaneous potentials, amounting, on the average, to 10,266 in the group of patients and to only 320 in the controls (2P less than 0.001). The investigation has shown that the occurrence of postischemic tetanic spontaneous activity per se does not help to discriminate between cases of latent tetany and healthy controls. However, a normocalcemic tetanic condition may be assumed if multiples occur with a complexity of quadruplets or more, if these multiples last at least 2 min, and if they appear in a rhythmic order and in groups.

Normal total plasma calcium in the newborn

The first week of human life is characterized by rapidly changing plasma calcium levels, as well as low concentrations in comparison with adults. Whereas the infant's cord blood has a higher concentration than the mother's blood, the level drops precipitously in the first 24 hr (first drop) after birth and reaches a minimum level (second drop) at about 48 hr. A third drop may follow between the fourth and seventh days, but is different from the other two in that it is generally preventable with proper milk feeding. The level is markedly influenced by starvation, diet, and age. During the first week, the full-term newborn may show calcium levels in the range of 1.75 to 3.00 mmol/1, whereas the premature newborn shows values of 1.50 to 2.50 mmol/1. The low birth weight infant displays intermediate values. The literature on diseases involving calcium in the newborn, particularly neonatal tetany, is especially helpful in establishing a concept of normal levels, providing clinically supported upper and lower values. Calcium studies on the new born have been notably advanced by use of sound ultramicrochemical analytical methods.

Stavudine induced acute necrotizing pancreatitis with tetany in a pediatric patient

A nine year old female patient presented with complaints of severe colicky abdominal pain, vomiting, and tingling with numbness for 3 days. Acute necrotizing pancreatitis associated with tetany due to anti-retroviral therapy was diagnosed. Stavudine was the probable causal agent. Unfortunately, the patient died due to severity of the reaction. High index of suspicion and early withdrawal of the offending drug may prevent further harm in such cases.

Migraine and Its Association with Hyperactivity of Cell Membranes in the Course of Latent Magnesium Deficiency-Preliminary Study of the Importance of the Latent Tetany Presence in the Migraine Pathogenesis

So far, there is no consistent and convincing theory explaining the pathogenesis of migraines. Vascular disorders, the effect of oxidative stress on neurons, and the contribution of magnesium-calcium deficiencies in triggering cortical depression and abnormal glutaminergic neurotransmission are taken into account. However, there are no reliable publications confirming the role of dietary deficits of magnesium and latent tetany as factors triggering migraine attacks. The aim of the study was to evaluate the influence of latent magnesium deficiency assessed with the electrophysiological tetany test on the course of migraine. The study included: a group of 35 patients (29 women and six men; in mean age 41 years) with migraine and a control group of 24 (17 women and seven men; in mean age 39 years) healthy volunteers. Migraine diagnosis was based on the International Headache Society criteria, 3rd edition. All patients and controls after full general and neurological examination were subjected to a standard electrophysiological ischemic tetany test. Moreover, the level of magnesium in blood serum was tested and was in the normal range in all patients. Then, the incidence of a positive tetany EMG test results in the migraine group and the results in the subgroups with and without aura were compared to the results in the control group. Moreover, the relationship between clinical markers of spasmophilia and the results of the tetany test was investigated in the migraine group. As well as the relationship between migraine frequency and tetany test results. There was no statistically significant difference in the occurrence of the electrophysiological exponent of spasmophilia between the migraine and control group. Neither correlation between the occurrence of clinical symptoms nor the frequency of migraine attacks and the results of the tetany test was stated (p > 0.05). However, there was an apparent statistical difference between the subgroup of migraine patients with aura in relation to the control group (p < 0.05). The result raises hope to find a trigger for migraine attacks of this clinical form, the more that this factor may turn out to be easy to supplement with dietary supplementation.