Case report of an elderly woman who developed a pain disorder following her husband's death]

We present the case of an elderly woman who developed a pain disorder following her husband's death. This patient consulted two or three gynecology clinics with anxiety due to external genital pain, the cause of which could not be identified. Subsequently, the patient came to our university hospital where she was diagnosed with "pain disorder" and "depression" by a psychiatrist. With medication and supportive psychotherapy, the patient showed positive clinical progress. The operational diagnosis of pain disorder was useful as it permitted the establishment of a diagnosis for a patient with pain, the cause of which could not be identified. In this case, the patient's external genital pain was thought to be a symptom of her loss of sexual identity and her depression following the death of her husband. It has been reported that such somatic pain appears when the patient does not mourn, leading to pathological symptons. Therefore, in supportive psychotherapy, it is important to listen carefully to the patients' complaints about their pain in order to provide them with the opportunity to finish grieving. As a complementary therapy to SSRI medication, supportive psychotherapy contributed strongly to this case's recovery.     

Case of amyloid polyneuropathy]

The authors report a case of sporadic secondary amyloidosis with polyneuropathy in a patient aged 50 years. The disease developed during chronic pyelonephritis. The case is described in view of its rare occurrence, diagnostic difficulties and interesting histological findings.     

Case of Behcet's disease]

The author reports a case of Beh?et's disease in a 45-year-old man with eye lesions, changes on the skin and in the nervous system with inflammatory changes in the cerebrospinal fluid. The course of the disease was chronic, with periodic exacerbations. Steroid treatment gave good results.     

A suspected case of alcoholic pellagra encephalopathy with marked response to niacin showing myoclonus and ataxia as chief complaints]

We report a 47-year-old alcoholic man with alcoholic pellagra encephalopathy (APE) showing myoclonus and ataxia as chief complaints. He had been a heavy drinker for 30 years. He had noticed appetite loss and subsequently showed a subacutely progressive gait disturbance. He had no history of diarrhea, dementia, or dermatitis. On admission, he showed severe alcoholic liver cirrhosis with a large amount of ascites, limbs and truncal ataxia, myoclonus of the limbs and areflexia, although his consciousness was alert and there were no sign of dermatitis. Though the plasma level of ammonia was normal, we started administration of amino acids suspecting hepatic encephalopathy. Symptoms showed no improvement, and subsequent administration of thiamine was also ineffective. A decreased serum level of niacin was demonstrated. After administration of nicotinamide, the symptoms improved gradually. This patient received a diagnosis of APE. Endemic pellagra, characterized by the classical triad of dermatitis, diarrhea and dementia, is known to be caused by a dietary deficiency of the niacin, and has now become very rare in developed countries. At present, pellagra is encountered most often in patients with chronic alcoholism, which is called APE. APE patients often show only disturbance of consciousness. Although several reports has described ataxia and myoclonus in patients with APE, APE patients with myoclonus and ataxia as chief complaints have not previously been reported. On autopsy cases, central chromatolysis of neurons in the dentate nucleus of the cerebellum, gracile and cuneate nuclei, and the Clarke's column has been demonstrated. The APE patients would show myoclonus and ataxia as their first symptoms. In conclusion, we would like to emphasize that administration of niacin should be started for the treatment of chronic alcoholic patients showing myoclonus and ataxia even without the classical triads found in endemic pellagra patients.     

Early complications following intracranial surgery]

The authors discuss early non-inflammatory postoperative complications developing in the first week after operations. The reported material comprised 97 patients from among 1 815 cases treated surgically in the years 1971--1973 at the Departments of Neurosurgery and Neurotraumatology, Medical Academy in Cracow. The most frequent causes of reoperations were brain oedema, epidural haematoma and haematoma in the empty space left after evacuation of lesion. In the group of reoperated patients the percent of fatal cases increased to 56,7%.     

Long-term prognosis following cerebrovascular disease]

A follow-up study on 885 cases of cerebrovascular disease who survived acute stage and were registered through prevalence survey in 1983, had been carried out for 5-8.5 years. The results shown that 34.58% died, 34.13% were independent and 31.29% needed help in various degrees. The older the age was, the worse the prognosis was. After 3, 5 and 8 years, the survival rates of the cases were 86.98%, 75.70% and 64.26% respectively, and all were lower than that in general population. The difference of survival rates between the ischemic cases and the hemorrhagic cases was not found.