Medullary paracoccidioidomycosis: report of a case

Paracoccidioidomycosis of the central nervous system presents either as meningeal or pseudotumoral lesions. Although occurring more frequently in the brain and meninges, they can occasionally involve the spinal cord. A case of paracoccidioidomycosis in the cervical spinal cord is reported in this paper. Difficulties in establishing the etiologic diagnosis, the importance of radiologic examination of the thorax, and the treatment of the patient are commented. In an extensive review of the literature on the subject, only three other cases have been found, which are also discussed.     

Are ADDH and ADHD the same or different?

To assess the relationship between the DSM-III criteria for attention deficit disorder with hyperactivity (ADDH) and the DSM-III-R criteria for attention-deficit hyperactivity disorder (ADHD), children from an inner city parochial school were evaluated using a 30-item teacher questionnaire consisting of the DMS-III and DSM-III-R criteria for these disorders, the revised Conners Parent and Teacher Questionnaires, and a continuous performance test. Diagnostic groups were established based on teacher ratings of the DSM items and evaluated in relation to the rating scale data and continuous performance test. While children who were identified by teachers as having ADDH almost always satisfied the criteria for ADHD, a new group of children who were hyperactive and impulsive but less clearly inattentive also met the criteria for ADHD. Implications of the change in diagnostic criteria are discussed.     

Nuclear medicine diagnosis of the thyroid

The progress made in ultrasonography and improved in vitro tests have changed the field of application for scintigraphy of the thyroid. Thyroid scanning itself has been improved by the use of isotopes with better imaging properties and less radiation burden (99mTc, 123I) and by gamma cameras for imaging. Scintigraphy yields real topographic and functional information on the gland, in addition to which ultrasonography gives morphological data only. This holds true especially for autonomous nodular goiter with iodine deficiency. The goal of thyroid imaging is always to match the appropriate diagnostic procedure with all the clinical data available. When optimized techniques (gamma camera, on-line processor) are used thyroid scintigraphy is useful for the diagnosis, adequate therapy and follow-up of various thyroid disorders.     

Results of long-term leukocyte interferon (alpha IFN) therapy using an individually determined dose schedule in recurrent laryngeal papillomatosis

Out of 24 patients with laryngeal papillomatosis 6 (5 female, 1 male) suffered from repeated relapses and underwent long-term treatment with alpha-IFN-therapy. Age at onset of the disease: 1 5/12-16 2/12 years. Duration of illness: 1-7 years, with several relapses were treated surgically and with laser-coagulation. Three out of 6 patients had a tracheal cannula and were cauterized by podophylline at 2-4 week intervals. IFN was given in dosages of 5-20 X 10(4) U/kg 2 or 3 times a week. IFN-dosage for each patient was determined using the induction kinetics of (2'-5')-oligo(A)synthetase (OAS) in the mononuclear cells of the circulating blood of patients with laryngeal papillomatosis. A continuous effect could be achieved by the dose of IFN determined in the described way always before OAS activity decreased to its initial level. All 6 patients responded favorably to the alpha-IFN-therapy. Two patients treated only with IFN showed remission without relapses. In 2 cases IFN was successfully used to prevent relapses after surgical treatment and laser-coagulation. In 2 patients with papillomatosis extending into the main bronchi the disease could only be brought to a standstill, i.e. it was not necessary to remove the papillomas. Two out of 3 patients with laryngeal papillomatosis could be decannulated. Long-term therapy following the above described principles is efficient and without significant side-effects. Three patients are in treatment for more than 3 10/12 years.     

PILOT PROJECTS TO STIMULATE ADVERSE DRUG REACTION REPORTING

Schemes for stimulating adverse drug reporting are described with particular emphasis on a recently introduced Mississippi Adverse Drug Reaction Reporting Programme.     

A proposed classification of swollen legs

The subject of enlarged legs is vast and complex. Up to now there has been no organic classification of the clinical picture involved. The basic problem is that of the criterion on which to base the classification. Literature on this subject has opted for the pathogenic criterion because it seems to facilitate the formulation of a classification which is of use to the doctor. One possibility would be to divide the syndrome into vascular and non-vascular swollen legs. The first group could in turn be separated into macro-circulating and micro-circulatory. The micro-circulatory forms can be primitive or secondary. Amongst the secondary micro-circulatory forms, two other groups can be singled out: secondary forms with local cause and secondary forms caused by organic pathology. However, there are clinical forms which are on the periphery of these different groups and these forms are subject to discussion regarding nosographic localization.     

Bonnet syndrome and posterior parasagittal tumor: clues to neural mechanisms

A case of Bonnet syndrome associated with blindness due to bilateral eye disease and a posterior parasagittal meningioma is reported. It is assumed that visual afferent deprivation alone is not enough to produce the syndrome and that, in most instances, a 'cerebral factor' must be operative if hallucinoses are to occur. The distinction between hallucinosis and hallucinations is favored and a common neural circuit for the mediation of hallucinotic imageries in general is suggested. One should not immediately put the blame on obvious eye or visual pathways affections when facing cases of Bonnet syndrome, as they are not likely to explain the complex array of images perceived by any given patient. On the contrary, the possibility of a clinically covert intracranial disease should be always raised and intensively looked for.