Treatment of post herpetic neuralgia in the elderly

The incidence of acute herpes zoster and post herpetic neuralgia (PHN) increases with age. PHN resolves spontaneously within three months in approximately 50% of cases, although 22% experience discomfort for more than a year. There is little good evidence that treatment with antiviral agents, corticosteroids, local and regional anaesthesia, amantadine or levodopa in the acute stage can prevent the development of PHN. However, few studies have sufficient statistical power to allow firm conclusions to be drawn. Amitriptyline is beneficial in patients with established PHN and has an analgesic effect which is independent of its antidepressant action. Anticonvulsants and neuroleptics are of unproven efficacy and should be avoided in the elderly as side effects are common. Various local anaesthetic and surgical techniques may provide temporary relief in individual patients although none has been shown to produce consistent benefit. Transcutaneous electrical nerve stimulation (TENS) is free from adverse effects and appears to benefit some patients. Intractable pain often results in over-prescribing with the risk of adverse drug reactions. Drug therapy should be minimized with careful assessment of the risk/benefit ratio for any additional medication.     

Experimental studies on the comparative infectivity and pathogenicity of Streptococcus suis type 2. II. Porcine and human isolates in laboratory animals

Mice, rats, guinea-pigs and rabbits were inoculated with isolates of Streptococcus suis type 2. An isolate cultured from the tonsils of a healthy pig, produced disease in rabbits after intravenous inoculation but not in mice, rats or guinea-pigs. An isolate of S. suis type 2, that was pathogenic for pigs and had been cultured from a human patient with clinical disease, produced signs of neurological disease in mice, rats and rabbits following intravenous inoculation. There was an apparent dose response in mice with 31% of mice receiving more than 10(6) organisms developing clinical disease, whilst mice receiving less than this did not develop disease. There were no detectable histopathological lesions in the brains or meninges of mice with nervous signs. It is proposed that the disease in mice may mimic that reported in humans and that mice may be a useful indicator species for determining the virulence of isolates cultured from pigs.     

Cardiac abnormalities in the fragile X syndrome.

Twenty three patients with fragile X syndrome underwent cardiovascular assessment. Echocardiography showed dilatation of the aortic root in 12 (52%) and mitral valve prolapse in five (22%), four of whom had an apical mid-systolic click on auscultation. Patients with fragile X syndrome have cardiac defects similar to those seen in other disorders of connective tissue such as Marfan's syndrome and Ehlers-Danlos syndrome. These, and other somatic features, suggest an underlying connective tissue dysplasia.     

Relative effect of surgery and radiotherapy on the internal jugular vein following functional neck dissection

We examined the internal jugular veins in three groups of patients who had undergone (1) a functional neck dissection and radiotherapy, (2) a functional neck dissection alone, or (3) radiotherapy alone, using a noninvasive color Doppler ultrasound scan. The internal jugular veins were ultrasonically bilaterally normal in 18% of patients who had undergone a functional neck dissection and radiotherapy, in 88% of patients who had undergone a functional neck dissection alone, and in 57% of patients who had undergone radiotherapy alone. The combination of a functional neck dissection and radiotherapy significantly affected the internal jugular vein when compared with a functional neck dissection alone.     

Pure partial trisomy for long arm of chromosome 9.

A case of a 4-year-old boy with trisomy of the long arm of chromosome 9 is described (46,XY, der (9), t (9;9) (q32;q12)). The trisomy is probably the result of a translocation of the long arm of the chromosome from one homologue to the other in a parental gonad. The clinical features of the child which include severe developmental retardation, bird-like facies, tapered fingers, and flexion contractures of the legs are similar to those of the few cases described of trisomy of the whole chromosome.