Aphysiologic performance on dynamic posturography

The remarkable ability of the body to maintain balance is the result of central nervous system integration of sophisticated inputs from the vestibular, visual, and somatosensory systems. Strategies by patients with balance dysfunction are aphysiologic when their performance is relatively better on more difficult conditions of sensory conflict than on easier ones. Twenty-two aphysiologic patterns on computerized dynamic posturography were compared with age-matched normal and vestibular patterns. The aphysiologic group performed significantly better than the patients in the vestibular dysfunction group on the most difficult subtests of computerized dynamic posturography, conditions 5 and 6, yet significantly poorer on the easier subtests, conditions 1 through 4. In addition, patients in the aphysiologic group tended to show greater intertrial variability compared with patients in both normal and vestibular system dysfunction groups. A stepwise linear discriminant analysis was used to determine a set of conditions that had significant value in discriminating between the three patient groups. Case studies are presented to further illustrate the clinical usefulness of computerized dynamic posturography testing in the evaluation of patients suspected of having a functional component to their on-feet balance problems. (OTOLARYNGOL HEAD NECK SURG 1995;112:676-88.)     

Aspergillus Fumigatus Infection of an Automatic Internal Cardiac Defibrillator

We report a patient without immune compromise with infection of an automatic internal cardiac defibrilla- tor patch due to Aspergillus fumigatus presenting 8 years after implantation. The mechanism of infection was unknown, but symptoms began 1 month after laser uvulopalatopharyngoplasty was performed for sleep apnea. The patches were surgically removed and the patient was treated sequentially with amphotericin B and itraconazole. He remains without evidence of infection 12 months after the completion of therapy.     

THE INFLUENCE OF ANTITHYROID DRUGS AND IODINE ON THYROID CELL MHC CLASS II ANTIGEN EXPRESSION

We have investigated the influence of antithyroid drugs (methimazole and propylthiouracil) and sodium iodide on the expression of major histocompatibility (MHC) class II antigen expression in human and rat thyroid cells. While methimazole and propylthiouracil significantly inhibited lectin-induced MHC class II (HLA-DR) antigen in crude human thyroid monolayer preparations these drugs had no influence on gamma-interferon induction of class II antigens in similar cell preparations. Hence, antithyroid drugs probably had a direct effect on thyroid monolayer T cells which are known to effect the lectin induction of MHC class II antigen via T-cell secretion of the cytokine, gamma-interferon (IF). Sodium iodide, similarly, had no direct influence on human thyroid cell MHC class II antigen expression induced by gamma-IF. However, iodide significantly inhibited the gamma-IF-induced expression of MHC class II antigens in a proliferating rat thyroid cell clone derived from FRTL-5 cells (clone 1B-6). In the rat thyroid cell clone this antagonistic action appeared to be exerted via inhibition of TSH-induced proliferation. These data add further support to the multifactorial nature of the profound immunosuppressive influence of antithyroid drugs in autoimmune thyroid disease and experimental thyroiditis. In contrast, iodides may have a major, and often overlooked, influence on thyroid cell proliferation and antigen expression.     

CHOLECYSTOKININ (PANCREOZYMIN)

The acetyl-derivative of the biologically active C-terminal 7-peptide portion of cholecystokinin (CCK), N-acetyl-O-sulfate-L-tyrosyl-L-methionyl-glycyl-L-tryptophyl-L-methionyl-L-aspanyl-L-phenylalanine amide was prepared by the condensation of 2-peptide segments with 1-isobutyloxycarbonyl-2-isobutyloxy-1,2-dihydroquinoline as coupling reagent. The N-terminal residue, tyrosine, was incorporated by the active ester method. The same 7-peptide was prepared also by stepwise chain-lengthening, starting with the C-terminal residue. The 9-fluorenylmethyloxycarbonyl group was applied for the protection of α-amino functions. In the release of amylase from acinar cells of the pancreas of guinea pigs, the acetyl-7-peptide amide was about 3 times more potent than CCK 27–33 and equal in potency to CCK 26–33. The new derivative strongly stimulated the contraction of the in situ guinea pig gall bladder.     

EXTERNAL HORDEOLUM (STY) CAUSED BY INFECTION WITH TRICHOPHYTON MENTAGROPHYTES

ABSTRACT: A 6-year-old boy developed a sty of his right eye lid. This was proven to be caused by Trichophyton mentagrophytes which was also recovered from a pet guinea pig.     

Infant mortality from spina bifida, congenital hydrocephalus, monstrosity, and congenital diseases of the cardiovascular system in England and Wales

The epidemiology of congenital abnormalities is reviewed and the data available in the Registrar General's Annual Reviews for England and Wales from 1848 to 1967 are analysed statistically. The time and place of reported epidemics of spina bifida and anencephalus are tabulated. It is concluded that the pattern of epidemics of dysraphism in time and place is inconsistent with a viral aetiology, and it is suggested that a proportion of embryos may be genetically susceptible to an antimetabolite present in a food under certain conditions of preservation, preparation or storage.     

CYSTIC FIBROSIS OF THE PANCREAS IN ADOLESCENCE AND ADULTHOOD

Since an increasing number of patients with cystic fibrosis now reach adolescence and adulthood, more will be treated by general physicians. Since 1953 approximately 200 patients have been cared for in this unit, and in January, 1967, 31 were over 14 years of age; five of these have since died, and their modes of death (chest infection and respiratory failure, three; moderate chest disease, massive hæmoptysis, one; mild chest disease and progressive liver disease, one) are considered. The clinical state of the survivors varies greatly and allows discussion of the natural history of the disorder. The well-being of patients depends both on the intrinsic severity of the manifestations of the disease and the efficacy of treatment. With careful attention to chest disease most of these older patients manage to lead relatively active lives and are in most instances gainfully employed.