Clozapine, ECT, and Schizoaffective Disorder, Bipolar Type

Opinions differ regarding the risks and benefits of the concurrent use of antipsychotic medication and ECT. A case example is presented of the safe and effective concurrent use of ECT and the newly available neuroleptic clozapine in a young patient with schizoaffective disorder, bipolar type. The patient's pulse did climb as high as 170-180 beats/min during a few of the seizures. More experience is needed with the combined use of clozapine and ECT.     

Reliability of Testing the Knee Extensors and Flexors in Healthy Adult Women Using a Cybex II Isokinetic Dynamometer

This work was supported by NIH grant P50-AR39221. The purpose of this study was to determine intraobserver and interobserver reliability using a Cybex II isokinetic dynamometer for the measurement of isometric and isokinetic strength (0, 60, 180, 300 degrees /sec) and endurance (240 degrees /sec) in 20 healthy untrained females. Subjects were randomly assigned to one of two testers. Intraobserver reliability coefficients for tester one and tester two ranged from 0.89 to 0.98 and 0.72 to 0.97, respectively. Interobserver reliability coefficients ranged from 0.69 to 0.95 across speeds and movements. Although the testers differed significantly in reliability (p < 0.01), no systematic differences in measured levels of performance were noted between testers one and two for the majority of the measurements. The results indicate that comparable muscular strength and endurance values can be obtained from knee extension/flexion tests at various speeds using a Cybex II isokinetic dynamometer. Comparable values were obtained whether subjects were tested by a single tester on two separate occasions or whether subjects were tested by a different tester on two separate occasions. J Orthop Sports Phys Ther 1991;14(1):37-41.     

Sequential electrodiagnostic evaluation of diabetic neuropathy after combined pancreatic and renal transplantation

To asses the long-term evolution of diabetic polyneuropathy after a combined kidney-pancreas transplant, an electrophysiological study was performed in 20 diabetic patients before transplant, and 1 (n=18), 2 (n=16), 3 (n=10) and 4 years (n=5) at a later date. Motor and sensory scores were calculated for conduction velocity and amplitude to determine the physiopathological process. During evolution the scores were not found to be decreasing. Motor and sensory velocity scores were significantly improved (p<0.05) 1=" and=" 2=" years=" after=" the=" graft,=" when=" score=" values=" tended=" to=" stabilize.=" motor=" and=" sensory=" amplitude=" scores,=" which=" are=" more=" sensitive=" for=" axonal=" loss=" assessment=" were=" slightly=" but=" not=" significantly=">     

Hypoxia and cyanosis in alpha-1-antitrypsin deficiency. Cirrhosis as an unusual etiologic factor

A patient with type PiZZ alpha-1-antitrypsin deficiency was found to have severe hypoxia despite normal pulmonary function testing and a normal chest radiograph. A nuclear medicine ventilation-perfusion study revealed a right-to-left shunt. Computed tomography showed minimal bleb formation, no diffuse changes, and hepatic changes of cirrhosis with portal hypertension. No nodular pulmonary masses or enlarged peripheral pulmonary vessels were found. The diagnosis of diffuse intrapulmonic arteriovenous shunts ("pulmonary spiders of cirrhosis") was suggested and then confirmed with a dynamic radionuclide flow study.     

Anaesthetic considerations in down’s syndrome: experience with 100 patients and a review of the literature

Down’s Syndrome (Trisomy 21, T21) occurs in approximately 0.15 percent of live births. In addition to the stigmata of the syndrome, other congenital defects are frequently found in these patients. Cardiac lesions are particularly prominent. To determine the complications associated with anaesthesia and surgery we examined the records of 100 consecutive patients (58 males, 42 females) who underwent surgery with general anaesthesia during a two year period, from March 1978-March 1980. In addition to the cardiac lesions, the low birth weight of Trisomy 21 infants, increased suceptibility to infections, atlanto-occipital dislocation, and reduced central nervous system catecholamine levels might be expected to result in an increased incidence of complications. This study of 100 patients with Trisomy 21 (T21) indicates that the incidence of complications is low. However, the anaesthetist must understand the pathophysiology of T21 in order to provide optimal anaesthetic care.     

Huntington's Disease — Imbalance of free amino acids in the cerebrospinal fluid of patients and offspring at-risk

Summary A total of 27 different amino acids were determined in the fasting, morning lumbar CSF of 12 patients with Huntington's Disease (HD), 8 at-risk offspring and 16 non-choreic control patients. A significant (P<0.001) decrease was observed for asparagine, isoleucine, leucine, phenylalanine, histidine, arginine, -aminoadipic acid and homocarnosine in patients with HD compared to the non-choreic controls. Only tyrosine was increased in HD. These alterations were to an extent more pronounced in 5 neurophysiologically conspicuous offspring. The alterations suggest that amino acid imbalance is an early metabolic disturbance in HD.

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Zusammenfassung Bei 12 Patienten mit manifester Huntingtonscher Krankheit (HD), 8 nicht erkrankten Nachkommen und 16 nicht choreatischen Kontrollpatienten wurden 27 verschiedene Aminosäuren im Liquor cerebrospinalis (nüchterner Lumballiquor) untersucht. Asparagin, Isoleucin, Leucin, Phenylalanin, Histidin, Arginin, -Aminoadipinsäure und Homocarnosin waren signifikant (P<0.001) erniedrigt bei Patienten gegenüber den Kontrollen. Diese Veränderungen waren bei 5 neurophysiologisch auffälligen Nachkommen teilweise ausgeprägter, was für eine frühzeitige metabolische Störung spricht. Tyrosin war als einzige Aminosäure erhöht. Die Veränderungen sprechen für eine Aminosäurenimbalanz bei Huntingtonscher Krankheit, deren Bedeutung besprochen wird.

     

Adrenomyeloneuropathy

Summary Adrenomyeloneuropathy (AMN) is reported in two kindreds. In the first family, four male patients were affected: two adults with the full clinical picture but with a different chronology of the main symptoms, a third adult with central nervous system involvement and a child who died early with adrenal insufficiency. The second family included two male patients with AMN, one adult with raised ACTH levels and his nephew with normal adrenal function. Two other young males died with adrenoleukodystrophy (ALD), one being subjected to a postmortem study.Clinical, endocrinological, neurophysiological and pathological studies were performed.The following conclusions can be made: (1) AMN and ALD are closely related entities; (2) there exists a considerable intrafamilial variability of the clinical picture; (3) AMN is to be included in the differential diagnosis of myelopathies and, conversely, signs of central nervous system damage must be sought in male patients with adrenal insufficiency; (4) electron microscopy of nerve twigs brings supportive diagnostic evidence pending the more widespread determination of the C26/C22 fatty acids ratios in cultured fibroblasts or plasma.This paper has been financially supported by the Fonds voor Geneeskundig Wetenschappelijk Onderzoek (grant no. 3.0004.81) and by the Baron Charles Bracht Foundation     

Radionuclide scanning in pseudo-Kaposi's sarcoma.

Sodium pertechnetate Tc 99m radionuclide scanning is considered to be a sensitive indicator in detecting lesions of Kaposi's sarcoma, including occult infiltrations. This report describes a "false-positive" scan in a patient with acroanglodermatitis (pseudo-Kaposi's sarcoma); therefore, this technique may not be useful in the differential diagnosis of these two clinically and histologically similar diseases. We suggest, instead that the technetium scan may be helpful in deciding on the course of therapy in acroangiodermatitis by demonstrating the nature of the underlying vascular anomalies.