Seizures induced by thinking

A patient with generalized convulsions noted that seizures were reliably precipitated by mental arithmetic. The interictal electroencephalogram revealed only a mild, diffuse, nonspecific disturbance, but bursts of generalized epileptiform activity with no obvious clinical expression accompanied efforts at mental arithmetic with a significantly high incidence. Tasks involving multiplication, division, and manipulation of spatial information were significantly associated with discharges, but few, if any, discharges appeared when addition and subtraction tasks of equivalent difficulty were performed. Tasks involving the retention of numerical information in short-term memory (e.g., immediate repetition of a series of 8 digits) were never associated with paroxysmal EEG activity. It is argued that generalized epilepsy of this kind may be related to focal dysfunction in a manner analogous to the involvement of the occipital lobe in cases of pattern-sensitive epilepsy.     

Transient asystole associated with amphotericin B infusion

Amphotericin B, a systemic antifungal agent, has not been associated with clinical evidence of cardiac toxicity. We report the case of a 76-year-old patient who developed transient asystole with cardiovascular collapse on two occasions, which coincided with infusion of amphotericin B. The patient was semicomatose and had candida septicemia and renal failure. Serum potassium and digoxin levels were elevated, and serum calcium was low when these episodes occurred. Subsequent postmortem examination revealed no gross evidence of cardiac disease apart from fungal vegetations on the aortic valve. A clear causal relationship between amphotericin B and transient asystole is not demonstrated, but a temporal association, confirmed with rechallenge, is documented in this patient. No similar cases were found in a review of the literature.     

Comparison of pilcher bag technique with standard suprapubic prostatectomy

A total of 930 cases of open prostatectomies done at Lenox Hill Hospital from 1965 to 1974 are reviewed. The Pilcher bag technique utilized in 830 cases is compared with 100 cases of suprapubic prostatectomy with suturing of the bladder neck. Operating time, intra- and postoperative blood transfusions, hospital stay, and complications are compared. Operative time and intra- and postoperative blood loss are significantly less with the Pilcher bag technique.