Continuous monitoring of panic

Data on naturally occurring panic attacks were gathered through continuous self-monitoring for 94 patients suffering from panic disorder with agoraphobia. A total of 1276 panic attacks were collected. In this article various aspects of panic attacks, including severity, duration and time of onset and situations in which panic occurs are addressed. In addition, the symptoms of panic were investigated, examining the (in)variability of attacks within each patient and the patterning of symptoms in the entire group of patients. The most important findings were as follows: attacks occurred predominantly in nonphobic situations; nocturnal panic attacks were generally more severe than attacks during the day; symptom patterns across various attacks, stemming from the same patient, were rather variable; and finally, a substantial number of the attacks (40%) did not meet the DSM-III-R criteria for number of symptoms.     

Lumbar nerve root: the enigmatic eponyms

Man's quest for recognition has not escaped the physician, whose contributions to medicine perpetuate his name in print. It is a final grasp for professional immortality, which for men like Imhotep and Hippocrates, has prevailed for millennia. This fervor was particularly evident in the latter 19th century, which created a flurry of eponyms, often two or more physicians publishing the same clinical observation. This article reviews the eponym epidemic as it relates to lumbar radiculopathy.     

Polyglucosan body axonal enlargement increases myelin spiral length but not lamellar number

The area of the unrolled myelin sheet of internodes of myelinated fibers (MF) of peripheral nerve is thought to be determined by axonal caliber and internodal length. We studied the effect of a focal increase of axonal caliber due to the deposition of polyglucosan bodies (PGB), amylopectin-like glucose polymers, on number of myelin lamellae (NL), interlamellar distance (periodicity), and myelin spiral length (MSL) from a sural nerve biopsy specimen of a patient with chronic inflammatory demyelinating polyneuropathy. Axonal area, NL, periodicity, and MSL were estimated within internodes of MF above, at, and below PGB. The axon caliber at the level of the PGB was significantly (P less than 0.002) increased when the PGB was included. At the PGB, NL and their periodicity were not significantly different from those above or below the PGB. The MSL was significantly longer overlying the PGB than it was in the same internode above or below the PGB. Because slippage or stretching of the myelin sheath as well as movement of molecular constituents of myelin is not likely over large distances, localized biosynthesis and assembly of new myelin may explain this increase of MSL.     

Application of immunohistochemical techniques to sural nerve biopsies.

The role of immunohistochemistry in the day-to-day diagnostic work of a peripheral nerve laboratory is not yet clearly established, although for conditions such as amyloid neuropathy, immunohistochemistry appears to be a useful adjunct to conventional techniques. Immunohistochemistry has provided new information about some neuropathies in which immune dysfunction is believed to play a central role. Immunohistochemical data about normal human nerve are scarce; a better appreciation of the normal cellular constituents of nerve, particularly the endoneurium, is needed. In the future, the techniques may be a means to understand better the pathogenesis of other types of neuropathy, such as inherited or toxic neuropathies, or to examine fundamental pathologic events such as axonal degeneration.     

Malignant fibrous histiocytoma of the pericranium: Case report

Summary Malignant fibrous histiocytoma only infrequently arises from structures of the head and neck. When it does, it most often originates in facial structures, particularly the maxilla.This case report details a malignant fibrous histiocytoma arising from the pericranium, and presenting clinically as a large indurated frontal calvarial mass. A CT scan showed its origin to be from the pericranium and demonstrated its intracranial extension.Radical excision presented a surgical challenge because of the extensiveness of the lesion. Yet, combined with post-operative teletherapy, a favourable outcome was obtained.     

Ulcerative balanoposthitis associated with non-syphilitic spirochaetal infection.

Ulcerative balanoposthitis associated with non-syphilitic spirochaetal infection was found in 41 (12%) of 344 consecutive men with genital ulcer disease in two clinics in South Africa. All patients with non-syphilitic spirochaetal infection were uncircumcised. Non-syphilitic treponemes were seen in only two of 60 uncircumcised men who had urethritis without genital ulceration. In 14 patients with ulcerative balanoposthitis no cause of genital ulceration could be identified. Most patients presented with large, serpiginous, superficial, foul smelling, and tender ulcers, the base of which was purulent with undermined edges. Non-tender inguinal lymphadenopathy was present in seven of 14 patients. One female sexual partner of a patient with non-syphilitic spirochaetal infection had a vaginal infection with non-syphilitic spirochaetes.     

Biochemical studies in a patient with a Tangier syndrome

The chemical composition of the major classes of lipids were evaluated in the plasma and in various other tissues of a 68-year-old woman with a syringomyelia-like syndrome affecting cranial, cervical and brachial regions. No tonsillar abnormalities were apparent on visual examination of the oropharynx but the absence of alpha-lipoproteins on serum lipoprotein electrophoresis prompted the tentative diagnosis of Tangier disease. The diagnosis was confirmed by lipid, lipoprotein and apolipoprotein analyses of the plasma. The plasma cholesterol was low (93-113 mg/dl) and the triglyceride concentration normal (133-160 mg/dl). The very low density lipoproteins had normal chemical composition and morphology, but migrated with beta rather than pre-beta mobility on paper electrophoresis. Low density lipoproteins were deficient in cholesteryl esters and enriched in triglycerides; their electrophoretic mobility and morphology were normal. A small amount of high density lipoprotein (approximately 1.4 mg/dl) was recovered from the plasma. This contained few particles of the size of normal high density lipoprotein and polyacrylamide gel electrophoresis of the lipid-free protein demonstrated a disproportionate increase in the A-II apolipoprotein. All of these abnormalities are consistent with Tangier disease. The serum concentration of glycosphingolipids was approximately 40% lower than normal, with the most marked reductions in the glucosylceramide (GL-1a) and trihexosylceramide (GL-3a) fractions. The relative quantity of long chain fatty acids (23 or more carbons) in serum sphingomyelin was reduced about 38% of that in control sera. Serum lecithin:cholesterol acyltransferase (EC 2.3.1.43; LCAT) activity was 25% of normal and the reduced activity was shown not to be related to a change of enzyme specificity or to a lack of appropriate substrate. These findings are likely related to the HDL deficiency which characterizes Tangier disease. A biopsy sample of apparently normal tonsil contained three to four times the normal amount of cholesterol, and the increase was due entirely to abnormal quantities of cholesteryl esters. Of great interest was the chemical documentation of increased cholesteryl esters in a nerve biopsy specimen. These findings indicate that the neurologic as well as the reticuloendothelial manifestations of Tangier disease may be related to cholesteryl ester accumulation. Lipoprotein profiles, their triglyceride and cholesterol concentration, and LCAT activity were obtained on the plasma of 7 closely related members of the kinship. None of these relatives were found to have the biochemical derangement of Tangier disease.     

Evidence for three populations by size in L5 spinal ganglion in man.

In recent morphometric studies of the cytons of lumbar motoneuron columns, it was possible to discriminate various populations by the criterion of size. It was felt that the use of celloidin embedding, optimal enlargement to increase the number of counting windows, and the use of improved morphometric analysis had been important to this discrimination. Employing the improved methods of histologic preparation and morphometry to a study of the L5 spinal ganglia of man, it has been possible to show tentatively that there are at least three populations of cytons by diameter. The average number of large, intermediate and small cytons were 11,429, 31,675, and 25,389 respectively. It should now be possible to test whether selective congenital absence or degeneration of any of these three populations of cell bodies is found in disorders affecting primary afferent neurons.     

Studies to improve fixation of human nerves. 1. Effect of duration of glutaraldehyde fixation on peripheral nerve morphometry

No change in the transverse fascicular area of rat peroneal nerve occurred when the duration of fixation in 2% glutaraldehyde was increased from 1 to 12 hr. Shrinkage in endoneurial area was inferred from the development of clefts. The number of myelin lamellae remained constant when the nerve was fixed in glutaraldehyde for 1 or for 12 hr. Unequivocal shrinkage of axis cylinders occurred with prolongation of glutaraldehyde fixation beyond 1 hr. In nerves fixed for 12 hr, this shrinkage was approximately 20%, compared to the area at 1 hr.