Hypothyroidism,Raynaud's phenomenon,and acute myocardial infarction in a young woman

We describe an acute inferior myocardial infarction in a 29-year-old woman with normal coronary arteries. She has suffered from Raynaud's phenomenon in the fingers for several years. Manifest thyroid deficiency was discovered during hospitalization. A functional-type link between hypothyroidism and myocardial infarction via vasospasm manifested as Raynaud's phenomenon is proposed as one possible etiology for the syndrome of myocardial infarction in young women.     

Plasma exchange: a controlled study of the effect in patients with Raynaud's phenomenon and scleroderma

Six female patients with stage I and II vascular scleroderma and Raynaud's phenomenon were treated with plasma exchange and placebo plasma exchange. Placebo exchange consisted of the return of the patient's own separated plasma. No consistent long-term objective improvement was demonstrated in patients treated with either plasma exchange or placebo plasma exchange. Immediate increases in pulse volume, digital blood pressure, and skin temperature occurred in some patients with both procedures. Mechanisms of change remain unexplained, and further study is warranted.     

The pattern of uterotubal insufflation in relation to ovulation

The time relation of the pattern of uterotubal insufflation to the moment of the menstrual cycle is investigated.Insufflations with a clear initial peak are considered to be present when a pressure difference of 5.320 kPa (40 mm Hg) or more is observed as compared with the lower mean plateau pressure.The mean of the length of time before the next menstruation of uterotubal insufflations without a peak is 16.0 days. The mean of insufflations preceded by a clear initial peak is 20.8 days before the next menstrual period. The difference is significant (P_D < 0.01). The mean of the length of time before ovulation of insufflations without a peak is 1.9 days. The mean of insufflations with a clear initial peak is 10.3 days before ovulation. The difference is significant (P_D < 0.01).It is concluded that uterotubal insufflation in the immediate preovulatory phase is easier than before. This phenomenon is not previously described.     

A study of work-related musculoskeletal case reports to The Health and Occupation Reporting network (THOR) from 2002 to 2003

BACKGROUND: Occupational musculoskeletal disorders are frequently seen by occupational physicians and rheumatologists, and there are well-established UK-based schemes set-up for reporting these conditions. An apparent fall in case reporting for work-related musculoskeletal disorders in Great Britain to The Health and Occupation Reporting network (THOR) was observed from 2002 to 2003. AIMS: To investigate changes in case reporting for musculoskeletal disorders sent by occupational physicians to Occupational Physicians Reporting Activity (OPRA) and by rheumatologists to Musculoskeletal Occupational Surveillance Scheme (MOSS) between 2002 and 2003. METHODS: Musculoskeletal cases returned by more than 800 physicians from Great Britain reporting to OPRA and MOSS in 2002-2003 were analysed. Changes in reporting are described at individual physician and group levels in: numbers of participants, levels of response, and numbers of case reports by disease category and major occupational and industrial groups. RESULTS: In 2002-2003, musculoskeletal disease was the most frequently reported major disease category in OPRA. Between 2002 and 2003, the proportion of musculoskeletal case reporting fell by 37% in OPRA, and 7% in MOSS. This fall was seen in many disease categories, across a wide range of occupations and industries. In OPRA, the greatest fall in reporting (74%) was for the category Raynaud's/Hand-Arm Vibration Syndrome/Vibration White Finger. CONCLUSIONS: The fall in occupational musculoskeletal case reporting between 2002 and 2003 cannot be explained by internal factors within the reporting system. This observation highlights the need for systematic investigation of trends in case reporting for work-related ill-health.     

Preoperative Prognostic Factors in Diabetic Pars Plana Vitrectomy

The postoperative, six-month visual acuities of 1056 diabetic vitrectomy cases were compared to the following preoperative findings: duration of decreased vision associated with detachments, pupillary responses, iris rubeosis, intraocular tensions, extent of neovascularization, macular status, the ability to recognize entoptic phenomena, bright-flash ERG, and ultrasonography. By comparing these findings to the postoperative visual results, several factors were detected that could be helpful in determining the preoperative prognosis for improved vision. However, major operative complications reduced the incidence of successful visual results from 53% to 22%.     

Doppler sonographic indices in diagnosing the nutcracker phenomenon in a hematuric adolescent

Compression of the left renal vein between the aorta and the superior mesenteric artery, known as the nutcracker phenomenon, may cause gross or microscopic hematuria, pain in the flank, proteinuria, or a combination of these symptoms. We report the case of a hematuric adolescent diagnosed with a high index of suspicion by noninvasive Doppler sonography using the diagnostic indices of Doppler sonography established for adults with hematuria. Compression of the patient's left renal vein at the aortomesenteric portion and dilatation at the hilar portion were visualized by magnetic resonance angiography, which verified the diagnosis.     

Syphilis in the HIV era

The incidence of syphilis has consistently increased from 2000 to 2002. We report a case of acquired syphilis with symptoms of Tullio phenomenon in a patient concurrently diagnosed with HIV infection. The resurgence of syphilis in HIV-positive groups at high risk has public health implications for prevention of both diseases.     

Near Reflex Substituting for Acquired Horizontal Gaze Palsy: A Case Report

Background Some patients with acquired horizontal gaze palsy overcome the adduction palsy by utilizing convergence. This substitution phenomenon is very rare. We report a patient with horizontal gaze palsy who was able to use convergence to compensate for the lack of adduction in the left eye.Case The patient was a 31-year-old woman with an arteriovenous malformation in the fourth ventricle. She suffered right gaze palsy and right abducens palsy after tumor surgery and radiation therapy.Observations Three years after the vascular accident, she was found to be able to adduct the left eye, in association with the adduction of the right eye. At the same time, constriction of both pupils and globe retraction of the left eye were observed. When she shifted the gaze direction of her left eye from left to right, an 11 and 8 diopter increase of myopia in the right and left eyes, respectively, was confirmed by objective refractometry.Conclusions The existence of convergence substituting for adduction in this patient with horizontal gaze palsy was confirmed by refraction change in addition to pupillary change. Jpn J Ophthalmol 2004;48:584–586 © Japanese Ophthalmological Society 2004     

Relationship between attention and arousal level in schizophrenia

The purpose of the present paper was to clarify the link between the attention and arousal level that supports the basis of the cognitive dysfunction in schizophrenia, by investigating the relationship between the simple reaction time and the closed-eye eye movements in 30 patients with schizophrenia and 20 healthy controls. In terms of closed-eye eye movements during the simple reaction time test, healthy controls showed an increase of s-type (small and slow) eye movements after the end of the preparatory interval (PI) in both regular and irregular series, while the patients with schizophrenia, particularly those in whom the cross-over phenomenon was observed, showed no changes and maintained a hyperarousal level during the regular PI test. These results indicate that the patients with schizophrenia could not maintain appropriate attention during the burden tasks and their hyperarousal level persisted. It is therefore suggested that there is a close relationship between attentional deficit and hyperarousal among patients with schizophrenia.     

Premonitory sensory phenomenon in Tourette's syndrome.

We administered a questionnaire designed to probe for premonitory sensations associated with motor tics to 50 patients with Tourette's syndrome (TS). Premonitory sensations were reported by 46 (92%) patients, and the most common sensation was an urge to move and an impulse to tic ("had to do it"). Intensification of premonitory sensations, if prevented from performing a motor tic, was reported also in 37 patients (74%), 36 patients (72%) reported relief of premonitory sensations after performing the tic, and 27 of 40 (68%) described a motor tic as a voluntary motor response to an involuntary sensation, rather than a completely involuntary movement. The "just right" sensation correlated with the presence of co-morbid obsessive-compulsive disorder. We conclude that premonitory sensations are an important aspect of motor tics and some patients perceive motor tics as a voluntary movement in response to an involuntary sensation.