Complex haptic hallucinations and palinaptia

A patient with biparietal lesions demonstrated complex stereognostic hallucinations and recurrent haptic sensations. Although there was complete astereognosis and palpatory apraxia, she palpated the hallucinated objects appropriately. A second patient with ictal haptic hallucinations is described, and the one case previously reported in the literature. Some observations and speculations are made concerning these rare phenomena.     

Long-term outcome of completion gastrectomy for nonmalignant disease

Between 1989 and 1995 we performed completion gastrectomy for non-malignant disease in 21 patients (11 men and 10 women, mean age 48.4 years). These patients had undergone a total of 48 prior gastric operations. Indications for completion gastrectomy in this group were anastomotic ulceration with stricture in eight patients, alkaline reflux gastritis and/or esophagitis in eight, postsurgical gastroparesis in two, gastroesophageal necrosis in two, and gastrocutaneous fistula in one. Major preoperative symptoms included nausea and vomiting in 16 cases, abdominal pain in 15, dysphagia in 14, heartburn in seven, and weight loss in five. Following completion gastrectomy, five patients (24%) had serious complications and there was one postoperative death (5%). Five patients were lost to follow-up. For the remaining 15 patients, mean follow-up has been 30 months with a range of 1 to 70 months. These patients were all interviewed and eight (53%) report significant improvement, two (13%) report moderate improvement, and four (27%) report no improvement; one patient (7%) has had worsening of symptoms since undergoing completion gastrectomy. The average body weight index was essentially unchanged after completion gastrectomy. We conclude that completion gastrectomy with Roux-en-Y esophagojejunostomy results in a favorable outcome in the majority of selected patients with diseases of the foregut who are unresponsive to less radical treatment. Presented at the Thirty-Seventh Annual Meeting of The Society for Surgery of the Alimentary Tract, San Francisco, Calif., May 19–22, 1996.     

Urinary output of endogenous monoamine oxidase inhibitor and isatin during acute migraine attacks

Summary Urinary output of endogenous monoamine oxidase (MAO) inhibitory activity, was significantly raised in serial samples collected across a migraine attack compared with collections during attack-free periods and in healthy controls, which did not differ from each other. There was a highly significant correlation in output between isatin, a major fraction of the MAO inhibitory activity, and output of the MAO inhibitory activity itself. However, although there was a tendency towards increased isatin excretion during migraine attacks, it failed to reach statistical significance.     

The evolving face of human immunodeficiency virus-related progressive multifocal leukoencephalopathy: Defining a consensus terminology

There is a need for consistent definition of human immunodeficiency virus (HIV)-associated cases of progressive multifocal leukoencephalopathy (PML), especially following the profound disease changes that have resulted from the use of highly active antiretroviral therapy (HAART). According to the criteria used for diagnosis, PML cases should be either referred to as “histology-confirmed,” with evidence of JC virus (JCV) infection in brain, “laboratory-confirmed,” with detection of JCV DNA in cerebrospinal fluid (CSF), or “possible,” in the presence of typical clinical and radiological picture, but no demonstration of JCV infection. Disease outcome should be defined by the evidence or lack of evidence of disease activity, rather than using survival or other variables. Disease activity should be based on clinical (scored neurological examination), radiological (magnetic resonance imaging), and virological (JCV DNA levels in CSF) indicators, to be assessed regularly, e.g., every 3 months until evidence of disease arrest or death. Furthermore, parallel assessments of other HIV-associated manifestations, including CD4+ cell counts and viral load, are required. A standard patient classification would be helpful for clinical management of PML patients, for their inclusion in clinical studies, and also will increase our current knowledge of PML and its evolution in relation with HAART.     

Scientific basis of competitive cross-country skiing.

The sport of cross-country skiing had its origins as a utilitarian mode of travel more than 4000 yr ago. From hunters carrying weapons and moving about on carved wooden skis, the sport has evolved to spandex-clad competitors carrying reinforced fiberglass poles while gliding on high-tech composite skis. The widespread use of ski-skating techniques coupled with the technological innovations of the last decade have profoundly changed the nature of competitive cross-country skiing. This symposium is intended to summarize the current state of scientific knowledge about the sport.     

Plate fixation of open fractures of the tibia

The results of immediate plate fixation of 97 open fractures of the tibial shaft in 95 patients are reported. Significant joint stiffness occurred in 11.4% and angular malunion of greater than 5 degrees in any plane was seen in 3.1%. The infection rate was 10.3%. However, even in those cases which develop delayed union or other complications, plate fixation of open fractures can produce excellent recovery of limb function.