Simultaneous prepubertal onset of panic disorder, night terrors, and somnambulism

Concurrent acute onset of night terrors, somnambulism, and spontaneous daytime panic attacks meeting the criteria for panic disorder is reported in a 10-year-old boy with a family history of panic disorder. Both the parasomnias and the panic disorder were fully responsive to therapeutic doses of imipramine. A second case of night terrors and infrequent full symptom panic attacks is noted in another 10-year-old boy whose mother has panic disorder with agoraphobia. The clinical resemblance and reported differences between night terrors and panic attacks are described. The absence of previous reports of this comorbidity is notable. It is hypothesized that night terror disorder and panic disorder involve a similar constitutional vulnerability to dysregulation of brainstem altering systems.     

Effects of different types of diet and sodium saccharin on proliferation at the limiting ridge of the rat forestomach

Sodium saccharin, at high doses in the diet, has been reported to cause hyperplasia of the forestomach (squamous portion of stomach), at the limiting ridge in F344 rats, in addition to its potential to induce proliferative effects on the urinary bladder epithelium. We have characterized this hyperplasia of the squamous epithelium of the forestomach at the limiting ridge in F344 and Sprague-Dawley rats given various doses of sodium saccharin for 4 to 95 wk. With increasing doses of sodium saccharin, the limiting ridge of the forestomach showed dose-related morphological changes: basal-cell hyperplasia, early papillary hyperplasia with basal-cell hyperplasia and papillary hyperplasia. Calcium saccharin in Prolab diet caused hyperplasia of the forestomach at the limiting ridge, similar to that caused by sodium saccharin. The severity of hyperplasia was influenced by the type of diet and by the strain of rats. AIN-76A diet without added sodium saccharin caused basal-cell hyperplasia in F344 rats, whereas Prolab, Purina and NIH-07 diets without added sodium saccharin had little or no effect on the forestomach. The effect of AIN-76A diet alone persisted through 95 wk of feeding without any evidence of tumour formation. In Sprague-Dawley rats, which appeared more sensitive to effects on the forestomach than F344 rats, Prolab 3200 and Purina diets without sodium saccharin caused basal-cell hyperplasia in more than half of the treated rats. The forestomach hyperplasia associated with AIN-76A or saccharin administration appears to be mild, limited in extent to the limiting ridge, and not associated with carcinogenesis.     

Hemifacial spasm. Results of unilateral myectomy

Hemifacial spasm (HFS) is a disorder characterized by unilateral involuntary spasm of the muscles innervated by the facial nerve (cranial nerve VII). The etiology is often a redundant or ectatic artery in the cerebellopontine angle that compresses the facial nerve. Neurosurgical decompression with implantation of a sponge between the ectatic artery and the facial nerve produces good results, but has a high complication rate and a poor patient acceptance rate. Various modes of peripheral neurectomy have also been advocated, but the recurrence rate is high and the preexisting functional and cosmetic eyelid deformities are exacerbated. The results of unilateral periorbital myectomy in 21 HFS patients are presented. Follow-up ranging from 1 to 7 years was available on 16 patients. Excellent or good results were obtained in 94% of these cases, and postoperative complications were minor. Transient lymphedema and forehead anesthesia are the most common complications. An unforseen benefit of periorbital myectomy surgery is the improvement or relief of lower facial contractions that occurred in 75% of patients. The authors believe the myectomy procedure is a safe, effective, predictable therapy for those HFS patients unwilling to risk a neurosurgical operation, and allows simultaneous reconstruction of associated eyelid and eyebrow deformities.     

Decline in human immunodeficiency virus seropositivity and seroconversion in US Navy enlisted personnel: 1986 to 1989. Navy HIV Working Group.

The US Navy administered 1,795,578 enzyme-linked immunosorbent assay (ELISA) tests to 848,632 active-duty Navy enlisted personnel during 1986 to 1989. This study identified 2438 human immunodeficiency virus (HIV)-seropositive active-duty enlisted Navy personnel, including 778 seroconverters. Three types of quarterly rates of HIV seropositivity and seroconversion were determined. All three rates declined. This decline could not be explained by changes in the population tested according to age, race, sex, occupation, or geographic location of home port.     

The natural history of Teflon catheter-associated phlebitis in children

During a prospective evaluation of intravenous therapy with peripheral Teflon catheters in children, we found 30 episodes of phlebitis (10.4%). This rate is less than that reported in adults. Catheter colonization was not related to phlebitic episodes, and catheter-related infections did not occur. No patient's hospital course was prolonged because of phlebitis. Thirty percent of the episodes developed after the catheter was removed, and premonitory symptoms were not helpful in predicting the onset of phlebitis. Factors associated with an increased phlebitic risk were parenteral nutrition, administration of nafcillin sodium or aminoglycosides, and patient age. Parenteral nutrition prolonged the course of phlebitis. No factors hastened the onset of phlebitis. The duration of cannulation was not significantly related to phlebitis, suggesting that in some children the catheters can remain in place longer than 72 hours.     

Upper extremity fractures in the acute spinal cord injured patient

Fifty-three long bone upper extremity fractures in 46 patients with recent spinal cord injuries were reviewed with reference to the outcome of operative versus nonoperative treatment. Twenty-four fractures had surgery and 29 fractures were treated nonoperatively. Criteria used in assessing outcome included range of motion, time to union, total rehabilitation time, and orthopedic and medical complications. Humeral fractures had similar outcomes with either operative or nonoperative treatment. Radial nerve injury occurring with humeral fractures prolonged the rehabilitation time. All three combined radial and ulnar fracture treated surgically developed synostosis whereas two of the three nonoperatively treated fractures had other orthopedic complications. Nondisplaced radial fractures responded appropriately to closed treatment. Displaced radial fractures treated nonoperatively had a high incidence of malunion. All ulnar fractures were treated operatively, and all achieved acceptable range of motion and fracture healing at the time of discharge. Medical complications such as deep venous thromboses and decubitus ulcers occurred more frequently in the nonoperatively treated group (28%) than in the operatively treated group (4%). Standard guidelines for upper extremity fracture care apply to the patient with a spinal cord injury. However, operative stabilization may be associated with a decreased risk of medical complications in these patients.     

A proposed role for silicates and protein in the proliferative effects of saccharin on the male rat urothelium

High doses of sodium saccharin, a non-genotoxic chemical, lead to the formation of silicate-containing precipitate and microcrystals in urine of male rats. Differences in urinary protein, pH, sodium and other factors affect silicate-containing precipitate and microcrystal formation as well as the bladder effects of sodium saccharin. Total urinary silicon concentration (mostly soluble) in sodium saccharin-fed rats is similar to or lower than the concentration in control rats. Binding of saccharin to male rat urinary proteins was demonstrated by equilibrium-gel filtration. We propose that by binding to urinary proteins under appropriate conditions, saccharin produces a nidus for the formation of silicate-containing precipitate and crystals. These appear to be cytotoxic to the superficial bladder epithelium, with cell death resulting in regenerative hyperplasia. Factors that influence the formation of these silicate-containing materials might provide a rationale for sex, species, dose and dietary differences in response to sodium saccharin.