Glossopharyngeal neuralgia; a cause of cardiac arrest

Glossopharyngeal tic douloureux or neuralgia is a comparatively rare but well-recognized syndrome. In respect to the stabbing paroxysmal nature of the pain and its relation to specific trigger zones, it is exactly comparable to the commoner trigeminal tic douloureux. In neurosurgical clinics the two types of neuralgia occur in a ratio of about one to forty.The significance of cardiac arrest and syncope associated with glossopharyngeal neuralgia was first emphasized by Riley and associates,¹ in a brief report of two cases in 1942. This report called attention to the afferent pathway of the carotid sinus reflex through the glossopharyngeal nerve and suggested the correlation of the simultaneous neuralgia and excessive stimuli to the sinus reflex. Neither of the two cases was reported to have been subjected to operation. Since then, no other reports of similar cases have come to light in medical literature. However, one of us (Ray) had the opportunity of examining such a case with Dr. Jefferson Browder in 1943 and this patient was relieved of all symptoms by intracranial section of the glossopharyngeal nerve.Because of the importance of further establishing the authenticity of the syndrome and calling wider attention to the importance of its recognition, there is justification for reporting another comparable case.     

Medical student abuse: perceptions and experience

Summary. A questionnaire containing 18 vignettes of common clinical educational situations with potentially abusive treatment of medical students and a 10-item attitude assessment about abusive behaviour were administered to the first-and fourth-year medical students at a mid-west US university medical school. The first- and fourth-year groups did not differ significantly on perceived abusiveness of most of the vignettes, although several of the individual vignettes were perceived significantly differently by the two groups. As hypothesized, the fourth-year students had experienced such situations more frequently. Attitudes towards abusive behaviour did not differ between the two groups. The authors contrast teaching interactions perceived as educationally useful and not abusive with those seen as abusive and not useful and offer explanations for the differences observed. Finally, the possible implications of the results for medical education are discussed.     

USE OF ATRACURIUM OR VECURONIUM TO PROLONG THE ACTION OF TUBOCURARINE

Forty patients received tubocurarine in a dose greater thanED₉₀. When neuromuscular function had recovered to amplitudeof the first contraction of the train-of-four equals 10% ofcontrol, a small increment of atracurium or vecuronium was administered,repeating the same increment at each subsequent recovery to10%. The intensity and duration of the neuromuscular block followingthe first increment was always greater than that of subsequentincrements. The duration and intensity of the block was progressivelyreduced with subsequent increments until the responses to furtherincrements were unchanged. These final means at steady statewere: group 1 (atracurium 1.1 mg) 6.4 (0.3) min; group 2 (atracurium2.0 mg) 8.2 (0.9) min; group 3 (vecuronium 0.25 mg) 5.8 (0.4)min; group 4 (vecuronium 0.5 mg) 13.2 (0.4) min.     

Meta-analysis of placebo-controlled studies of the efficacy of Epogam in the treatment of atopic eczema. Relationship between plasma essential fatty acid changes and clinical response

Gamma-linolenic acid in the form of a particular variety of evening primrose oil (Epogam) has been reported of value in the treatment of atopic eczema. Nine controlled trials of evening primrose oil were performed in eight centres. Four of the trials were parallel and five cross-over. Doctors and patients assessed the severity of eczema by scoring measures of inflammation, dryness, scaliness, pruritus and overall skin involvement. Individual symptom scores were combined to give a single global score at each assessment point. In the analysis of the parallel studies, both patient and doctor scores showed a highly significant improvement over baseline (P less than 0.0001) due to Epogam: for both scores the effect of Epogam was significantly better than placebo. Similar results were obtained on analysis of the cross-over trials, but in this case the difference between Epogam and placebo in the doctors' global score, although in favour of Epogam, failed to reach significance. The effects on itch were particularly striking. There was no placebo response to this symptom, whereas there was a substantial and highly significant response to Epogam (P less than 0.0001). When the improvements, or otherwise, in clinical condition were related to changes in plasma levels of dihomogammalinolenic and arachidoni acids, it was found that there was a positive correlation between an improvement in clinical score and a rise in the fatty acid levels.     

DEATHS FROM SUDDEN INFANT DEATH SYNDROME ON PUBLIC HOLIDAYS AND WEEKENDS

Deaths from sudden infant death syndrome (SIDS) between 1979 and 1984 were tabulated by month for weekdays, weekends and public holidays. Examination of deaths by day of the week showed the weekend had more deaths than the weekdays (χ₂= 26.3, df = 6, p = 0.0002) and that this pattern occurred in both the under three months and three-11 months age group. There were 40 deaths on the 78 public holidays in the six years under study. Modelling the data showed that there was no difference between the number of deaths on holidays compared to weekends.     

Reduction by Pyridostigmine Pretreatment of the Efficacy of Atropine and 2-PAM Treatment of Sarin and VX Poisoning in Rodents

Reduction by Pyridostiginine Pretreatment of the Efficacy ofAtropine and 2-PAM Treatment of Sarin and VX Poisoning in Rodents.KOPLOVITZ, I., HARRIS, L. W., ANDERSON, D. R., LENNOX, W. J.,AND STEWART, J. R. (1992). Fundam. Appl. Toxicol. 18, 102–106. This study concerned the effect of pyridostigmine pretreatmenton (a) the antidotal efficacy of atropine and 2-PAM in sarin,tabun, and VX poisoning in mice and guinea pigs and on (b) theoxime-induced reactivation of VX-inhibited whole blood acetyicholinesterase(AChE) of guinea pigs. One hour prior to organophosphate (OP)challenge with sarin, tabun, or VX, animals were given oraldoses of pyridostiginine to induce approximately 30 and 60%inhibition of whole blood AChE; controls received vehicle. Micewere challenged im and guinea pigs sc with the OP compounds.Treatment with atropine (11.2 mg/kg to mice; 32 mg/kg to guineapigs) plus 2-PAM (25 mg/kg) was given im at 10 sec postchallengein mice and 1 min postchallenge in guinea pigs. In the reactivationexperiments, pyridostigmine or saline was given im to guineapigs 30 min prior to VX (8.24 µg/kg, sc), atropine (16mg/kg) was given im at 1 mm, and 2-PAM (25 mg/kg) at 16 minpostchallenge. Pyridostigmine significantly enhanced the efficacyof atropine and 2-PAM against tabun in both species. In contrast,pyridostigmine reduced or did not increase the efficacy of atropineand 2-PAM against sarin or VX in both species. Recovery of VX-inhibitedAChE by 2-PAM was decreased significantly in pyridostigminepretreated animals. The results suggest that pyridostigminepretreatment may adversely effect the efficacy of atropine and2-PAM as antidotes for VX and sarin intoxication.     

Application of monoclonal antibodies against major basic protein (BMK-13) and eosinophil cationic protein (EG1 and EG2) for quantifying eosinophils in bronchial biopsies from atopic asthma

A monoclonal antibody prepared against the eosinophil major basis protein (MBP) was compared with the anti-eosinophil cationic protein (ECP) antibodies (EG1 and EG2) in immunostaining of bronchial biopsies from atopic asthma and controls. Anti-MBP (designated BMK-13) did not cross-react with other eosinophil basic proteins (i.e. ECP, eosinophil peroxidase [EPO] or eosinophil-derived neurotoxin [EDN]) and stained more than 98% of peripheral blood eosinophils irrespective of their degree of activation. EG2 stained 15% of resting and 75% of activated eosinophils; EG1 recognized 74% and 78% of resting and activated cells, respectively. The numbers of BMK-13, EG1 or EG2-positive staining cells in bronchial biopsies from asthma were significantly greater than atopic non-asthmatics (P less than 0.02, P less than 0.01 and P less than 0.05, respectively) and normal non-atopic controls (P less than 0.001). For each of the various groups studied, the rank order for the number of eosinophils stained was BMK-13 greater than EG1 greater than EG2. BMK-13 stained significantly more cells from bronchial biopsies of atopic asthma and atopic non asthma when compared to EG2 (P less than 0.001 and P less than 0.05, respectively). Since only a proportion of BMK-13+ cells were EG2+, these results suggest that not all tissue eosinophils are actively secreting. Thus, BMK-13 can serve as a useful pan-eosinophil marker in tissue sections since it appears to stain most eosinophils.