[Clinical manifestations of primary Sjogren's syndrome]. / Kliniske manifestasjoner ved primaert Sjögrens syndrom.

The article reviews the symptoms and signs of primary Sjögren's syndrome. It describes the clinical and laboratory investigations of such patients, and briefly discusses the occurrence of malignancy in Sjögren's syndrome.

Coma.

The preceding discussion is an attempt to stress anatomy in the diagnosis of coma. By localizing the offending lesion, the physician can apply the appropriate diagnostic and therapeutic measures more adeptly. Because physicians are also frequently asked to prognosticate, I have tried to summarize the work of Plum and Posner in their study of the outcome of patients presenting in coma. The primary care physician is encouraged to plan at least for the basics in case he or she is faced with a comatose patient.

CT observations on the natural history of asymptomatic cerebral infarction following transient ischaemic attacks.

Two hundred and sixty-one neurologically asymptomatic patients were examined by computed tomography (CT) following a variable number of transient ischaemic attacks (TIAs) experienced over different time intervals. Cerebral infarcts were discovered in 101 patients. Dominant hemisphere infarcts were usually small, of recent origin and most often associated with less than 5 TIAs and a short history; whereas non-dominant hemisphere infarcts were found twice as frequently and were larger and older and correlated with repeated TIAs over many months. All infarcts, independent of size, were confined to a single vascular territory, suggesting haemodynamic rather than embolic causes. By comparing the age and size of the infarcts with the number of TIAs and their chronicity, the hypothesis emerged, suggesting that infarcts may occur early on and progressively enlarge with repeated attacks.

Ophthalmic manifestations of esthesioneuroblastoma.

Esthesioneuroblastoma, a tumor that arises from the olfactory sensory epithelium, often manifests with ocular and orbital signs and symptoms. A review of 38 cases of esthesioneuroblastoma at the Mayo Clinic revealed that ophthalmic signs or symptoms occurred in 28. Twenty patients had ophthalmic signs or symptoms at the time of presentation, and five of these had ocular symptoms as the primary complaint. Five patients presented to an ophthalmologist, but a nasal or paranasal sinus tumor was not suspected. Periorbital pain and excessive tearing were the most commonly reported symptoms. The most common ophthalmic sign was eyelid edema followed by proptosis, globe injection, and ptosis. Recognition of the signs and symptoms of neoplasms of the nose and paranasal sinuses and consideration of esthesioneuroblastoma in the differential diagnosis by clinicians and pathologists allow for prompt management of this tumor.

Tear studies in ocular rosacea.

To determine whether tear pH in ocular rosacea was alkaline or acidic compared to normal, I studied tear pH measured by pH electrode or paper in 12 patients with rosacea without ocular manifestations, 23 patients with mild ocular manifestations, and nine patients with severe ocular manifestations. There was no diagnostically useful difference in tear pH between any of these groups and normal controls. Possible pitfalls include the effect of anesthetic eyedrops on tear pH, the effect of basal tear secretion, and discrepancies between electrode and paper measurements. Measurements by pH paper cannot be adjusted by an error constant to yield an equivalent electrode value. Treatment of active ocular rosacea with tetracycline for one month had no effect on tear pH in six patients.

Lightning injuries.

The physical properties of lightning are given, including a description of the different observed lightning forms. The wide variety of effects of lightning on humans is reviewed. In the prehospital care of those struck by lightning, emphasis is upon immediate resuscitation of those who appear unresponsive. Recommendations for emergency department evaluation, treatment, and disposition are given. Guidelines to prevent humans from being struck by lightning are discussed.

Primary Sjogren syndrome: clinical and immunopathologic features.

Primary Sjogren syndrome is an autoimmune condition in which dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia) result from lymphocytic infiltration of lacrimal and salivary glands. Clinical and laboratory features of 60 primary Sjogren syndrome patients seen at our clinic during the past three years are presented. These patients illustrate the wide spectrum of extraglandular features that may occur as a result of lymphoid infiltration of lung, kidney, skin, stomach, liver, and muscle. They further emphasize the difficulty in classifying a patient as primary or secondary Sjogren syndrome (ie, sicca symptoms associated with systemic lupus erythematosus, rheumatoid arthritis, or scleroderma), particularly early in the disease course. As an initial step in understanding the pathogenesis, the lymphocytes that infiltrate the salivary glands and lymph nodes were characterized by using monoclonal antibodies that recognize distinct lymphocyte subsets and by using in vitro functional assays. These studies have demonstrated that affected tissues have infiltrates of T cells with helper/inducer activity and with a high frequency of "activation antigens." The immunohistologic techniques are useful in differentiating "benign" and "pseudolymphoma" lesions (both due predominantly to T cells) from non-Hodgkin lymphoma (usually due to B-cell infiltrates). Although there is no "cure" for primary Sjogren syndrome patient's symptoms may be significantly improved by measures aimed at prevention of ocular and dental complications and by the recognition of extraglandular features that may be amenable to specific treatment.

[Occipital spike-wave with and without benign epilepsy in the child]. / La pointe-onde occipitale avec et sans épilepsie bénigne chez l'enfant.

We describe 31 children with runs of high amplitude and variable frequency spike-and-wave discharges on the occipito-postero-temporal regions at the EEG. This characteristic EEG pattern can be seen on the posterior areas of one or both hemispheres only when the eyes are closed. A functional spike-wave focus of temporo-rolandic localization also occurred in 13 cases. Clinically, 10 children were seizure-free with minimal brain dysfunction in 8 of them. Of these, only 4 patients suffered from febrile convulsions while the 17 other patients were undergoing treatment for visual, motor or vegetative partial seizures, and even generalized fits. The prognosis of this essentially functional childhood epilepsy was good under phenobarbital therapy in almost all of our cases. This benign occipital epilepsy is related to childhood epilepsy with rolandic paroxysms.