Pseudohemiparesis and Tourette syndrome.

Three patients with Tourette syndrome and transient recurrent hemiparetic posturing (pseudohemiparesis) are presented. The transient nature of this posturing is not consistent with a static central nervous system deficit. It is felt that the Tourette syndrome symptomatology and pseudohemiparesis share a common pathophysiology. The inclusion of pseudohemiparesis in the differential diagnosis for cerebral palsy is suggested.

Rehabilitation services in rural communities: delivery by hospital based and local teams.

Since rehabilitation services are generally not available on a local basis to rural communities, a rural service delivery approach, the Coordinated Ambulatory Rehabilitation Evaluation Services (CARES) Project, was established. The program demonstrated a local rural rehabilitation capability based on primary care physicians, a local hospital, and nonphysician rehabilitation providers working cooperatively with a rehabilitation specialty hospital 640km away. Service delivery profiles of the hospital and local teams were compared for pediatric and adult clinics. The project was successfully implemented with 281 patients seen in their local areas.

Abnormal cellular immune responses during acquired zinc deficiency.

The cellular immune response of a 17-year-old decerebrate male with acquired zinc deficiency was studied. He had been fed a commercial formula which contained 7.6 mg zinc per kilogram. His caloric intake had been inadequate as judged by his cachexia. A detailed pretreatment nutritional assessment (five separate observations) which included total serum protein and globulins, albumin, folate, vitamins A, B2, C, ceruloplasmin, and plasma zinc, copper, iron, and total iron binding capacity revealed that the patient was deficient only in zinc and calories. His plasma zinc was 41 +/- 5 microgram/d1 compared with our laboratory norm of 89 +/- 9 microgram/d1 for young adult males. Cellular immunity was assessed by delayed skin reactivity to dinitrochlorobenzene and by in vitro lymphocyte transformation studies. Before zinc therapy the patient rendered a negative skin reaction to dinitrochlorobenzene, and the ability of his lymphocytes to undergo blast transformation in response to mitogen stimulation was significantly depressed with a stimulation index of 4.7 +/- 0.8 as compared with 139.1 +/- 77.3 for controls. Within 3 weeks after zinc therapy (22.7 mg zinc per day) he demonstrated a positive delayed skin reaction to dinitrochlorobenzene and a normal lymphocyte response stimulation index = 205.5 +/- 42.6 versus 199.3 +/- 58.2 for control). In addition, a pretreatment facial seborrhea and a decubitus ulcer rapidly healed.

Evidence of dietary copper and zinc deficiencies.

The mean daily amounts of copper and zinc found in hospital diets by atomic absorption spectrometry were 0.76 and 9.4 mg, respectively. Comparison of these diets with published data showed median daily amounts of copper and zinc to be 0.78 and 12.0 mg, respectively, for 20 diets made from conventional foods. These amounts of copper and zinc are less than the 2 mg of copper and 13 mg of zinc thought to be required daily by adults. Hospital diets and perhaps diets in general seem to be low in copper and zinc; the amounts of copper are lower than those of zinc in comparison with respective requirements. Common dietary amounts of these elements may cause health problems.