Water excretion and plasma vasopressin in psychotic disorders.

To investigate the pathogenesis of water intoxication in psychotic disorders, a standard water load test was given to 23 unmedicated patients with schizophrenic or schizoaffective disorders. Levels of plasma arginine vasopressin were measured concurrently. Compared with 28 healthy volunteers, the psychotic patients had significantly smaller cumulative urine output and higher minimum urine osmolalities. Patients whose current illness had lasted less than 24 weeks exhibited the most severe antidiuretic state and also had the highest plasma arginine vasopressin levels. Water intoxication in acute exacerbations of psychosis may develop as a result of impaired excretory mechanisms.

Dysfunction of sensory nerves during attacks of hypokalemic periodic paralysis.

Reversible electrophysiologic abnormalities of sensory nerve function were found by chance in three patients with hypokalemic periodic paralysis, a disorder previously considered to affect the function of muscle membranes only. A formal, prospective study was therefore conducted. Serial nerve conduction studies were done in ten additional patients. Amplitude of sensory action potentials was significantly smaller during paralytic attacks, but did not differ from controls after normalization of serum potassium concentration. These apparently novel findings might be explained by previous electrodiagnostic studies either not involving the testing of sensory nerves at all, or not being repeated after recovery from an attack. Involvement of sensory nerves in hypokalemic periodic paralysis is suggested to arise through dorsal root ganglia having an incomplete blood-nerve barrier and sensory neurons being particularly vulnerable to derangements affecting nerve cell metabolism. Neuronal inexcitability is postulated to occur consequent upon possible inactivation of the sodium-potassium pump by the low concentration of extracellular potassium. In patients with acute areflexic limb weakness, the diagnosis of hypokalemic periodic paralysis should not be excluded by abnormal results of sensory nerve conduction studies.

Oral antibiotic therapy of skeletal infections in children.

Oral and intravenous (IV) antibiotic regimens were compared in 15 children with etiologically defined osteomyelitis and/or septic arthritis. On admission all children were started on standard IV therapy; seven were changed to oral antibiotics within 72 hours and the remaining eight continued on IV therapy for four weeks. Oral antibiotic doses were adjusted to achieve a peak serum bactericidal titer of greater than or equal to 1:8 against the patient's own pathogen. All patients were treated in hospital for four weeks; therapy continued for a minimum of six weeks or until the erythrocyte sedimentation rate (ESR) fell below 20 mm/hr. The clinical course and outcome were similar in both groups. There were no treatment failures nor any relapses during a 12-month follow-up period. This prospective study supports, with controlled data, the concept that acute skeletal infections can be safely and successfully treated with carefully monitored oral therapy.

Decreased acquisition of glucocorticoid resistance in tetraploid human lymphoid cells.

Resistance to dexamethasone (1 microM) was measured in glucocorticoid-sensitive diploid and tetraploid clones of the human leukaemic cell line CCRF-CEM (clone C7) during continuous culture and after X-ray or chemical mutagenesis. In continuous culture resistant diploid cells accumulated at a rate of about one cell per 10(5) divisions, while the rate for tetraploid cells was less than one per 10(7) divisions. Chemical and X-ray mutagenesis caused a marked increase in the number of resistant diploid cells but had very little effect on tetraploid cells. These results are consistent with a mutational basis for the acquisition of the glucocorticoid-resistant phenotype in human lymphoid cells.

Autosomal dominant inheritance of the Kabuki make-up (Niikawa-Kuroki) syndrome.

We report on three individuals (two sibs and their father) with the Kabuki make-up syndrome. The two sibs had congenital dislocation of the hips and all three individuals had short stature and the facial characteristics of the syndrome. To our knowledge this is the first report of familial occurrence of the Kabuki make-up syndrome.

Intrathecal synthesis of IgG in benign intracranial hypertension: a re-examination.

In a previous retrospective study, 4 of 9 patients with benign intracranial hypertension were unexpectedly positive for intrathecal synthesis of immunoglobulin (Ig) G by quantitative measurement (log IgG index). This was remarkable as the only disease among many studied that showed such a discrepancy. A further study was done, now prospectively. Log IgG index values were elevated in 2 of the 11 new cases. As before, qualitative measurement (isoelectric focusing) gave uniformly negative results. Five of the 6 instances where the log IgG index was elevated could be accounted for, in fact, by abnormal values of constituent variables other than cerebrospinal fluid IgG. Quantitative tests for intrathecal synthesis of IgG can give misleading results on their own. Immunological mechanisms most probably are not involved in the pathogenesis of benign intracranial hypertension.

Episodic cervical dystonia associated with gastro-oesophageal reflux. A case of adult-onset Sandifer syndrome.

Sandifer syndrome is a dystonic movement disorder described in children with severe gastro-oesophageal reflux. We now report a patient who had the features of Sandifer syndrome first developing in adult life. Onset of dystonic episodes followed closely the occurrence of a Bell's palsy, while symptoms of peptic oesophagitis had been present for several months beforehand. Successful symptomatic treatment of gastro-oesophageal reflux was accompanied by cessation of the dystonic episodes. Possible pathophysiological mechanisms of the abnormal movements in Sandifer syndrome are discussed.

Undergraduate clinical neurosciences programme development: a consumer-based evaluation.

Intern responses to a questionnaire were used to evaluate an undergraduate clinical neurosciences programme. The data obtained were judged an authentic measure of instructional efficacy. Most interns rated themselves competent in performing the neurological examination but ill-equipped to interpret their findings and to manage effectively common problems, especially emergencies. Neurological diseases and the non-biomedical aspects of patient care were identified relatively infrequently as matters needing greater emphasis. Explanations for these findings may include a curriculum of traditional format, differences in teaching and assessing theoretical and practical competence, and the typical responsibilities of interns in an academic hospital. Intern evaluation of undergraduate clinical programmes can provide data useful to their development.