Ischemic injury to the brachial plexus following subclavian flap aortoplasty.

An ischemic brachial plexus lesion developed 6 days postoperatively in an infant undergoing subclavian flap aortoplasty for coarctation. To our knowledge, this complication has never been previously reported. Types of postoperative brachial plexus lesions are discussed. The blood supply to the brachial plexus is described. An ischemic lesion of the plexus should be suspected when brachial palsy follows operations that involve sacrifice of the subclavian artery.

Tardive dyskinesia treated with pimozide.

We have investigated the action of pimozide in tardive dyskinesia induced by prolonged administration of phenothiazines. Improvement was recorded in a double blind study of 18 patients treated with maximum tolerated dosage (mean 18.8 mg/day) for 6 weeks. There was no deterioration in the therapeutic action of pimozide over this time. Parkinsonism and sedation were the main adverse effects. They were corrected by reduction of the dose of pimozide, but often recurred so that further adjustments of dosage were necessary. Our findings support the view that tardive dyskinesia is produced by a disturbance in the balance of central transmitters such that dopaminergic transmission is increased.

Whole-brain death reconsidered--physiological facts and philosophy.

Four main areas generating confusion in discussion on brain death are identified as a) the relation of criteria of death to concepts of death, b) the argument about whether death is an event or a process, c) the inadequate differentiation of different neurological entities having different cardiac prognoses, and d) insufficient awareness of the separate issues of 'determining death' and 'allowing to die'. It is argued that if by death we mean the dissolution of the human 'organism as a whole', then whole-brain death is death. Behavioural patterns, legitimate in the presence of a cadaver, should be legitimate from the time whole-brain death is diagnosed.

KIE: Disagreeing with the viewpoint expressed by Alister Browne in a preceding article, Pallis contends that codifying the definition of death as whole-brain death is both practical and conceptually valid. He discusses the different meanings of "a vegetative state," "whole-brain death," and "brain-stem death," and concludes that it is legitimate to tie decisions on such medical procedures as maintaining life support systems to a whole-brain definition of death.

Trichinella thrives in both oxidative and glycolytic human muscle fibres.

In a deltoid biopsy from a severe case of human trichinosis the larvae of Trichinella spiralis did not exhibit any predilection for any particular fibre type. Type I and type II fibres were involved with a frequency proportionate to their distribution in the muscle sampled.

Reversible nicotinamide-deficiency encephalopathy in a patient with jejunal diverticulosis.

A patient with severe malabsorption due to massive diverticulosis of the small intestine developed an acute encephalopathic syndrome which responded dramatically to intravenous nicotinamide. Various mechanisms are discussed whereby nicotinamide deficiency might have occurred in this clinical context.

Metronidazole neuropathy.

Two patients are described who developed sensory neuropathy after the ingestion of 30.6 and 114 g metronidazole respectively. The drug, widely used in gastroenterological and gynaecological practice, has not hitherto been considered neurotoxic. The implications are stressed in relation to the differential diagnosis of patients with gastroenterological disorders who develop peripheral neuropathy.