Biomedical subjects
Publications and source records attributed to C E Wells.
A case history twice discussed previously in the literature is reexamined. The patient probably suffered a manic-depressive illness, and remission, therefore, is not specifically attributable to psychotherapy. The significance of psychotherapy in the patient's treatment is argued, but for its supportive, not its curative, effects.
A new antibody reacting with a cell membrane-related antigen is described in a patient with myasthenia gravis and chronic liver disease. The antibody gave a striking peripheral immunofluorescence in all cells tested and did not react with smooth muscle fibres, being distinct from anti-actin and anti-myosin antibodies. The antigen was widely distributed in human and animal tissues. The exact relationship of this antibody to the clinical condition is not obvious but its presence is further evidence of widespread disturbances of humoral immunity in myasthenia gravis.
Transient psychotic episodes may result from continuous cerebral epileptiform discharges unaccompanied by clinically observed seizures. Such episodes may mimic depressive, hysterical and schizophrenic psychosis and delirium. I describe two patients here and review eight patient histories from the literature. Diagnosis is established by use of electroencephalography during the psychotic episode. Correct diagnosis is essential because specific treatment is available and additional episodes may be prevented by appropriate long-term anticonvulsant therapy.
Nitroglycerin sublingual tablets were studied over a 1-year period to determine tablet stability in terms of loss of strength, uniformity of tablets, and degradation of the drug itself. Tablets from six different firms were analyzed by a semiautomated procedure. The samples included two molded tablets and four compressed tablets, ranging in age at the time of initial assay from 40 days to over 1 year. The results indicated that there is a loss of strength of nitroglycerin tablets and that refrigeration slows down this loss. The study also indicated that these tablets were stable during the year of testing in terms of tablet uniformity and degradation of nitroglycerin.
Two cases of polycythaemic chorea are described, both of which were complicated by severe heart disease. The first was a child with patent ductus arteriosus and coarctation of the aorta causing severe cyanosis and secondary polycythaemia. Chorea began intermittently at an early age, becoming continuous by his fifth birthday. The second was a middle-aged male with tight mitral stenosis and a story of paralytic chorea in his teens. Polycythaemia rubra vera was eventually diagnosed two years after mitral valvotomy, some seven years after the onset of chorea.
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Two semiautomated analytical systems have been developed to determine ergonovine and methylergonovine maleate in single tablets and injections. The active ingredient is dissolved in a tartrate buffer. In the fluorometric method the stream is automatically diluted with tartrate buffer and excited with ultraviolet light; the resulting fluorescence is measured and recorded. In the colorimetric method, the stream is automatically made basic with sodium hydroxide and extracted with n-butanol. The extract is mixed with p-dimethylaminobenzaldehyde reagent. After reaction, the solution is mixed with sodium nitrite solution, and the developed color is measured at 550 nm. Recoveries of 100% were obtained from spiked placebos. Standard deviations for powdered tablet and injection samples ranged from 0.63 to 1.24%. Comparisons with the USP XVIII methods are presented.
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Two patients with Herpesvirus hominis (herpes simplex) encephalitis were investigated by serial isotope encephalograms using technetium-99m pertechnetate. In the first case the diagnosis was made by brain biopsy, and by successful tissue culture, and was confirmed by a significant rise in antibody titre, but in the second the laboratory evidence was exclusively serological. Necrotizing encephalitis was presumed in both cases because the illness was grave and focal signs developed in conjunction with radiological and electroencephalographic evidence of circumscribed lesions of the hemisphere. The emergence of new lesions in the brain scan at a time of clinical remission was found to be a warning of impending relapse. Such lesions had to be distinguished from areas of increasing uptake of isotope due only to local change in vascular permeability. Decay of EEG activity together with clinical signs of focal abnormality over an area of isotope concentration indicated a necrotizing lesion. Cytosine arabinoside (cytarabine), an alternative to idoxuridine as an antiviral drug, was used in both cases. A third patient, suspected in life of having a degenerative encephalopathy, was found at necropsy to have necrotizing encephalitis. Herpes infection though probable was not confirmed. The most severe lesions were in the frontal and temporal lobes, which had shown increased uptake of technetium in the encephalogram performed six weeks before her death.
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Vaccination against influenza may be complicated by a neurological illness. Two case histories are presented together with a summary of seven others.
Acute neurological disorder followed an upper respiratory infection in 19 patients in south-east Wales during the winter of 1969-70. Spinal and radicular syndromes predominated and included seven cases of transverse myelopathy. Serological tests suggested that the preceding infection was due to influenza A virus in eight cases, to other viruses in six, and were negative in five.
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