Biomedical subjects
Publications and source records attributed to E Wilder-Smith.
A case of a young male Chinese recent migrant with anorexia nervosa and schizophrenia is presented. The relevant diagnostic issues relating to anorexia nervosa among Chinese males and the nature of the relationship between anorexia nervosa and schizophrenia are discussed.
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In general, meningopolyradiculitis (Bannwarth's syndrome, stage 2 of neuroborreliosis) follows a predictable monophasic self-limiting course. In contrast, we report the case of a patient with an untreated meningopolyradiculitis which evolved into acute schizophrenia-like psychosis due to persistent infection with Borrelia burgdorferi. The psychosis resolved within 1 week of treatment with ceftriaxone. This case shows that the usually benign monophasic meningopolyradiculitis may progress to severe CNS complications, which may have implications on current pathophysiological beliefs.
Cardiac arrhythmias are a well known cause of epileptic seizures. Epileptic seizures resulting in cardiac arrhythmias are less well recognised and cardiac arrhythmias are commonly presumed to be of primary cardiac origin. This paper describes a patient with complete AV heart-block during a partial complex seizure. Simultaneous EEG/ECG monitoring was used to show the secondary nature of the bradyarrhythmia.
We present a case report of Cogan's syndrome and a review of the literature. Cogan's syndrome is most likely due to autoimmune disease primarily affecting the vestibulocochlear organ and cornea and secondarily resulting in systemic disease. 40% of patients develop bilateral complete deafness and 70% show signs of systemic disease mostly in the form of cardiovascular symptoms. The mortality rate of 10% is mainly due to vasculitis. It is important to consider Cogan's syndrome in the differential diagnosis of sudden hearing loss accompanied by ocular signs in young patients, as high morbidity and mortality rates are effectively lowered by early immunosuppressive treatment.
In a young woman, episodes of visual symptoms were accompanied by simultaneous nonspecific EEG alterations. Concurrent Doppler sonography showed increased blood flow velocity with latency of a few seconds in the posterior cerebral arteries only. This is typical for local autoregulatory hyperperfusion due to increased neuronal activity, thus indicating focal epileptic discharges and excluding migrainous attacks.
Cogan's syndrome is a rare systemic autoimmune disease with preeminent ophthalmological and vestibulocochlear manifestations. Untreated, the disease usually results in profound deafness; eye involvement is usually self-remitting. Ten to twenty percent of patients either develop serious aortic valve disease or vasculitis or both. When given early, immunosuppressive therapy has been shown to be effective in treating all aspects of the disease. Thus, early disease recognition is of great significance. We present a patient with Cogan's syndrome and briefly discuss therapeutic implications.
A 65-year-old female presented with Bannwarth's syndrome. Symptoms initially responded to antibiotics but soon progressed despite further adequate antibiotic treatment. Consistently absent antibody titres to Borrelia burgdorferi, repeated CSF examinations combined with an extensive search for tumour, revealed leukaemic meningitis secondary to uterine centrocytic-centroblastic lymphoma. The diagnostic steps required to elucidate the aetiology of meningopolyradiculitis, especially when chronic and progressive, are described.
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A sensitive and specific automatic bioluminescent method is described for glucose determination in serum samples using commercially available reagent-kits. The Boehringer Gluco-quant kit, originally designed for spectrophotometric measurement, was successfully coupled to the bacterial luciferase NAD(P)H-linked system. The method's validity was proven by comparison with a spectrophotometric method. Correlation was excellent (r = 0.98, n = 50). Precision attained by 30 assays was good (CV 1.19%). The assay was verified by determining the glucose concentrations of more than 1000 serum samples. Using a microcomputer-controlled automatic luminescence analyser (Berthold LB 950 T) and reagent kits for luminometry (Boehringer Mannheim, LKB Wallac, Lumac/3M), the complete assay can be performed fully automatically with commercially available reagent kits. More than 200 samples can be assayed by one individual per day. The bioluminescence method is at least 100 times more sensitive than spectrophotometric measurements. Other reagent kits tested (Behring, Merck, Sigma) are also suitable for coupling to the NAD(P)H-linked luciferase system.