Coccidioidal synovitis of the knee

Four patients are described with documented coccicioidal synovitis of the knee joint. In two of them, no previous diagnosis of coccidioidomycosis had been made prior to diagnosis of coccidioidal synovitis. The other two had active disease after courses of amphotericin B administered both parenterally and intra-articularly for disseminated coccidioidomycosis and coccidioidal synovitis. After synovectomy and limited parenteral amphotericin B therapy, none of the four patients whos evidence of active synovial infection two to seven years later. Synovectomy appears to be an important aspect of the optimal therapy of coccidioidal synovitis of the knee, and when performed, the parenteral dosage of amphotericin B can be limited. Intra-articularly administered amphotericin B is also advocated when possible.

[Centronuclear myopathy with autosomal dominant inheritance(author's transl)]

For the first time in Germany cases of a "centronuclear myopathy" are described in a 14-year-old boy and his 18-year-old sister. First symptoms in both patients appeared at 4 to 5 years of age with a "sleepy facial expression", clumsy gait and rapid fatigue. Within few years the disease progressed to generalized muscle weakness and atrophy, ptosis, ophthalmoplegia externa and areflexia. Weakness and atrophy were most pronounced in the distal muscles of the lower extremities. Both patients were free of epilepsy and the EEG recordings were normal. Motor and sensory nerve conduction velocities were normal. Repetitive stimulation of nerves revealed a normal transmission from nerve to muscle. Muscle biopsy showed a type I muscle fiber hypotrophy and a type II muscle fibre hypertrophy in addition to a predominance of type I fibres. Both fibre types showed central nuclei, sometimes appearing as chains in longitudinal sections. In most cells with central nuclei there persists a very small pericentral zone free of myofibrils but with increased activity of oxidative enzymes and phosphorylase. 2--3% of muscle fibres in cross sections showed a decreased of absent enzyme activity in the most peripheral fibre zone. Electron microscopy showed evidence of a centrally distinct myofibrillar disintegration. The father of both children had a ptosis at least from the 20th year of age. 5 years later generalized progressive muscle atrophy was recorded. Aged 51 years he died of pneumonia. Though not proved most probably the father suffered from the same disease as the children, pointing to an autosomal dominant inheritance in this family. The disease, according to the literature, seems to be genetically heterogeneous. The clinical picture seems to be independent of the mode of inheritance. Our patients showed a relatively rapid progression of symptoms. Pathogenetically the "centronuclear myopathy" may result from a disturbance of correlated nerve-muscle structures starting during early fetal life.

Attempted validation of a "pragmatic classification of depression"

Limited aspects of Blinder's pragmatically derived classification of depressives based on syndrome characteristics were assessed. Blinder's syndrome descriptions were cast into items for an observer-rated interview and into a parallel, patient-rated schedule. Interobserver ratings were statistically reliable (γ′ = .78, p < .001). Patients' self-ratings were positively related to observer ratings (γ′ = .69, p = 01), but observers rated patients as more depressed than patients rated themselves ( t = 2.93, p = .01). Observer ratings only were factor analyzed. The unrotated factors obtained accorded better with previous factor analytic studies than with the syndrome aspect of Blinder's pragmatic classification.

Analytic-perceptual style and verbal conditioning

Relations among analytic-perceptual style, awareness, and desire for reinforcement within a Taffel-type verbal conditioning paradigm were assessed. Witkin's Embedded-figures Test and Mayman's Rorschach form level scores were analyzed separately as indices of analytic-style. Data were analyzed by multiple linear regression with linear contrasts. Embedded-figure scores did not relate to any others. But form level interactions with awareness and desire for reinforcement and a triple interaction provided limited support for the hypothesis that an active analytic style facilitates awareness and verbal conditioning, if the reinforcer is desired.

Raised serum alkaline phosphatase in rheumatoid disease. An index of liver dysfunction?

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