A full genome search in multiple sclerosis

The aetiology of multiple sclerosis (MS) is uncertain. There is strong circumstantial evidence to indicate it is an autoimmune complex trait. Risks for first degree relatives are increased some 20 fold over the general population. Twin studies have shown monozygotic concordance rates of 25-30% compared to 4% for dizygotic twins and siblings. Studies of adoptees and half sibs show that familial risk is determined by genes, but environmental factors strongly influence observed geographic differences. Studies of candidate genes have been largely unrewarding. We report a genome search using 257 microsatellite markers with average spacing of 15.2 cM in 100 sibling pairs (Table 1, data set 1 - DS1). A locus of lambda>3 was excluded from 88% of the genome. Five loci with maximum lod scores (MLS) of >1 were identified on chromosomes 2, 3, 5, 11 and X. Two additional data sets containing 44 (Table 1, DS2) and 78 sib pairs (Table 1, DS3) respectively, were used to further evaluate the HLA region on 6p21 and a locus on chromosome 5 with an MLS of 4.24. Markers within 6p21 gave MLS of 0.65 (non-significant, NS). However, D6S461, just outside the HLA region, showed significant evidence for linkage disequilibrium by the transmission disequilibrium test (TDT), in all three data sets (for DS1 chi2 = 10.8, adjusted P < 0.01)(DS2 and DS3 chi2 = 10.9, P < 0.0005), suggesting a modest susceptibility locus in this region. On chromosome 5p results from all three data sets (222 sib pairs) yielded a multipoint MLS of 1.6. The results support genetic epidemiological evidence that several genes interact epistatically to determine heritable susceptibility.

[Symptomatic antiphospholipid antibody after neuroleptic drugs]

Symptomatic antiphospholipid antibody has rarely been described in patients treated with neuroleptic drugs. We report the appearance of this antibody in association with retinal artery occlusion, in a 40-year-old man treated by neuroleptic drugs who later developed acute agranulocytosis following clozapine.

Differential drug response of panic and agoraphobic avoidance in a case of panic disorder

A case is presented of a patient with severe panic disorder and agoraphobia in whom initial treatment with clomipramine resulted in complete elimination of panic attacks, with no improvement in agoraphobic avoidance. The addition of phenelzine to the pre-existing clomipramine treatment resulted in rapid and complete disappearance of the agoraphobic avoidance. The possible implications of this case for our understanding of the neurobiological relationship between panic attacks and agoraphobia are discussed.

Migraine and intracerebral hemorrhage

Stroke is a well described complication of migraine. Recently, attention has been drawn to the development of cerebral hemorrhage in middle-aged patients with common migraine. We report a patient with classic migraine who developed an intracranial hemorrhage 36 h after the onset of a migraine attack and had a good recovery over a period of six days. Including our patient there are now five cases, all females, with this complication of migraine. It is postulated that the condition is fairly common and under reported.

Microsurgical end-to-end anastomosis in ureteral injuries

The application of microsurgery to repair the injured ureter using a double-layer end-to-end anastomosis is described and 2 cases are reported. The results in both cases are excellent.

Long-term effects of extreme situational stress on sleep and dreaming

Sleep data were obtained on 11 patients who had survived traumatic events and who complained of sleep disturbances. Each was awakened from REM and non-REM sleep for dream recall. The patients had lower sleep efficiency indices (because of prolonged sleep latency and larger amounts of "awake" plus "movement" time within sleep periods), shorter REM time, and longer REM latencies than did control subjects. Four of the 11 patients had REM- and non-REM-related nightmares, which, in two sea disaster patients, were associated with REM-related motor activity. The rest of the patients had unusually low dream recall in spite of high eye movement density.

Experimental researches regarding the metabolic changes determined by the prolonged exposure to light or by keeping in darkness

The authors conducted complex investigations in the domain of the intermediary metabolism under experimental conditions on 24 dogs grouped into three lots: lot A, twelve dogs, exposed for six months to the action of continuous light; lot B, six dogs, maintained in darkness; lot C, six dogs, maintained for the same period in the animal house, getting the same food as the other two lots, which are the control lot. We determined some biochemical, hematological, enzymatical parameters, before the beginning of the experiment, and after 24 hours, 48 hours, 7, 14 and 21 days, one, two, three, six months. Then the animals were sacrificed, and fragments from the aorta, coronary vessels, myocardium, brain, adrenals, pancreas and liver were examined both on the optical and on the electronic microscope and we analysed some fats from the vascular tissues. The net decrease of proteinemia with lot A was registered, concomitantly with a net decrease of serumalbumins, of the alpha 1-globulins and of the gamma-globulins, and with a rise of the alpha 2- and beta-globulins. The values of glycemia increased with lot A, and less with lot B. The thrombocytes decreased obviously with lot A, and less with lot B. GPT decreased with lot A, and GOT increased. The serum Zn decreased slowly with lot A, and more irregularly but more obviously with lot B. The serum Cu increased with lot A, and decreased with lot B. Alterations on the level of arterioles from the brain, aorta, myocardium and pancreas were evidenced, as well as electronmicroscopical alterations of the arteriolar walls and of the cellular organelles. The lipids from the brain, aorta and myocardium increased with both of the experimental lots and so did the cerebrosides, lecithins and the sphyngomyelin.

[Noninvasive diagnosis of occlusive processes of the brachiocephalic arteries: Doppler sonography compared to ophthalmodynamometry and ophthalmodynamography]

97 patients with suspected cerebrovascular disease were examined using ophthalmodynamometry/ophthalmodynamography and dopplersonography. In 49 of the patients we found haemodynamic changes typical of brachio-cephalic artery occlusion processes. In 36 patients angiography was performed either as a preparation for vascular surgery or for further clarification. Ophthalmodynamometry/ophthalmodynamography examination yielded diagnosis in 87%, dopplersonography and combined use of ophthalmodynamometry/ophthalmodynamography and dopplersonography in 94% of the brachio-cephalic artery occlusion processes.

Nursing care of an osteogenesis imperfecta infant and child

Because the child with osteogenesis imperfecta is hospitalized in the same setting many times throughout his childhood, the nursing staff become well acquainted with him and his family, and are able to assess the child's and parents' understanding of this chronic debilitating disease. The staff can help them to develop a realistic attitude toward their life and future plans. The family should be encouraged to see that the OI child attends a regular school whenever possible so that their active, excellent minds can develop. The family and child should be assured that an OI child can be educated to become a self-supporting adult.