Search

Objective. —To study the clinical characteristics of respiratory tract illness caused by Chlamydia pneumoniae . Design. —Prospective clinical, bacteriologic, and serologic study. Secondarily, a matched comparison of patients with and without evidence of C pneumoniae infection (serologic titers ≥1:64 and Setting. —Four primary care (family practice) clinics in Madison, Wis, and nearby towns. Patients. —The study included 365 white males and females (mean age, 34.2 years). Main Outcome Measures. —Association of acute C pneumoniae infection with signs and symptoms of respiratory illness and the relationship of C pneumoniae antibody titer with wheezing at the time of enrollment in the study, and with the diagnosis of asthmatic bronchitis. Results. —Nine (47%) of 19 patients with acute C pneumoniae infection had bronchospasm during respiratory illness, and there was a strong quantitative association of C pneumoniae titer with wheezing at the time of enrollment in the study ( P =.01). In the matched study, C pneumoniae antibody was significantly associated with asthmatic bronchitis after, but not before, respiratory illness (odds ratio, 7.2; 95% confidence interval, 2.2 to 23.4). Four infected patients had newly diagnosed asthma after illness, and four others had exacerbation of previously diagnosed asthma. There was no serologic evidence of coexisting Mycoplasma pneumoniae, Chlamydia trachomatis , or respiratory viral infection in 96% of patients with asthmatic bronchitis and asthma. Conclusions. —Some Cpneumoniae antibody titers, although not diagnostic of chlamydial infection by present criteria, probably represent acute reinfection or ongoing chronic infection. Repeated or prolonged exposure to C pneumoniae may have a causal association with wheezing, asthmatic bronchitis, and asthma. ( JAMA . 1991;266:225-230)

Originally stimulated by interviewing an anosmic patient who stated she could still perceive flavors, we turned to the literature on the subject of flavor and found that uncertainty continues to exist as to the importance of olfactory and extraolfactory sensations in this regard. Because of the availability of five patients whose olfactory nerves had been surgically proved to be destroyed, either by basofrontal brain tumors or by cranial trauma, the opportunity presented itself for more definitive study. METHOD The five patients (one the subject of a published case report 1 ) mentioned in the preceding paragraph were studied, together with a group of 10 normal controls. The patients without the sense of smell were of both sexes and of varying ages and occupations and had been anosmic for varying periods. The controls fell into similar categories. Smokers and nonsmokers were present in both groups. One control had complete dentures. All subjects

• The diagnosis of pernicious anemia with dorsolateral spinal degeneration was made in two patients, and the progress of the neurological symptoms was halted by treatment with cyanocobalamin. Both patients, however, suffered exacerbations of these symptoms after a lapse of time, which was 13 months in one case and six years in the other. Neither responded to intensified medical treatment. In the first case, an extramedullary, intradural psammomatous meningioma at the 10th thoracic level was found at operation, and removal of the tumor was followed by marked improvement. In the second case, the lesion proved to be an extradural neurofibroma. In both, the initial diagnosis of pernicious anemia was corroborated by a test depending on the absorption of cyanocobalamin labeled with radioactive cobalt. These experiences illustrated the usefulness of the cyanocobalamin-absorption test, the response of patients with pernicious anemia to cyanocobalamin therapy, and the possibility that two unrelated causes of neurological symptoms may coexist in a single patient.

THIS REPORT was prompted by the circumstance that both the patients reported had unusual clinical histories and that in both communicating hydrocephalus developed as a result of meningeal meningiomatosis. In addition, attempts were made to control the increased intracranial pressure in each instance by the use of drainage through a polyethylene tube. The character of the lesions was not revealed until necropsy. Necropsy also afforded an opportunity to study the effects of the various operative procedures which had been employed in the hope of controlling increased intracranial pressure and the communicating hydrocephalus. It is not within the scope of this presentation to discuss the cause of hydrocephalus 1 or the merits or demerits of procedures employed in attempting to control hydrocephalus of the obstructive 2 or communicating type. 3 Russell 4 discussed the pathologic changes in this condition, and Davidoff 5 reviewed the literature concerning various operative methods of treatment.

• Diabetes insipidus as seen in experimental animals after cutting the supraopticohypophysial tracts usually passes through three phases. This explains some phenomena seen in human subjects. In the first case here described, surgery in the vicinity of the optic chiasm was followed (a) by a polyuria of 27,930 cc. in 24 hours, then (b) by a gradual return to normal urinary output at about the sixth day, and finally, after about three days of normal output, (c) by establishment of a permanent phase of diabetes insipidus amenable to treatment with vasopressin tannate. Animal experiments suggest that the interphase (b) can be explained as meaning a transient outpouring of antidiuretic hormone by the detached, degenerating posterior lobe. The permanent phase (c) then represents exhaustion of the antidiuretic material from the posterior lobe. Severe diabetes insipidus is known to occur only in the presence of a functioning anterior pituitary lobe. In the third case here described, a polyuria had existed for more than six years in the presence of signs of hypophysial disease. A spontaneous amelioration of the polyuria was then noted concurrently with signs that the anterior lobe was failing; the polyuria returned after treatment with cortisone was begun. Spontaneous remission in a long-standing case of diabetes insipidus should alert the clinician to the possibility that the anterior lobe of the hypophysis is becoming involved in the disease process.

Since Feb. 27, 1940, a total of 503 mentally ill patients have undergone prefrontal leukotomy at the Rochester (Minn.) State Hospital. The open method of Lyerly 1 has been used exclusively. The early operations were graded 4 on the scale devised by Love. 2 As much as possible of the white matter was cut in the plane of the coronal suture. Undesirable after-effects, such as inertia, confusion, and untidiness, always were in evidence after the operation. Most of the patients tended to become obese, and in many some masking of the facies developed. In order to prevent or to minimize these unpleasant sequelae, the trend has been to cut less extensively. 3 In all cases, the cut has been made in the plane of the coronal suture. Therefore, the variations have been in the extent and in the location of the cut in this plane. STUDY OF ELECTRICAL POTENTIALS In

The term "glioma of the optic nerve" has been employed commonly to designate a primary tumor arising in the anterior visual pathways (optic nerve, chiasm, and optic tracts). Recently, during a larger study of tumors of the orbit and its contents, it became apparent that a fair proportion of the growths took origin from the optic nerve. It next emerged that primary neoplasms of the optic chiasm and of the optic tracts were at least as common as those of its orbital segment. Moreover, regardless of the point of origin or the extent of the process, these new growths had similar microscopic characteristics and were gliomas rather than neurofibromas. Clinically such a disproportionately large number of them affected children that a congenital origin seemed suggested, and the more-than-occasional associated phenomena of neurofibromatosis (von Recklinghausen's disease) implied that they might even be neoplasms of a hereditary type. These observations were confirmed