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Acute generalized exanthematous pustulosis is clinically characterized by fever, pruritus and an acute pustular eruption. It can be described as having an abrupt onset and then spontaneous resolution occurs shortly after the start of symptoms, and there is usually only a single episode. Most cases have been triggered by the ingestion of drugs. Diltiazem hydrochloride is a calcium channel blocker that is commonly used for treating hypertension and angina. This drug was found to be the responsible agent in our current patient. There have been 9 such case reports in the English medical literature, yet this is the first such report in the Korean medical literature. We present the case of a 51-year-old male who experienced an acute generalized exanthematous pustulosis due to diltiazem hydrochloride and we review the relevant literature.

Neurocardiogenic syncope is a very common cause of syncope. In some patient populations, such as children and adolescents, it is the most common cause of syncope. Yet, despite numerous publications on the subject, decisions on treatment of the disorder remain ambiguous. In patients with frequent episodes of neurocardiogenic syncope, the decision to treat is obvious. However, in patients with a single or infrequent episode(s), the decision to treat is often times very difficult. If such patients have a clear precipitant, such as phlebotomy, treatment beyond education may not be necessary. In most patients with a single or infrequent episode(s), we look principally at two clinical factors. The first factor we consider is whether or not a reasonable prodrome of symptoms occurred prior to syncope. The second clinical factor is the lifestyle and/or occupation of the patient. For instance, a patient with a sedentary lifestyle and two syncopal episodes usually does not require treatment if the episodes occur with a 30–60 second prodrome. This would allow the patient time to sit or lie down and thus avoid injury. Conversely, a truck driver with a single episode would be appropriate to treat if the episode occurred with little or no prodrome. We realize these guidelines are vague. However, the decision to treat in these cases is often difficult, and physicians should be afforded considerable latitude in planning therapy based on the patient’s clinical circumstance. In addition, it is our opinion that any patient with neurocardiogenic syncope and clinical episodes that occur while in the seated position require treatment. These patients are at risk for syncope during activities such as driving or operating other vehicles, industrial equipment, etc. In these individuals, the customary method of lying down in order to abort an episode is often ineffective and/or unrealistic.

Twenty two patients presented with otogenic tetanus. Seventeen patients had acute histories with only a single episode of otitis media with otorrhoea. Fifteen patients had unilateral central perforations, five had bilateral central perforations and two had no perforations but had acutely congested tympanic membranes which were bulging suggesting the presence of purulent fluid behind them. All patients with perforations had a purulent pulsatile discharge. A coexisting aerobic infection was seen in 85 per cent of the cultures and 59 per cent of these were due tostaphylococcus aureus(versus 25 per cent in the controls). Only one patient had received partial immunization. Tetanus resulting from otitis media is not an indication for surgery.

A total of 51 periodontal sites from 6 adults with no systemic diseases or medication were selected for the study. All sites showed radiologic bone loss and pockets of 4 mm or more. Crevicular fluid (CF) was collected by inserting filter paper strips into periodontal pockets for 5 s and was measured by Periotron. Samples were collected before and 2, 5, 10, 20, and 40 days after a single episode of periodontal treatment (scaling, root planing and curettage). Plaque Index (P1I), Papilla Bleeding Index (PBI) and pocket depth (PD) were measured before and 40 days after treatment. The amount of bone loss was estimated from orthopantomograms taken immediately before the trial. Two days after treatment an increase in the amount of CF was seen. After this the amount of CF decreased, reaching the pretreatment level on day 5 after treatment and a level clearly below pretreatment level on day 10 after treatment. Forty days after treatment a slight increase in the amount of CF was seen. The difference between pretreatment values and values at days 2, 10, 20, and 40 was highly significant. In pretreatment samples, positive correlations were found between the amount of CF and PD, PBI and bone loss and, in samples collected 40 days after treatment between CF and PD. CF measurements made before treatment were of no value in predicting the changes in clinical parameters after treatment.

Inflammatory pseudotumor (IPT) of the kidney is a very rare lesion. We describe an 8-year-old boy with IPT of the kidney presenting as a single episode of hematuria. The case highlights a new feature, metaplastic bone, not previously described in IPT. This new feature may be helpful in establishing the correct preoperative and histopathologic diagnosis of IPT of kidney and avoiding inappropriately aggressive therapy. Despite its rarity, IPT of the kidney should be kept in mind in the differential diagnosis of a solitary renal mass.

• The incidence of recurrent injury requiring evaluation and treatment at an urban trauma center was assessed by examination of data from the registry of an urban trauma unit. A subgroup of 342 recidivists sustained 711 traumatic injuries. This represented 6.4% of trauma service activations or consultations. The rates of recurrence in random groups of 100 patients with trauma and 50 patients with traumatic deaths were 5% and 12%, respectively. These rates of recurrent injury are lower than those of several previous reports. Comparison of patients with recurrent episodes of trauma with patients who experience a single episode of trauma revealed significant differences in age, sex distribution, mechanism of injury, and fatal outcomes. Recidivists averaged only 7.9 months between episodes of injury. In patients with recurrent trauma with fatal outcomes, the mean interval between initial injury and death was 18.8 months. Early identification of patients at high risk for recurrence may provide an opportunity for behavior modification. ( Arch Surg. 1992;127:668-670)

To evaluate the role of gastroesophageal reflux (GER) as a possible cause of recurrent bronchopulmonary infection in Chinese children, 23 patients were studied prospectively with 24-h pH monitoring. Their ages ranged from 3 to 25 months. The patients studied were chosen by the criterion of repeated, radiographically documented bronchopulmonary infection with a frequency of two or more episodes in the most recent 6 months, or a single episode with a protracted course longer than 3 months. Twenty-one of the 23 showed abnormal GER on 24-h pH monitoring. Twenty children received medical therapy, 17 of whom were followed regularly for 14-29 months. Eleven had subsidence or improvement of symptoms at follow-up. Follow-up pH monitoring was performed in 5 of the 11 patients, and showed improvement. Six failed to show improvement with medical therapy. Follow-up pH monitoring revealed increased reflux in two of them. Three of the six received fundoplication and had marked improvement of reflux and symptoms postoperatively. Clinical resolution corresponded well to 24-h pH monitoring. GER may be considered one of the possible contributing factors in any child with chronic recurrent bronchopulmonary infection, and antireflux therapy might be beneficial. Twenty-four hour pH monitoring was the best single test for diagnosing GER and determining the severity of the disease.

During a 4-year period, at least 12 of 40 patients with cystic fibrosis (CF) who were newly colonized with Pseudomonas aeruginosa had acquired it at CF recreation camps, clinics, or rehabilitation centers. After introduction of hygienic precautions at the CF clinic, only a single episode of nosocomial transmission of P. aeruginosa was detected at the CF ward during the subsequent 2 years.

A 63-year-old woman presented with increasing abdominal distension for several months and acute onset breathlessness. She had no risk factors for liver disease although she had experienced a single episode of jaundice 28 years previously, for which she …

In most reports, Transient Global Amnesia (TGA) consisted of a single episode of total amnesia. The detailed investigation on the process of recovery from amnesia in the present two cases of TGA indicated the existence of a complex episode of TGA which consisted of a sequence of episodes of total amnesia.

A 57-year-old male was admitted with a 2-week history of fever, rigours, and confusion and a single episode of retrosternal chest pain. He had recently undergone a circumcision. Clinical examination revealed a temperature of 38.3°C and a balanitis. Urinanalysis revealed haematuria and proteinuria. He had acute renal failure (urea 24.5 mmol/L, creatinine 341 µmol/L) …

Purpose The aim of the study was to evaluate the risk for urethral lesions in girls with myelomeningocele (MMC) treated by clean intermittent catheterization (CIC) for a minimum of 10 years. Material and methods The medical records of 31 females with MMC, followed from the start of CIC until the age of 11-20 years, were examined. CIC had been performed for a median of 15 years (range 10-19). Altogether CIC was used for 459 years. Non-coated polyvinyl chloride (PVC) catheters were used in all cases. Anticholinergic treatment was given for 176 of the CIC years. Results Macroscopic hematuria was seen in 4 individuals. In 2 patients hematuria was caused by urethral adenomas that were cured by resection. The third individual had hematuria due to urethritis and the fourth had a single episode that resolved spontaneously. Isolated difficulties at catheterisation occurred in 16 patients. There was no correlation with anticholinergic treatment. The problems were solved after introduction of lubrication gel or by other minor changes of the management. The risk for difficulties at catheterisation was 6 times higher before puberty than after, doubled during use of catheter Ch 8-10 compared to Ch ≥12, and doubled during assisted CIC compared to self-CIC. Conclusions In girls and young females with MMC performing CIC with non-coated PVC catheters for at least 10 years, urethral adenomas were noticed in 2 individuals. No further serious complications were identified.

Discussing the usefulness of drugs in childhood epilepsy, Dr Newton (January 2004, JRSM1) suggests that ‘After two seizures most people will have a further seizure and this is probably the pivotal point at which the decision to treat or to delay treatment should be made’. Since antiepileptic drugs do not alter the natural course or long-term remission rate of epilepsy, the primary aim of treatment is to prevent seizure recurrence. In certain patients the recurrence rate after a single episode is particularly high—for example, those with a history of brain injury;2 those who had status epilepticus;3 and those who had a partial rather than a generalized seizure.4 The risk of recurrence after a first episode of seizure is much higher in children with abnormal electroencephalograms (EEGs) than in those with normal EEGs (80% versus 31%).5 Those with an abnormal CT scan at initial seizure have a higher risk of recurrence than those with normal scans.6 Though I agree with Dr Newton that antiepileptic drugs (AEDs) are generally not required after a first episode of unprovoked seizure, these are factors that might favour early treatment. Children and parents also need education on how to avoid precipitating factors. In one study, a lower relapse rate (uninfluenced by AED therapy) was observed in a group educated to avoid such factors.7 If drugs are prescribed, many patients and caregivers need help in managing prescriptions to minimize the risk of adverse effects.8

Currently the insertable loop recorder is usually indicated when the patient has recurrent syncopes and conventional Holter and electrophysiological testing have been negative. We report the case of a patient with dilated cardiomyopathy, admitted to our hospital due to a single episode of syncope. After performing conventional diagnostic procedures, including continuous electrocardiographic monitoring for 48 hours, 24-hour Holter and electrophysiological study, no abnormalities were detected. Therefore, a insertable loop recorder was implanted, which was activated by the patient one month later after a pre-syncopal situation. The Holter reading evidenced self-limited monomorphic ventricular tachycardia, confirming the arrhythmic origin of the syncope. In patients with severe structural heart disease, in whom syncope can be caused by a malignant ventricular arrhythmia, the insertable loop recorder can be indicated in a single episode of syncope when the electrophysiological study is negative.

In 1982 we recruited a cohort of patients presenting with acute guttate psoriasis (AGP). Subsequently, we reported the findings of our study on the role of streptococcal infection in the initiation of AGP in theArchives. 1 In a follow-up study aimed at assessing the risk of further psoriasis after a first episode of AGP, we have traced 15 of the 16 patients reported in our study who had presented with their first episode of AGP more than 10 years earlier. Five patients were examined by one of us (B.A.M.), four patients responded to a postal questionnaire, four patients were interviewed by telephone, and, in two cases, information was derived from the general practitioner's record. One patient could not be traced. Five of the patients (two females and three males), including one of the two patients who were not contacted directly, now have chronic psoriasis. Ten patients (six females

Sexual selection acting on male body size was investigated over a single episode of selection, the mate attraction phase, within a natural aggregation of the European field cricket, Gryllus campestris L. Males successful in attracting a female were significantly larger than those that failed to do so. The cross-sectional method of Wade and Arnold (1 984a, b) was adopted to assess the intensity of sexual selection acting on male size during this study. The results are compared with those of similar studies made on North American field crickets.

Glacial influence on deposition of the upper Proterozoic Sayunei and Shezal Formations (Rapitan Group) of northwestern Canada is well established. Diamictites of the Stelfox Member of the Ice Brook Formation, 1 km higher in the section and resting on platformal carbonate and siliciclastic strata of the Keele Formation, are here interpreted as glaciomarine. The glacial interpretation is based on the presence of dropstones, till pellets, extremely angular quartz grains, intercalations of laminated mudrocks and sandstone, and rare striated stones. The Stelfox glacial deposits are unique in that they lie above the lowest occurrence of faunas of Ediacaran type. The establishment of two episodes of Late Proterozoic glaciation in northwestern Canada, as opposed to the previously recognized single episode, enhances the possibility that these two glaciations correspond to the two recognized in parts of Australia and Africa.

Analysis of Mariner 10 stereoscopic images of the surface of Mercury suggest that ancient, intercrater plains consist in part of visually indistinct but topographically defined circular depressions inferred to be highly degraded craters and basins. Embayment of some craters within the heavily cratered terrain and transection of basins and craters by intercrater plains suggest that formation of at least some intercrater plains postdates the later portions of the bombardment of Mercury by large objects. On the other hand, superposition of crater ejecta onto portions of intercrater plains in other areas indicates that some large craters formed into a pre-existing, intercrater plains unit. A single episode of obliteration (to form intercrater plains) or bombardment (to produce the large craters) cannot be reconciled with available observations. A more complex history of contemporaneous crater and plains formation is suggested.

The saga of Ceyx, king of Trachis, begins at Met. 11.266 and continues to 11.748. Ceyx' adventures form the longest single episode in the Metamorphoses (482 verses), slightly longer than the Phaethon legend (432 verses, Met. 1.747–2.400). Three metamorphoses take place in the course of the Ceyx narrative. The first is that of Ceyx' brother Daedalion who is transformed into a hawk. The second transformation occurs in the course of the exiled Peleus' visit to Ceyx when a wolf attacks Peleus' cattle and sheep and is eventually turned into stone. The third metamorphosis is that of Ceyx and his wife Alcyone into halcyons.The linking together of these three metamorphoses was entirely an Ovidian invention: it had never been done before. It is therefore important to see the Ceyx story as a whole, as it was put together by Ovid. Attention naturally concentrates on the most interesting episode in it – the Ceyx–Alcyone – but the Daedalion and Peleus episodes are integral parts of the narrative and not separate legends. The story is framed by the contrasting transformations of the two brothers. The fierce and bellicose Daedalion becomes a bird of prey (Met. 11.344). The gentle and uxorious Ceyx becomes a happily paired halcyon (11. 741–8). It is ironic that we first meet Ceyx when he is mourning the transformation of his brother into a bird, since the same end awaits him. The brothers' characters are very different but their fates are similar. Ceyx' dealings with Peleus (11. 268–409) bring out the king of Trachis' hospitable, peace-loving, godly and husbandly qualities and give us a rounded and detailed picture of his personality to balance the developed character-study of his wife Alcyone which is to follow. The spotlight passes from Ceyx to Alcyone at Met. 11. 410.

Previous reports have shown that endotoxin decreases serum iron in experimental animals. In this study fever was produced in nine female and nine male normal subjects in order to define the temporal and quantitative changes in serum iron and ferritin concentrations. Six volunteers were randomly given bacterial endotoxin (5 ng/kg) or saline intravenously and received the alternative compound a week later. Serial blood samples were drawn at 4-hr intervals for a 24-hr period, beginning when the compound was administered, for the determination of serum iron and ferritin concentrations. The same study was performed with intramuscular etiocholanolone (0.3 mg/kg) or the vehicle, propylene glycol, as a control, but the first blood sample was obtained 9 hr after the compound was given. In addition, blood samples were obtained at 12-hr intervals in six volunteers for 11 days after an intramuscular injection of etiocholanolone. The results showed a significant increase (p less than 0.005 for etiocholanolone, P less than 0.01 for endotoxin) in serum ferritin and a significant decrease (p less than 0.005 for etiocholanolone, p less than 0.001 for endotoxin) in serum iron for both pyrogenic compounds compared with the control compounds. However, the amount of fever and the changes in the iron parameters were greater with etiocholanolone. One episode of induced fever with etiocholanolone effected changes in serum ferritin and iron concentrations that lasted 10 days. Thus this study demonstrated that a single episode of fever in man produced rapid and prolonged changes in serum iron and ferritin concentrations.

In a 6-week, randomized, double-blind study, adinazolam mezylate (Deracyn® Tablets, The Upjohn Company) was compared with placebo for the treatment of depression in 80 inpatients who met the criteria for single episode or recurrent DSM-III Major Depression. Subjects were admitted to the hospital 3 days before the start of the study and remained hospitalized for at least the first week of treatment. Efficacy was evaluated after 2, 4, 7, 14, 28, and 42 days of treatment. Adinazolam was significantly superior to placebo on all observer-rated and all global patient-rated measures of efficacy. Twenty-five subjects (63%) completed 6 weeks of adinazolam treatment and of these, 88% responded within 7 days. Only 15 placebo-treated subjects (38%) completed the study. Drowsiness and mild to moderate cognitive complaints were the only side effects observed more frequently with adinazolam, and both were transient. The results show that adinazolam is safe and more effective than placebo for the treatment of major depression.

The authors examined the effects of large intravenous doses of sufentanil (5-160 micrograms/kg) on cerebral blood flow (CBF) and cerebral metabolic rate for oxygen (CMRO2) in rats. CBF and CMRO2 were measured by a modified Kety-Schmidt technique using 133Xenon washout. Progressive decreases in CBF and CMRO2 occurred in animals receiving sufentanil. The maximum decrease was 53% and 40% for CBF and CMRO2 respectively, at a dose of 80 micrograms/kg. The values for CBF and CMRO2 in this group were 105 +/- 10 ml X 100 g-1 X min-1 (mean +/- SEM) and 6.5 +/- 0.5 ml X 100 g-1 X min-1, respectively, compared with 226 +/- 28 ml X 100 g-1 X min-1 and 10.9 +/- 1 ml X 100 g-1 X min-1 in the control group, which received N2O 70% in oxygen. Larger doses of sufentanil did not cause further significant changes in CBF and CMRO2. Sharp waves appeared on the electroencephalogram (EEG) of all the animals following sufentanil injection, and some animals had EEG changes develop consistent with seizure activity. This seizure-like activity appeared to consist of a single episode of short duration in the groups receiving 5, 10, and 20 micrograms/kg sufentanil. The incidence and frequency of seizure activity increased in the groups receiving higher doses of sufentanil, although the duration of seizures was still short. The results of this study indicate that sufentanil causes a significant decrease in CBF and CMRO2 similar to that previously reported for fentanyl, and high doses of sufentanil may cause frequent seizure-like patterns appearing on EEG.

During slow-wave sleep, rat brain glycogen increases within a few minutes to about 70% above waking levels. Upon awakening, the increment is lost within 2–5 min. After repeated episodes of sleep, brain glycogen levels are comparable to those observed after only a single episode of sleep. Liver glycogen is unaffected by slow-wave sleep.

Incisors, cuspids and premolars in 33 patients with advanced chronic periodontitis were treated by plaque control and 1 single episode of supra- and subgingival debridement. The results were monitored by probing attachment level measurements for 6 sites of each tooth every 3rd month during a period of 24 months. A total of 1368 sites were observed. From these were selected 280 "non-responding" sites showing 1.0 mm or more loss of probing attachment at 24 months compared to baseline. Scatter diagrams of the sequence of 9 probing attachment recordings obtained during the 24-month study were produced for each of these 280 sites. Study of these scatter diagrams resulted in identification of 7 different patterns of probing attachment change over time. A linear pattern of gradual loss of probing attachment throughout the 24-month observation period was found for 73% of the non-responding sites. Of the less frequently seen patterns, 3 approximated a linear course and 3 were non-linear. Linear analysis of regression as a statistical method to determine attachment loss for individual sites seems to be suitable for sites with linear patterns and for sites approximating a linear pattern. The insensitivity of regression analysis in non-linear patterns may be acceptable if a cautious analysis is warranted.

9 adult subjects with severe periodontitis were monitored following oral hygiene instruction and a single episode of crown and root debridement. Baseline recordings for probing attachment level were obtained both immediately pre-instrumentation and immediately post-instrumentation. Sites with gain, no change or loss of probing attachment level at 3 and 12 months compared to both pre- and post-instrumentation were identified. The classification was based upon the use of triplicate recordings at each time point, a site-specific standard deviation for measurement variability, and the requirement of a minimum of 1.0 mm change. The relative frequencies of gain, no change, and loss of probing attachment were then calculated for sites of various residual probing depths at 3 and 12 months. This was performed to evaluate if a given probing depth at re-evaluation, e.g., 7.0-7.5 mm, could be used as an indicator of the need for supplementary treatment following the initial therapy, based upon the observed probing attachment changes compared to baseline. As an example of the results of the present study, 60% of sites with residual probing depths of 7.0-7.5 mm showed probing attachment gain greater than or equal to 1.0 mm compared to the post-instrumentation baseline, and only 2% had undergone probing attachment loss greater than or equal to 1.0 mm. The overall results suggest that a relatively deep residual probing depth at re-evaluation following initial therapy, by itself, provides little evidence of lack of improvement compared to baseline. On this basis, the use of a specific probing depth at 3 or 12 months following treatment as a yardstick for the provision of supplementary treatment may not be justified.

A conversation analytic treatment of a single episode of talk-in-interaction is used to sketch a mechanism for steering recipients of bad news to better guesses of what the news is. The account of the mechanism makes use of the notion of “preferred/dispreferred response” and distinguishes different usages of that notion. The results of the exploration are used to recommend an approach to specialized contexts in which bad news is communicated, as well as an approach to “specialized” talk more generally.

On Jan. 24, 1986, during the inbound trajectory to Uranus, the planetary radio astronomy instrument on Voyager 2 detected left-hand-polarized emission for several hours at frequencies near 200 kHz. Unlike the dominant source observed on the nightside of the planet, only a single episode of this inbound emission was seen, and the emission was extremely weak. Generating less than 500 kW, it is probably the weakest freely propagating planetary radio emission thus far observed by Voyager. This weak emission is associated with a source region in the vicinity of the north (dayside) magnetic pole of Uranus, where magnetic-field lines point approximately in the direction of the spacecraft when the emission is observed. Therefore the wave normal angle relative to B is probably less than 90 deg in the generation region. It is concluded that direct wave generation in the magnetoionic ordinary mode is most likely. The source location for this emission is consistent with a region magnetically conjugate to the dominant nightside source, which is located in the vicinity of the south magnetic pole. The ordinary mode emission is discussed in the context of the electron-cyclotron maser mechanism.

Healing following non-surgical periodontal therapy was studied and the results of instrumentation performed by 6 operators compared. Incisors, cuspids and premolars with periodontal pockets up to 11 mm deep in 20 patients were treated by plaque control and a single episode of supra- and subgingival debridement. A split-mouth approach was used to compare the participating therapists. The effects of the therapy were monitored using changes in plaque score, bleeding score, probing pocket depth and probing attachment level. Marked improvement, similar to that seen in previous studies evaluating non-surgical therapy was noted during the initial 6-9 months. No further changes of the recorded parameters could be observed during the rest of the 24-month observation period. Differences between sites treated by the various operators were negligible. Thus, it appears, that deep periodontal pockets in incisors, cuspids and premolars may be successfully treated by plaque control and 1 episode of instrumentation and that operator variability may be limited.

Alaskan Natives (Indians and Eskimos) have an extraordinary incidence of invasive Haemophilus influenzae type b (Hib) disease (500 cases/100,000 children younger than 5 years of age) and also an increased incidence of recurrent disease. However, the incidence of primary Hib disease and recurrent disease are not excessive in non-Native children in Alaska (mainly Caucasian). Twelve recurrent cases in Alaskan Natives were studied, 10 of which were detected in surveillance activities between 1971 and 1984. These recurrent episodes occurred 23 to 197 days after the initial episodes (median, 51 days); the overall rate of recurrent disease was 3.5%. The ages of the patients with recurrent disease were significantly younger than single episode cases. To determine if disease recurrence was a manifestation of the high disease incidence and earlier age at onset of disease, we calculated an expected number of recurrent cases for our study population, based on the incidence observed in children with first episodes and the period of observed follow-up. The expected number of recurrent cases was only 1.9, significantly fewer than the 10 observed, indicating that age and the high incidence of disease alone were not the only factors contributing to the recurrent disease. No other significant clinical or epidemiologic risk factors could be identified. Patients who develop recurrent invasive Hib disease may represent a subset of this population with unusual disease susceptibility.

Ischaemic pain was induced in two groups of subjects. The pain was initially assessed using the McGill Pain Questionnaire and then by recall 7 days later. The pain experienced by a group of patients suffering from rheumatoid arthritis was similarly assessed before and after rehabilitatory surgery. Memory for the single episode of ischaemic pain was superior to that for the chronic rheumatoid pain.

The course of 132 patients with documented acute diverticulitis was analyzed: 99 patients treated medically and 33 patients treated surgically were followed for an average of 9.2 years. Seventy-three per cent of the medical group and 79% of the surgical group had no further symptoms or hospital admissions as a result of their diverticular disease once they were recovered from the acute episode. For three-quarters of the patients, therefore, acute diverticulitis occurred as a single episode that responded to either medical or surgical management. Considering the morbidity and cost to the patient, the treatment of the patient recovered from acute diverticulitis should be medical, with operation reserved for complications.

Physical manipulation of the hypothermic patient is well known to cause ventricular fibrillation. Careful review of the literature fails to demonstrate a true temporal relationship between orotracheal intubation and ventricular fibrillation (VF) when acceptable temperature-corrected arterial blood gases have been obtained. Eleven mongrel dogs were anesthetized and cooled, with orotracheal intubation and extubation performed every two degrees centrigrade, starting at 27 C. Ventilator settings were adjusted to maintain normal pH according to arterial blood gases drawn every two degrees and corrected for temperature. There was only one episode of VF during 42 intubations performed at temperatures less than 28 C (2.38%). There were eight separate episodes of spontaneous VF unrelated to intubation in five dogs. Four of these five with spontaneous VF were resuscitated with countershock only, further cooled, and reintubated an additional 11 times without a single episode of VF during intubation. Our data suggest that the incidence of VF during intubation in the hypothermic patient is much less than previously described, provided that normal pH is maintained and hypoxemia is corrected.

True palmar aneurysms are rare tumors of the hand. They occur most commonly in the hypothenar region and are the result of nonpenetrating blunt trauma. This trauma may be repetitive or a single episode. The absence of palmar fascia, the proximity to the hook of hamate, and the superficial location of the distal ulnar artery and superficial palmar arch are predisposing factors.

Interviews were conducted with 515 individuals between the ages of 20 and 80 years to gather data on acetazolamide therapy and the occurrence of urolithiasis. One hundred forty-eight patients were treated with chronic oral acetazolamide therapy for one week to 348 months (mean 40.9 months). The overall occurrence of individuals developing one or more stones was significantly higher in the group treated with acetazolamide than in the group not treated with acetazolamide ( P = 0.01, logistic multiple regression). Twelve patients developed one or more stones during acetazolamide therapy (interval between the initiation of therapy and the occurrence of the first stone was one to 108 months, mean 14.4 months. The rate of individuals developing one or more stones per year during acetazolamide treatment was 11 times higher than the rate in the group not treated with acetazolamide. The rate of individuals developing one or more stones per year during acetazolamide treatment was 15 times higher than the rate in the acetazolamide group prior to the initiation of acetazolamide therapy. Nine of the 12 individuals (75%) who developed calculi during acetazolamide therapy did so within the first 12 months of treatment. Ten of these patients were maintained on acetazolamide therapy and five (50%) developed a second stone in one to 88 months (mean 29.2 months). Eight patients with a history of a single episode of idiopathic urolithiasis were treated subsequently with acetazolamide (mean duration of therapy 28.8 months) without developing a second stone. The results of this study support the clinical impression that chronic acetazolamide therapy is associated with an increased occurrence of urolithiasis.

A 55-year-old man is convalescing from mitral valve replacement five days earlier. He had severe calcific mitral stenosis and moderately severe hypertension, with repeated attacks of acute pulmonary edema. He had always been in normal sinus rhythm, except for a single episode of atrial fibrillation associated with one of his episodes of acute pulmonary edema. He had been taking digoxin (0.25 mg daily) but this was stopped the day before the operation. The cardiac rhythm has been mostly regular since the operation, but occasional irregularities have been noted. An ECG on the fifth postoperative day is shown.

The clinical and laboratory experience with the lupus anticoagulant was reviewed in 37 patients. The anti-coagulant is thought to act by blocking the activation of prothrombin by the prothrombin activator comlex of factors Xa, V, and phospholipid. Although the anticoagulant has been principally associated with diseases of immune origin, 14 of the present patients had disorders not thought to be immune in nature. Eighteen patients underwent twenty-one operative procedures with only a single episode of excessive bleeding. In the author's experience, the lupus anticoagulant is a rare cause of bleeding.

Hippocampal electrical activity has been studied in 12 unanaesthetized, unrestrained rabbits during hypnosis and spontaneous activity in the experimental cage, before and among hypnosis trials. Quantitative analyses showed that rhythmic slow activity (RSA) occurred during exploratory movements (mean frequency 7.2 Hz) and also during spontaneous immobility, but a lower percentage and frequency (6.5 Hz). RSA was always present during the induction of hypnosis, but its frequency decreased and disappeared at the beginning of immobility, when it was replaced by a large amplitude irregular activity (LIA). During hypnosis RSA occurred in short periods, at low frequency (5.7 Hz). During the initial part of hypnosis, the lowest percentage of RSA was recorded. In the sec ond and third part, RSA increased in number of episodes, total amount, duration of a single episode and mean frequency. RSA of higher frequency occurred at the end of hypnosis, preceding righting movements. The relationships between hippocampal RSA and animal hypnosis are discussed.

An influenza epidemic occurred in Fukuoka, southern part of Japan in January, 1978 in which both influenza virus A(H1N1) and A (H3N2) were isolated. Thirty-two institutionalized children with influenza were studied at the time of this shift from A (H3N2) to A (H1N1). Fourteen virus strains were isolated. Thirteen strains belonged to influenza virus A (H1N1) (A/USSR/92/77-like strain) and one a mixed strain of A (H1N1) and A (H3N2) (A/Texas/77-like strain). The hemagglutination inhibition (H1)tests of paired sera indicated that of the 32 Children, 27 Showed a significant increasein HI antibody titers for influenza virus A (H1N1). 2 for A (H3N2) and the remaining 3, including the case from which the mixed virus strain was isolated, for both A (H1N1) and A (H3N2). These offers 3 cases were thought to be probably infected simulataneously with both influenza virus A (H1N1) and A (H3N2). Clinical manifestations due to influenza virus A (H1N1) were moderate and the 3 cases of probable simultaneous infection with both influenza virus A (H1N1) and A (H3N2) did not show two clinical episodes but rather a single episode with clinical manifestations similar to the cases with single virus infection.

Although scholars have expended increasing efforts over the last twenty years or so in either detecting or establishing large structural and thematic units within Ovid'sperpetuum carmen, little attention, as far as I am aware, has been directed towards the evident care taken by Ovid in his arrangement of material within individual episodes, and the resultant over-all structure of those episodes. The aim of the present paper is to focus attention upon a single episode to which Ovid seems to have paid particular attention in these respects. I refer to the long story of Phaethon, which occupies the last part of book 1, and most of the first half of book 2, of theMetamorphoses, and intend to explore two different lines of approach in examining the structure of this episode.

Eighty-three patients, 43 women and 40 men, with hemispheric transient ischemic attacks (TIAs) and normal angiograms were studied. Fifty-two of the patients had a single episode of transient ischemia, whereas 31 had multiple episodes prompting initial evaluation. Follow-up ranging from 3 to 132 months was obtained for all patients. In this period, six patients suffered a cerebrovascular accident and five had further hemispheric TIAs. These results are in contrast to our earlier data, which suggested a benign prognosis in this group of patients. Results of this updated study show that the prognosis of patients with hemispheric TIAs and normal angiograms is not so benign as originally reported. Those patients with multiple events before initial evaluation are at increased risk of subsequent cerebrovascular accident or TIA. Close observation of this group of patients is recommended. (J V ASC S URG 1987;6:548-52.)

The orientation and movement sense of shear fractures in pseudotachylyte generation zones developed in the Ikertoq shear belt, West Greenland are described, and the fracturing sequence is inferred. The generation zones occur in strongly foliated gneisses, and consist of concordant, usually paired, principal displacement shear fractures (paired shears), on which most melt was generated, and a system of minor shear fractures. Minor shear fracturing was most intense between principal displacement shear fractures, and most melt intruded from these paired shears inwards with respect to the zone. Intrusion of injection veins of pseudotachylyte off the principal displacement shear fractures, is believed to be contemporaneous with minor shear fracturing in the generation zones. Generation zones affect intact rocks, and individual principal displacement shear fractures have a maximum displacement of 4.6 m. Paired principal displacement shear fractures are up to 3 m apart, and have a maximum observed length of 1 km. In all the zones described, the fracturing appears to be the result of a single episode of slip. Both dextral and sinistral generation zones occur within the study area, and have different geometries. In each case the displacement is strike-slip.

The purposes of this study were to obtain a detailed description of the clinical features of pseudoepileptic (PE) seizures, to try to reproduce these events in the laboratory during a single recording, and to establish a framework useful to the clinician for evaluating patients whose behavior suggests physiological seizures, but about which doubt remains. We analyzed 37 episodes of PE seizures recorded in 30 patients during a single three-hour video/EEG recording. The PE seizures occurred spontaneously or were induced by sequential activation procedures. The historical information together with behavioral observations show that the PE seizures mimicked primary generalized seizures in 15 episodes, elementary partial seizures with secondary generalization in 21 episodes, and complex partial seizures in a single episode. Our data underscore the usefulness of the video/EEG recording method and suggest activation techniques which, combined with detailed historical information, aid in establishing the diagnosis of PE seizures.

The condition of nerves among women in the small Peruvian town of Puente Piedre is described. Both nervios (a symptom) and Nervios (a disorder) describe a woman's difficulty with nerves. In Puente Piedre, the identification of an anxiety condition among women depends only on the women's age. Younger women with anxiety symptoms are diagnosed as nervios, a temporary condition ascribed to a single episode of high blood pressure. Menopausal women with similar symptoms, on the other hand, are thought to have a specific disorder, Nervios. In Puente Piedre, Nervios clearly is a folk illness limited to women of menopausal age.

An outbreak of food poisoning caused by Salmonella typhi-murium, phage-type 12, in which 122 persons were infected, is described.Isolation of the same organism from the drains of two large abattoirs, from pig faeces at one abattoir, and from the floor drains of fifteen out of fifty-four butchers' shops and bakehouses examined, together with records showing that this organism had been recently isolated from pigs and cattle in the neighbourhood, suggested that meat was the vehicle of infection.We are indebted to Dr E. S. Anderson and the staff of the Central Enteric Reference Laboratory and Bureau, Colindale, for phage-typing the cultures of S. typhi-murium.We should like to thank Prof. Scott Thomson for his encouragement and advice in the preparation of this paper and Mr J. Morgan and Mr B. M. Jones of the Public Health Laboratory, Cardiff, for their technical assistance.

A syndrome characterised by complete absence of erythrocyte and leucocyte glucose-6-phosphate dehydrogenase (G.-6-P.D.) activity, chronic non-spherocytic haemolytic anaemia, and decreased leucocyte bactericidal and metabolic activity has been observed in three male siblings of a Canadian family. The oldest patient had episodes of recurrent granulomatous lymphadenitis, the second sibling had a single episode of cervical lymphadenitis, while the youngest has been free of infection. An intermediate defect in leucocyte microbicidal and metabolic activity and red and white blood-cell mosaicism was detected in the mother. The findings support the concept that complete or severe deficiency of G.-6-P.D. may affect both red-blood-cell survival and white-blood-cell function and express with the combined picture of haemolytic anaemia and mild chronic granulomatous disease.

This is a study of 25 patients of 109 patients who had been discharged from a private psychiatric hospital without a definite psychiatric diagnosis—undiagnosed. These 25 patients, in contrast to the other 84, remained undiagnosed after re-evaluation of their records and after a personal follow-up of a mean of 46 months, and therefore were termed undiagnosable. These patients were divided into a `sick9 and a `well9 group. Of the 6 `sick9 undiagnosable patients, 4 were characterized by an abundance and a wide spectrum of symptoms enough to fulfil the criteria for multiple psychiatric disorders which seemed to us unlikely to occur simultaneously in one patient. `Well9 undiagnosable patients had minimal if any psychiatric symptoms, except for the acute single event that resulted in the index admission to hospital; or had a primary medical disorder or a single symptom which was chronic; or had a moderate to severe single episode consisting of symptoms and signs that were still too few to meet the criteria for a psychiatric disorder, but their symptoms were close to meeting the criteria for schizoaffective illness. It is emphasized that less than one quarter of the initially undiagnosed patients were undiagnosable, and it is suggested that even that portion may be decreased by further follow-up.