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ACUTE INTERNAL AND EXTERNAL OPHTHALMOPLEGIA WITH MUSCLE WEAKNESS
1110 All the
improvements showed an increase in the paling a varying degree of improvement in their ankle
interval, and
pulses. As I also used a technique detailed by E. TroensegaardHansen, it is hard to reconcile these two series. Suffice it to state that amnion implantation has proved definitely beneficial in a fair proportion of cases of peripheral vascular disease.
W. B. WELPLY.
Cork.
ACUTE INTERNAL AND EXTERNAL OPHTHALMOPLEGIA WITH MUSCLE WEAKNESS
SIR,-Dr. Kelly and Dr. Gibberd (April 6) ask for information about cases similar to their own. We showed such a case lately at the Settimana Medica degli Ospedali in Rome. Histological findings were consistent with acute polyneuritis of the oculomotor nerves. A
35-year-old Army officer, twelve days before his death, sore throat, cough, and fever up to 39-39.5° C (102-2-1030 F). On the fourth day he had dysarthria, diplopia, and photophobia; next day he regurgitated his food on swallowing. Neurological examination, on admission, revealed complete bilateral paralysis of the third, fourth, and sixth nerves, and paralysis of the palate. There were no other cranial nerves paralysed at that time, nor was there weakness of the limbs. In the cerebrospinal fluid there was a slight fell ill with
increase in protein and 3 cells per c.mm. In the next two days the seventh and twelfth nerves on the right side became paralysed. There were no disturbances of consciousness till the end. Virological and bacteriological studies were negative. Necropsy revealed no significant gross changes. Histologically, the nerve-cells in the nuclei of the third, fourth, and sixth nerves were swollen, with chromatolysis of Nissl granules, and eccentric displacement of the nucleus. Fig. 1 shows nerve-cells in the lateral nucleus of the third nerve; fig. 2 is a control preparation to demonstrate the normal appearance of these cells. The third nerves were redematous, with scanty perivascular lymphocytic infiltration (fig. 3); Gros-Bielschowsky preparations showed fragmentation of the nerve-fibres. We do not know of other cases ofacute polyneuritis
cranialis which were studied histologically, since the disease usually runs a benign course. In Doring’s case,’ there was paralysis of the limbs, and the oculomotor nerves were not affected. Istituto di Anatomia Patologica dell’ Università, AMICO BIGNAMI Policlinico Umberto 1, MARIO SERVI. Rome. DEPARTMENTAL DRUG REFERENCE SERVICE SIR,-A readily available and up-to-date source of reference on drugs is a useful service to have in a
hospital department
or a
practice.
At this unit the most informative literature on drugs that is obtained from the pharmaceutical manufacturers, from journals, and elsewhere is collected and filed according to the name or use of the product. In this way a comprehensive file has been built up which has come to contain much more than most doctors have time or space to collect for themselves. The file is kept at a central point in the building and is open for reference to medical and nursing staff and students.
.mention this idea as I am sure many other hospitals, departments, and practices would find the provision of such a service a valuable and appreciated addition Fig. 1-Nerve-cells in lateral nucleus of third (oculomotor)
nerve
to
their services.
Psychiatric Unit, St. James’s Hospital,
(x 140).
Leeds,
9.
D. A. SPENCER.
PERNICIOUS ANÆMIA, CHRONIC THYROIDITIS, AND ANTITHYROGLOBULIN ANTIBODIES
SIR,-Pernicious anaemia and myxoedema not infrequently coexist.23 Chronic thyroiditis has been described at necropsy of patients with pernicious anaemia. Bastenie4 described a patient with perniciousansemia in whom myxoedema had developed a year before death, and recorded latent chronic thyroiditis in 4 cases of macrocytic ansemia. Williams and Doniachobserved thyroiditis on patients with pernicious anxmia. The presence of anti-thyroid (complement fixing) antiFig. 2-Normal
appearance of cells in
fig.
1
(x 140).
bodies has been described by Goudie et al. in one case.6 Recently we found strong titres of anti-thyroglobulin antibodies in 2 out of 4 well-documented cases. case 1 (a 71-year-old woman), diagnosed at the age of 53, adequate treatment had been given in the last years. In case 2 (a woman aged 45) the diagnosis had been made at the age of 37, and treatment had been insufficient. Both patients were euthyroid. In case 1 a trace dose of radioactive iodine gave the following results: uptake at 24 hr. 78%; conversion-rate 42%;
In
no
131p.B.I.
uptake
per litre.
Fig. 3-Lymphocytic infiltration in third (oculomotor) nerve (x130).
hr. 0-18% per litre. In case 2 the results were: hr. 68%; conversion-rate 50%; 131p.B.I. 0-10% In both patients, the high values for radioactive
at 24 at 24
1. Z. Nervenheilk. 1944, 156, 243. 2. Means, J., Lerman, J., Castle, W. B. Trans. Ass. Amer. Phycns, 45, 363. 3. Tudhope, G. R., Wilson, G. M. Quart. J. Med. 1960, 29, 513. 4. Bastenie, P. A. Bull. Acad. Méd. Belg. 1944, 9, 179. 5. Williams, E. D., Doniach, I. J. Path. Bact. 1962, 83, 255. 6. Goudie, R. B., Anderson, J. R., Gray, K. G. ibid. 1959, 77, 389.
1930,
improvements showed an increase in the paling a varying degree of improvement in their ankle
interval, and
pulses. As I also used a technique detailed by E. TroensegaardHansen, it is hard to reconcile these two series. Suffice it to state that amnion implantation has proved definitely beneficial in a fair proportion of cases of peripheral vascular disease.
W. B. WELPLY.
Cork.
ACUTE INTERNAL AND EXTERNAL OPHTHALMOPLEGIA WITH MUSCLE WEAKNESS
SIR,-Dr. Kelly and Dr. Gibberd (April 6) ask for information about cases similar to their own. We showed such a case lately at the Settimana Medica degli Ospedali in Rome. Histological findings were consistent with acute polyneuritis of the oculomotor nerves. A
35-year-old Army officer, twelve days before his death, sore throat, cough, and fever up to 39-39.5° C (102-2-1030 F). On the fourth day he had dysarthria, diplopia, and photophobia; next day he regurgitated his food on swallowing. Neurological examination, on admission, revealed complete bilateral paralysis of the third, fourth, and sixth nerves, and paralysis of the palate. There were no other cranial nerves paralysed at that time, nor was there weakness of the limbs. In the cerebrospinal fluid there was a slight fell ill with
increase in protein and 3 cells per c.mm. In the next two days the seventh and twelfth nerves on the right side became paralysed. There were no disturbances of consciousness till the end. Virological and bacteriological studies were negative. Necropsy revealed no significant gross changes. Histologically, the nerve-cells in the nuclei of the third, fourth, and sixth nerves were swollen, with chromatolysis of Nissl granules, and eccentric displacement of the nucleus. Fig. 1 shows nerve-cells in the lateral nucleus of the third nerve; fig. 2 is a control preparation to demonstrate the normal appearance of these cells. The third nerves were redematous, with scanty perivascular lymphocytic infiltration (fig. 3); Gros-Bielschowsky preparations showed fragmentation of the nerve-fibres. We do not know of other cases ofacute polyneuritis
cranialis which were studied histologically, since the disease usually runs a benign course. In Doring’s case,’ there was paralysis of the limbs, and the oculomotor nerves were not affected. Istituto di Anatomia Patologica dell’ Università, AMICO BIGNAMI Policlinico Umberto 1, MARIO SERVI. Rome. DEPARTMENTAL DRUG REFERENCE SERVICE SIR,-A readily available and up-to-date source of reference on drugs is a useful service to have in a
hospital department
or a
practice.
At this unit the most informative literature on drugs that is obtained from the pharmaceutical manufacturers, from journals, and elsewhere is collected and filed according to the name or use of the product. In this way a comprehensive file has been built up which has come to contain much more than most doctors have time or space to collect for themselves. The file is kept at a central point in the building and is open for reference to medical and nursing staff and students.
.mention this idea as I am sure many other hospitals, departments, and practices would find the provision of such a service a valuable and appreciated addition Fig. 1-Nerve-cells in lateral nucleus of third (oculomotor)
nerve
to
their services.
Psychiatric Unit, St. James’s Hospital,
(x 140).
Leeds,
9.
D. A. SPENCER.
PERNICIOUS ANÆMIA, CHRONIC THYROIDITIS, AND ANTITHYROGLOBULIN ANTIBODIES
SIR,-Pernicious anaemia and myxoedema not infrequently coexist.23 Chronic thyroiditis has been described at necropsy of patients with pernicious anaemia. Bastenie4 described a patient with perniciousansemia in whom myxoedema had developed a year before death, and recorded latent chronic thyroiditis in 4 cases of macrocytic ansemia. Williams and Doniachobserved thyroiditis on patients with pernicious anxmia. The presence of anti-thyroid (complement fixing) antiFig. 2-Normal
appearance of cells in
fig.
1
(x 140).
bodies has been described by Goudie et al. in one case.6 Recently we found strong titres of anti-thyroglobulin antibodies in 2 out of 4 well-documented cases. case 1 (a 71-year-old woman), diagnosed at the age of 53, adequate treatment had been given in the last years. In case 2 (a woman aged 45) the diagnosis had been made at the age of 37, and treatment had been insufficient. Both patients were euthyroid. In case 1 a trace dose of radioactive iodine gave the following results: uptake at 24 hr. 78%; conversion-rate 42%;
In
no
131p.B.I.
uptake
per litre.
Fig. 3-Lymphocytic infiltration in third (oculomotor) nerve (x130).
hr. 0-18% per litre. In case 2 the results were: hr. 68%; conversion-rate 50%; 131p.B.I. 0-10% In both patients, the high values for radioactive
at 24 at 24
1. Z. Nervenheilk. 1944, 156, 243. 2. Means, J., Lerman, J., Castle, W. B. Trans. Ass. Amer. Phycns, 45, 363. 3. Tudhope, G. R., Wilson, G. M. Quart. J. Med. 1960, 29, 513. 4. Bastenie, P. A. Bull. Acad. Méd. Belg. 1944, 9, 179. 5. Williams, E. D., Doniach, I. J. Path. Bact. 1962, 83, 255. 6. Goudie, R. B., Anderson, J. R., Gray, K. G. ibid. 1959, 77, 389.
1930,