Myotonia due to cold. A benign syndrome of myotonic contraction after exposure to cold manifesting a characteristic hereditary pattern

Western Society for Clinical Research Pennsylvania Hospital and the second on the Children’s Service at the University of California Hospital. In the former, studies were made on the fat content of the chyle obtained by puncture of a vesicle on the scrotum at intervals following ingestion of cream. In the latter the lymphatics of the pelvis, external genitalia and lower extremities were visualized by x-ray after injection of diodrast by direct puncture of a vesicle on the labia majora. It was shown that the valves of the lymphatics were deficient in this case. In both patients an attempt was made to resect the pelvic lymphatics. Although there was temporary improvement, in neither case was the condition completely relieved. The possibility of lymphangiography in the study of lymphedema is discussed. ON

THE CLINICAL USEFULNESS OF HYPO-

TONIC INTRAVENOUS SOLUTIONS. F.

R. Schemm, M.D., John A. Layne, M.D. and (by invitation) John S. Gilson, M.D., Great Falls, Montana. (From the Department of Medicine,

Great

Falls Clinic.)

\Ve have found hypotonic solutions given by vein effective in maintaining water balance when the administration of water per se was indicated and when the customary amounts of sodium chloride or dextrose found in isotonic solutions appeared undesirable. The hypotonic solutions, at first of two-thirds and later of onehalf of isotonic strength, were particularly useful in postoperative or azotemic diabetic patients with cardiovascular-renal complications. Hypotonic solutions have now been used in more than thirty-five instances, extending over periods of treatment from five to thirteen days. A total of from 1 to 4 L. were given daily, in volumes varying from 500 to 1,500 cc. at a time, with a rate of flow that ranged from 14 to 22 cc. per minute. One of the most useful solutions contained 2.25 Gm. of sodium chloride and 12.5 Gm. of dextrose in 1,000 cc. of water. With this latter solution, one can give, for example, with 4,000 cc. of water 50 Gm. of dextrose and 9 Gm. of sodium chloride in twenty-four hours. These amounts give a good base line for maintenance in, for example, postoperative diabetics with duodenal drainage, providing enough water and dextrose and not too much sodium. One-half isotonic strength saline or dextrose can be added or substituted for the combined solution when there appears to be need for more sodium or dextrose. MARCH, 1949

39’

Studies of the blood immediately after administration of these hypotonic solutions or after several days’ use of them showed no detectable dilution or disturbance of the electrolyte pattern of the blood, indicating how swiftly plain water is diffused throughout the 50 L. of total body water. In some instances these solutions were used in patients recovering from episodes of acute, profuse pulmonary edema. MYOTON~A DUE TO COLD. A BENIGN SYNDROMEOF MYOTONIC CONTRACTION AFTER EXPOSURETO COLD MANIFESTINGA CHARACTERISTICHEREDITARY PATTERN. Frank

H. and tion Salt

Tyler, M.D., Thomas A. Witten, M.D. Fayette B. Stephens, Ph.D., (by invitaand introduced by Hans H. Hecht, M.D.), Lake City, Utah. (From the Depart-

ment

of

College

Medicine,

University

of

Utah

of Medicine.)

The disease (paramyotonia congenita) described by Eulenberg in 1886 and by Rich in 1895 has not been clearly distinguished from other myotonias by most neurologists since that time. The opportunity to study a family with the disorder now presents itself. The syndrome consists of myotonic reaction occurring most frequently in facial, oculomotor and intrinsic hand muscles as the result of exposure to cold. Other factors are of little importance in the occurrence of the myotonia, but quick movement following rest or gross voluntary movement occasionally precipitate it in certain members of the family. The anomaly is present at birth and persists throughout life with a tendency to improvement not very marked and without the development of muscular atrophy and other degenerative changes. A case of myotonic muscular contraction induced by exposure to cold or chilling is reported. A family history of sixty-two persons manifesting the disorder with a typical Mendelian dominant pattern of inheritance is presented. The myotonia responds to quinine in the same fashion as other myotonias. CLINICAL AND LABORATORY RELIABILITY OF PROTEIN-BOUND BLOOD IODINE DETERMINATIONS.Donald

W. Petit, ll4.D. (by invitation), Paul Starr, M.D. and A. L. Chaney, Ph. D. (by invitation), Los Angeles, California. (From the Department of Mecbtine,

University

of Southern

California.

j

Because of increasing acceptance of the usefulness of protein-bound blood iodine determina-