Search

The effect of slow intravenous infusion of luteinizing hormone-releasing hormone (LH-RH) on serum LH was studied in 58 patients with anatomically verified hypothalamo-pituitary disorders as well as in control groups. Normal responses to the LH-RH test were found in 15 out of 15 cases with intrasellar pituitary tumours and in five out of six cases after transsphenoidal surgery for an intrasellar pituitary tumour. Twenty-one out of 25 patients where a pituitary tumour with both supra- and intrasellar extension had been removed had pathological responses to the test. All eight patients with hypothalamic disorders, mainly tumours not directly influencing the pituitary, gave normal responses to the LH-RH tests. Out of four patients with hypothalamopituitary malformations a pathological response to the LH-RH infusion was found in three cases and a normal response in one case. The increase of serum LH after LH-RH infusion was pronounced and rather constant in males and post-menopausal women. It was more difficult to evaluate a “normal” test response in women of fertile ages because of the great variations during the different menstrual phases. It is concluded that the LH-RH test may be of importance in the investigation of patients with suspected tumours of the pituitary as well as for differential diagnosis between hypothalamic and pituitary disorders of gonadotropin secretion.

Objectives To explore, in an age perspective, women's lifetime sexual techniques and the extent to which they had led to orgasm. To relate these techniques and current erotic perceptions to orgasmic function in women sexually active during the last 12 months and to describe the relative impact of orgasmic function/dysfunction on their sexual well‐being. Methods A nationally representative sample of 18‐ to 74‐year‐old women (N = 1,335) participated. Nearly all were heterosexual. Current orgasmic capacity was broadly and subjectively classified into: no, mild, or manifest dysfunction. Sexual techniques and erotic perceptions were recorded together with level of sexual satisfaction. Results Generational differences characterized age at first orgasm and intercourse, types and width of sexual repertoire, and also current erotic perceptions, while orgasmic dysfunction and distress caused by it were less age dependent. Likely protectors of good orgasmic function, mainly against manifest dysfunction, were: a relatively early age at first orgasm, a relatively greater repertoire of techniques used—in particular having been caressed manually or orally by partner(s), achievement of orgasm by penile intravaginal movements, attaching importance to sexuality and being relatively easily sexually aroused. In turn, among other aspects of female sexual function women who did not have orgasmic dysfunction or distress were particularly likely to be satisfied with their sexual life. Conclusion Besides providing data on matters frequently said to be sensitive this investigation shows that women's generation and with it several long‐ranging aspects of women's sexual history and their feelings of being sexual are important indicators of their orgasmic and thereby their overall sexual well‐being. When (in clinical practice) establishing treatment strategy for women with orgasmic dysfunction due respect should be given to these factors. Fugl‐Meyer KS, Oberg K, Lundberg PO, Lewin B, and Fugl‐Meyer A. On orgasm, sexual techniques, and erotic perceptions in 18‐ to 74‐year‐old Swedish women. J Sex Med 2006;3:56–68.

In a previous study, patients with suspect Creutzfeldt-Jakob’s disease (CJD) have been examined with Positron Emission Tomography (PET) combining N-[11C-methyl]-L-deuterodeprenyl (DED) and [18F] 2- fluorodeoxyglucose (FDG) in an attempt to detect astrocytosis and neuronal dysfunction, two of the hallmarks in CJD. Increased DED uptake with pronounced hypometabolism matching the areas with high DED retention was found in the fronto-parieto-occipital areas and cerebellum of patients with confirmed CJD. However, the temporal lobes did not present such a pattern. In 6 of the 15 examined patients the autopsy was performed, but a strict comparison between the PET results and the histopathology could not be done. Recently, one patient with suspect CJD was examined with PET using DED and FDG. The results of the examinations in this patient showed a pattern similar to that found in the brain of the CJD patients from the first study. The patient died shortly after the examination and an autopsy could be performed. The autopsy showed neuronal death, astrocytosis and spongiform changes in the brain. The diagnosis of definite sporadic CJD was established by the Western blot analysis, confirming the presence of the prion resistant protein (PrPres). The PET data demonstrated high DED uptake and extreme low glucose uptake in the left brain hemisphere whereas the right side was less affected. The autopsy was performed allowing the comparison between high DED uptake and the histopathological findings of reactive astrocytosis revealed by immunostaining with antibodies against glial fibrillary acid protein (GFAP). The results confirmed the presence of a pattern with high ratio DED/FDG, similar to that found in the previous study and revealing for the first time, a good correlation between high DED uptake and high density of reactive astrocytes as demonstrated by immunostaining.

PURPOSE: To explore the association between the use of neuroactive drugs and reports of epileptic seizures. MATERIAL: Using the WHO adverse drug reactions (ADR) database, VigiBase, we surveyed reports of suspected seizures from 1968 until February 2006. Case reports of ADRs, that were classified as convulsions were collected and compared to the total number of ADRs reported. RESULTS: The total number of ADRs was 7,375,325. The number of convulsive events was 71,471. The ratio of convulsive ADRs to the total number of ADRs reported for each drug was evaluated and expressed as a percentage. The 10 drugs most frequently associated with convulsive ADRs were maprotilene (14.42%), escitaloprame (9.78%), buproprione (9.49%), clozapine (9.0%), chlorprothiexene (8.89%), amoxapine (8.74%), donepezil (8.40%), rivastigmine (6.41%), quetiapine (5.90%) and trimipramine (5.69%). CONCLUSIONS: Based on the reports in VigiBase, ADR reports relating to antidepressants, antipsychotic and cholinomimetic drugs included seizures more often than other neuroactive drugs.

OBJECTIVES—To find and investigate, retrospectively, as many cases as possible of Creutzfeldt-Jakob disease (CJD) in Sweden dying during the period 1 January 1985 to 31 December 1996 and to detect any possible case(s) of new variant CJD. METHODS—The patients were found through computer search of all death certificates in Sweden on which CJD was mentioned, through information from the Swedish neuropathologists, and spontaneous reports from Swedish doctors and hospitals. Data concerning the patients were then collected from patients' case records and from brain histopathology reports. RESULTS—In total 72 cases of spongiform encephalopathy were confirmed as definite by neuropathology, one of them with Gerstmann-Stäussler-Scheinker disease. In 51 further cases there were no brain pathology data but the diagnosis "probable" (37 patients) or "possible" (14 patients) CJD according to WHO criteria could be made on clinical grounds. There was a variation in number of deaths/year, from a minimum of five (1985) to a maximum of 16 (1990). Sixty patients died during the period 1985-90 and 62 during 1991-6. The sex ratio was nearly 1:1. Calculated for a population of 8.6 million (mean of 12 years) in Sweden this gives 1.18/million/year. Age at the time of the presenting symptoms ranged from 34 to 84 years. Only one patient was under 40 at the onset of symptoms. He had a spongiform encephalopathy but prion protein staining was negative. The duration of symptoms that could be attributed to CJD was 6 months or less in 75 cases, 7-12 months in 16 cases, 1 to 2 years in 15 cases, and more than 2 years in 16 patients. By definition all patients were demented. Other more common symptoms and signs were aphasia, dysphasia, dysathria, ataxia, myoclonus, pareses of the extremities, rigidity or spasticity, different types of hyperkinesias, and other psychiatric symptoms (depression, anxiety, and aggressiveness). Less common symptoms were hallucinations (mainly visual), visual defects, sensory symptoms (paraesthesias, itching, or pain), apraxia of swallowing, and disorders of eye movements. CONCLUSIONS—The incidence, the symptomatology, the age distribution (age in years at onset and at death), and the duration of illness were similar to those of other countries except for the cases of new variant CJD in the United Kingdom. There is so far no indication of any cases of new variant CJD in Sweden.

Bei 37 Fallen von Epilepsie, die auf fruhere antiepileptische Medikation nicht zufriedenstellend angesprochen hatten, wurde Mogadon in Dosen von 10–30 mg taglich zu der fruheren Medikation hinzugefugt. 15 der Falle hatten eine psychomotorische Epilepsie, in 6 anderen Fallen lagen partielle Anfalle anderen Typs vor, in 2 Fallen Petit mal, in 2 Fallen myoklonisches Petit mal und in 12 Fallen unklassifizierbare Anfalle vom generalisierten Typ. Die Behandlungszeit betrug bis zu 3 Jahren. Samtliche Patienten waren Erwachsene.

Positron emission tomography (PET) is a technique which enables characterization of a large number of functional and biochemical parameters in vivo and thus vastly expands the diagnostic potentials of present neuroradiology.

Transsphenoidal diagnostic puncture of skull base tumours has been a routine procedure in Uppsala for a decade. Bromocriptine is the treatment of choice for patients with prolactin secreting pitutiary adenomas. Here we report on a patient with a pituitary adenoma who instead developed an increase in tumour size after bromocriptine treatment. Magnetic resonance imaging showed the tumor to be cystic. A transsphenoidal puncture was used therapeutically instead of surgery with excellent result.

This paper reports on sexual dysfunction experienced by 25 women with relatively mild multiple sclerosis (MS), previous accounts having been largely confined to problems encountered by males. The study included a matched comparison group of 25 women with migraine. All subjects were investigated neurologically, with particular reference to the lower segment of the spinal cord. Two case histories help to illustrate the results, and it is concluded that major sexual problems of organic nature are common and early symptoms in MS. The implications for treatment are discussed.

✓ This study was based on 24 consecutive patients operated on for pituitary adenoma with suprasellar extension, and treated postoperatively with radiotherapy. The follow-up period was 5 to 10 years. A clinical examination, endocrine evaluation, perimetry, computerized tomography (CT) and sellar roentgenography were performed in 19 of 20 surviving patients. The CT scans revealed four recurrences, while perimetry only showed an increased visual field defect in one patient. Plain sellar films were of no value for diagnosis of recurrence. Prolactin determinations seemed to have a limited value in recurrence diagnosis, but very high levels spoke in favor of a recurrence. Thus, CT was found to be the superior method of diagnosing recurrences. It is proposed that CT be used regularly in the follow-up study of patients operated on for a pituitary adenoma.