Corticosteroid hormonal influence on cranial computerized tomography: observations in the Rhesus monkey.

Six adult male Rhesus monkeys (T), treated with 0.5 mg/kg dexamethasone for 106 days, and 6 weight-watched controls (U), were studied postmortem with pathologic examination and cranial computerized tomography (CT). Cortical atrophy, as defined by perisulcal atrophy and ventricular dilatation, was found in 50% of each group, but marked changes were noted only among T. Adrenal, brain, and body weights were all lower among T (p less than 0.05). No significant histopathologic abnormalities were found. Our data suggest that CT changes of cortical atrophy may be caused by corticosteroid hormones alone, but are inconsistent and probably dependent upon individual susceptibility to the effects of corticosteroids.

Posttraumatic sports-related musculoskeletal abnormalities: prevalence in a normal population.

The prevalence of posttraumatic musculoskeletal (MS) abnormalities attributable to athletics within general populations has not been identified. In this study, comprehensive athletic histories and MS examinations were performed on 127 medical students, aged 23 to 32. A total of 158 separate congenital, developmental, and acquired MS abnormalities were detected among 93 subjects (73.2%). Forty-seven subjects (37.0%) demonstrated 64 separate sports-related abnormalities, including decreased joint range in motion (ROM), articular laxity, synovitis, tendinitis, and bursitis. Participants in contact sports had the highest prevalence, runners were intermediate, and participants in noncontact sports had the lowest prevalence of posttraumatic MS abnormalities. Ninety subjects (70.8%) had previous history of sports-related injuries. Participation in specific sports correlated with predictable injury patterns and with their sequelae as noted on physical examination. The data presented suggest a high incidence of sports injury in general populations, and demonstrate that posttraumatic MS abnormalities attributable to athletics are highly prevalent in otherwise normal young adults.

Systemic lupus erythematosus with myocarditis complicating pregnancy.

We report a patient with systemic lupus erythematosus and myocarditis complicating pregnancy. Cardiomegaly and compensated congestive heart failure persisted postpartum and we had the therapeutic dilemma of a pregnancy six months later. The defined maternal prognosis of a similar disease, peripartum cardiomyopathy, suggested the need for termination of pregnancy.

Computerized tomography in evaluation of atlantoaxial subluxation in rheumatoid arthritis.

Nineteen patients with rheumatoid C1-C2 subluxation of greater than or equal to 5mm were studied by computerized tomography (CT). CT demonstration of spinal cord compression as defined by loss of posterior subarachnoid space was present in 11/19 (CT+) and absent in 8/19 (CT-). Fourteen patients were examined by a blinded neurologist. Cord compression by CT correlated better with clinical neurologic status than did routine radiographic studies. Absent superficial abdominal reflexes and history of bladder dysfunction correlated highly with cord compression by CT. Two CT+ patients developed neurologic deterioration requiring spinal fusion. Our data suggest that CT is a useful, noninvasive adjunct in management of patients with rheumatoid C1-C2 subluxation.

Articular and soft tissue abnormalities in a "normal" population.

One hundred twenty-three medical students underwent comprehensive locomotor physical examinations as part of their sophomore physical diagnosis course. Sixty-nine point one per cent of subjects were found to have between 1 and 7 separate congenital, developmental, post-traumatic, inflammatory or idiopathic abnormalities. More than 30 different types of abnormalities were noted. The data presented suggest a high prevalence of locomotor abnormalities in a "normal" population, and supports the need for history and physical examinations in the selection of control subjects for clinical studies.

Hypokalemic periodic paralysis in Sjögren's syndrome.

A 30-year-old woman had scleroderma, Sjögren's syndrome, deforming polyarthritis, distal renal tubular acidosis, hypokalemic periodic paralysis, and persistent mild myopathy. During a five-year period the patient's otherwise mild course of disease was complicated by the occurrence of five episodes of severe flaccid muscle paralysis involving both proximal and distal muscle groups. Between the paralytic episodes the patient functioned well without replacement therapy, and had normal potassium levels. The sicca component was mild and went unrecognized for several years. There was no family history of muscle disease. The data presented in this report support the view that the paralytic episodes were due to hypokalemia secondary to renal tubular acidosis associated with Sjögren's syndrome. Hypokalemic periodic paralysis may occur as a rare complication of Sjögren's syndrome and renal tubular acidosis.