[A man with sexual disinhibition caused by paraneoplastic limbic encephalitis]. / Een man met seksuele ontremming veroorzaakt door paraneoplastische limbische encefalitis.

A 63-year-old man with symptoms of depression and sexual disinhibition was admitted to a psychiatric clinic for the elderly. Because the man's symptoms rapidly became more severe he was referred to the emergency room. There, his illness was diagnosed as paraneoplastic limbic encephalitis with positive anti-Hu antibodies; this is a paraneoplastic neurological syndrome presenting with short-term memory loss, epileptic seizures and psychiatric symptoms. For the prognosis of the illness it is essential that the syndrome is diagnosed as early as possible. Since patients sometimes present with mainly psychiatric symptoms it is important that psychiatrists are fully informed about the symptoms and are able to make an accurate diagnosis.

Corneal sensitivity in patients with leprosy and in controls.

AIMS: In a quantitative prospective study the corneal sensation in patients with leprosy was compared with age matched controls. METHODS: The patients with leprosy were classified as paucibacillary and multibacillary and were divided in three groups: (1) patients without clinically detectable eye pathology; (2) patients with lagophthalmos, (3) patients with signs of iridocyclitis. The corneal sensitivity was assessed with the Cochet and Bonnet aesthesiometer. RESULTS: There was a significant decrease in corneal sensitivity in multibacillary patients without clinically detectable eye pathology and in patients with lagophthalmos or iritis when compared with controls. A significant correlation between the loss of power of the orbicularis oculi muscle and the degree of corneal sensation loss could not be established. No significant decrease in corneal sensitivity was found in paucibacillary patients without eye pathology compared with the control group. CONCLUSION: The results of this study showed that loss of corneal sensation can occur while there is no clinically detectable eye pathology, at least in multibacillary patients. Regular checkups of the corneal sensation should, therefore, be part of the routine control of leprosy patients. Health education on eye care and early warning signs should be encouraged.

Repeated measurements of serum cholesterol and blood pressure in relation to long-term incidence of myocardial infarction. The Zutphen Study.

Repeated risk factor measurements reduce the amount of random error due to intraindividual variation. Annual measurements of serum cholesterol and systolic blood pressure were done in a cohort of 878 men, aged 40-59 years, between 1960 and 1970. This study examined for both risk factors the association with the incidence of myocardial infarction (MI) during follow-up till 1985. Mean values from repeated measurements yielded stronger statistical associations with MI incidence than single observations. However, when measurements were extended over too many years in this middle-aged cohort, a bias occurred due to selective loss of high-risk individuals as early cases. This was especially the case of serum cholesterol. Taking account of trends in regression analysis did not show any advantage over the use of mean values.