[Familial indifference to pain with somatosensory asymmetry: possible central anomaly]. / Forme familiale d'insensibilité à la douleur avec asymétrie de la somesthésie: anomalie centrale?

A family of seven siblings is described. The mother and six siblings have been examined, the eldest and youngest of whom suffer from congenital indifference to pain , although both were ticklish, and itched. The functions examined included somatosensory perception thresholds and autonomic functions; perception thresholds were greatly raised in the painfree subjects and to a lesser extent in some other family members, asymmetrically in all cases, being higher in the dominant hand. Painfree Subject 1 also underwent cerebrospinal fluid analysis at age 16, which showed normal B-endorphin levels but undetectable enkephalins. Electrophysiological tests when a child demonstrated notably that most (raised) measured values were lowered by naloxone. Light microscopic sural nerve biopsy performed on painfree Subject 1 in childhood did not suggest any abnormalities other than a thickened nerve sheath. Threshold asymmetry has not been observed in large numbers of subjects without neurological deficits. There were no significant autonomic changes in any tested family member, though there was some asymmetry. It is suggested that the findings may imply a congenital anomaly of the central nervous system which accounts for the somatosensory, biochemical, and electrophysiological abnormalities.

A preliminary study of the treatment of trochanteric fractures of the femur with the Kenwright nail.

We present a preliminary study of the results of treatment of 106 fractures of the trochanteric region of the femur, using a new expanding compression nail, the Kenwright nail. The device obtains a secure hold in the femoral head and compresses the fracture line, to give very firm fixation, enabling patients to bear weight immediately with much more confidence than with conventional methods of fixation. Earlier discharge from hospital has been possible, with the release of valuable beds. In no case has the nail cut out. A similar study of its use in intracapsular fractures will be reported.

Acute brucellosis treated with trimethoprim and sulphamethoxazole.

Four patients with acute brucellosis are described, none of whom had any connexion with farming or milk industry, the source of infection being different in each case. The diagnosis was made by serological tests, and in three of the four cases was confirmed by positive cultures from bone marrow (one case) and liver biopsy (two cases). Treatment with the combination of trimethoprim/sulphamethoxazole was successful in three out of four cases, and in the fourth case failure may have been due to the development of trimethoprim resistance.