Encephalomyocarditis syndrome (EMC syndrome)

Among 28 autopsy-cases with EMC had been none diagnosed clinically before. Typically we found an interstitial myocarditis and perivenous encephalitis with a preferred participation of the brain stem, eventually resulting in a central failure. There were only 5 cases with meningitis. Myelitis was not found. Former cardiac, less often cerebral lesions are likely risks for the lethal event.     

Premenstrual syndrome

This paper is an overview of research on premenstrual syndrome (PMS), focusing on the key topics of definition of the syndrome and the relationship of PMS to psychiatric illness. The etiology and treatment of PMS is discussed. Medical-legal implications of PMS are also reviewed with attention directed to the few studies and court cases relating PMS to the concept of diminished criminal responsibility. Researchers are beginning to make some progress with respect to criteria for the diagnosis of PMS. Much work remains concerning the questions of the relationship of PMS to psychiatric disorders and whether PMS should be considered as one syndrome or many.     

Neuromyotonic syndrome

A syndrome with constant rest activity was observed in the EMG of a 28-years-old female patient. An H-reflex was detected for normal nerve conduction velocity. Hypomagnesemia was striking among the laboratory values. Bioptic investigation yielded centralisation of nuclei, variations in the diameter of muscle fibres and a predominance of type I fibres. The findings and the response to Finlepsin point to neuromyotonic syndrome.     

Acrocephalosyndactylia--Vogt syndrome

A genetically remarkable case of the Vogt syndrome (combination of the Apert and Crouzon syndromes) associated with a dysraphia syndrome is described. Clinically, malformations corresponding to the Apert syndrome were prominent, and radiological examination of the skull revealed a prominent Crouzon syndrome. Investigation of the familial background revealed the presence of malformations in other members of the family, such as malformation of the extremities and acrocephalus. On the other hand, the father's age of 63 years was considerably higher than that of fathers in the average population, so that the possibility of a new mutation had to be considered. The fact that the mother suffered an attack of influenza during pregnancy, finally, brought the possibility of peristatic influences being involved in the complex malformations.     

The hypothalamo-pituitary-adrenal axis in chronic fatigue syndrome and fibromyalgia syndrome

The hypothalamo-pituitary-adrenal (HPA) axis plays a major role in the regulation of responses to stress. Human stress-related disorders such as chronic fatigue syndrome (CFS), fibromyalgia syndrome (FMS), chronic pelvic pain and post-traumatic stress disorder are characterized by alterations in HPA axis activity. However, the role of the HPA axis alterations in these stress-related disorders is not clear. Most studies have shown that the HPA axis is underactive in the stress-related disorders, but contradictory results have also been reported, which may be due to the patients selected for the study, the methods used for the investigation of the HPA axis, the stage of the syndrome when the tests have been done and the interpretation of the results. There is no structural abnormality in the endocrine organs which comprise the HPA axis, thus it seems that hypocortisolemia found in the patients with stress-related disorder is functional. It may be also an adaptive response of the body to chronic stress. In this review, tests used in the assessment of HPA axis function and the HPA axis alterations found in CFS and FMS are discussed in detail.     

Rape trauma syndrome

The relationship of rape trauma syndrome to the official diagnostic nomenclature of Post-Traumatic Stress Disorder in the DSM-III is extensively discussed. The theoretical and practical clinical issues involved in rape trauma are reviewed as well as the early court rulings on the admissibility of rape trauma syndrome in criminal and civil cases.     

Rubinstein-Taybi syndrome.

Rubinstein-Taybi Syndrome was first described in 1957 but only in 1963 as a distinguishable type of moderate mental retardation. The cause is still unknown although some type of genetic origin is possible. No consistent chromosomal abnormality has been demonstrated, the chromosomal analysis is normal, and cases are generally not considered hereditary. The recurrent risk for siblings is approximately 0.1% but may be as high as 50% for offspring of patients with the syndrome. The Rubinstein-Taybi syndrome is not at present detectable before birth and is evenly found in both males and females. The syndrome was thought to be rare but an increase in the number of reported cases each year suggests it is not as rare as estimated. It is thought to occur in about 1 in 300,000 births, and since it has become readily identifiable, more than 400 cases have been reported worldwide.     

The missionary syndrome

Early sexual explorations of children that are of a traumatic nature are often labeled by the child as bad or wrong and subsequently repressed. The guilt that results from the labeling may be intensified at a later date by some other similar incident, and at this time the person may make a binding commitment or promise to God to serve Him in some dutiful way. If, at a later date, these plans to serve God cannot be realized, depression, phobias, or conversion symptomatology may occur, which we have referred to as the Missionary Syndrome.Ray O. Sexton, M.D., is a psychiatrist in private practice in Memphis, TennesseeWith Dr. Sexton, he maintains a private practice in Memphis, Tennessee.     

Stiff man syndrome

Our 51-year old patient developed low back pain and an increase of tonus mainly in the left limb and trunk muscles. Microscopic examination of the muscles and electronmicroscopic examination of the sural nerve and that of the gastronemic muscle did not show any specific deviation. On the basis of spontaneous activity observed during EMG examination, protracted motor activity of great amplitude when moved passively, as well as characteristic clinical symptoms and the disease process Stiff-man syndrome was diagnosed. Considering literature data, we tried applying diazepam (Seduxen and Rivotril)-presumably increasing the praesynaptic inhibition and affecting the reticular system of the brain stem-, as well as GABA medicaments (Lioresal and Depakine) increasing synaptic transport. By giving Seduxen, Rivotril and Baclofen simultaneously a lasting remission of symptoms could be reached. Applying Depakine in combination with the above medicines proved ineffective, presumably because of synergetic side effects.     

Neuroleptic malignant syndrome

Neuroleptic Malignant Syndrome is a disabling reaction to neuroleptic drugs recently discussed in psychiatric literature in Europe, Japan, and the United States. It is rare but potentially fatal and is more likely to occur in men, especially young men, than in women. The cause is unknown, but dopamine depletion in the brain is suspected. Treatment usually begins by withdrawing the neuroleptics and then providing supportive therapy for the usual symptoms of high fever, muscular rigidity, labile blood pressure, and tachycardia. The Neuroleptic Malignant Syndrome usually lasts two to three weeks.