“Orofacial Dystonia—A Silent Killer”: Mandibular Fractures with Orofacial Dystonia, A Report of a Case and Review

Mandibular parasymphysis fracture is very commonly observed especially in old age when there is resorptions of the alveolar ridges. In cervical dystonia, there is centrally mediated disease in which there is uncontrolled and spasmodic contraction of the facial and the masticatory muscles. Due to the application of this sudden and uncontrolled force, there is a tendency of the bone to unfavourably remodel and weaken. The case presented here is of a geriatric patient who presented to us with a fracture at the right parasymphysis and left dentoalveolar region of the mandible and was suffering from cervical dystonia. Management of this case posed a challenge in every step, and it needed a resurgery where the fracture was managed by the placement of reconstruction plate. Not many cases in the literature have been reported where dystonic movements have resulted in the fracture of the mandible.

Aripiprazole induced hiccups

Hiccups are a product of involuntary, intermittent spasmodic contraction of the diaphragm and inspiratory intercostal muscles that results in sudden inspiration and abrupt closure of the glottis. The exact pathophysiology of hiccups remains unknown. However, certain neurotransmitters, medications, and other factors have been implicated. We report a case of a 38 year old patient who developed hiccups three days after adding aripiprazole 5 mg once a day to his medication regimen. Medical and environmental causes were ruled out and aripiprazole was discontinued. One day later, the hiccups resolved. Several case reports have described patients who developed hiccups when treated with aripiprazole and related this to changes in neurotransmitter concentrations. However, due to limited literature, it was difficult to determine rate of occurrence of this adverse event with aripiprazole. A temporal but not a causal relationship was observed between initiating aripiprazole and development of hiccups in this patient. A causal relationship cannot be established since the patient was not re-challenged with aripiprazole. Nonetheless, clinicians should be cognizant that use of aripiprazole may be associated with hiccups.

A Case of Cephalic Tetanus in a Developed Country

Tetanus is a potentially life-threatening infection that results from contamination of skin wound by Clostridium Tetani spores. Although, it remains an important health problem in developing countries without strict national immunization programs, this condition is rare in the developed world. The most frequent presenting symptoms are trismus and dysphagia, due to the spasmodic contraction of the masticatory muscles. Then the disease usually diffuses with a descending pattern inducing a generalized contraction of the agonist and antagonistic muscles, which characterize a tetanic spasm. Mortality usually results from respiratory failure, cardiovascular collapse, or autonomic dysfunctions. Treatment usually requires the prompt admission to the intensive care unit to avoid the development of potential life-threatening complications. We report the case of a 78-year-old farmer, who was referred to us with progressive onset of lock-jaw and muscular stiffness of the facial region, that had occurred after he had scratched himself with a rose. The recognition of the presenting signs of cephalic tetanus allowed the prompt management of the infection. However, because of the rarity of this condition, the clinicians may be unfamiliar with the clinical presentation, and be unsuspecting of the diagnosis.

Beta2-Adrenergic Agents in Asthma

For reasons not well understood, the prevalence of asthma, as well as its associated morbidity and mortality, has been increasing worldwide over the past 10 to 15 years. The pathophysiologic mechanism currently thought to underlie asthma involves both airway inflammation and bronchial hyperresponsiveness. Children who have asthma experience acute exacerbations of their disease, often precipitated by viral respiratory infections, by exposure to allergens or irritants, and by exercise. Wheezing, shortness of breath, chest tightness, and cough, all common symptoms that lead patients to seek relief, result at least in part from spasmodic contraction of bronchial smooth muscle. Drugs that relax bronchial smooth muscle produce the most immediate effect on airway caliber, even though edema and mucous secretions also contribute to airway obstruction.

Sperm transport in the fowl

(1) The distributions of living and dead sperm in the oviducts of hens a t various time intervals after artificial insemination were determined by using sperm labelled with 32P and assaying the radioactivity of serial sections of the oviduct. Appropriate. tests of the method showed it to be valid and reasonably accurate for short-term experiments. (2) The number of sperm reaching the site of fertilization at the upper end of the oviduct (the infundibulum) was dependent primarily on where in the lower genital tract the sperm were deposited. Following intravaginal insemination with 2 X 108 sperm, from 7 X 103 to 70 X 103 sperm were detected in the infundibula of different hens up to 1 hr after insemination. After intra-uterine insemination with a like number, from 137 X 103 to 2642 X 10103 sperm were detected. (3) The junction of the vagina and uterus (or shell gland) proved to be a barrier to sperm progress, as was shown by the greater efficiency of sperm utilization above the junction than below it. (4) Dead sperm inseminated intravaginally did not pass into the uterus but those inseminated into the uterus reached the infundibulum in as great numbers as a similar sample of living sperm. This suggested that the mechanism of sperm transport differs on either side of the uterovaginal junction. (5) From the speed of transport of sperm and the passage up the oviduct of sperm-free fluid injected into the uterus, it is suggested that the spasmodic contraction of muscle investing the wall of the upper vagina and lower uterus induced as a response to tactile stimuli is mainly responsible for sperm movement from the uterovaginal junction to the infundibulum. (6) Motility of sperm is necessary only to traverse the vagina and perhaps to penetrate the vitelline membrane of the egg during the process of fertilization. At other stages of movement between the vagina and the egg, sperm play a passive role in their own transport.

THE EFFECT OF TEMPERATURE VARIATIONS AND OF CERTAIN DRUGS UPON THE INTESTINAL MOTILITY OF ELASMOBRANCH FISHES

A rise of temperature increases the rate of the spontaneous contraction of the spiral intestine and valve, rectum and colon. At any one temperature the upper end of the spiral intestine has the same rate of contraction as the lower end, whereas the upper end of the spiral valve has a higher rate than the lower end. The rectum and colon have no rapid rhythm, but give a single spasmodic contraction every half hour or so.Adrenaline, pilocarpine and acetylcholine stimulate all the above parts, though the effect of pilocarpine on the spiral valve is very indefinite. Atropine has no effect on normal contractions, but counteracts the effect of acetylcholine and pilocarpine.

An Attempt to Classify (Pathologically) the Various Fundus Pictures in Diseases of the Choroid

Mr. Hepburn read a paper on the above subject, and by means of suitable fundus drawings endeavoured to prove that all pictures could be relegated to one or other of the following groups:— Inflammatory: ( a) Acute stage; ( b) scarred stage. Vascular: ( a) Acute stage; ( b) scarred stage; ( c) slow progressive changes due to disease or spasmodic contraction of the vessel walls. Hyaline, calcareous, and similar degenerations of the membrane of Bruch. New growths. Congenital; including colobomata. Injuries; leading to concussion changes and ruptures.

STUDIES ON THE EFFECT OF CERTAIN TOXIC SUBSTANCES IN BACTERIAL CULTURES ON THE MOVEMENT OF THE INTESTINES

Following intravenous injection, filtrates of young cultures of B. paratyphosus B often produce marked diarrhea in rabbits. A study was made of the effect of these toxic filtrates on the motility of the small intestines of the rabbit. The observations were made on a segment of the small intestines in situ, and in the living animal. It was found that an immediate slight rise of tone of the longitudinal muscles occurred following intravenous injection of sterile broth. The same rise was noted after the injection of the toxic filtrate; but with these it was followed later (10 minutes elapsing at least) by a very strong but gradual rise of the diastolic and systolic tone, i.e., by spasmodic contraction of the intestinal muscle, which persisted at times for as long as 2 hours. In order to record simultaneously the effect on the longitudinal and circular muscles, and the propulsive efficiency of the segment the Sollmann and Rademaekers modification of Baur's technique was employed. This arrangement showed that the stimulation of the longitudinal muscles is accompanied by a similarly strong stimulation of the circular muscles, by peristalsis, and therefore by a greatly increased propulsion of intestinal contents which was sufficient to overcome the inhibition that usually occurs after preparation of the animal. With this arrangement an instance of peristaltic spasm was also noted. Broth alone failed to produce the phenomenon. Isotonic magnesium chloride or sulfate added to the bath relaxed the muscles again. Animals under deep urethane anesthesia did not show the diarrhea occurring in the intact controls, but sometimes exhibited it after the effect of the anesthetic had disappeared. So far no effects have been observed on the isolated strip (Magnus method), and further studies are being made to localize the effect, to neutralize it with a specific antiserum, and to observe the effect of filtrates of other members of the bacterial group including the dysentery bacilli.