Within one month of starting oral prednisolone treatment weakness unexpectedly increased in four patients aged 34 to 75 years with purely motor forms of acquired chronic demyelinating neuropathy. By contrast, steroids produced the expected improvement in 11 other patients with symmetric sensorimotor chronic inflammatory demyelinating polyneuropathy. Two of the patients with purely motor demyelinating neuropathy were subsequently treated with high dose IVIg (0.4 glkglday for five days) with prompt improvements in strength measurements and motor nerve conduction. Thus IVIg seems to be the treatment of choice and steroids should be used with extreme caution, if at all, in patients with purely motor forms of acquired demyelinating polyneuropathy. ( Neurol Neurosurg Psychiatry 1994;57:778-783)

A typical case of herpes zoster auris is described. Sections of the teniporal bone of tlie clinically affected side show extensive lynipliocytic or round cell infiltration of the facial nerve throughout its length and of the auditory nerve. There is considerable perivascular "cuffing" by lymphocytes in tlie modiolus, in the perineural tissue of the facial nerve, the cliorda tympani and the skin of the external auditory meatus.The vestibular, spiral and geniculate ganglia contain numerous normallooking neurones, although there is scattered lymphocytic infiltration of the surrounding nerve tissue. There are no necrotic changes in the ganglia. This case is in complete accordance with the main histopathological findings in four cases previously described : there is profuse and widespread lymphocytic infiltration in the facial nerve. This is in striking contrast to tlie microscopical findings in Bell's palsy.Tlie syndrome bearing Rainsay Hunt's name is based on a niore extensive lesion of the facial nerve and other nerves and parts of tlie central nervous system than is implied by the somewhat misleading term "gcniculate ganglionitis". It is essential that patients suffering from herpes zoster auris-for which the term "cephalic zoster' 'is considered to be a niore appropriate one-should be fully examined including lumbar puncture, and that in fatal cases, the brain and spinal cord should be obtained, if possible, for histopathological analysis.Herpes zoster (herpes froin herpein to creep, zoster a sword belt), zone or shingles never presents a difficult diagnosis. Its aetiology and to some extent pathology, particularly of cephalic zoster have been considered obscure.The paucity of histophathological reports prompts us to describe the findings in the temporal bones of a woman who died of carbon monoxide poisoning following intractable tinnitus caused by a severe attack of herpes zoster auris with facial palsy. I1 might be useful first to survey our knowledge of the aetiology of herpes Acta Otolaryng. (Stockh.) 63 Acta Otolaryngol Downloaded from informahealthcare.com by Nyu Medical Center on 08/05/15 For personal use only. England Acta Otolaryngol Downloaded from informahealthcare.com by Nyu Medical Center on 08/05/15 For personal use only.

No abstract

In the last twelve months, 216 pairs of paiatine tonsils were removed in the Ear, Nose and Throat Department of Manchester Royal Infirmary. These operations were usually in children, from whom adenoid tissue (the pharyngeal tonsil) was removed at the same time. In the absence of a special reason, neither tonsils nor adenoids from children find their way to the surgical histology department: this is true enough to require special requests for specimens so that other people can see these organs. Adult tonsils are, of course, different in this respect.The age and sex distribution of tonsillectomy for the last four years is shown in Table I, and is remarkable for the high figure for males in the first two five-year periods and for females in the 10-25 year age group. The figures for the four-year totals of females are highly significant, and in fact the female preponderance in the adolescent and young adult groups brings-the total figures up to a near-equal distribution for the sexes, in spite of the early male preponderance. Very few tonsils are removed in Manchester Royal Infirmary before the age of 4, and hence the male period of risk appears to be 3-9 years of age and that of females 10-25 years.