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lagra in persons who subsist mainly on corn, which contains only small amounts of tryptophan and niacin some of the niacin being in bound form and unavailable for absorption It should be pointed out that, in experimental subjects, only the cutaneous-gastrointestinal-neurasthenic manifestations of pellagra have been produced by the feeding of tryptophan- or niacinde cient diets; neurologic abnormalities were not produced by these diets (Goldsmith) As a corollary, only the dermal, gastrointestinal, and neurasthenic manifestations respond to treatment with niacin and tryptophan; neurologic disturbances in pellagrins have proved to be recalcitrant to prolonged treatment with nicotinic acid, although the peripheral nerve disorder may subsequently respond to treatment with thiamine In monkeys, degeneration of peripheral nerves as well as the unique cerebrocortical changes of pellagra were induced by a de ciency of pyridoxine (Victor and Adams, 1956).

therefore, because pe2 = p2 pe = p2e we have e2 pi G(Me + m) i pe2 pe2 3 GMe i p = Gi pe2 3 e2 =

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Swank and Adams described degeneration of the peripheral nerves in pyridoxine- and pantothenic acid de cient swine, and Vilter and colleagues produced polyneuropathy in human subjects rendered pyridoxine-de cient; these subjects also showed seborrheic dermatitis and glossitis (indistinguishable from that of niacin de ciency) and the cheilosis and angular stomatitis that are usually attributed to ribo avin de ciency The foregoing observations indicate that certain lingual and cutaneous manifestations of pellagra may be produced by a de ciency of pyridoxine or other B vitamins and that the neurologic manifestations of pellagra are most likely due to pyridoxine de ciency In the special case of Hartnup disease (which resembles pellagra in most respects including the dermatitis), a niacin de ciency is believed to result from the high excretion of indicans and indole metabolites (see page 818) Nutritional Spinal Spastic and Ataxic Syndrome This syndrome is observed occasionally in nutritionally depleted alcoholics.

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The main clinical signs are spastic weakness of the legs, with absent abdominal and increased tendon re exes, clonus, extensor plantar responses, and a loss of position and vibratory senses In our experience, this syndrome is usually associated with other nutritional disorders, such as Wernicke disease and peripheral and optic neuropathy In prisoner-of-war camps, the spastic syndrome was observed in association with mental and emotional changes and dimness of vision, and at times with widespread muscular rigidity, confusion, coma, and death The latter syndrome has never been studied pathologically, so that it is impossible to state whether the lesions are the same as or different from those of pellagra or from Strachan syndrome, described further on.

SECURITY SCAN To check server statistics: 1. Launch the Global MMC Console (Quick Launch Area | Global MMC Console). 2. Connect to the appropriate server (Action | Connect to another computer) and either type in the server name (\\servername) or use the Browse button to locate it. Click OK when done. 3. Move to the WINS service (Services and Applications | WINS). 4. Make sure you click the WINS service and that its information is displayed in the right pane, then right-click on WINS to select Display Server Statistics from the context menu. 5. This will display current statistics for the server, including uptime, discovers, offers, requests, and more. Make note of these values in your monthly WINS log. Click Close when done. You can use the same context menu to select Scavenge Database, Check Database Consistency, and Check Version ID Consistency.

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The syndromes of tropical spastic paraparesis and of lathyrism, another form of spastic paraplegia common in India and certain parts of Africa, were for many years suspected of being nutritional in origin but are now known to be due to a virus and a toxin, respectively These and other types of tropical spastic paraplegia are discussed in greater detail with the spinal cord diseases (Chap 44) A chronic tropical disease of the peripheral nerves, called ataxic neuropathy of Nigeria, has been attributed to the ingestion of inadequately detoxi ed cassava (Osuntokun) Another form of spastic ataxia called konzo has been attributed to the production of cyanide by an ingested toxic glycoside in individuals who are protein de cient The differential diagnosis of spastic ataxia is quite broad and includes especially multiple sclerosis.

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