Measuring psychoneurotic behavior in cross-cultural surveys.

In recent years, a number of studies have appeared which attempt to measure neurotic disorders among population samples in different cultural settings. The problem of how to define and measure psychiatric disorders in untreated groups, and especially in cultures to which the investigators are not native, is, however, far from resolved. The present report describes an effort to study psychological stress among the Serer of Senegal. We describe a method we used to develop a questionnaire to tap symptoms of psychiatric distress, and which would be geared to the realities of place and setting. By means of a factor analysis of the responses to this questionnaire by more than 400 subjects, we identify four dimensions by which the Serer express neurotic disturbance. Further analyses presented in the report demonstrate that these are not merely ways of expressing symptoms based on physical illness, that they are able to discriminate between ill and well people in the Serer frame of reference, that they possess domain validity, and that they demonstrate important similarities and differences with factors obtained using similar techniques in different cultural settings. From a methodological point of view, we illustrate the importance of using a multidimensional approach in such studies.


Rheumatic brain disease: a disease in its own right.

In many cases of patients who had rheumatic fever--at times undiagnosed--there is a chronic involvement of the brain as a result of disseminated recurrent obliterating arteritis or emboli in the small blood vessels, especially in the brain membranes or the cortex. As a result, disseminated, unstable, and transient neurological and psychiatric symptoms appear. The nature of these symptoms depends upon the age of the patient and the time of onset of the disease. It is suggested that the term "rheumatic brain disease" or "rheumatic encephalopathy" be used, and introduced into the nomenclature of the American Rheumatic Association.


Prognostic implications of neuropsychological test performance for surgical treatment of epilepsy.

Surgical treatment of epilepsy is undertaken on the basis of prognostically favorable clinical and laboratory data. Analysis of neuropsychological test data obtained preoperatively and postoperatively from 14 surgically treated patients indicates that specific measures of neuropsychological test performance may provide prognostic information aside from the utility of this testing for lateralization and localization. An impairment Index which is derived from the extensive test battery was related to change of seizure frequency. The groups of patients which have an improved or seizure-free status postoperatively also have the least preoperative neuropsychological impairment. The group of patients which did not show improvement of seizure frequency had a younger mean age at onset of seizures (x = 6.7 years), while the group which was rendered seizure free had a later age at onset (x = 17.2 years). There was no relationship for the duration of seizures prior to surgery and the outcome following surgery.


Depression and normal pressure hydrocephalus. A dilemma in neuropsychiatric differential diagnosis.

Normal pressure hydrocephalus (NPH) is a surgically correctable syndrome of progressive dementia, gait abnormalities, and urinary incontinence resulting from an occult hydrocephalus in association with normal cerebrospinal fluid pressure. Occurring most frequently in midlife and often idiopathic in origin, the early course of the illness may be characterized by symptoms of apathy, inattentiveness, agitation, and poverty of thought which mimic a depressive illness and may delay the recognition and treatment of the underlying structural defect. A review of the literature reveals that this association of depressive symptomatology and NPH has received little attention in the psychiatric literature, and the authors describe a case of NPH which presented as a severe, agitated depression. Clinical findings which suggest the presence of NPH are discussed, and the need to include NPH in the differential diagnosis of depression in the presenium is emphasized. The authors believe such diagnostic vigilance is necessary if the needless deterioration of potentially salvageable individuals is to be prevented.


An analysis of 70 years of morphine classical conditioning: implications for clinical treatment of narcotic addition.

A review of all morphine classical conditioning studies performed since Pavlov reveals significant shifts in methodological and conceptual thinking during the past 7 decades. These shifts have tended to obscure the fact that a great deal of basic data are still needed before morphine classical conditioning can be understood. These data are needed to help clarify the relationship between drug conditioning and drug addiction. Recent evidence, for example, suggests that once morphine autonomic conditional reactions are established, they are highly resistant to extinction. The inclusion of these types of data in any conceptualization of drug dependency would appear to be of help in the formulation of new clinical approaches to this problem.


Dream recall and the contraceptive pill.

Data collected on women students at Edinburgh University allowed a comparison to be made between those who were taking a contraceptive pill and those who were not. The evidence suggests that women taking a contraceptive pill are more likely to recall dreaming, and that it is the progestagenic component that is the more active one. However, the data collected do not exclude the possibility that the differences observed are the consequence of other psychosocial variables; further research is recommended.


The use of assertive training and psychodynamic insight in the treatment of migraine headache: a case study.

In this paper, a case study is cited in which two techniques, assertive training and the development of psychodynamic insight, were used in an A/B/BC experimental design to treat successfully a patient suffering from severe migraine headaches. The point is made that in treating psychosomatic disorders, the structure of the disorder has to be treated, necessitating consideration, where relevant, of a number of dimensions of functioning integrated into an effective treatment program rather than the use of single unidimensional techniques.


Changes in CO2 responsiveness and in autoregulation of the cerebral circulation during and after halothane-induced hypotension.

CO2 responsiveness of the cerebral circulation has been measured in baboons before, during, and after halothane-induced hypotension. At a systolic blood pressure (BP) of 60 mmHg, C02 responsiveness was abolished, but was maintained at higher levels of BP. After hypotension, CO2 responsiveness returned to control values. Autoregulation to BP increases induced by intravenous noradrenaline was impaired when cerebral perfusion pressure during the hypotensive period had been below 30-40 mmHg. It is concluded that at levels of halothane-induced hypotension commonly employed clinically, CO2 responsiveness of the cerebral circulation may be absent. The return of CO2 responsiveness in the post-hypotensive phase argues in favour of controlled hyperventilation after neurosurgery which has involved induced hypotension.


A dominant form of adult neuronal ceroidlipofuscinosis (Kufs' disease) with an associated occipital astrocytoma: early diagnosis by cortical biopsy.

A patient with a dominantly inherited form of Kuf's disease and an associated occipital astrocytoma is presented. This is the first reported case in which the diagnosis of Kufs' disease was made by a cortical biopsy several years before its expected clinical onset. The nosology of this disease, and its clinical, genetic, and histopathological characteristics are discussed. The establishment of an early diagnosis by cortical biopsy and its implications are considered.


New methods of estimating the number of motor units in a muscle.

Two electrophysiological methods have been described for estimating the number of motor units (MU) in a muscle. The methods are based on the original methods of Mc Comas and others, which involve dividing the maximum compound potential (MCP) of muscle evoked by supramaximal electrical stimulation of nerve by a mean motor unit potential (MMUP). The important modifications in the methods are the incorporation of the fluctuations in the response of MU to electrical excitation and a possible correction for the overlap in the firing levels of motor axons. The methods have been used in the estimation of the number of motor units in the first dorsal interosseous, thenar, hypothenar, and extensor digitorum brevis muscles of normal subjects and patients with various neuromuscular disorders. The results indicate that previous motor unit estimates were in general erroneously high.


Clonus: beats provoked by the application of a rhythmic force.

(1) Clonus has been elicited by using a printed motor in nine patients with sustained ankle clonus. (2) When a dorsiflexing biasing force was applied to the foot the amplitude, but not the frequency, of the clonus varied according to the strength of the force. (3) When the biasing force was withdrawn there could be, for some seconds, continuing EMG evidence of a rhythmic discharge. (4) The clonus did not synchronise with an externally applied rhythmic force. In all relevant observations beats were set up between the clonus and the applied force. (5) When clonus was started by the abrupt application of bias the waveform in successive trials was fairly closely repeatable. (6) Beats were also established in two cases of wrist clonus. (7) It is concluded that clonus is not due to the self re-excitation of proprioceptive reflexes but is dependent on a spinal generator, the rate of beating of which is normally independent of peripheral circumstances, although it may be switched on and its activity maintained by appropriate events.


Equivocal plantar responses: a clinical and electromyographic study.

Thirty patients in whom others found equivocal plantar reflexes were studied clinically and electromyographically (EMG-og flexor hallucis brevis, extensor hallucis longus, and tibialis anterior), during mechanical stimulation of the sole. Bias of recording or interpretation of EMG was excluded. The study was repeated after one week; the EMG outcome was reproducible in 26 patients (87%). Of these 26, a pathological reflex was suspected by the clinician in 17, but shown by EMG in only six patients. Compared with the 'final' diagnosis, false-pathological EMG results did not occur; conversely, EMG criteria were wide enough to demonstrate expected, but clinically unconvincing, Babinski signs. Various factors that cause false impressions in the routine situation could be identified. Provided one has some experience with reference groups, EMG can improve clinical interpretation of equivocal plantar responses.


Acute optic neuritis and the prognosis for multiple sclerosis.

In a retrospective survey of acute optic neuritis 144 cases in adults were found and, of these, 127 were reviewed, five had died of causes related to multiple sclerosis, and 12 were lost to follow-up. There was a statistically significant seasonal variation in the incidence of optic neuritis. When the life-table method of analysis was used, the probability of developing multiple sclerosis rises to 78% 15 years after an episode of optic neuritis. At review, 49 (73%) of the 67 patients with multiple sclerosis were independent and leading active lives.


Epidemiology of primary tumours of the brain and spinal cord: a regional survey in southern England.

This survey is based upon 894 patients presenting with primary tumours of the brain, spinal cord, and meninges, over a nine year period in the Wessex population of about 1 1/2 million. All patients were 15 years of age or over. Each tumour type is characterized by age, sex, district, social class, and by rural or urban distribution. Standardized morbidity ratios for each tumour type are calculated for each health district. Gliomas are the commonest tumour with an average annual incidence of 3.94 per 100,000; they occur with a lower frequency in large urban areas. Grade 3-4 astrocytomas (glioblastoma multiforme) have a peak annual incidence of 7.53 per 100,000 in the 50-59 years age group and are more common in males. The peak incidence for oligodendrogliomas is also 50-59 years but for grade 1-2 astrocytomas it is 30-39 years. Meningiomas have an average annual incidence of 1.23 per 100,000 with a peak incidence of 2.48 per 100,000 at 60-69 years; they have a female predominance (female 1.76 per 100,000; male of 0.64 per 100,000). Rural districts have a lower incidence of meningiomas than urban areas. There is some variation in the distribution of gliomas, meningiomas, and Schwannomas throughout the Wessex region and there is a suggestion of geographical clustering of ependymomas, acoustic neuromas, and meningiomas. An excess of patients with grade 1-2 astrocytomas and oligodendrogliomas is seen in social classes 1 and 2 and a deficit in classes 4-5; a similar, but less marked, preponderance is seen with meningiomas.


Treatment of tic douloureux with a new anticonvulsant (clonazepam).

Twenty-five patients affected by 30 episodes of tic douloureux were treated with a new anticonvulsant, clonazepam. In 40% there was complete control of the neuralgia and an additional 23.3% were significantly helped by the drug. Sixteen patients had previously been resistant to carbamazepine, and eight of them were completely and one partially relieved by clonazepam. The side-effects, somnolence and unsteadiness of gait, were present to some extent in 80 and 88% of the cases respectively, being severe in about half of them. It is concluded that clonazepam can be considered as a second choice for the treatment of this condition, after proven failure with carbamazepine. Possible mechanisms of action are discussed.


Voluntary nystagmus in five generations.

Voluntary nystagmus is not a pathological condition. By voluntary effort, rapid synchronous pendular eye movements in the horizontal plane can be performed. Voluntary nystagmus has a frequency of 10 to 25 Hz, amplitude up to 6 degrees, and can be maintained for up to 35 s. Oscillopsia is a concomitant feature. It has been reported in more than 100 individuals since 1855 but only once in three siblings, or in two generations. This paper reports five cases in five generations of one family and autosomal dominant inheritance with high penetrance is suggested.


Visual localization in patients with unilateral brain disease.

The accuracy of localization of briefly exposed single dots and pairs of dots was assessed in patients with lesions of the left and right hemispheres and in control patients without history or evidence of brain disease. A remarkably high frequency of impaired performance was found in the patients with right hemisphere lesions. The performance of the patients with left hemisphere lesions was comparable with that of the control patients. Visual field defect was associated with defective localization in the right hemisphere group but not in the left hemisphere group. Aphasic disorder and age were not related to performance level. The relationship of the findings to those of previous studies of visual localization in patients with unilateral brain disease is discussed.


Analysis of a case of periodic alternating nystagmus.

A patient is described in whom there was periodic deviation of the eyes in darkness associated with alternating nystagmus. An exactly similar situation occurs in normal man subjected to a pendular stimulus. It is proposed that in this patient there was alternating activity of the vestibular nuclei on either side of the brain-stem as a result of a removal of cerebellar inhibition, and that this caused periodic shifts in the null region of Daroff and Dell'Osso.


Aseptic cavernous sinus thrombosis after internal carotid arterial occlusion in polycythaemia vera.

Two patients with untreated polycythaemia vera developed intracranial internal carotid arterial occlusion followed by monocular blindness and the characteristic features of ipsilateral cavernous sinus thrombosis. Primary septic source and signs of systemic infection were absent. It is suggested that the predisposing factors in this unusual syndrome were hyperviscosity and venous sludging induced by the basic haematological disorder and progression of the thrombotic process within the internal carotid artery towards its intracavernous portion with occlusion of the ophthalmic artery and of the arterial branches which supply the walls of the sinus.


Neuropsychiatric manifestations of infective endocarditis: a study of 95 patients at Ibadan, Nigeria.

Thirty-eight percent of patients with infective endocarditis (36 of 95) had neuropsychiatric manifestations. In 75% (27 of 36), these features were the major presenting picture. Fifteen patients (42%) presented with cerebrovascular lesions and seven (19%) with meningitis. Toxic encephalopathy (12.5%) was not uncommon. Other neurological syndromes seen included psychosis and spinal cord lesions. The mortality was high especially when the infective endocarditis was acute in onset. It is essential to search diligently for an underlying cardiac cause in patients who present with neuropsychiatric symptoms because treatment of the underlying pathology improves prognosis.


Cerebral cryptococcosis in Malaysia.

Cryptococcal infection of the brain as encountered in a tropical country is reviewed. The meningitic form is not uncommon and there has been, in the last decade, an apparent, if not real, rise in incidence in Malaysia as in Singapore. Only exceptionally was there overt evidence of immunological deficiency. Hydrocephalus was present in about three-quarters of the patients with meningitis and shunts were employed readily. The presence of multiple small intracerebral cysts could be suspected clinically but treatment for this complication  was ineffective. The antifungal agent used most frequently was 5-fluorocytosine. Resistance to this drug developed in about one patient in four. There is a need for further epidemiological studies and for a continuing search for new antifungal agents.


Myoclonus epilepsy with cerebellar Lafora bodies. Report of a case.

A case is reported of an 18 year old man with progressive myoclonus epilepsy. Histopathological examination revealed the presence of numerous Lafora bodies in the cerebellar granular layer, without other significant changes in the central nervous system or in other organs.


Intraocular haemorrhage as a complication of pneumoencephalography.

The ocular fundi of 20 patients were examined before and after pneumoencephalography. In four of these, fresh venous retinal haemorrhages were seen, and a further patient had developed an exudate. Possible reasons for a rise in retinal venous pressure include bodily inverting the patient, compression of the thorax, the use of positive pressure respiration, and the air injection itself. It may be advisable to take steps to limit the effects of such possible causative factors.


'Sneeze syncope', basilar invagination and Arnold-Chiari type I malformation.

Syncope precipitated by sneezing in an adult male associated with an Arnold-Chiari type I malformation and basilar invagination presents a clinical problem  in the differential diagnosis and pathological anatomy of Valsalva-related syncope. An abnormally acute clivoaxial angle, small foramen magnum, and type I Arnold-Chiari malformation appear to be a combination of features intolerant of Valsalva-induced changes in cerebral volume, brain-stem position, CSF fluid dynamics, or blood vessel relationships. Proposed mechanisms of pressure transmission to the area of intracranial pathology are discussed.


Positional cerebral ischaemia.

Four patients are described in whom recurrent, dramatic transient clinical worsening accompanied elevation from the supine toward the sitting position, though postural hypotension was not present. In each patient occlusive cerebrovascular disease was documented angiographically. During an acute stroke syndrome, some patients' compensatory capacity may be so tenuous that postural changes may produce clinical worsening. Possible mechanisms are discussed.


Patterns of arousal in comatose patients.

The EEG changes, with associated cardiorespiratory phenomena and, where possible, postmortem findings, are described in six patients in coma, with some reference to other similar cases. Spontaneously occurring periodic changes were observed at varying intervals between 20 s and 4 min but most commonly at 1/2-2 min. These involved simultaneous cardiorespiratory, EEG, and somatic motor phenomena related to changes in the level of arousal. It is suggested that a physiological periodicity of the arousal mechanisms exists which may be of importance in the understanding of the pathophysiology of comatose states.


Anterior tibial compartment syndrome following prolonged tetany.

A patient developed a persistent, disabling, bilateral anterior tibial compartment syndrome after salicylate self-poisoning. Prolonged tetany is postulated as the probable mechanism.


Progressive dialytic encephalopathy.

A subacutely progressive dialytic encephalopathy lasting for three to 15 months in 11 patients who had been on haemodialysis for 14 to 36 months was characterized by dementia, language disorder, myoclonic jerks, behavioural disturbance, distinctive EEG abnormalities, and normal or nonspecific neuropathological findings.


Familial benign intracranial hypertension.

Three sisters with benign intracranial hypertension are reported. This is the first documentation of benign intracranial hypertension in three family members. Obesity is a striking feature in these patients as well as five of the six previously reported patients with familial benign intracranial hypertension. Pregnancy and chronic dysfunctional uterine bleeding, well known predisposing factors in this syndrome when it occurs sporadically, were present in two of the sisters. A familial metabolic defect may be responsible for the intracranial hypertension in these patients.


Abnormal dynamic scintigraphy in hydrocephalus: a proposed mechanism.

Dynamic brain scintigraphy was performed on seven patients with documented hydrocephalus of various aetiologies. The patients had a characteristic abnormality consisting of lateral displacement of the proximal middle cerebral activity associated with a paracentral lucent zone. No focal areas of increased activity were identified on the static brain images. A proposed mechanism for these findings is discussed.


Sturge-Weber syndrome with bilateral intracranial calcification.

Four children affected by Sturge-Weber syndrome and demonstrating bilateral intracranial calcification are described, bringing up to 21 the number of similar reported cases. The frequency of bilateral hemisphere involvement in this syndrome is not known, but it might be as high as 15%. If present, neurosurgical intervention is, in our opinion, contraindicated.


Experimental studies of the effects of extrinsic factors on conduction in normal and demyelinated nerve. 1. Temperature.

Previous studies in experimentally demyelinated mammalian nerves have demonstrated that a reversible conduction block occurs with small increases of temperature within the animal's normal body temperature range. This phenomenon is believed to be the mechanism for clinical temperature effects in multiple sclerosis. This study examines some quantitative thermal relationships in demyelinated nerves of guinea pigs with experimental allergic neuritis. The observed results in normal and experimental animals are in good agreement with previous theoretical calculations based on the effects of temperature on the voltage and time-dependent behavior of the ionic permeabilities of the nodes of Ranvier. Guinea pigs with increasing motor dysfunction generally exhibited corresponding increases in the overall latency of the conducted action potential, as well as decreases in amplitude. In addition, the lower the initial velocity increment per degree of temperature elevation, the lower was the temperature at which conduction block began to occur. Except for a few cases in which the recorded action potential was bimodal, with response at both normal and prolonged latency, the results tended to indicate a remarkedly uniform involvement of the sciatic nerve within the region of temperature control.


Normal median nerve proximal latency in carpal tunnel syndrome: a clue to coexisting Martin-Gruber anastomosis.

Five of 65 patients referred for electrodiagnosis because of clinical evidence of carpal tunnel syndrome were found to have near normal latency on proximal stimulation of the median nerve, although the distal motor latency was prolonged. In one patient, the proximal latency was actually shorter than the distal latency. The failure of the proximal latency to be prolonged in proportion to the distal latency results in a spuriously high apparent conduction velocity in the forearm segment of the nerve. This value may even exceed the conduction velocity of the corresponding nerve segment in the unaffected arm. Stimulation studies on the ulnar nerve reveal that this disparity is the result of some of the median nerve fibres destined for the thenar muscles taking an aberrant course through the ulnar nerve and thus escaping compression at the wrist. A median-ulnar communication in the forearm, the 'Martin-Gruber' anastomosis, may occur in up to 15% of the population. The presence of the Martin-Gruber anastomosis in patients with carpal tunnel syndrome results in a partial or total sparing of thenar muscles from denervation and the paradoxical recording of normal proximal latencies in the median nerve when the distal latency is prolonged.


Peripheral motor nerve function in diabetic autonomic neuropathy.

Motor conduction velocity was measured in the median, ulnar and common peroneal nerves of 32 diabetics with clinical features of autonomic neuropathy. The responses to the Valsalva manoeuvre and sustained handgrip, and the postural fall in blood pressure were used to assess the integrity of the autonomic nervous system. Abnormalities in the three autonomic function tests were significantly correlated with the forearm conduction velocity of the ulnar nerve, the conduction velocity and motor latency of the common peroneal nerve, and the H reflex. These results show that, in diabetics with autonomic neuropathy, abnormalities in the autonomic nervous system parallel changes in the peripheral nerves. Any diabetic with peripheral neuropathy should be examined for evidence of autonomic nervous system involvement.


Pronator syndrome: clinical and electrophysiological features in seven cases.

The clinical and electrophysiological picture of seven patients with the pronator syndrome is contrasted with other causes of median nerve neuropathy. In general, these patients have tenderness over the pronator teres and weakness of flexor pollicis longus as well as abductor pollicis brevis. Conduction velocity of the median nerve in the proximal forearm is usually slow but the distal latency and sensory nerve action potential at the wrist are normal. Injection of corticosteroids into the pronator teres has produced relief of symptoms in a majority of patients.


Pain mechanisma in causalgia.

A study of the clinical features of causalgia and the central neuronal effects of injuries to peripheral nerves suggests that causalgia is the functional expression of the intensity of the retrograde neuronal reaction in which pools of dorsal horn neurones become converted into foci of abnormal activity. These foci initiate a chain reaction along transmission pathways as far centrally as the cortex, causalgia being the terminal effect of this disorderly activity on the sensorium. This is the basis of the 'turbulance hypothesis' introduced to account for the pain.


Brain abscess and subdural empyema. Factors influencing mortality and results of various surgical techniques.

The authors review the results of various surgical techniques in relation to mortality and morbidity in 100 consecutive cases of brain abscess and subdural empyema. The mortality rate is the same with total excision and fractional drainage of brain abscesses, although in acute and subacute cases slight differences between both techniques are seen. In terms of morbidity, fractional drainage appears to be more favourable than total excision. The authors believe that factors other than surgical procedure influence mortality in cases of brain abscess and subdural empyema. These factors are defined in detail.


Thyrotoxic neuropathy (Basedow's paraplegia).

Polyneuropathy is a rare but possible manifestation of severe hyperthyroidism. The patient reported here developed a polyneuropathy affecting mostly leg muscles (Basedow's paraplegia) during the course of severe thyrotoxicosis. The polyneuropathy was confirmed with sequential electrophysiological studies of nerves and muscles and by muscle biopsy. The involvement of the proximal leg muscle is also interpreted as a neuropathic or nerve-mediated process rather than a concomitant thyrotoxic myopathy.


Dupuytren's disease in epilepsy: result of prolonged administration of anticonvulsants.

In a study of chronic epileptics in a residential centre we recorded a 56% incidence of Dupuytren's disease. The lesions were usually bilateral and symmetrical and frequently associated with knuckle pads and plantar nodules. There was no direct relationship between Dupuytren's disease and frozen shoulder. Dupuytren's disease was seen equally in those with idiopathic or symptomatic epilepsy. The incidence increased with the duration of epilepsy and is probably a sequel to long-term administration of phenobarbitone. Reasons are given for presuming that the association between Dupuytren's disease and antiepileptic therapy is mediated through the peripheral stimulation of tissue growth factors and not through the central release of growth hormone or through alterations in liver metabolism.


Bulbar infarcts.  Vascular lesions in 26 observations.

The pattern of arterial occlusion and related lesions have been studied in 26 cases with 38 medullary infarcts. In 10 of these cases, only the intracranial vessels were examined. In the 16 other cases, the entire cerebral arterial supply was dissected. Medial infarcts were more often related to occlusion of the vertebral artery involving the termination of the artery (7/10 cases). In 6 cases a thrombosis on an atheromatous plaque and, once, an embolus of cardiac origin, were found. Lateral infarcts were usually due either to occlusion of the vertebral artery (14/23 cases), reaching, in 10 cases, the mouth of the posterior inferior cerebellar artery (PICA) or to an isolated occlusion of the latter vessel (3 cases). A thrombosis on an atheromatous plaque was found in 15 cases, and emboli from the heart or from the origin of the vertebral artery in the others. The dorsal infarcts were related, in 4/5 cases, to an isolated occlusion of the stem of the PICA and, in the other case, to one of the vertebral artery involving the ostium of the PICA. A thrombosis due to atheromatous stenosis was found in 4 cases, an embolus of cardiac origin in the other one.


Intracisternal virus-like particles in brain of a multiple sclerosis patient.

Doughnut-shaped particles, 55-65 nm in diameter, were revealed by electron microscopy in the cisterns of the rough endoplasmic reticulum of cells from an active lesion in autopsied brain tissue from a multiple sclerosis patient. The morphology of the particles closely resembled that of coronaviruses.


Charcot-Marie-Tooth disease associated with "essential tremor": Report of 7 cases and a review of the literature.

A study of 7 cases of Charcot-Marie-Tooth disease associated with a dyskinesia resembling benign essential tremor is presented. In 4 patients, the family history strongly suggested an autosomal mode of transmission, 2 cases were sporadic without an established genetic pattern and 1 was probably recessive. The distal parts of the upper and lower limbs showed imparied muscle strength with slight or no atrophy in 4 patients and conspicuous weakness and wasting in another 2. One patient was a chairbound. Although essential tremor and the tremor seen in these patients are clinically (phenotypically) similar it seems possible that they result from two different genotypes. Further, it seems that cases with Charcot-Marie-Tooth disease and "essential tremor" are not the result of the association of two separate dominant characteristics which are generally inherited as mendelian dominant traits. In spite of the diversity of the clinical manifestations of the peripheral neuropathy, the semiologically different types of essential tremor and the electrophysiological data, it is concluded that patients who develop a peripheral neuropathy on a familial basis and who exhibit clinical features of similar character, suffer from a common type of pathological disorder. Stress is laid upon the fact that Friedreich's ataxia and Charcot-Marie-Tooth disease share many clinical features. It is suggested that when Friedreich's ataxia and Charcot-Marie-Tooth disease seem to be present in the same individual and/or alternate in different members of the same family, the process is likely to be one of Charcot-Marie-Tooth disease. The value of the type of inheritance, natural history, clinical examination and electrophysiological data in differentiating Charcot-Marie-Tooth disease (with or without essential tremor) from other degenerative disorders is analyzed.


Different excitability of type 1 and type 2 alpha-motoneurons. The recruitment curve of H- and M-responses in slow and fast muscles of rabbits.

To evaluate the different excitability of Type 1 and Type 2 alpha-motoneurones, we analyzed comparatively the threshold and amplitude of the H-reflex and the Hmax/Mmax ratio in a slow muscle, soleus, and in a fast muscle, lateral gastrocnemius, of the rabbit. The H-reflex had almost always the same threshold in the muscles examined, but in soleus its amplitude increased much more than in lateral gastrocnemius when the stimulus intensity was increased. A clear difference in amplitude of the H-reflexes was already evident with stimuli subliminal for direct responses (M). The maximal H-reflex was always much higher in soleus than in lateral gastrocnemius. The calculation of the mean Hmax/Mmax ratio showed that it was 3 times higher in the slow than in the fast muscle. On the basis of these results, showing a clear-cut difference in the reflex excitability of slow and fast muscles and in the light of other experimental data available in the literature, we tend to conclude that Type 1 alpha-motoneurones are exclusively, or at least predominatly, depolarized by stimulation of afferent Ia fibres.


Bulbar infarcts. Systematic study of lesion topography in 49 cases.

A pathological study has been carried out of 49 examples of medullary infarction in 33 patients. The medial infarcts, very seldom single (2 /12), spared the subolivary levels. The pontomedullary junction was affected in 3 /9 cases studied. The lesions were more frequent in the ventral part of the arterial zonal pattern. They more often extended to its dorsal part at the level of the middle and upper one-third of the olive. The lateral infarcts, seldom single (6/30), extended to the subolivary levels in 6/22 cases studied and to the pontomedullary junction in 9/24 cases. The structures involved in each case and the area of the lesions at each cranio-caudal level have been studied. None of the 7 dorsal infarcts was single; in 6 of these cases there was also a cerebellar infarct involving the area of supply of the posterior inferior cerebellar artery. The subolivary levels (1/6) and ponto-medullary junctions (1/6) were seldom affected. The extent of the lesions in these uncommon infarcts has been described in detail.


The nigrostriatal projection in the cat. Part 1. Silver impregnation study.

The course and destination of the degenerating nigrostriatal fibers were studied by selective silver impregnation methods in 37 cats with unilateral lesions in the substantia nigra. The nigrostriatal fibers ascend along the dorsomedial border of the substantia nigra to the prerubral area; they proceed for a short distance through the lateral hypothalamus, enter the medial part of the internal capsule and run in a dorsorostral direction to reach the head of the caudate nucleus and the rostral portion of the putamen. A smaller number of degenerating fibers obliquely cross the peduncular part of the internal capsule and traverse the entopeduncular nucleus and the pallidum to terminate in the central and caudal portions of the putamen. Some features of the topical distribution of the nigrostriatal tract are described. Apparently, the more anterior part of the pars compacta sends axons primarily to the head of the caudate nucleus and to the most rostral putamen. The most medially situated nigral neurons project to the fundus striati. The posteromedial cell groups of the pars compacta innervate primarily the central putamen and the caudal part of the caudate nucleus. The projection of the lateral cell group of the posterior zona compacta to the caudal putamen is sparser than from the other nigral groups, suggesting that a part of them has another destination, possibly lower in the neuraxis. The contribution of the pars of reticulata to the nigrostriatal connections seems to be modest, according to the small number of neurons; they project to the lateral caudate and putamen. Thus, the ascending nigrostriatal fibers mirror the distribution of the descending striatonigral fibers. No convincing evidence for the existence of a nigroentopeduncular and nigropallidal projection was found.


An electron-microscopic study of the development of virulent and avirulent strains of Semliki forest virus in mouse brain.

Two strains of Semliki Forest Virus (SFV),  the avirulent and virulent, were used to study the development of virus in both baby and adult mouse brain. The development of SFV in the brain was similar in baby and adult brain using the virulent strain and in the baby mouse brain using the avirulent strain. Mature virus could not be found in adult mouse brain using the avirulent strain. This paper shows that extracellular virus particles near the cell membrane stimulate the formation of coated vesicles and thus absorption of virus particles by the cell. It is suggested that these coated vesicles with contained virus particles are stimulated to develop nucleoid cores on their membrane forming cytopathic vacuoles, Type II (CPV-II). Excessive membrane growth takes place and the membrane of the CPV-II with the nucleoid cores invaginates to form intravacuolar tubules. It is suggested that these tubules become responsible fro the formation of mature virus particles. Thus the membrane of the CPV-II appears to be responsible for the development of both the inner core and outer coat of the virus.


A modification of eye-head coordination by CNS disease.

When a subject, seated and facing ahead, was asked to look toward one side, the result was a combined movement of the eyes and head. Normal subjects began the eye movement just before the onset of head movement; 4 neurologic patients who showed abnormalities in eye movements (saccades that tended to be smaller in amplitude and lower in velocity than those of the control subjects) regularly began eye movement after the onset of head movement. Thus the initiation of the head rotation was not as much retarded in these patients as that of eye movement. Amplitudes of the movements were reduced in the patients, but this change too was less for the head than for the eyes. Because the amplitude and velocity of the head movement were less affected in the patient group, the relative contribution of the head to the total gaze shift was increased. It appears as if, when the oculomotor system is affected, the head can assume a leading role in the initiation and execution of gaze shifts.


Frequency of Alzheimer's neurofibrillary tangles in the cerebral cortex in progressive supranuclear palsy (subcortical argyrophilic dystrophy).

The frequency of Alzheimer's neurofibrillary tangles was studied, employing large sections of the cerebral hemispheres, in the cerebral cortex in 2 cases of progressive supranuclear palsy. The majority of the neurofibrillary tangles were found in the smaller nerve cells of the third layer. The typical triangular form was rare, and most of them showed argyrophilic neurofibrillary filaments which coiled around the well-preserved nucleus. We concluded that their occurrence in the cerebral cortex is one of the morphological manifestations of the disease process.


A study of visual processes in a case of interhemispheric disconnexion.

A 75-year-old right-handed woman, after a probable cerebral infarct, developed an irregular constriction of the visual fields, a left-sided agraphia, and an anomia for objects in the left hand. Subsequent testing demonstrated an inability to name, though ability to recognize, letters and objects flashed in the homonymous left visual field. An inter-hemispheric disconnexion syndrome was inferred from these findings. The present publication concerns mainly the visual aspects of this disconnexion syndrome. Tasks were devised to test the abilities of the major and minor hemisphere: (a) the left hemisphere demonstrated a complete dominance for language expression and an incomplete dominance for written language comprehension; (b) the right hemisphere appeared to be dominant for some visuo-spatial tasks including number comprehension; (c) when the hemispheres were given contradictory visual informations on a non-verbal task (chimeric stimuli) there was a predominance of the right hemisphere. The right hemisphere appeared able to process complex information. Specialization of functional activities in each hemisphere is briefly discussed.


In vitro cellular responsiveness in multiple sclerosis patients to a purified measles virus nuclear core and to other viral antigens.

The Clausen modification of the peripheral blood buffy coat leukocyte migration test was used to test patients with multiple sclerosis, normal subjects and patients with other neurologic diseases for cell-mediated immunity to commercial measles virus, purified nuclear core material from a human neurotropic strain of measles virus, as well as to commercial preparations of rubella, mumps and parainfluenza HA2. Leukocytes of multiple sclerosis patients showed significantly less mean inhibition of migration in the presence of both measles antigens, mumps and parainfluenza but no difference from controls when incubated with rubella. No correlation could be found between the degree of migration inhibition and concomitant serum anti-measles neutralization antibody titers to the same strain of virus. The use of purified viral antigens might result in more meaningful studies of the status of cellmediated immunity to viral antigens in multiple sclerosis. The relationship of our findings to other studies in this area and to the pathogenesis of multiple sclerosis is discussed.


Organized cerebral heterotopia in the ethmoid sinus. A case report.

A 60-year-old woman afflicted with spontaneous CSF rhinorrhea was found to have a  heterotopia consisting of well-differentiated neurons organized in layers in the lamina propria of the mucosa of the ethmoid sinus. This heterotopic cerebral anlage is best classified within the spectrum of "nasal gliomas". The origin of this malformation is a failure of closure of the anterior neuropore which delays the ingrowth of the mesoderm that is destined to form the skull and dura beyond the 10th week of gestation, leaving behind trapped cerebral tissue. The presentation of this congenital malformation late in life is attributed to the development of sinusitis.


[An experimental study of the psychostimulant action of amantadine].

According to previous experimental and clinical data, we have tested the hypothetic psycho-stimulating activity of amantadine on experimental sensitized models. We obtained a strong action on the spontaneous sleep of rats at a dose of 10 mg/kg and a less striking action in diminishing the effects of barbitol on the righting reflex of mice and in reducing the narcosis of rats induced by mebubarbital. This action does not seem to be due to a release of catecholamine because the lesions produced by electrocoagulation in the ascending aminergic pathways or pretreatment by alpha-methylparatyrosine (AMPT) do not block it. It is suggested that there may be a non-aminergic receptor of amantadine which is different from the amphetamine receptor.


Spontaneous sleep and induced arousal. A depth-electroencephalographic study.

Although arousal effects from electric stimulation have been found in animals, reports of similar responses in humans have been uncommon. During depth electroencephalography in a 16-year-old boy for evaluation of intractable temporal lobe seizures, electric stimulation of a pair of contact leads located within the dorsal and medial portions of the thalamus but not within specific sensory nuclei produced unequivocal behavioral and electrographic arousals from spontaneous sleep. Lowvoltage stimuli were effective during non-REM and REM sleep. These findings verify the presence of a thalamic arousal system in the human.


[Cerebral hemangiopericytoma. Ultrastructural study of one case].

The authors report electron-microscopic observations upon a primitive cerebral haemangiopericytoma. The vascular appearance of the tumour is due to the presence of abundant extracellular material which has a structure like that of vascular basement membranes. The fact that the tumour cells are pericytes is confirmed by the existence of intracytoplasmic microfilaments of 60-80 A in diameter, sometimes gathered into osmiophilic aggregations and forming simple cellular junctions (zonulae adherentes). Stress is laid upon the importance of differentiating this rare tumour from an angioblastic meningioma; the haemangiopericytoma is more rapidly growing and carries a more serious prognosis.


Neural crest defects. A neuroanatomic basis for classification of multiple malformations related to phocomelia.

Skeletal and internal structures are shown to be linked anatomically through segmental levels of innervation, or "neurotomes", and are related embryologically to the neural crest. Congenital abnormalities within the same or adjacent neurotomes would explain the distribution of defects in thalidomide embryopathy and morphologically similar multiple malformation syndromes. Classification of these "neural crest defects" on the basis of the segmental nerve supply is suggested.


Correlative assay of computerized cranial tomography CCT, water content and specific gravity in normal and pathological postmortem brain.

An assay of water content and specific gravity in normal and pathological autopsy brain has been correlated with CCT attenuation values obtained just prior to brain cutting. Formalin fixation does not alter normal values so that fixed brain appears to be suitable for this type of study. Low attenuation values in CCT correlate better with changes in specific gravity, rather than water in infarcts, but they have a close relationship to water content in edema. The high water content in infarcts of the white matter reveals a striking disparity in fluid control between cortex and white matter, which has not been emphasized in experimental studies. Water movement within and around blood clots has been discussed.


Organ culture of craniopharyngioma and its cellular effects induced by colloidal chromic phosphate.

Since a marked clinical improvement has been reported following chromic phosphate treatment in recurrent craniopharyngioma, we have attempted to study the in vitro cellular changes of two craniopharyngiomas maintained in organ culture system and subsequently treated with colloidal chronic phosphate. When incubated for 24 and 48 hours respectively, at a concentration of 10 muCi/ml. of colloidal 32P, only vacuolar degeneration and hyperchromasia of the tumor cells have been observed. When incubated with 50 muCi/ml. for 24 hours, further cellular degeneration and focal necrosis begin to appear. Up to 48 hours after 50 muCi/ml. obvious necrosis and extensive degeneration become apparent. Autoradiography confirms the fact that radioactive material is absorbed by the tumor cells. Brain tumors when maintained in an organ culture system may serve as a useful model for the evaluation of the effects of various chemotherapeutic and radiotherapeutic agents in vitro.


Pathogenesis of methylazoxymethanol-induced lesions in the postnatal mouse cerebellum.

Previous studies have shown that methylazoxymethanol acetate (MAM) and methylazoxymethanol glucoside (cycasin) cause destruction of differentiation cells in the postnatal mouse cerebellum. The major features of the resulting architectural disarray were Purkinje cell misalignment and granule cell deletion along with cerebellar dysfunction. Although it was clear from a number of studies that destruction of differentiation cells in the immediate postnatal period was the primary lesion, several important facets of the pathellular response to the injury was incompletely described. The relationship of the cellular response to the subsequent pathological alterations was not completely evaluated. Also, the presence of unattached Purkinje cell dendritic spine postsynpatic sites suggested that their development had occurred without presynaptic parallel fiber terminal differentiation. The possibility of early synaptogenesis and degeneration was not, however, completely ruled out.


Gold tracer studies of muscle regeneration.

Rabbits were injected with soluble gold, and cold injury was inflicted upon their extraocular muscles. Following the typical freeze-thaw damage in which the myofiber basement membrane is preserved, a polymorphonuclear granulocyte exudation occurred. At this stage only a few interstitial cells with long processes contained gold. At one and two days abundant mononuclear cells with gold were observed at the site of injury. In subsequent stages of muscle regeneration the amount of tracer decreased but myoblasts, and even fully formed myotubes, often contained detectable gold. Some data on "in vivo" gold salt kinetics and the specificity of gold localization were utilised in the study of the relation between mononuclear interstitial cells and myoblasts.


Reversal of dementia in normotensive hydrocephalus after removal of a cauda equina tumor. Case report.

An elderly man presented with signs of normotensive hydrocephalus. Elevated protein content in the spinal fluid led to the diagnosis of an "asymptomatic" cauda equine neurilemoma and its removal. Within 6 weeks the patient's mental status had dramatically improved. Chronic transudation of plasma proteins including fibrinogen into the subarachnoid space had probably impeded spinal fluid reabsorption. It is suggested that the leakage of fibrinogen into the cerebrospinal fluid may be the cause of hydrocephalus in other clinical settings in which there is an elevation of the spinal fluid protein.


Interhemispheric ependymoma mimicking falx meningioma. Case report.

A report of an interhemispheric ependymoma with classical angiographic characteristics of falx meningioma illustrates that a neoplasm of intracerebral origin may present in a predomimantly extracerebral location.


Arteriovenous malformations of the transverse dural sinus.

Clinical, radioanatomical, and therapeutic aspects of dural arteriovenous malformations in the region of the transverse sinsu are discussed on the basis of seven personal observations and the analysis of 72 reported cases. Common symptoms are headache and troublesome tinnitus aurium. More serious neurological deficiencies may occur as a result of distrubance in cerebral hemodynamics. A complete neuroradiological investigation is essential for adequate treatment. Most frequent arterial feeders are the occipital, tentorial, and middle meningeal arteries. Ligation of the occipital artery is not sufficient in most cases. Operative isolation of the transverse sinus by craniotomy and dural section is considered by far the most successful treatment and should be performed whenever ligations fail or are not indicated.


Facial nevi associated with anomalous venous return and hydrocephalus.

The authors describe two children with anomalous intracranial venous return associated with bilateral facial nevi, macrocrania, and cephalic venous hypertension. Both children had functional absence of the jugular bulbs, forcing the intracranial venous effluent to exit through persistent emissary pathways. Both children had sustained intracranial hypertension, with one child developing symptomatic communicating hydrocephalus that responded satisfactorily to shunting. The relationship between these patients and those with Sturge-Weber syndrome is discussed. The embryologic abnormality producing the anomalous venous return is characterized. The link between venous hypertension and the development of hydrocephalus is discussed. The increased cranial compliance seen in this age group may predispose certain pediatric patients to develop hydrocephalus when stressed by venous hypertension.


Spectrum of the hangman's fracture.

The authors review their experience in managing 26 cases of "hangman's fracture." The basic mechanism of injury was hyperextension of the upper cervical spine. Radiographic studies revealed a spectrum of injury beginning with the classical hangman's fracture and progressing to the simple C-2 laminar-pedicle fracture. Appreciation of the fracture instability will dictate the method and duration of fracture treatment. Management by a closed, nonoperative means resulted in solid union of the bone in all fully treated cases, with a minimum of morbidity.


Sensory and nonsensory portions of the nucleus "ventralis posterior" thalami of chimpanzee and man.

In man and chimpanzee, the large-celled region in the posteroinferior portion of the lateroventral thalamic mass, commonly called the nucleus ventralis posterior thalami, is separated cytoarchitecturally into two regions. The anterior portion is called the nucleus ventrointermedius (Vim) and the posterior part, the nucleus ventrocaudalis (Vc). In the chimpanzee it was found that most of the fibers from the superior cerebellar peduncle entered Vim on the way to distribution in the anterior half of the lateroventral thalamic mass. Fibers from the posterior spinal column (medial lemniscus) entered the Vc. No overlap was evident in the radiations from the two sources. An unusual human case is presented suporting the sensory function of Vc since a lesion in this nucleus resulted in persistent contralateral paresthesia. On the other side, a discrete lesion in Vim caused no sensory disturbance.


Carbamazepine in the treatment of the flashing pain syndrome.

Five patients were seen who described similar rapid shot-like pains that we have called "flashing pain syndrome" and whose pain was relieved by carbamazepine. The pathology of these conditions is not uniform, but the clinical description appears to be specific for an unpleasant condition that will respond dramatically to carbamazepine.


Surface ultrastructure of human ependyma.

Specimens of human ependyma obtained immediately after death were immersion-fixed and studied with a scanning electron microscope. Human ependyma is nearly identical in its surface ultrastructural features to the ependyma of other mammals.


Some characteristic findings of isotope cisternograms in children.

The authors describe the characteristic pattern in the isotope cisternograms of normal children and emphasize that, in interpreting isotope cisternograms, the age of the patient must be taken into account.


Shunt system patency testing by lumbar infusion.

A simple and reliable bedside infusion test is described to evaluate shunt-system patency in adult patients with treated "normal" pressure hydrocephalus. Fifteen consecutive patients with ventriculoperitoneal shunts were tested by a two-part infusion test between 2 days and 32 months after shunt surgery. When we used the criteria presented, shunt patency could be established with certainty, and shunt malfunction could be established with relative certainty. Shunt malfunction was verified surgically.


Carotid sinus syndrome. Report of five cases and review of the literature.

Five cases of carotid sinus syndrome are presented. The syndrome is defined by spontaneous attacks of dizziness and fainting which can be reproduced by graded pressure on one carotid sinus. Three forms of the clinical syndrome, cardioinhibitory, vasodepressor, and cerebral, are discussed. The hyperactive carotid sinsu reflex, in which there is ventricular asystole lasting at least 3 seconds or a decrease of more than 50 mm Hg in systolic and diastolic blood pressure, should be differentiated from this syndrome. Treatment modalities include reassurance, drugs, radiotherapy, cardiac pacemakers, and surgical approaches. Carotid sinus syndrome should be considered in the differential diagnosis of unexplained syncope, arteriovenous block, or inappropriate sinus bradycardia.


Effect of central venous pressure on brain tissue pressure and brain volume.

In cats, brain tissue pressure (BTP) was measured by the wick-catheter method. The BTP was positive, but lower than cerebrospinal fluid pressure. Elevation on central venous pressure led only to a transient proportional increase of BTP. When the calvaria and dura of one hemisphere were removed, the rise of BTP was even less. Water content of the brain was normal in either case, even after prolonged venous hypertension. Venous hypertension led in all cases to a marked increase of the brain volume which was caused by vessel dilatation. In brain edema, produced by rinsing the brain surface with ouabain and concentrated saline, BTP was increased permanently by venous hypertension. The water content of the brain was much greater than normal. From these results it was concluded that congestive edema does not occur in the brain unless the tissue is damaged. However, venous hypertension does cause brain swelling.


Multidirectional tomography in cervical spine injury.

Forty-one patients with acute cervical spine injury were examined by both conventional radiography and multidirectional tomography and the findings compared. Indications for tomography are given.


Oncotic aneurysm. Case report.

The author describes a case of intracerebral and subarachnoid hemorrhage associated with an intracranial aneurysm caused by a metastatic tumor. The aneurysm formation is explained as being result of tumor cells invading the vessel wall while still preserving the arterial circulation.


Scintigraphic criteria for hepatic metastases from cancer of the colon and breast.

Scintigraphic criteria for hepatic metastases were studied by examination of 333 liver scintigrams performed on 275 patients with primary cancers of the colon or breast. Focal defects in radiocolloid distribution correctly signaled the presence of metastatic colon carcinoma in 88% of the patients with that disease and incorrectly pointed to only 6% of the patients without such metastases. In contrast, the same criterion detected only 67% of hepatic metastases from breast carcinoma. This lower sensitivity could be improved to 87% by adding heterogeneity or hepatomegaly to the criteria for abnormality when patients with breast cancer are examined. Scintigraphic indicators of metastatic disease may vary according to the site of primary cancer.


Factors affecting the uptake of 99mTc-sulfur colloid by the lung and kidney.

Occasionally patients injected with 99mTc-sulfur colloid (TSC) for liver--spleen imaging show increased uptake by the lungs or kidneys. In animals, increased lung uptake of TSC can be produced by injecting endotoxin intraperitoneally. Using an intraperitoneal endotoxin model, we studied the effect of heparin on dose-response curves for TSC uptake by the lungs and kidneys. Over a dose range of 1 mug to 10 mg of endotoxin, TSC uptake by the lungs increased progressively; heparin had no effect. In the kidneys, endotoxin in doses from 1 mug to 1 mg resulted in an increased TSC uptake which was less marked than that in the lungs and which was also unaffected by heparin. However, at a dose of 10 mg of endotoxin, a marked increase occurred in TSC uptake by the kidneys, and this could be prevented by heparin. Although the increased TSC uptake by the kidneys at lower doses of endotoxin and by the lungs at all doses is probably not related to intraavascular coagulation, the marked increase in TSC uptake by the kidneys at 10 mg of intraperitoneal endotoxin probably is related to intravascular coagulation, possibly by entrapment in fibrin deposits in the renal capillaries.


Salivary gland uptake of 67Ga-citrate following radiation therapy.

Radiogallium uptake in the salivary glands is strongly correlated with prior therapeutic radiation which includes the cervical region. Fifteen of 17 patients with increased salivary gland uptake had such a history. An easily identified characteristic pattern of symmetric localization of 67Ga occurs in the parotid and submandibular regions in these patients. This pattern must not be mistaken for recurrent tumor in the cervical region.


99MTc-diphosphonate bone imaging and uptake in healing rat extraction sockets.

Clinically positive bone scans of the jaws may result from a variety of benign dental conditions. An experimental system for studying radionuclide imaging and uptake in the jaws of rats was developed. Sequential 99mTc-diphosphonate bone scans and radionuclide uptake determinations were performed on rats after standardized extractions of their mandibular left first molars. Positive bone scans were seen 4-16 days after molar extraction, and increased radionuclide uptake was found in the healing extraction wounds 4-42 days after the extraction. Conventional radiography and histology fail to show unusual bony architecture in extraction sockets at such times. These results correlate with clinical findings in patients and suggest that human beings may have positive bone scans for several months after dental extraction.


Two unusual causes of peripatellar nonmetastatic positive bone scans in patients with malignancies: case reports.

Bone scans performed with 99mTc-polyphosphate in two patients with epidermoid carcinoma of the lung each showed activity in one knee area. In the first case, radiographs of the area revealed Pellegrini-Stieda calcification over the internal femoral condyle. Uptake corresponded to this process, rather than to a lesion deep in the bone. In the second case, the activity accumulation in the right tibia was the only abnormality noted in the scan. An open biopsy revealed Paget's disease, and no radiographic evidence of Paget's disease was found in any other bone. These cases again illustrate that localized accumulation of a bone-scanning agent, in patients with known primary tumors, does not necessarily denote malignancy in bone.


Lung scintigraphy with 51Cr-erythrocytes in Goodpasture's syndrome: case report.

A lung scan using 51Cr-labeled erythrocytes in a patient with Goodpasture's syndrome revealed radioactivity in the lung due to massive intrapulmonary hemorrhage.


The effect of carrier technetium in the preparation of 99mTc-human serum albumin.

Accumulation of daughter 99Tc in 99Mo-99mTc generator systems may adversely affect the preparation of certain 99mTc radiopharmaceuticals. In a study of the effect of "carrier" technetium on the radiochemical purity of 99mTc-human serum albumin, varying amounts of 99Tc were added to a commercially available electrolytic kit. The maximum amount of 99Tc that could be added to such a kit and still maintain radiochemical purity above 90% was about 3 X 10(15) atoms. When kits containing 10(16) 99Tc atoms were electrolyzed for the conventional 42 sec, the radiochemical purity was only 50.8%. However, when the electrolysis time was varied, it was found that electrolysis for 80 sec yielded a product with greater than 90% radiochemical purity. Four solutions to the problem created by the 99Tc carrier effect are described.


A high-frequency ultrasonic nebulizer system for radioaerosol delivery.

A prototype high-frequency ultrasonic nebulizer, coupled with a nebulization chamber, has been designed specifically to overcome the problem of inefficient and unpredictable radioaerosol delivery. The objective was to reduce mean particle size, increase aerosol concentration, and minimize dead space. Thirty-nine patients were studied, including 15 patients in significant respiratory distress. Delivery of the radioaerosol proved to be rapid, efficient, and reproducible, and excellent alveolar distribution patterns were obtained in all 39 patients. Minimal nonpathologic tracheal deposition occurred in five patients, but this did not interfere with the interpretability or diagnostic validity of the study. All other instances of airway aerosol deposition correlated with documented airway disease. The images obtained with this system are a reliable measure of ventilatory distribution and airway tubulence.


Influence of dose rate on carcinogenesis resulting from x-ray, 113In, and 198Au irradiation.

The potential hazards from internally administered radionuclides used in nuclear medicine are usually compared with one another and with diagnostic x-rays on the basis of the absorbed dose in rads, with no regard to the dose rate of the radiation. This study compared the carcinogenic potential of a dose of 250 rads delivered at different dose rates to rat livers by x-ray, 113mIn, and 198Au. The chemical carcinogen N-2-fluorenyldiacetamide was administered after irradiation to reduce the latent period and increase the number of radiogenic liver tumors. No significant difference in tumor incidence was observed among groups of animals treated with either 198Au, 113mIn, or x-irradiation.


Collimation for imaging the myocardium. II.

Line-source response functions and modulation transfer functions (MTF) were used to compare the spatial resolutions obtained with an Anger camera system and four different nuclides used as myocardial-imaging agents: 99mTc, 123I, 201Tl, and 43K. The measurements were made with a low-energy converging collimator (LECY, a medium-energy converging collimator (MEC), and a pinhole collimator. The MTF values for 99mTc were very similar for all three collimator types, although the LEC collimator gave slightly higher values at hgih spatial frequencies and had 40% greater sensitivity. Iodine-123 was satisfactorily imaged only with the MEC and pinhole collimators, which in turn yielded MTF values comparable to those measured for 99mTc. Thallium-201 produced MTF curves that were similar for the MEC and pinhole collimators; the curve for th LEC collimator was slightly poorer. All three MTF curves for 201 Tl were inferior to those of 99mTc. For imaging with 43K, only the pinhole collimator provided marginally acceptable spatial resolution.


Neutron-activation measurement of metabolic activity of sodium in the human hand.

Turnover of sodium in the human hand was studied by neutron activation. One hand of each subject was irradiated with a 1.5-rad dose of partially thermalized fast neutrons. The activity of 24Na was measured at intervals from 3 min to 48 hr after irradiation. The loss of sodium from the hand during this period can be described either by two exponentials or by a single power function. The latter description involves only two disposable factors compared with four in the former. The rate of loss of sodium was found, on the average, to be greater in patients suffering from bone disease than in normal subjects. Neutron activation is a powerful method for studying sodium turnover because the sodium atoms are labeled simultaneously and with equal probability, regardless of the turnover time of individual bodily compartments.


In vitro studies of leukocyte labeling with technetium-99m.

A method for labeling leukocytes in vitro with 99mTc is described. Separated leukocytes are incubated with 99mTc, followed by reduction with stannous chloride and washing with acid citrate dextrose solution. Maximum labeling occurs after at least 5 min incubation with pertechnetate, followed by at least 10 min incubation with stannous chloride. Labeling is similar at room temperature and at 37 degrees C. The labeled leukocytes are viable, and reutilization of label does not occur in vitro. In acid conditions (pH 5.2), the elution of 99mTc from leukocytes is comparable with that of 32P-diisopropylfluorophosphate, but 99mTc elution is greater at pH 7.2--7.4. Neutrophils label more heavily with 99mTc than do monocytes, lymphocytes, erythrocytes, or platelets.


Significance of radiocontaminants in 123I for dosimetry and scintillation camera imaging.

Estimates of absorbed radiation dose and qualitative assessments of image resolution were compared for pure 131I and for 123I produced by the 122Te(d,n), 124Te(p,2n), and 127I(p,5n) 123Xe reactions. A substantial reduction in radiation dose is indicated when 123I replaces 131I, in spite of the radiocontaminants typically present 30-35 hr after the production of 123I by any of these methods. Only a marginal further reduction in radiation dose was noted with use of the most "pure" 123I as opposed to the least "pure" 123I. Comparable scintillation camera resolution was obtained for all 123I preparations at 30-35 hr after bombardment when the medium-energy and pinhole collimators were used. However, the radiocontaminants in the 123I produced from tellurium affected image resolution when the low-energy collimator was used.


Interpolative background subtraction.

A method for background subtraction is presented. The data are digitized scintigraphic images, stored in 64 X 64 frames. Within this array a rectangular area surrounding the target is defined. All data points outside of this area are set equal to zero. From each data point within the area, the computer subtracts a background value equal to the average of the two intersecting linear interpolations between the values at the edges of the rectangular area having the ordinate and abscissa values of the point of interest. The rationale for this approach is discussed and its application in myocardial perfusion studies is illustrated.


Radiopharmaceuticals. XIX. 11C-labeled octylamine, a potential diagnostic agent for lung structure and function.

After intravenous injection, 11C-octylamine - HC1 is rapidly sequestered by the rabbit lung. The initial lung uptake during the first minute was 70 +/- 6% of the administered dose, and 40% of the injected dose remained after 15 min. Approximately 12% of the administered radioactivity is exhaled as 11CO2 during the first 30 min.


Vitamin E and selenium interrelations in the diet of Atlantic salmon (Salmo salar): gross, histological and biochemical deficiency signs.

Either simultaneous or separate dietary deficiencies of vitamin E and selenium in Atlantic salmon during first 4 weeks of feeding caused twice the mortality shown in fish fed both supplemental vitamin E (0.5 IU/g dry diet) and selenium (0.1 mug/g). Subsequent dietary repletion with both vitamin E and selenium significantly reduced mortality during the following 2 weeks. Larger salmon (0.9 g initial mean weight), with vitamin E deficiency with or without selenium resulted in the following deficiency signs: extreme anemia, pale gills, anisocytosis, poikilocytosis, elevated plasma protein, exudative diathesis, dermal depigmentation, in vitro ascorbic acid-stimulated peroxidation in hepatic microsomes, yellow-orange liver color, yellow-brown intestinal contents, enlarged gall bladder distended with dark green bile, low vitamin E in carcass and hepatic tissue, muscular dystrophy, increased carcass fat and water, and a response to handling characterized by a transitory fainting with interruption in swimming. A deficiency of dietary selenium suppressed plasma glutathione peroxidase activity. Supplemental selenium with vitamin E significantly increased tocopherol activity in hepatic, but not carcass tissues. Supplements of both vitamin E and selenium were necessary to prevent muscular dystrophy.


Effect of dietary alpha tocopherol on liver microsomes and mitochondria of aging rats.

Rats of three age groups were fed tocopherol deficient or supplemented diets for 16 weeks or until signs of tocopherol deficiency were apparent. Erythrocyte hemolysis and liver tocopherol content were used as measurements of the tocopherol status of the rats. The following measurements were made on liver microsomal and mitochondrial fractions of all three groups; phospholipid content, lipid peroxidation, fatty acid patterns, pigment fluorescence, ANS fluorescence and the activities of several membrane bound enzymes. Eleven week-old rats displayed signs of vitamin E deficiency after consuming the diet for 7 weeks. Forty-two-week-old rats displayed borderline deficiency signs after 16 weeks of consuming the diet whereas 67-week-old rats displayed no deficiency signs. The need for dietary tocopherol, therefore, appeared to decrease with increasing animal age. Age related alterations in membrane compositional and functional parameters were not modified by either tocopherol deficient or supplemented diets. Tocopherol does not appear to stabilize microsomal membrane composition or function although mitochondrial membranes appear to be labilized by the dietary manipulation of the vitamin.


The effect of cycloheximide on hepatic RNA synthesis and nucleolar size in rats force-fed a threonine-devoid diet.

Young rats were force-fed a complete or threonine-devoid diet for 3 days. On the fourth morning, rats of each group were injected intraperitoneally with cycloheximide (150 mug/100 g body weight) or saline with [6-14C]orotic acid 30 minutes later, 2 hours before killing. Incorporation of [6-14C]orotic acid into hepatic RNA fractions (whole homogenate, postmitochondrial supernatant, microsomes, ribosomes, nuclei and soluble) revealed elevated levels (cpm/mg RNA) in rats force-fed the threoninedevoid diet in comparison to those of rats force-fed the complete diet. However, treatment with cycloheximide decreased the incroporation of [6-14C]orotic acid into the hepatic RNA fractions of the rats force-fed the threonine-devoid diet to levels that were similar to those in rats force-fed the complete diet with or without cycloheximide treatment. Studies dealing with nucleoli isolated by sucrose gradients from livers of control and experimental rats revealed heavier nucleoli and more radioactive labeled RNA in nucleoli ([6-14C]orotic acid administered 30 minutes before killing) of rats force-fed the threonine-devoid diet than in those force-fed the complete diet for 3 days. Treatment with cycloheximide decreased the elevated incorporation in the experimental rats. Also, electron microscopic studies revealed that after cycloheximide treatment, the enlarged hepatic nucleoli of the experimental rats became smaller and returned to a more normal pattern, as found in the control rats. The studies suggest that active hepatic protein synthesis is involved in the increased hepatic RNA synthesis in rats force-fed the threonine-devoid diet and that following inhibition of protein synthesis, as induced by cycloheximide, there is a rapid inhibition of the accelerated hepatic RNA synthesis observed in rats force-fed the threonine-devoid diet with a rapid reversal toward a normal level, i.e. toward that found in control rats.


Decreased dietary protein or energy intake and plasma growth hormone levels of the pregnant pig, its fetuses and developing progeny.

The effects of low protein diets on plasma growth hormone were studied in pregnant pigs, fetuses and the developing progeny. Pregnant pigs were fed 18%, 3% or 0.5% protein diet throughout the gestation period. At 10, 13 and 15 week of gestation, fetuses were removed from the uterus after the dam had been bled to death. Plasma samples were used for growth hormone determinations. In a second experiment, 2-day old pigs from another set of pregnant pigs fed the diet containing 18%, 3% or 0.5% protein during gestation were cross-fostered to control nursing dams and weaned at 4 weeks of age to a standard diet. Plasma obtained at regular intervals was used for growth hormone determination. Plasma growth hormone was significantly higher in dams fed 0.5% protein after week 13 of gestation. High growth hormone (ten times the dam GH level) was observed in all fetuses irrespective of maternal dietary manipulation. Offspring of severely protein deprived pits (0.5% protein) had significantly elevated growth hormone levels up to 12 weeks of age in spite of cross fostering to a control dam after birth. The data suggest that there is little or no effect of maternal protein restriction on fetal growth hormone levels but the persistent high growth hormone levels in the progeny of severely malnourished pigs indicate a possible impairment of the production, release or catabolism of growth hormone and/or its releasing factor.


Immunoreactive growth hormone levels in pigs fed protein or energy restricted diets during the postweaning period.

Developmental changes in growth hormone levels during protein or energy malnutrition was studied in weaned pigs. Three or 4 weeks old pigs from control dams were fed a control diet (18% protein), an energy-restricted diet (18% protein) or a low protein diet (6% protein) for 8 weeks. Energy restriction was achieved by feeding the control diet in amounts that allowed very little growth. After the restriction period, all pigs were fed the control diet ad libitum for another 8 weeks. Blood samples were collected at intervals throughout the experiment and the plasma was analyzed for growth hormone by radioimmunoassay. Post weaning protein deprivation resulted in higher growth hormone levels during the restriction period as compared to control pigs or pigs with a restricted energy intake.


Influence of ascorbic acid on selenium nutrition in the chick.

Experiments were conducted to determine the nature of the effect of dietary ascorbic acid on selenium nutrition in the chick. Results showed that ascorbic acid resulted in increased activities of the selenium-containing enzyme glutathione peroxidase in plasma, accompanied by an apparent reduction in the dietary selenium requirement of the vitamin E-deficient chick. The ascorbic acid contents of plasma, liver, kidney and adrenals were not affected by selenium or vitamin E deficiencies, indicating that selenium-vitamin E deficient chicks are not rendered scrobutic. Absorption experiments using ligated duodenal loops or oral doses indicated that dietary ascorbic acid promoted the enteric absorption of selenium but did not affect the absorption of vitamin E. These results support the hypothesis previously reported that factors which inhibit the oxidation of dietary selenium promote its absorption and, perhaps, its post-absorptive utilization in metabolically active components of the cell.


Differential effects of high dietary levels of vitamin A on the vitamin E-selenium nutrition of young and adult chickens.

Experiments were conducted to determine the nature of the interaction of high levels of vitamin A and vitamin E-selenium nutrition in the chicken. Results showed that chicks were protected from the vitamin E-selenium deficiency disease exudative diathesis (ED) by a high dietary level of vitamin A (1.0 X 10(6) IU/kg) which moderately depressed growth. A greater concentration (1.5 X 10(6) IU/kg) of vitamin A in the diets of hens fed a low vitamin E diet hastened their depletion of plasma tocopherols and increased plasma glutathione peroxidase (GSH-px) activity. At hatching the progeny of vitamin A-fed hens were severely depleted of plasma tocopherols but had normal plasma GSH-px activities. They showed increased susceptibility to ED when fed selenium-deficient, vitamin E-free diets for 2 weeks. Absorption studies using ligated duodenal loops or oral doses indicated that high-level dietary vitamin A promoted the enteric absorption of selenium but interfered with the absorption of vitamin E. The dual nature of these effects was related to the ED-protective influence of vitamin A when fed to chicks, and the ED-stimulative influence on progeny when vitamin A was fed to dams.


The effect of a long-term excess of pyridoxine on the fatty acid composition of the major phospholipids in the rat.

The effect of a long-term excess of pyridoxine on the fatty acid spectrum of phosphatidylcholine, lysophosphatidylcholine and phosphatidylethanolamine of liver, plasma and kidneys in rats was studied to determine whether this response might be opposite to that observed during a deficiency. As a function of time, the fatty acid composition of the phospholipids generally changed similarly in both the control group and the pyridoxine-treated group. Though differences did occur between the two groups, particularly on day 14 of the treatment, they generally disappeared by day 22. We therefore attributed the major part of the changes occurring in the pyridoxine-treated rats to the age or development of the rats rather than to the pyridoxine treatment itself. In general, the proportion of arachidonic acid increased with time in the phospholipids of both groups while that of linoleic acid decreased. The magnitude of these changes and the proportion of the different fatty acids in the various phospholipids were not uniform from one phospholipid to another or from one tissue to another. Possible mechanism were discussed.


Color-tolerance data and the tentative CIE 1976 L a b formula.

In response to general request of CIE Technical Committee TC 1.3 for evaluation of the proposed small-color-difference formula, tentative CIE 1976 L a b, unit color-difference contours generated this formula have been calculated and compared to cross sections in the chromaticity diagram of ellipsoids fitted nearly optimally to relevant visual color-tolerance data.


A method for the treatment of metamerism in colorimetry.

All of the spectrally different colors that match according to an observer form a metamer ensemble. We present a new method to generate the metamer ensembles for both direct light and reflecting-surface-color problems. The method is based on the properties of particular metameric functions (the simple elements) and is particularly appropriate for treating problems of theoretical limits of metamerism. The method is illustrated with several practical examples and is compared with previously known methods.


Theory of spatial-frequency filtering by the human visual system. I. Performance limited by quantum noise.

A theory and model of the visual system are presented to explain the detection of static sinusoidal gratings near the threshold. The model incorporates a set of independent decision centers and associated photoreceptive fields (PRFs). The decision criterion value at each decision center is proportional to the standard deviation of the excitation current transmitted from a PRF to its associated decision center caused by quantum fluctuations in the absorption of light. It is well known that the spatial-frequency-response (SFR) function and the spatial-impulse-response (SIR) function of a photodetector are a Fourier transform pair. A systematic examination of the SIR and SFR functions of PRF configurations consisting of rectangular regions of alternately excitatory and inhibitory response reveals that modulation sensitivity of the visual system is explained at scotopic and photopic illuminance by a set of PRFs composed of a single excitatory region and a central excitatory region bordered by inhibitory regions, respectively. The complete model is shown to yield a high degree of conformity between theoretical and experimental threshold modulation curves.


Theory of spatial-frequency filtering by the human visual system. II. Performance limited by video noise.

A detailed theory of the detection of sinusoidal gratings displayed with suprathreshold luminous fluctuations is developed by employing a previous model of the visual and decision-making systems. An important feature of the model is the organization of the photoreceptors and decision-making system into a set of parallel, independent photoreceptive field (PRF)-decision center channels that function like a set of parallel spatial-frequency filters, each associated with an independent threshold detector. A technique is proposed for determining the modulation sensitivity functions (MSFs) of single detection channels by obtaining threshold modulation (MTN) data at a fixed sinusoidal grating frequency (v) while varying the center frequency (vc) of narrow-band luminous fluctuations caused by video noise (VN). The theory predicts that the ratio, at a given v, of MTN obtained as a function of vc to the MTN obtained without VN is proportional to the MSF of the particular channel for which the widths of the excitatory and inhibitory regions of the PRF equal a half-period of v. Good agreement between theoretical curves and experimental data appearing in the literature provides strong corroboration of the theory.


Mesangiocapillary glomerulonephritis in lambs. III. Quantitative and qualitative aspects of immunopathology.

Newborn Finnish Landrace lambs subsequently affected with mesangiocapillary glomerulonephritis (MCGN) were deficient in the third component of complement (C'3), serum levels being approximately 5 per cent. of those in unaffected lambs. Hypocomplementaemia persisted until symptoms of renal failure occurred at around 6-8 wk of age. Immunofluorescence examinations of renal cortex with antisera specific for IgG, IgM, IgA, C'3 and fibrin supported previous morphological evidence of a strong similarity between this disease and MCGN in man. Similar examinations of choroid plexus suggested that immune complexes containing IgG, IgM and C'3 were present in the interstitium.


Localisation and tissue effects of tritiated dehydroretronecine in young rats.

Sixteen male Spraque-Dawley rats were injected with 3H-dehydroretronecine. The rats were subsequently evaluated for gross and microscopic changes. Scintillation counts and autoradiographic studies of the various organs demonstrated that the pyrrole accumulates in organs which were shown here and by others (Peterson et al; Allen and Hsu) to be affected most severely by dehydroretronecine and dehydroheliotridine. In the present experiment 3H-dehydroretronecine was shown to decrease the growth rate of the rats, decrease the percentage of circulating neutrophils and alter the hepatic mitotic index. Histologically, accumulations of label were seen in the glandular region of the stomach, in the liver, in Huxley's and Henle's layers of the hair follicles and in the epithelial cells lining the convoluted tubules of the kidney. Scintillation counts on the various tissues and autoradiographic evaluations of tissue sections indicate that there is a preferential localisation of radioactivity in the gastric mucosa which is postulated to be related to the pH in this area.


The development and persistence of bronchialgland hypertrophy and goblet-cell hyperplasia in the pig after injection of isoprenaline.

Pigs were injected i.m. with isoprenaline sulphate on 6 consecutive days. In the bronchial mucosa of animals killed 24 hr after the sixth injection there was a significant increase in the ratio of submucosal gland thickness to bronchial-wall thickness, indicating glandular hypertrophy. The hypertrophy was due to an increase in size of mucous cells, which were filled with secretion. There was also a much higher proportion of acid glycoprotein in the mucous acini of IPN-treated pigs compared with those of controls. This acid glycoprotein was predominantly sialomucin, but a small quantity of sulphomucin, not present in the normal animal, was observed. IPN also caused a significant increase in the number of goblet cells in the bronchial epithelium, but there was no change in their glycoprotein type, most containing exclusively sialomucin. IPN produced a significant increase in the weight of the salivary and adrenal glands, and of the heart, in which the right and left ventricles were hypertrophied equally. Examination of pigs killed up to 3 mth after IPN showed that the submucosal gland hypertrophy persisted for about 1 mth and the goblet cell hyperplasia persisted for 2 mth.


A quantitative microscopical study of tumour cell nuclei in lymphatic metastasis, using a Quantimet.

The projected areas of nuclei of tumour cells in experimental and human tumours have been measured with a Quantimet. In nearly all the specimens examined the nuclei in the lymph node metastasis, and the nuclei in the site from which metastasis had occurred, were similar in size. In one case of human breast cancer, nuclei in the axillary nodal metastasis were twice as large as those in the mammary primary. In another case of human breast cancer a few very large nuclei were seen only in the mammary primary.


Triamcinolone-induced systemic infections in female mice.

Six-week-old female mice were injected for prolonged periods of time with a synthetic glucocorticoid (triamcinolone diacetate). With the progression of the experiment the mortality rate increased significantly. Tissue samples were obtained from the surviving animals after 10, 22, 35 and 45 consecutive daily injections. Cultures were obtained from kidney and liver homogenates as well as from blood samples. Quantitative measurements indicated severe renal and hepatic infections which were followed by bactoeremia. The prevalent organisms in all cultures were enterobacteriae such as E. coli, Klebsiella, Pseudomonas and Streptococcus fecalis. Placebo-control animals which received daily injections of the vehicle revealed a moderate, transient infection.


An improved method of reporting on laryngectomy specimens.

A new simple method is described for the macroscopic examination of total laryngectomy specimens. The technique facilitates assessment of the spread of laryngeal carcinoma without the need of serial sections.


The influence of hepatic microsomal amidopyrine demethylase activity on halothane hepatotoxicity in the horse.

The hepatotoxic effect of oral halothane in the horse is increased by pretreatment with phenobarbitone or DDT but not by chlorpromazine. Phenobarbitone and DDT increase the activity of hepatic amidopyrine N-demethylase but chlorpromazine does not. Carbon disulphide protects the liver of the horse against halothane.


Tumoural lipocalcinosis: a clinicopathological study of 20 cases.

Twenty cases of tumoural lipocalcinosis are described. Active and inactive stages can be recognised, each with distinctive histological features. The aetiology and pathogenesis of the lesion remains obscure.


Malakoplakia of the prostate.

A case a malakoplakia of the prostate is reported, the fourth case in this site. The clinical features, histology and ultrastructure are described.


Venous infarction of the adrenal glands.

An investigation of 78 cases of adrenal haemorrhage and necrosis disclosed that 32 were examples of adrenal venous infarction. In all these cases there was thrombosis of the main adrenal vein and in most there was also thrombosis of the capsular veins, a finding which has not been well established. In a number of cases with venous infarction there was clinical and pathological evidence that disseminated intravascular coagulation (DIC) had occurred, but it appears that it was not the direct cause of venous thrombosis. The majority of cases of venous infarction occur in patients with severe infection, frequently of the respiratory tract. Venous infarction was found in five cases with hypothermia an association which had rarely been described, and in three of these there was evidence of DIC. This is apparently the first occasion on which DIC has been demonstrated in cases of hypothermia in man. The cause of venous thrombosis in the adrenal glands is obscure in most cases of venous infarction, although in three it was due to involvement by metastatic carcinoma. It is suggested that the factors responsible for the initiation of thrombosis in the adrenal veins are catecholamines, thrombin, fibrin and endotoxin. Localisation of the thrombi to the adrenal vein is due to the unique anatomical structure of the vein which, under certain circumstances, results in the local stasis of blood.


An ultrastructural and ultrahistochemical study of the placenta of the diabetic woman.

An ultrastructural and ultrahistochemical study has been made of placentae from seven women, all of whom were established diabetics before the onset of pregnancy. None of these women had suffered from any of the hypertensive complications of pregnancy. Patchy focal syncytiotrophoblastic necrosis was evident and indirect evidence of syncytial damage was seen in the form of marked cytotrophoblastic hyperplasia. The syncytial necrosis appeared to be lysosomally mediated, possibly as a result of altered intracellular pH. Occasional cytotrophoblastic cells also showed degenerative changes. Most of the villous trophoblast was, however, morphologically normal and showed features suggestive of normal or increased synthetic, transfer and excretory activity. Focal thickening of the villous trophoblastic basement membrane was seen and this did not appear to be due to deposition of immune complexes. The endothelial cells of the villous capillaries appeared unduly immature but no evidence was seen of immune complex deposition in these vessels or of diabetic angiopathy. It is concluded that the diabetic's placenta shows a consistent pattern of abnormalities which appear to be a direct result of the diabetic state.


Yellow pulmonary hyaline membranes.

Yellow pulmonary hyaline membranes were observed at autopsy in 16 newborn infants between 1972 and 1974 in four hospitals of Philadelphia, Pa., and Newark, N.J. Other pediatric pathologists in this country and in Spain have seen the same lesion within the last decade. Chemical analysis of affected lung tissue, histochemistry, and electron microscopy show the yellow color to be due to the presence of bilirubin. No substantial clues concerning the basic etiology or mechanism for the formation of these unique membranes emerge from a detailed review of clinical and postmortem data nor from comparison of these data with those for 68 control infants with the usual acidophilic pulmonary hyaline membranes. We are left, however, with the impression that prolongation of life, relatively elevated levels of serum bilirubin, and protracted assisted ventilation (with either CPAP or PEEP) are intimately related to their formation.


How do children and funerals mix?

Although no specific post-funeral syndrome seems to exist, many, if not most, children under the age of six or seven seem not benefited psychologically by attending a funeral. Although some young children can tolerate funerals well if sensitively supported by their parents, the fact is that such support is more often absent than present. One useful indicator of the parents' ability to make the funeral experience a positive one is whether or not the child wishes to attend. A child, no matter how young, who feels secure in attending should usually do so. Conversely, a child who refuses or is steadfastly reluctant to attend a funeral is usually perceiving accurately his parents' inability in their own mourning to provide him with adequate support for this emotionally charged endeavor.


A familial defect in cellular chemotaxis associated with redheadedness and recurrent infection.

This study describes a familial defect in polymorphonuclear leukocyte chemotaxis associated with redheadedness and recurrent infection in two of six siblings. Laboratory data indicate that this defect in chemotaxis is not associated with a concurrent defect in leukocyte bactericidal activity. Additional studies demonstrate that although these children experience recurrent infections, immunoglobulin levels (IgG, IgA, IgM, and IgE) and complement components (total hemolytic complement, Clq, C3 and C3PA) are all within normal limits. Measurements of PMN random mobility and phytohemagglutinin-stimulated lymphocyte transformation were also within normal limits. These studies demonstrate a familial PMN defect limited to leukocyte chemotaxis and associated with recurrent infection and possibly redheadedness.


Hyperimmunoglobulinemia E in a child with allergic bronchopulmonary aspergillosis and bronchiectasis.

A 12-year-old boy was hospitalized for resection of a bronchiectatic lesion. Investigation of an elevated cencentration of serum IgE led to a diagnosis of allergic bronchopulmonary aspergillosis. ABPA has rarely been described in the pediatric age group. This hypersensitivity lung disease is characterized by intermittent wheezing, fever, recurrent pulmonary infiltrates, eosinophilia, hyperimmunoglobulinemia E, and Type I (allergic) skin reactivity to aspergillus extract. Hyphae of aspergillus may also be found in expectorated brown mucus plugs. Type III (Arthus) skin test response and presence of precipitating antibody to this fungus may be demonstrated. Central bronchiectasis or pulmonary fibrosis may result from uncontrolled progression of this disease.


Insulin and proinsulin in normal and chemical diabetic children.

Plasma levels of total immunoreactive insulin and immunoreactive proinsulin were studied in 10 normal children and 15 children with chemical diabetes ranging in age from 5 to 13 years. Eleven of the children with chemical diabetes demonstrated significantly elevated TIRI during fasting and following glucose administration. There was a delay in the increment of plasma TIRI in four children with chemical diabetes, but otherwise their TIRI levels were normal. In these four children IRP was not significantly different from normal; however, in the remaining children with chemical diabetes, those with elevated TIRI, the IRP was elevated following glucose administration. Although the IRP was significantly elevated in the hyperinsulinemic group, the TIRI was also increased to such an extent that the glucose intolerance demonstrated in these patients could not be attributed to the elevated IRP.