Melanocytes--a UV-sensitive neural network and circadian rhythms.

The melanocytes are acutely sensitive to a single pulse of UV and express neural differentiation. The present work was undertaken to observe whether the melanocyte can sense variations in the duration of UV exposure. Whole skin organ cultures from marginal zone in vitiligo were exposed to a single pulse of UV, 30, 60, 90 and 120 s each. Catecholoxidase levels in the marginal melanocytes and the volume of melanocytes were used to calculate and quantitate the changes in enzyme production. The melanocytes' dendricity, volume and enzyme production increases with the duration of UV exposure. This sensitivity of the marginal melanocytes, to changes in the duration of UV exposure, simulates the coat color changes in weasels and the polar fox exposed to extreme variations in the day/night cycles. The UV response is associated with proliferation of melanocytes as it is G2-phase dependent. Thus the melanocytes form a UV-sensitive neural network responding to annual changes in the photoperiodicity.


Development of the urinary system of the marsupial native cat Dasyurus hallucatus.

The development of the mesonephros and metanephros was examined in the marsupial Northern native cat, Dasyurus hallucatus, from birth through to the end of lactation. The mesonephros was present at birth, reached a maximum volume 11 days after birth and had regressed completely by day 30. The metanephros was present on day 2; glomeruli were first seen on day 8, and nephrogenesis continued until day 89 post partum. The newborn native cat is at a very primitive stage of development compared to other marsupials. However, at weaning, like other marsupial species, the native cat has developed a fully morphological and functional urinary system.


Morphology of corpuscular receptors in hairy and nonhairy human skin as visualized by an antiserum to protein gene product 9.5 compared to anti-neuron-specific enolase and anti-S-100 protein.

The present study elucidates the morphology of encapsulated receptors in human skin by means of immunohistochemistry for the recently characterized neurospecific marker protein gene product 9.5, in comparison with neuronal specific enolase and S-100 protein. Only two types of corpuscles are identified, Meissner's corpuscles and simple coiled corpuscles. Moreover, this investigation reveals that though regional specialization may exist with regard to the encapsulated receptor density, the comparison of hairy and nonhairy skin does not reveal important differences.


Nerve growth factor receptor-like immunoreactivity in the human spinal cord.

Nerve growth factor (NGF) receptor-like immunoreactivity has been demonstrated in the normal human adult spinal cord using the monoclonal antibody ME20.4. Intense immunoreactivity was associated with fibres and terminals in the substantia gelatinosa. In lamina IX the neuropil demonstrated punctate staining, the motor neurons themselves being negative. At thoracic levels occasional neurons of the intermediolateral column cell group were NGF receptor positive. Fine axonal and punctate terminal reactivity was observed in the gracile fasciculus, corresponding to axons in transverse section. Similar, though slightly less dense immunoreactivity was observed in the cuneate fasciculus. The demonstration of NGF receptor immunoreactivity may provide a useful marker of sensory innervation in the human spinal cord.


An immunoelectron-microscopical observation of mouse juxtaglomerular cells in the case of experimental hydronephrosis.

Changes in juxtaglomerular (JG; renin-containing) cells in experimental hydronephrosis 1 month after ureteral ligation were investigated with immunoelectron-microscopical techniques. Two types of granules, electron dense (D) and lucent (L), were observed. D type granules were labeled more intensely with gold particles than those of L type. Granules intermediate between D and L types and exocytosis of D types were observed. In the cells containing D types exclusively, gold particles were restricted to the granules, whereas in the cells containing both D and L type granules, the particles were scattered throughout the cytoplasmic cytosol. The authors discuss the mechanisms of renin release in JG cells.


Lymphoid tissue changes during early syngeneic pregnancy in the RT1u rat.

An active immunological response by the female to mating and pregnancy is important, if not essential, to successful reproduction. Alloantigens which have been demonstrated on spermatozoa include histocompatibility antigens. In the enigmatic success of the fetal allograft, the conceptus survives owing to failure of the mother either to initiate or complete the process of rejection. In this study, AO(RT1u/AgB2) female rats were caged with male rats of the same strain. Observations were obtained from the first 5 days of their postcoital period, identifying lymphoid tissue changes which are due to the presence of the ejaculate and early products of conception in the female reproductive tract. A significant increase in intrathymic proliferation by day 3 is thought to be a hormonal effect induced by the cervical stimulation at mating. The postcoital exodus of lymphocytes from the thymus is possibly in response to coitus and induced by the seminal plasma to safeguard the implanting conceptus.


Prenatal growth pattern of the human maxilla.

Regarding maxillofacial morphogenesis there has been a long debate on the growth of the maxillary structure. Using 120 normal fetal maxillae of gestational ages from 16 to 41 weeks, palatal radiograms and frontal histologic sections were made. We have observed two pairs of accentuated growth areas in the fetal maxillae and named them primary growth centers to formulate the maxillary trapezoid (MT) by radiologic image. The MT is formed by four primary growth centers that are best demonstrated by palatal radiograms of the fetal maxilla as well as by frontal histologic sections. The dimensional increase in the MT during the fetal period is documented and statistically analyzed. From this series of results, we have suggested that the growth centers which demarcate the MT are the basic structures of the developing human maxilla. It was also found that the four primary growth centers are the most active sites for maxilla formation until 20 weeks of gestation and thereafter the growth of the maxilla is enhanced by the participation of the intramembranous bone formation along the periphery. This was in contrast to the central primary growth centers that have already finished maturation in the early fetal period and remain only as a peripherally radiating arrangement of thick trabecular bones.


[Post-eruptive formation of the root apex. A scanning electron microscopic study].

During the course of root formation, histologic examination show many pictures; however, the last stage of root formation is not well documented. In this paper, we describe cellular and extracellular components of immature teeth with incompletely formed roots. The odontoblast cells were observed with reticular fibers. The cementoblasts and epithelial cells covered the cementoid tissue. The results are discussed.


Ontogeny of afferents to the fetal rat cerebellum.

Afferents to the fetal rat cerebellum have been studied in fixed tissue with the fluorescent tracer, 1,1'-dioctadecyl-3,3,3',3'tetramethylindocarbocyanine perchlorate (DiI). The dye was applied to the cerebellar anlage at ages from embryonic day (E) 12 to birth (P0). Central processes of vestibular ganglion cells were found to be the first identifiable afferents to the cerebellum, being present at least by E13 and perhaps as early as E12. Ipsilateral spinocerebellar fibres may be labelled from E15, vestibular nuclei (both ipsi- and contralateral) also from E15, while contralateral inferior olivary nuclei could not be retrogradely labelled until E17. Trigeminocerebellar neurons in the interpolaris subnucleus of the nucleus of the trigeminal spinal tract and neurons of the lateral reticular nucleus were not labelled until E22 and P0, respectively. Finally, contralateral pontine nuclei were retrogradely labelled from the cerebellum after birth.


Histological study of the temporomandibular joint capsule: theory of the articular complex.

The findings of the histological study of the human temporomandibular joint confirm that the cranium and the lower jaw are jointed by two temporomandibular articular complexes (one on the left and another on the right side), each made up, in turn, of two joints--a condylomeniscal condyloarthrosis and a reciprocally fitting meniscotemporal joint. Both these joints are surrounded by short capsular bands which stretch from the condyle to the meniscus and from the latter to the temporal bone and form the true joint capsules. Longer bands which extend from the condyle to the temporal bone may be regarded as reinforcements passing over two articulations.


Morphological, histochemical and immunohistochemical differences between tumorous and adjacent tissues in chemically induced colon cancer in rats.

Methods of morphological, histochemical and immunohistochemical analyses were used to further characterize differences between tumourous and adjacent grossly normal tissues in chemically-induced colon cancer in rats. Colon tumors were induced by the treatment of rats with 1,2-dimethylhydrazine or with N-methyl-N'-nitro-N-nitrosoguanidine alone or with subsequent treatment with deoxycholic bile acid. Tissues were studied morphologically (for the presence of goblet cells in the colon crypts, and the extent of infiltration of lymphocytes into the crypts and between them), histochemically (for the presence of positive reaction to neutral and acid mucopolysaccharides) and immunohistochemically (for the presence of tissue polypeptide antigen). All data were evaluated quantitatively, and index of tissue damage was calculated for both tumorous and non-tumorous tissues. Significant morphological differences were found between tumorous and adjacent apparently normal tissue. Histochemically and immunohistochemically, both types of tissue reacted very similarly to exposure to the carcinogens. Index of damage was significantly different from normal untreated colon in both kinds of tissue. It was suggested that precancerous state in tissue adjacent-to-tumor could be detected using the combination of these methods.


[Histology, immunocytology, histochemistry and muscle fiber innervation of the pectoralis major and supracoracoideus muscles of Excalfactoria chinensis chinensis (L.)].

The morphology of the pectoralis major muscle and its antagonist, the supracoracoideus muscle, of the Chinese quail was studied in comparison with the Japanese quail, in relation to behavioral characteristics. The actomyosin ATPase reaction after alkaline and acid preincubation reveals two fibre types. The indirect immunofluorescence, using specific antibodies against 'slow' (twitch) myosin from the human vastus lateralis muscle, provokes a weak reaction. All fibres observed show focal, monoaxonal 'en plaques' endings, typical of the phasic motor system. For the two quail species, the muscle structure seems adequate in relation to the movement characteristics, meaning muscle activity of migratories, flying long distances.


Thenar and hypothenar muscles and their innervation by the ulnar and median nerves in the human hand.

The thenar and hypothenar muscles as well as their supplying nerves were analyzed with an improved dissecting method. Among the four thenar muscles, the m. abductor pollicis brevis (AbPB) has a separate muscle belly, whereas the m. opponens pollicis (OP), the superficial and deep heads of the flexor pollicis brevis (sFPB and dFPB), and the adductor pollicis (AdP) are fused with each other to make a single mass (deep thenar muscle group). These muscles are innervated by branches of the recurrent nerve and the accessory recurrent nerve from the median nerve as well as by terminal branches of the deep branch (ramus profundus) of the ulnar nerve. These three nerves frequently form a loop within the deep thenar muscle group (thenar loop), and a branch to the OP and one to deep parts of the sFPB often make a smaller loop (intrathenar loop), whereas the AbPB receives a separate nerve branch. Among the hypothenar muscle, the m. abductor digiti minimi and the m. flexor digiti minimi brevis are fused with each other, and their supplying nerves frequently form a loop in these muscles (intrahypothenar loop), whereas the m. opponens digiti minimi is separated from the others and receives a separate nerve branch. In the distribution pattern of supplying nerves to the thenar and hypothenar muscles, we find regularities in that they branch off in a regular manner from the ulnar and the median nerve, and that nerve branches to those muscles with fused bellies frequently communicate with each other to make loops.


Effects of 1 alpha(OH)-vitamin D3 and 24,25(OH)2-vitamin D3 on long bones of glucocorticoid-treated rats.

Glucocorticoids may induce osteopenia in experimental animals and in man. In order to study the possible effects of vitamin D metabolites in the prevention of glucocorticoid-induced osteopenia in rats, we administered 1 alpha(OH)-vitamin D3, 24,25(OH)2-vitamin D3 or a combination of both metabolites, by intragastric intubation, to rats treated daily by intramuscular injections of 10 mg/kg cortisone acetate. Treatment with the vitamin D metabolites started after 1 month of glucocorticoid therapy, at the time osteopenia was already present. Cortisone acetate decreased the gain weight, increased alkaline phosphatase (AP) and decreased Ca serum levels. It also decreased tibial wet and ash weight and tibial Ca content. Computerized histomorphometry of sections from the upper tibia showed decreased epiphyseal bone volume and increased bone marrow volume; decreased height of hypertrophic cartilage in the growth plate and decreased amount of persisting cartilage in the metaphyseal bone trabeculae were also observed. Administration of 24,25(OH)2D3 alone did not reduce these glucocorticoid-induced bone changes and sometimes even worsened them. 1 alpha(OH)D3 reversed many of the deleterious effects of cortisone acetate. It reduced serum AP levels, increased serum Ca levels, increased bone ash weight, epiphyseal and metaphyseal bone volume, with a concomitant reduction in epiphyseal and metaphyseal bone marrow volume. The best results were obtained by a combination of 1 alpha(OH)D3 and 24,25(OH)2D3. It is presumed that both metabolites are needed to reduce the impact of glucocorticoids on bone. 1 alpha(OH)2D3 acts on the gut, increasing Ca absorption (which was decreased by glucocorticoids), and 24,25(OH)2D3 directly acts on bone to enhance bone formation and mineralization.


Presence of melanin in the cat pineal gland.

Light- and electron-microscopic features of pigmented cells in the cat pineal gland are described. These cells were observed throughout postnatal life from the second postnatal day to the oldest cats studied (up to 13 years old). No apparent relationship was observed among the amount of pigment and the animal age or sex. Pigmented cells showed a preferential localization at the ventral surface of the pineal gland near its distal end. The pineal pigment was histochemically identified as melanin. Pineal pigment granules showed ultrastructural features similar to melanocyte melanin granules.


Structural characterization of the mandibular condyle in human fetuses: light and electron microscopy studies.

Mandibular condyles from 18- to 20-week-old human fetuses were examined in the light and electron microscope with particular attention to intratissue organization and extracellular matrix. In the human fetus the condyle has been divided into five layers: (1) the most superficial, articular layer, (2) chondroprogenitor cell layer, (3) condroblast cell layer, (4) nonmineralized hypertrophic cell layer, and (5) mineralized hypertrophic cell layer. The articular layer is rich in collagen fibers (mostly of the type I collagen), but the cells seldom divide. By contrast, in the chondroprogenitor cell layer and upper part of the chondroblastic cell layer mitosis gives rise to new cells. The matrix in the latter layer is composed of thick banded 'lucent' fibrils in a loose feltwork of granules representing cartilage proteoglycans. The daughter cells in the progenitor cell layer undergo differentiation which is apparently completed along the lower border of the mineralized hypertrophic cell layer--the ossification front. The matrix in the hypertrophic cell layer reveals distinct matrix vesicles that undergo mineralization and subsequently coalesce to form larger sheets of mineralized extracellular matrix. Mineralized cartilage serves as a backbone for new bone formation as marrow-derived osteoblasts and osteoclasts attach to remnants of mineralized cartilage, which enables the turning on of the remodeling cycles involved in new bone formation. It can be concluded that the process of endochondral ossification as has been reported in lower animals is recapitulated in the human fetus, thus the dynamics associated with condylar morphogenesis is maintained through phylogeny.


Sensitivity of the fetal rat pituitary-adrenal system to corticotropin-releasing factor in organ culture.

Six groups of adrenal glands from 17-day fetal rats were explanted to organ culture for 2 days. In one group, adrenal gland was cultured alone, and in the remaining five groups adrenal gland was cultured with pituitaries from fetuses ranging in age from 14 to 18 days. In each of the groups, half of the cultures had corticotropin-releasing factor (CRF) added to the medium. A histometric parameter utilized the size of adrenocortical cells as an indicator of sensitivity of the pituitary-adrenal system. When 17-day adrenal gland was cultured alone, addition of CRF did not cause any enlargement of cortical cells. When the adrenal gland was cultured with two 14-day pituitaries, cortical cells were enlarged. Addition of CRF to this culture induced no further change. With two 15-day pituitaries in the presence of CRF, cortical cells were slightly larger than those in the absence of CRF. With 16- to 18-day pituitaries, a marked hypertrophy of cortical cells was induced, and the addition of CRF caused further acceleration in their enlargement. These results suggest that, in organ culture, 14-day pituitary can release some adrenocorticotropic hormone (ACTH) with or without additional CRF. Older pituitaries (16- to 18-day) can apparently release an amount of ACTH in the presence of CRF that is greater than their own spontaneous ACTH secretion.


Myasthenia gravis in Hong Kong Chinese. 1. Epidemiology and adult disease.

A territory-wide study of myasthenia gravis (MG) was conducted in Hong Kong. Two hundred and sixty-two Chinese patients (159 adult and 103 paediatric onset) were identified, corresponding to a point prevalence and period prevalence of 53.5 and 62.2 per million respectively, and an average annual incidence of 4.0 per million population. Nine patients died, 7 from MG, giving a case fatality rate of 0.027. Female predominance was present in the whole group of patients (female to male ratio 1.6:1) and in those with adult disease (ratio 2.1:1), but not in those with onset in childhood (ration 1.1:1). Onset of disease was most common in the first 3 decades of life, and became less common in subsequent decades. Juvenile onset MG occurred in 39.3% of patients and restricted ocular MG in 47.9%. Familial occurrence was found in 5 patients. In the 159 adult onset patients, ocular disease was most common (32.7%), followed by mild generalised (29.6%), moderately severe generalised (24.5%), fulminating (11.9%) and late severe disease (1.3%). The mean age of onset of symptoms was 36.7 years. The symptomatology was similar to that of Caucasoid populations. Autoimmune thyroid disease was the commonest associated disease, and the incidence of thymoma among thymic abnormalities was high at 38%.


Absence of interaction between oxcarbazepine and erythromycin.

When erythromycin (ERY) is co-administrated with the antiepileptic carbamazepine (CBZ), a drug interaction may cause an increase in CBZ plasma concentrations, which can result in CBZ related toxic symptoms. This cross-over study was designated to investigate whether ERY influences the pharmacokinetics of the new antiepileptic oxcarbazepine (OXC) and its metabolites. In 8 healthy volunteers there were no significant differences in AUC, peak plasma concentrations or time to peak concentration when OXC was administered either with or without ERY. The results of this study suggest that OXC may offer an important advantage over CBZ especially when concomitant therapy with ERY is required.


Neuropsychological assessment in MS: clinical, neurophysiological and neuroradiological relationships.

We assessed cognitive performance and its relationship with clinical and anatomic disease severity in MS with mild to moderate handicap; 34 definite MS and 18 healthy subjects matched for age and education were submitted to a neuropsychological test battery. Both groups were examined for anxiety. MS patients underwent magnetic resonance imaging examination. MS performed worse than controls on all WAIS-P subtests and had learning, short- and long-term verbal memory impairment. Cognitive deficits were not related to abnormal emotional states, but were found to be associated with attentional process and information-processing speed impairment. Cognitive impairment did not correlate with severity of physical disability. The most severe memory deficits were found in patients with extensive periventricular damage.


Humoral CSF parameters in the differential diagnosis of hematologic CNS neoplasia.

Cerebrospinal fluid (CSF) and serum samples of 20 patients with central nervous system manifestations of hematological malignancies including primary cerebral lymphoma (n = 5) and disseminated non-Hodgkin lymphoma (n = 7) were examined for albumin, IgG, IgM, fibronectin, beta 2-microglobulin, interleukin-6, soluble interleukin-2 receptor, tumor necrosis factor alpha, and oligoclonal immunoglobulin bands. Although a broad range of abnormalities were detected, no reliable CSF parameter for the diagnosis of leptomeningeal spread from hematological neoplasias could be identified. An analysis of 61 repeat lumbar punctures added little to the findings of the first CSF examinations. Currently, immunochemical studies of CSF cell surface markers and early biopsy have probably more clinical value than the determination of the humoral CSF parameters included in this study. However, analysis of cytokine synthesis by single CSF cells using molecular biology techniques may improve the differential diagnosis of hematological neoplasia of the brain and spinal cord in the future.


First seizure in adults: a prospective study from the emergency department.

A prospective study of 98 consecutive adults with a first seizure to determine the most important etiological factors and the optimum diagnostics. 27 were thought to have cryptogenic seizures. Main causes of symptomatic seizures were: cerebral infarction, alcohol-withdrawal, CNS infections, tumors, vascular malformations, traumatism and miscellanea. Eight were infected by human immunodeficiency virus (HIV-1) representing 8.2% of all the patients with a first seizure and 20% of the 15-45-year age group. CT disclosed structural lesions in 33 cases. MRI in those with normal CT and no other explanation of seizure revealed additional lesions in 22.2%, but did not change management in any. We conclude that CT is essential in evaluation of adults with first seizure. MRI may be useful in selected cases. The HIV-infected now represent an important group with a first seizure.


Nocturnal prolactin and growth hormone levels in children with complex partial and generalized tonic-clonic seizures.

This study measures whether there is a rise in the secretion of nocturnal prolactin and growth hormone (GH), during the delta phase of the first sleep cycle in children who are suffering from either complex partial or generalized tonic-clonic seizures. The findings are compared with those obtained in the control group of patients which is made up who suffer from pseudoseizures. There is a moderate but significant rise in the nocturnal prolactin plasma level in both types of infantile seizures. No significant difference was found in the GH.


Aging and spectral analysis of EEG in normal subjects: a link to memory and CSF AChE.

We studied the effect of aging on EEG spectra recorded from T5-O1 (T6-O2) derivation. The aging series composed of 52 normal individuals aged 20 to 91 years. Seventy-nine per cent of visual and 81% of quantitative EEGs were considered normal. The absolute amplitude of delta and theta bands and absolute power of delta band were lower for the oldest group (aged 60 and over) than for the youngest group (aged 20-39 years). Age was inversely related to the amount of delta and theta indicating that the amount of slow activity in quantitative EEG does not increase with age in the context of good health status. Women had more beta activity compared with men. In addition, the amount of beta and alpha bands showed tendency for a reduction with age. Fifteen subjects aged 50 years or older participated in a 2-year follow-up including EEG and neuropsychological evaluation. Seven of them deteriorated in learning ability and showed increase in delta activity. In the oldest age group, delta amplitude was positively correlated with intrusion errors in the list learning test and inversely related to acetylcholinesterase activity of the CSF. Thus, a link between the cholinergic system, EEG slowing and memory problems in old age is suggested.


Elevation of serum ceruloplasmin levels in brain tumours.

Serum ceruloplasmin levels have been estimated in 80 patients with various intracranial space occupying lesions and in 30 controls. The ceruloplasmin levels were significantly increased in all brain tumours except in meningiomas. After therapy, the ceruloplasmin levels were still significantly increased when compared to controls and their respective preoperative values. However, the rise in levels of ceruloplasmin in malignant tumours compared to benign was statistically not significant. It is concluded that ceruloplasmin may have a role to play as an acute phase reactant protein in brain tumours.


Debrisoquine hydroxylation in Parkinson's disease.

Debrisoquine (DBQ) metabolism was studied in 80 Parkinson's disease (PD) patients, 26 of whom had young onset Parkinson's disease (YOPD), and in 143 controls. There was no significant difference between the proportion of poor metabolisers of DBQ among YOPD patients compared either to other parkinsonians, or to controls. Nor was there a significant correlation between the age of disease onset and DBQ metabolic ratio (MR). The results do not support the suggestion that impairment of DBQ metabolism (and hence cytochrome P450) is a primary defect in YOPD. However, in comparison with controls, MR values were modestly but significantly higher in PD patients, even in those not treated with drugs known to affect DBQ metabolism.


Effects of withdrawal of phenytoin on cognitive and psychomotor functions in hospitalized epileptic patients on polytherapy.

The effects of the withdrawal of phenytoin (PT) on cognitive and psychomotor functions of long-term patients in an epilepsy centre were studied. The patients had been treated for many years (31.1 +/- 10.8 yrs.) with PT in combination with other antiepileptic drugs. The serum concentration of PT was in the lower to middle therapeutic range (6.8 +/- 3.1 mg/l). Only patients in which the efficacy of PT was questionable were included in the study. PT was withdrawn in 17 patients. The PT dose was not changed in 12 patients (control group). Psychological tests were carried out immediately before the withdrawal of PT and about 10 weeks later. Tests were also carried out with the control group at the same time. A significantly improved performance (using a composite score) was noted after the withdrawal of PT. The statistical evaluation of the different tests showed an significant improvement in one test of concentration and two tests of psychomotor function (tapping and pursuit rotor with the dominant hand). There was no significant change in the frequency of seizures.


Intravenous gamma globulin in progressive MS.

In an attempt to prevent disease exacerbations, intravenous gamma globulin (500 mg to 2 g/kg) plus methylprednisolone was administered monthly to 14 patients with progressive multiple sclerosis, 11 of whom were steroid dependent. Seventeen exacerbations of disease activity were seen in 11 patients over a mean follow-up period of 7.8 months. Four exacerbations occurred in 3 patients within one month of receiving 1.6 to 2.0 g/kg of intravenous gamma globulin (IVGG). Most exacerbations occurred within 2 weeks of steroids being tapered; thus a steroid sparing effect of IVGG could not be demonstrated. We conclude that IVGG plus methylprednisolone can be given safely at monthly intervals for a prolonged period but in the dosage administered did not prevent exacerbations in 80% of patients with progressive multiple sclerosis.


Oscillatory activity in different motor subsystems in palatal myoclonus. A case report.

In a patient with palatal myoclonus the mutual interaction between voluntary movements and the myoclonic activity was analysed. Amplitude and frequency of myoclonic activity in hand muscles were modulated by flexions and extensions. A 1:1 relationship was found between EMG-bursts in hand muscles and palatal movements. A 1:2 relationship was found between eye and finger movements. Resetting of myoclonus in the abductor digiti minimi muscle occurred after cutaneous ulnar nerve stimulation. It is suggested that feedback plays an important role in the generation of the oscillatory activity in PM in addition to pacemaker activity in brainstem neurons.


Ex vivo release of eicosanoids after aneurysmal subarachnoid hemorrhage: a preliminary experience in humans.

Authors addressed the question whether the byosynthesis and the release of specific eicosanoids may occur in human brain cortex, and if the qualitative pattern of arachidonic acid metabolism is similar to that observed in experimental SAH. Human brain samples from 18 patients operated on for anterior communicating artery aneurysm (5 unruptured aneurysms considered as control cases, 7 patients operated on between Days 1 and 4 after SAH and 6 patients operated on between Days 10 and 14) were studied for the ex vivo release of 4 selected eicosanoids (Prostaglandin D2, E2, 6-keto-PGF1a and Leukotriene C4). Levels of arachidonate metabolites were determined by radioimmunoassay technique. PGD2 release is significantly lower in cases operated on delayed phase if compared to both control cases (p less than 0.05) and patients operated on in the acute phase, while there is no significant difference between the release of PGD2 in control cases and patients operated on in the acute phase. Release of 6-keto-PGF1a is significantly higher in patients operated on in a delayed phase (p less than 0.03 vs patients operated on in the acute phase and p less than 0.05 versus control cases). The release of LTC4 is significantly enhanced (p less than 0.05) in cases operated on in the acute phase if compared with unruptured aneurysms. The release of PGE2 is significantly enhanced in patients operated on in the acute phase (p less than 0.05) if compared to patients with unruptured aneurysm.(ABSTRACT TRUNCATED AT 250 WORDS)


Early and late outcome in head injury patients with radiological evidence of brain damage.

This study examined the early and late outcome in head injury patients with focal or multifocal (unilateral or bilateral) brain contusions revealed by computerized tomography (CT) scanning. The outcome was also evaluated in patients hospitalized due to brain concussion. Three months after the injury (the early outcome) 43% of the 86 cases with multifocal contusions on the CT scan were dead. As evaluated by the Glasgow Outcome Scale, all the 57 patients with a focal brain contusion, as well as the 117 cases with brain concussion, made a good recovery or were moderately disabled. The late outcome (1 to 5 years after injury) was evaluated in 78 cases with brain contusion and in 85 cases with brain concussion, and revealed that complaints and impaired adaptive functioning were frequent in both the contusion and concussion group. The occurrence of headache, dizziness and sleep problems did not significantly differ among the various head injury groups. However, focal or multifocal brain contusions on the CT scan increased the frequency of impaired memory, impaired concentration, speech problems, weakness in arms or legs and seizures with loss of consciousness. Cognitive deficits and speech problems were particularly common in patients with a focal contusion in the temporal lobe. The late adaptive and social functioning were most markedly impaired in cases with multifocal bilateral contusions.


Platelet-activating factor acetylhydrolase activity in red blood cell-stroma from patients with cerebral thrombosis.

Platelet-activating factor (1-O-alkyl-2-acetyl-sn-glycero-3-phosphocholine, PAF) is a bioactive phospholipid and inactivated by a specific enzyme, PAF acetylhydrolase (PAF-AH). We have measured PAF-AH activity in red blood cells (RBCs) from patients with a history of cerebral thrombosis and age-matched healthy controls. The activities in 34 patients and 34 controls were 1.29 +/- 0.28 and 1.64 +/- 0.26 nmol/10(9) RBCs/min (or, 30.0 +/- 5.8 and 35.1 +/- 4.7 nmol/g protein/min) (mean +/- SD), respectively, and the difference was significant (p less than 0.001). In patients, RBC PAF-AH activity correlated positively with RBC filterability, an index of RBC deformability (r = +0.501, p less than 0.05). The RBC activity may play a role in scavenging oxidation products of membrane phospholipids. Lower RBC PAF-AH activity may predispose to ischemic diseases by disturbing microcirculatory behavior of the RBCs.


Clinical-radiographic correlations within the first five hours of cerebral infarction.

Fifty patients, ages 54-79, with ischemic hemispheric strokes productive of hemiparesis, at a minimum, underwent standardized neurological evaluations, computed tomographic scanning and cerebral angiography (N = 38) or carotid ultrasound (N = 12) within 5 h of onset. A second scan was performed at 5-7 days. Clinical scores were not associated with a history of, or the presence of: hypertension, smoking or cardiac disease, including atrial fibrillation, nor with severe internal carotid artery stenosis or occlusion. Clinical scores were adversely affected by early scan abnormalities (especially mass effect), lesion size, intracranial arterial occlusions, elevated serum glucose levels and the subsequent development of hemorrhagic infarction. Glucose levels correlated with infarct size and the development of hemorrhagic infarction. Delayed intracranial arterial filling and collateral flow were associated with reduced infarct size but did not confer clinical protection. We believe that combining the initial glucose level and scan results has prognostic significance, and early angiography is valuable in characterizing infarct etiology and assessing clinical severity.


Chorea gravidarum and chorea associated with oral contraceptives--diseases due to antiphospholipid antibodies?

A woman with chorea gravidarum in the absence of SLE is described. She later developed severe chorea while using the contraceptive pill, and high titered antiphospholipid antibodies were detected in serum. A rapid recovery after high dose i.v. methylprednisolone was observed. Deterioration occurred in a later pregnancy.


Stretch reflex of quadriceps femoris and its relation to rigidity in Parkinson's disease.

Much evidence suggests that parkinsonian rigidity is due to hyperactivity of a reflex arc. While tendon jerk and H reflex are not modified in Parkinson's disease (PD), the long-latency component of stretch reflex (LLR) shows an increased size in PD. It has been proposed that this modification could account for rigidity. We studied in 14 PD patients and 8 normal subjects the stretch reflex of the quadriceps femoris. The muscle was stretched by a torque motor in two experimental sets: at rest and with voluntary background activity. Latency, duration and size of the reflex were compared in two groups; correlation between size of the reflex and rigidity was investigated. A lower threshold for the reflex was found in PD patients in trials at rest, and LLR showed increased size and duration in trials with background activity. No clear relationships between these data and rigidity were demonstrated.


Epidemic of acute inflammatory myopathy in Karnataka, south India: 30 cases.

Thirty patients of acute inflammatory myopathy were seen over a short period of 11 months (February to December 1986) at NIMHANS, Bangalore, South India. The characteristic features were: short febrile illness followed a few days later by myalgia, edema of extremities, severe motor weakness and involvement of multiple other systems. Their mean age was 32.3 years and M:F ratio was 4:1. CK levels were increased in all. EMG done in 23 patients showed spontaneous activity in 13 and myopathic pattern in all. Nerve conduction studies revealed abnormalities in 12 cases. Muscle biopsy done in 21 patients showed varying degree of myophagocytosis and inflammatory infiltrates. All patients received steroids for only 6-8 weeks. Twenty-two patients recovered, one developed residual disability and 7 patients died during the acute phase. None of the survivors has developed relapse so far. Such cases with monophasic illness in clusters have not been reported earlier.


Oxiracetam in dementia: a double-blind, placebo-controlled study.

A multicentre, double-blind, between-patient study was carried out to evaluate the efficacy and tolerability of oxiracetam (800 mg tablet), in comparison with placebo, each given twice daily for 12 weeks to patients suffering from primary degenerative, multi-infarct or mixed dementia. Efficacy was assessed by a neuropsychological battery (simple reaction time, controlled associations, short story, Raven's Progressive Matrices, token test, digit span, word list learning), administered at the beginning and at the end of the study, and by a quality of life scale, administered at entry and after 6 and 12 weeks treatment. Sixty-five patients (28 men, 37 women, mean age 71 yrs) were enrolled; 58 completed the study: 2 on oxiracetam were withdrawn because of poor tolerability, 2 (one in each group) were withdrawn for poor compliance, one (on oxiracetam) for the occurrence of a transient ischaemic attack (defined as not related to the treatment) and 2 for administrative reasons. A significantly (p < 0.01) different effect in favour of oxiracetam was observed on the quality of life scale, and confirmed by significant (defined according to the Bonferroni technique) differences in some neuropsychological tests (e.g. controlled associations, short story). Four patients in the oxiracetam group complained of a total of 5 unwanted effects, and 1 on placebo complained of 3 unwanted effects, but none of them was withdrawn from the study.


Slowed reaction time in asymptomatic HIV-positive patients.

A total of 24 asymptomatic HIV-infected patients (CDC II/III) and 27 HIV-negative controls were tested for speed of reaction and for general neuropsychological functioning. Reaction time was assessed with two computerized tests with differing levels of cognitive complexity. The results show that the asymptomatic HIV-positive patients have a significantly longer mean reaction time to simple and complex stimuli (SRT p < 0.001, CPT p < 0.05), and a significantly greater standard deviation (SD) (SRT-SD p < 0.005). No significant differences were observed on any of the clinical neuropsychological tests, or in the number of false positive (FP) or non-responses to stimuli (NR) from the CPT. The results indicate that asymptomatic HIV-infected patients are slower and have a greater intra-subject variability in speed using a simple test for reaction time. The difference is less pronounced when doing a more demanding cognitive task and not significant in a test of visuo-motor coordination or on other clinical neuropsychological tests. Emotional state or cognitive strategies affecting speed/accuracy trade-off do not account for the findings.


Six-year follow-up study on the efficacy and safety of vigabatrin in patients with epilepsy.

Twenty-five patients with epilepsy (mostly with partial seizures) who had responded favourably to a short-term trial of add-on vigabatrin entered maintenance treatment. After 52 to 78 months, 15 patients continue to take the drug with good therapeutic response. Median monthly seizure frequency during the last 2 months on vigabatrin in all patients, including drop-outs, was 3.5 (range 0-74) as compared with 10 (range 3-98) during an initial placebo period (p < 0.01). Drop-outs were caused by adverse events in 2 cases (ataxia and psychotic symptoms respectively), seizure breakthrough in 4 cases and reasons unrelated to treatment in 4 patients. In most patients, side effects were absent or mild, the most frequent complaint being weight gain. It is concluded that the antiepileptic efficacy and good clinical tolerability of vigabatrin are generally maintained during long-term treatment for up to 6 years.


Effect of torasemide on intracranial pressure, mean systemic arterial pressure and cerebral perfusion pressure in experimental brain edema of the rat.

The study was performed to establish whether a lipophilic loop diuretic, torasemide could modify intracranial pressure and cytotoxic brain edema. Brain edema was induced by water intoxication in nephrectomized rats. Following intravenous injection of 100 mg torasemide/kg body weight at 50, 60, 70, 90 and 120 min, a significant decrease of intracranial pressure was observed.


Immunosuppression by whole-body irradiation and its effect on oedema in experimental cerebral ischaemia.

The effect of global immunosuppression by sublethal whole body X-irradiation on the development of cerebral oedema was assessed 24 h after right middle cerebral artery occlusion in the rat. Irradiation produced a significant leukopenia and thrombocytopaenia, and significantly reduced cortical oedema when compared to non-irradiated control animals.


Five different tests of reaction time evaluated in HIV seropositive men.

In an attempt to develop a short neuropsychological test battery five different tests of reaction time were assessed according to their ability to discriminate between HIV seropositive men and healthy controls. In all tests a patient group with clinical symptoms was slower than the control group. In the complex reaction time test, which has a large cognitive aspect, even a clinically "asymptomatic" group was slower than the control group. The movement test, a new test with a large motor component, identified most slow responders, defining approximately half of the patients with clinical symptoms and one third of the "asymptomatic" patients as such. A test battery consisting of three tests is suggested for serial assessment and screening.


CT-scanning and magnetic resonance imaging in idiopathic spasmodic torticollis.

Twenty-five consecutive patients with idiopathic spasmodic torticollis (IST) were investigated with computerized tomography (CT) or magnetic resonance imaging (MRI) of the brain. In only six patients (24%) did CT or MRI reveal brain pathology (focal cortical atrophy and lacunary infarcts). No consistent pathological pattern was detected. Consequently, CT and MRI of the brain provides little diagnostic information in this disorder.


Radiological assessment of stenosis of the internal carotid artery at the junction with the common.

Stenoses at the origin of 100 internal carotid arteries from patients with ischemic cerebrovascular disease were studied by intra-arterial angiography. Three principles were employed to evaluate the degree of stenosis: 1) verbal description, grading stenoses as mild, moderate of severe, 2) estimation of the true residual diameter, and 3) calculation of percent stenosis, defined here as the diameter of the artery at the origin relative to that at the level of the angle of the mandible. The true diameter, estimated to the nearest whole mm, corresponded well with the verbal description, and correlated significantly with percent stenosis. Since the true diameter is precisely defined, easy to estimate, and directly related to its hemodynamic effect, we suggest that this simple parameter, rather than the more commonly used, but more vaguely defined term "percent lumen reduction", is used to grade stenoses of the internal carotid artery.


Carbamyl phosphate synthetase-1 deficiency discovered after valproic acid-induced coma.

Valproic acid induced coma is presented in an adult patient without a history of metabolic disease. Liver biopsy revealed a reduction in activity of carbamyl phosphate synthetase-I, an enzyme obligated for transformation of ammonia to urea in the urea cycle. After recovery CT scan follow-up showed marked cerebral atrophy which did not exist prior to the state of coma. Risk factors are discussed.


Early onset MS under the age of 16: clinical and paraclinical features.

MS in juvenile patients under the age of 16 occurred in 31 (5%) of our whole MS population of 620 patients in the time from 1975-1991. It does not differ clinically from the disease as observed in 72 patients with later onset MS in respect to symptoms at onset, course, progression rate, rate of relapses and abnormalities in CSF and MRI. However, fever, headache, nausea and vomiting with pleocytosis in CSF during the first episode and development of oligoclonal bands with passage of time may be characteristic in some juvenile patients. The presence of oligoclonal bands and MRI results are of high diagnostic value in this special group of patients.


Cortical metabolism in posterolateral thalamic stroke: PET study.

In 8 patients with small unilateral posterolateral thalamic (or, in one case, thalamocapsular) stroke (infarction or hemorrhage) selected on strict clinical (pure hemisomatosensory deficit without hemiparesis, visual field defect or neuropsychological impairment) and MRI criteria, we studied cortical energy metabolism using positron emission tomography with the 18F-fluorodeoxyglucose or the 15O-oxygen method. We found no significant ipsi- or contra-lateral metabolic depression either in the whole cortical mantle or in the sensorimotor cortex. These results support the hypothesis that location of thalamic stroke is a major determinant of the ipsilateral cortical hypometabolism characteristic of cognitively impaired patients with thalamic lesions and further emphasize the influence of the "non-specific" thalamocortical system on resting cortical metabolism. The lack of sensorimotor cortex hypometabolism in our patients suffering from hemidysesthesia and/or -hyperpathia also suggests that cortical metabolism is unaltered in thalamic pain.


Large striatocapsular infarcts: clinical presentation and pathogenesis in comparison with lacunar and cortical infarcts.

In a well-defined prospective series of 247 patients with a first-ever supratentorial brain infarct, 15 patients (6%; 95% confidence interval 3-9%) had a large striatocapsular infarct. Twelve (80%) had signs of cortical dysfunction, whereas risk factor profile, frequency of significant carotid stenosis, and frequency of potential cardioembolic sources did not differ between patients with striatocapsular and those with cortical infarction. However, patients with striatocapsular infarction more frequently had potential cardioembolic source and significant carotid stenosis than patients with lacunar infarction. Our findings show that large striatocapsular infarcts differ from lacunar infarcts with regard to both presenting signs and symptoms, and pathogenesis, whereas they resemble infarcts involving the cortex. Such patients should therefore be managed and treated as patients with cortical infarction.


Anticardiolipin antibodies, a disease marker for ischemic cerebrovascular events in a younger patient population?

The prevalence of anticardiolipin antibodies (ACLA) in sera of 49 patients having had their first TIA or ischemic stroke before 50 years of age was studied using a solid phase enzyme immunosorbent assay (ELISA). Five patients had IgM antibodies, eight had IgG, and three had antibodies belonging to both classes. Although ACLA were detected in 32% of patients (95% confidence interval [CI] 19-45%), the ACLA positive group did not differ with respect to clinical characteristics and distribution of major stroke risk factor frequency from the ACLA negative group. Further investigations are needed to establish the role of ACLA in the pathogenesis of ischemic cerebrovascular diseases.


Local intraarterial thrombolysis for acute stroke in the carotid artery territories.

We have tested the feasibility of local intraarterial thrombolytic therapy in ischemic stroke in the carotid artery territories observed within 5 h of the onset of symptoms. Only 5 of 615 consecutive patients were enrolled. They were 1 man and 4 women aged 50 to 75 years. Angiography disclosed occlusion of the M2 tract in one, of the M3 tract in one, of the carotid siphon in one of M4 tract in two. Intraarterial urokinase was infused at a mean dosage of 560,000 units close to the site of occlusion. Four of them had partial or complete recanalisation at early angiographic control and were independent at 6th month control. The one who did not demonstrate recanalisation was confined to a wheelchair. One patient, who had recanalisation, sustained a hemorrhagic transformation of the brain ischemia not interfering with outcome. Our experience, at the light of the low rate of enrollment, despite the results, suggest that intraarterial thrombolysis may be a therapeutic tool for selected patients with stroke in the carotid artery territories and not a routinary treatment for them.


Inhibition of the startle reaction by physostigmine in patients with early brain damage.

The influence of physostigmine and atropine on the startle reaction and EEG epileptic paroxysmal activity was examined in 24 severely impaired children with early brain damage. The startle motor reaction could be regularly evoked by tapping on the sternum in 12 of the patients. Physostigmine inhibited this reaction significantly, while atropine was without effect. In 12 patients without a previous startle reaction, atropine had a possible activating effect, however, the result was not significant. Physostigmine had no effect. The EEG paroxysmal activity was inhibited by physostigmine and activated by atropine in both groups of patients. A cholinergic system disturbance was suggested in the pathophysiology of the paroxysmal activity. The disturbance which is probably present in early brain damage, is presumed to be also involved in the genesis of the startle reaction.


Correlation of magnetic resonance imaging and CSF findings in patients with acute monosymptomatic optic neuritis.

Acute monosymptomatic optic neuritis (AMON) may be the first indication of multiple sclerosis (MS), and this sign offers a special opportunity to study the very early clinical stages of MS. This prospective investigation compares results of CSF findings and magnetic resonance imaging (MRI) in a large, homogeneous and well-defined group of patients with AMON. Of 68 consecutively referred patients, 11 had clinically definite MS, another 5 refused a lumbar puncture, and 7 could not participate for various reasons. With the remaining 45 untreated patients, aged 12-52 (mean 31) years, with idiopathic AMON, we have studied interrelationships of CSF findings (leucocyte count, IgG-index and in 29 of the patients oligoclonal bands (OB)) and MRI. Lumbar puncture and MRI were performed within median 24 and 16 days of onset, respectively. In the CSF one or more abnormalities (in 17/45 = 38% pleocytosis, in 16/45 = 36% increased IgG-index, and in 20/29 = 69% OB) was found in a total of 23/29 = 79% of patients. MRI at 1.5 T (double SE and IR sequences) showed multiple cerebral lesions in 65% of patients. A significant relation was observed between results of MRI and leucocyte count (p < 0.05) and between results of MRI and IgG-index (p < 0.05), but not between results of MRI and OB (p > 0.20). Over a median observation period of 27 months, 13 patients developed clinically definite MS. All of these patients had lesions on MRI at onset, illustrating the prognostic importance of MRI findings. Results of CSF had until now no marked predictive value for developing clinically definite MS.


Remission rate after thymectomy in myasthenia gravis when the bias of immunosuppressive therapy is eliminated.

The clinical course of all 86 myasthenia gravis (MG) patients who were thymectomized at Sahlgrenska Hospital between 1955 and 1980 was evaluated in order to estimate what the rate of complete clinical remission (with or without anticholinesterase medication) would be without immunosuppressive (IS) therapy; 19 of 73 patients without thymoma received IS therapy. A suitable way of dissociating the course after thymectomy from the influence of IS therapy is the Markov method. The calculated probability of remission was 0.18, 0.35, 0.43, 0.53 and 0.56 in the 0-1, 2-3, 4-5, 5-10 and more than 10-year periods after thymectomy. A similar result (53 +/- 7%) was obtained by a life-table method with censoring of IS-treated patients when they received such therapy. Time to remission was significantly shorter for patients with age of MG onset before 35 years. Timing of IS therapy after thymectomy is discussed, considering the post-thymectomy remission rate.


Impaired blood superoxide dismutase in the traumatic paraplegic patients.

Blood superoxide dismutase (SOD) activity and blood copper, zinc-superoxide dismutase (Cu.Zn-SOD) content were measured by luminol chemiluminescence assay and by single radial immunodiffusion assay, respectively, in 50 patients with paraplegia due to traumatic injury to the spinal cord by the Tangshan Earthquake on July 28, 1976, compared with 20 age-matched healthy subjects. We found that blood SOD activity and blood Cu.Zn-SOD content in the paraplegic patients were significantly lower than those in healthy subjects (p < 0.01). In healthy subjects, blood Cu.Zn-SOD fully expressed the enzymatic activity, whereas only 77% of blood Cu.Zn-SOD in the paraplegic patients expressed the enzymatic activity, indicating that in the patients, part of blood Cu.Zn-SOD protein is in a state without function. Also the serum lipid peroxide level in the paraplegic patients was higher than that in healthy subjects (p < 0.05). These findings suggest decreased endogenous blood protection against oxygen derived free radicals in these paraplegic patients.


Estimating neuron dendritic length in 3D from total vertical projections and from vertical slices.

The recently developed method of total vertical projections is illustrated to estimate the total dendritic length of a human Substantia Nigra neuron. Next, the length of the different orders of dendritic branches, and the mean segment length for each order--commonly regarded as important parameters in neuron physiology--are also estimated. Finally, it is shown how to estimate the mean dendritic length in a population of neurons from vertical slices of arbitrary and unknown thickness. Being unbiased and highly efficient, the proposed methods offer interesting alternatives to current procedures used for the metric analysis of neuron arborizations.


Stereological quantitation of human brains from normal and schizophrenic individuals.

The complex organization and high density of nerve cells in the human brain presents a challenge to the estimation of total cell numbers. The first unbiased counting method, the disector, was described in 1984 and has since made it possible to accurately count total neuron numbers in any region that can be defined, while excluding artifacts of earlier counting methods. The disector method has been applied to normal neocortex and to four subcortical brain regions from schizophrenics and controls. The total neuron number in neocortex in 26 normal individuals was estimated to be 25.10(9). A 40 and 50% reduction of total nerve cell number was found in the mediodorsal thalamic nucleus and nucleus accumbens in schizophrenics, respectively. Furthermore, the Cavalieri principle has been used to estimate the volume of human cortex, white matter, central grey regions and the volume of the ventricular system in both controls and schizophrenics. As shown by these studies, the introduction of unbiased stereological methods and subsequent modifications in recent years have made it possible to estimate a number of parameters in the human brain without the biases included in most classical works. By comparison, earlier conventional counting methods have been relatively time consuming, mostly biased to a smaller or larger degree, and generally less precise. The application of these new neurostereological methods will undoubtedly provide greater confidence for future brain studies.


Estimation of the total number of neurons in different brain areas in the Mongolian gerbil: a model of experimental ischemia.

The quantitative stereological method is applied to a study of the number of neurons in three different areas in the brains of an animal model, the Mongolian gerbil. The simplicity and accuracy of the method is emphasized. The usefulness of the method and the model is mentioned especially focusing on the major disabling disease in the Western world today, cerebrovascular disorders. Some results are presented to give an idea of the maximum number of neurons in these animals within the delineation of the brain areas here applied.


Mean volume of pigmented neurons in the substantia nigra in Parkinson's disease.

A new unbiased stereological estimator, the rotator, was used to estimate the mean volume of pigmented substantia nigra (SN) neurons in three Parkinson's disease (PD) brains and age-matched controls. Average pigmented neuron volume was 31,300 microns 3 (5200) in controls and 28900 microns 3 (120) in patients. Estimating the absolute size distribution, revealed that PD patients had approximately 80% less total SN pigmented volume than controls. Compared with biased methods, in addition to dramatic improvements in efficiency and accuracy, results obtained by the unbiased rotator suggest that primarily the largest pigmented neurons in SN are lost in PD.


The aging brain.

A recent interest in aging of the nervous system is related to the remarkable increase in the numbers of elderly persons throughout the world. As a reflection of the added years, pathologies in the older person have also increased. Primary among those which affect the activities and behavior of these people are the dementias, especially Alzheimer's Disease. To focus on such problems, however, requires an understanding of the changes which take place in the normal aging nervous system. This paper reviews some of the accepted criteria for these changes as well as the possible attempts by the nervous system to alter its structure in response to these changes.


Quantitative neuropathology in epilepsy.

Counting of neurons has brought new insight to the mechanism of epilepsy. The reduction in Purkinje cells and neuron loss in hippocampus are related to generalized convulsions in man. Generalized convulsions provoked by electric shock in rats do not result in neuron loss. However, mongolian gerbils from seizure-susceptible strains with "spontaneous" seizures of various types, have a reduced number of H1-neurons and Purkinje cells after only a restricted number of seizures of any type. Loss of neurons is a possible consequence of generalized convulsions. Even "seizure activity", as such, seems to damage nerve cells. The consequence is early effective treatment in such cases where epilepsy is a secondary threat as in febrile convulsions, post-traumatic, post-infectious and post-infarction epilepsy.


Ultrastructure of the microglia that phagocytose amyloid and the microglia that produce beta-amyloid fibrils.

The function of microglia associated with beta-amyloid deposits still remains a controversial issue. On the basis of recent ultrastructural data, microglia were postulated to be cells that form amyloid fibrils, not phagocytes that remove amyloid deposits. In this electron microscopic study, we examined the ability of microglia to ingest and digest exogenous amyloid fibrils in vitro. We demonstrate that amyloid fibrils are ingested by cultured microglial cells and collected and stored in phagosomes. The ingested, nondegraded amyloid remains within phagosomes for up to 20 days, suggesting a very limited effectiveness of microglia in degrading beta-amyloid fibrils. On the other hand, we showed that in microglial cells of classical plaques in brain cortex of patients with Alzheimer's disease, amyloid fibrils appear first in altered endoplasmic reticulum and deep infoldings of cell membranes. These differences in intracellular distribution of amyloid fibrils in microglial cells support our observations that microglial cells associated with amyloid plaques are engaged in production of amyloid, but not in phagocytosis.


Neuronal uptake of plasma proteins in brain contusions. An immunohistochemical study.

Twenty-five cases of cerebral contusions of various age were examined immunohistochemically for neuronal uptake of albumin and fibrinogen. The neurons in the damaged areas were heavily stained in all cases, even in those of only a few minutes' survival, and they remained positive for serum proteins until they disappeared from the lesions. In hematoxylin and eosin-stained sections, neuronal changes were observed from the first minutes after the lesion but they were indistinguishable from the shrunken "dark" neurons that occur as artifacts in poorly fixed material. However, in contrast to the artificially changed cells, the truly damaged ones took up serum proteins. It is concluded that staining with antisera against serum proteins may serve as early markers for neuronal injury before reliable histological changes have developed.


Tubulovesicular structures in Creutzfeldt-Jakob disease.

By electron microscopy tubulovesicular structures (TVS) have been consistently observed in brain tissue of transmissible spongiform encephalopathies such as natural and experimental scrapie, bovine spongiform encephalopathy and experimentally induced, but not naturally occurring, Creutzfeldt-Jakob disease (CJD). For the first time we report here the presence of TVS in human brains with CJD as detected by transmission electron microscopy. TVS were observed in all three CJD specimens (two biopsies, one autopsy), but they were rare and were found only in one or two location(s) per grid. TVS were seen in distended pre- and postsynaptic terminals and measured approximately 35 nm in diameter; they were smaller and of higher electron density than synaptic vesicles. Their occurrence in all types of transmissible spongiform encephalopathies irrespective of the affected host and the strain of the infectious agent suggests their biological significance.


Immunohistochemical localization of the proteinase inhibitor region of amyloid precursor proteins in the neocortex of Alzheimer's disease and aged controls.

The immunohistochemical localization of the proteinase inhibitor region of amyloid protein precursors (APPI) in the postmortem human neocortex was studied using a polyclonal antibody raised against a purified recombinant human APPI derivative produced by COS-1 cells. APPI-like immunoreactivity (APPI-LI) was found diffusely in the human neocortex. APPI-LI appeared as irregularly shaped granular structures. The size of the APPI-LI structures was 1-4 microns in diameter. APPI-LI usually formed a cluster of 10- to 20-microns diameter in the cortical gray matter and 20- to 40-microns diameter in the subcortical white matter. Double staining for APPI and glial fibrillary acidic protein indicated that APPI-LI in the white matter and molecular layer was localized exclusively in the fibrillary astrocytes. In contrast, APPI-LI was found in neurons as well as in the fibrillary astrocytes in layers II through to VI. Under fluorescence microscopy, APPI-LI in both neurons and fibrillary astrocytes were found in close association with lipofuscin. The present observations indicate that APPI is localized in neurons and astrocytes in the human neocortex and that APPI may be associated with lipofuscin or lysosome in the human neocortex.


Neuropathologic findings in surgically treated hemimegalencephaly: immunohistochemical, morphometric, and ultrastructural study.

Tissues from three cases of hemimegalencephaly (HME) causing intractable seizures treated by cortical resection were studied using immunohistochemical, ultrastructural, and morphometric techniques. Severe cortical dysplasia was seen in all cases and included lesions best characterized as hemilissencephaly and polymicrogyria. Blurring of the cortex-white matter junction, the presence of large neuronal heterotopias, and neuronal cytomegaly were frequent observations. Immunohistochemical analysis demonstrated cellular colocalization of astrocytic markers glial fibrillary acidic protein and vimentin in one case of hemilissencephaly. Morphometric data showed significant increases over controls in neuronal profile area in all cases of HME. Neuronal cell density was increased significantly above controls in one of the cases. The study shows that HME results from severe cortical dysplasia which may be caused by multiple insults, manifest in one of several ways, and reflects abnormal or altered signals that regulate cortical morphogenesis.


Stress-response (heat-shock) protein 72 expression in tumors of the central nervous system: an immunohistochemical investigation.

This report deals with the expression of stress-response (heat-shock) protein 72 (srp 72) in a series of 95 primary human brain tumors and 21 carcinoma metastases to the central nervous system (CNS). Immunohistochemical procedures were employed; cells of the human cervical cancer line HeLa S3 were used as positive controls. The protein was detected in 14/22 meningiomas and in 6/13 glioblastomas. Tumor cells expressing srp 72 were also found in 4/17 astrocytomas, 2/9 pituitary tumors, 2/14 primitive neuroectodermal tumors and 1/10 medulloblastomas. Whereas the majority (8/10) of the breast carcinoma metastases had tumor cells that expressed srp 72, only 2/11 lung tumor metastases were positively stained. These results document srp 72 expression by a variety of primary and metastatic tumors of the CNS.


The cerebrovascular response to experimental lateral head acceleration.

A number of microvascular changes, such as the development of astrocyte lucency, increased endothelial pit/vesicle activity, development of crater like lesions, and endothelial microvilli have been reported after injury to the brain. Lateral head acceleration in the non-human primate, however, still provides the best experimental model for human diffuse axonal injury. No attempt has yet been made to document the spatial extent or time course of the microvascular response to acceleration injury to the head. We have examined the brains of baboons 1, 4, 6, and 12 h and 7 days after acceleration injury to the head to analyse the microvascular response. In the experimental animals there was a short-term rise in intracranial pressure followed by a long-term resolution, and a reduction in both mean arterial blood pressure and cerebral perfusion pressure which, however, never dropped below 75% of baseline for more than 5 min after injury in any animal. We found evidence for extravasation of blood in a small number of blood vessels in all parts of the brain. Interendothelial tight junctions are not disrupted. Pit/vesicle activity rises in the 1st h in the occipital cortex, but not until 4 h in the frontal cortex, and remains elevated for at least 7 days. There is little change in the thalamus. Development of microvilli is most rapid in the frontal cortex with peak values at 1 h, but slower in the thalamus and occipital cortex where peak values are only obtained at 6 h. Highest numbers of microvilli occur in parasagittal regions of the brain.(ABSTRACT TRUNCATED AT 250 WORDS)


Simultaneous detection of ferritin and HIV-1 in reactive microglia.

Using ferritin as a marker of reactive microglia, we demonstrated a close association between proliferation of reactive microglia and expression of human immunodeficiency virus type 1 (HIV-1) in brain tissue from autopsied cases of acquired immunodeficiency syndrome (AIDS). An increased number of ferritin-positive reactive microglia was observed in formalin-fixed paraffin-embedded brain sections from all 13 AIDS cases examined. Similar findings were observed in brain tissue from other neurological diseases (subacute sclerosing panencephalitis, herpes simplex encephalitis and multiple sclerosis). Multinucleated giant cells were found in 7 of the AIDS cases which were also intensely labeled for ferritin. Dual-label immunohistochemistry using anti-ferritin and cell-specific markers showed that ferritin-positive cells were distinct from astrocytes, neurons and endothelia using anti-glial fibrillary acidic protein (anti-GFAP), anti-neurofilament protein and Ulex europaeus agglutinin 1, respectively. In 5 AIDS brains, only ferritin-positive cells were shown to contain HIV-1 gp41 antigen using dual-label immunohistochemistry. In addition, HIV-1 RNA was localized in ferritin-positive reactive microglia but not in GFAP-positive astrocytes using immunohistochemistry combined with in situ hybridization. Ferritin-positive reactive microglia and multinucleated giant cells were co-labeled with the microglial marker, Ricinus communis agglutinin 1 (RCA-1). However, RCA-1 also extensively stained resting microglia only a few of which were co-labeled for ferritin. The density of ferritin-positive cells was correlated with the presence of HIV-1 RNA-positive cells in AIDS brain. Thus, ferritin immunoreactivity can be used as an activation marker of microglia in archival paraffin sections and reflects the extent of inflammation in HIV-1-infected brain.


Increased iron content in the putamen of patients with striatonigral degeneration.

We measured the total content of iron, copper, zinc and manganese in the putamen of four patients with striatonigral degeneration (SND) and age- and gender-matched normal controls. The iron content in the SND patients was five times greater than in the controls. Electron microscopic histochemistry revealed the iron reaction products in the pigments showing a triphasic pattern of coarse, electron-dense globules, fine granular and fibrillary materials, and lamellated structures. These findings suggest that increased iron deposition may be related to pigment formation in the putamen of SND.


Brain lesions of the Leigh-type distribution associated with a mitochondriopathy of Pearson's syndrome: light and electron microscopic study.

Pearson's syndrome is a disease of refractory sideroblastic anemia and exocrine pancreatic dysfunction due to abnormal mitochondrial DNA (mtDNA). A male infant with Pearson's syndrome developed necrosis of both thalami and basal ganglia when he suffered from gastroenteritis at 1 year and 11 months of age. He died of sepsis at the age of 2 years and 4 months. Analysis of mtDNA from various organs revealed abnormal mtDNA with deletion by 5 kbp, confirming the diagnosis. At autopsy, the brain had symmetrical cavities in putamen, caudate nuclei and medial nuclei of the thalami. Ferruginous granules in nerve cells in medial thalamic nuclei, and scattered round bodies with neuronophagia in lateral nuclei were found at light microscopic observation. Electron microscopy showed that these granules were composed of radiating spicules and a dense layer containing packed cytoplasmic organelles, respectively. The macroscopic distribution of brain lesions was very similar to and characteristic of Leigh's disease. This similarity leads to the supposition that defective intracellular energy utilization common to Leigh's disease could be responsible for brain lesions in this case. Although the histological appearance was somewhat atypical for Leigh's disease, very acute formation of brain lesions in this case was thought to have caused the histological difference.


Prevalence of retinitis pigmentosa and allied disorders in Denmark. II. Systemic involvement and age at onset.

A population survey of retinitis pigmentosa and allied disorders in the Danish population disclosed 1301 cases prevalent in Denmark per January 1, 1988. Crude prevalence rates and World Standardized prevalences of systemic and non-systemic RP are presented. Sixty-four per cent of all RP-cases were non-systemic. A preponderance of males was encountered in both systemic and non-systemic RP. Usher disease was diagnosed in 12%, Bardet-Biedl syndrome constituted 5%, and the frequency of Spielmeyer-Vogt disease was 1% of all prevalent RP-cases. Other defined syndromes occurred in 1% of the cases. The Danish figures with respect to Usher disease are compared with standardized prevalence rates from Sweden and Finland. Nineteen per cent of patients affected by non-systemic RP had an onset later than 30 years of age. In patients affected by systemic RP the eye disease tended to an earlier debut with only a few per cent beginning after the age of 30 years.


Contrast visual acuities in cataract patients. II. After IOL implantation.

Contrast visual acuities were measured in 100 eyes of 75 patients who attained a best-corrected visual acuity of greater than or equal to 0.8 (20/25) after intraocular lens (IOL) implantation. The variable contrast visual acuity chart (VCVAC), with three contrast levels of 90, 15, and 2.5% and reverse polarity of 90% contrast, was used to measure contrast visual acuities. The follow-up period ranged from 3 to 35 months (mean 7.41). The mean visual acuities measured with the 90, 15, and 2.5% charts were 0.92 (SD = 0.11), 0.59 (SD = 0.13), and 0.33 (SD = 0.14), respectively. The mean visual acuity measured with the 90% reverse polarity chart was 0.97 (SD = 0.11). The decreases in visual acuities compared with the 90% contrast were 0.64 and 1.48 octaves in the 15% and the 2.5% contrast charts, respectively. The pattern of the contrast acuity profile was comparable to normal subjects, but in 28 of 100 (28%) eyes, the visual acuities measured with the reverse polarity chart were slightly better than those measured with the standard 90% contrast chart, suggesting that the glare effect still exists after IOL implantation, though to a lesser degree than in cataractous eyes.


Exfoliation syndrome in patients scheduled for cataract surgery.

A series of 305 consecutive patients 30 years of age or older scheduled for cataract surgery was examined to find out the frequency of exfoliation syndrome, the predominant type of cataract, and the intraocular pressure status. The mean age of 222 (72.8%) females and 83 (27.2%) males was 71.7 (+/- 11.1) years (range 32 to 91 years). Exfoliation was detected in 77 (25.2%) patients. It was unilateral in 37 (48.0%) patients, the affected eye being in 29 (78.4%) cases scheduled for cataract surgery, and bilateral in 40 (52.0%) patients. Exfoliation was increased steadily with age. It was most often seen on the anterior lens capsule (88.9%). Krukenberg's spindle was seen in 31 (20.4%) eyes of patients with and in 12 (2.6%) eyes of patients without exfoliation (p less than 0.001). Nuclear sclerosis predominated in eyes with (83.8%) as compared to those without (61.9%) exfoliation (p less than 0.01). Posterior subcapsular cataract was less common in eyes with exfoliation (1.5%) than in eyes (21.1%) without it (p less than 0.001). A tendency to slightly higher preoperative intraocular pressure was measured in eyes with exfoliation as compared to those without it, and glaucoma occurred much more frequently (33.8% vs 10.8%) in the former group (p less than 0.001). Exfoliation and capsular glaucoma, which must be promptly detected to avoid surgical complications, are frequent in patients scheduled for cataract surgery.


Fluorescein and fluorescein glucuronide in plasma.

The evaluation of the blood-ocular barrier for fluorescein requires the measurement of free and unconjugated fluorescein in plasma. This study introduces a new and simple method for the determination of free fluorescein in plasma on the basis of determined total free plasma fluorescence and the free fraction of fluorescence. An excellent good correlation between differential spectrofluorophotometry and this new method is demonstrated. After intravenous administration of sodium fluorescein, the contribution of fluorescein glucuronide to total free plasma fluorescence was evaluated on basis of the areas under the plasma concentration/time curves for fluorescein and fluorescein glucuronide, respectively. After 1 h 8.2% of total free fluorescence in plasma was found to originate from fluorescein glucuronide and after 24 h 18.3% originated from this metabolite. It was concluded that although plasma fluorescein glucuronide measurements are important in the exact evaluation of the blood-ocular barrier, the contribution of fluorescein glucuronide to vitreous fluorescence after intravenous fluorescein administration seems to be of minor magnitude.


Primary argon laser trabeculoplasty vs. pilocarpine. Short-term effects.

This is a prospective study of 82 newly discovered patients with simplex or capsular glaucoma from two centres, collected between 1984 and 1989 and selected at random for primary treatment by either laser or pilocarpine. Preliminary two-year follow-up shows that primary laser treatment gives a significantly higher number of patients where the intraocular pressure is successfully controlled. Primary argon laser trabeculoplasty has been carried out in 40 patients. The first treatment was given to either the upper or to the lower half of the trabecular meshwork. In the second treatment after one month the other half was treated. In both groups the first treatment gave the highest pressure reduction. The somewhat higher pressure reduction after upper treatment versus lower was insignificant. The degree of trabecular pigmentation did not influence the two month follow-up result, neither did the type of glaucoma. Of the eyes treated with laser, peripheral anterior synechiae could be seen in 18%. Acute intraocular pressure rises greater than 5 mmHg occurred in 21% of the eyes after the first treatment and in 37% after the second treatment. Pressure rises greater than 10 mmHg occurred in 5% after the first and in 10% after the second treatment. No pressure-lowering substances were given. Considering that 16% of the eyes had an intraocular pressure that was higher than baseline pressure even 6 h after either first or second treatment, it is recommended that a pressure-lowering medication on the day of treatment should be administered.


Epikeratophakia for keratoconus. Long-term results using fresh, free-hand made lamellar grafts.

Epikeratophakia using fresh, free-hand made corneal grafts was done in 16 patients with keratoconus. The follow-up period averaged 27.8 months (range 13-45 months). A significant improvement of visual acuity was obtained (p = 0.002), and 14 of the 16 eyes (87.5%) achieved a corrected visual acuity greater than or equal to 6/12. The spherical equivalent and the cylindrical refractive error were reduced (p less than 0.05), and a significant flattening of the central corneal curvature was obtained (p less than 0.002). The mean postoperative central corneal astigmatism was 4.25 D. Postoperatively, the mean central corneal thickness was 0.670 mm, and the mean central thickness of the epithelialized graft was 0.336 mm. Six patients reported some postoperative glare or blurring of vision, despite a visual acuity greater than or equal to 6/9 on the Snellen chart. No significant subjective or objective changes were noticed after the 6-month postoperative follow-up visit.


Quantitative layer-by-layer perimetry adapted to the Humphrey Field Analyzer. I. Design of methodology and instrumentation.

Quantitative layer-by-layer perimetry is a psychophysical technique believed to assess response characteristics of individual retinal layers. This paper presents a new design of this technique, implemented into the existing hardware environment of the computerized perimeter Humphrey Field Analyzer. The technique was optimized for a more simple, fast and reproducible testing of larger visual field point patterns. The paper deals with the design of instrumentation and with methodological aspects of this adaptation of the technique.


Quantitative layer-by-layer perimetry adapted to the Humphrey Field Analyzer. II. Centre-surround interaction produced by sustained surround stimulation.

In this paper the practical applicability of a new design of quantitative layer-by-layer perimetry is confirmed by studying centre-surround interaction produced by sustained surround stimulation in preliminary trials on four normal individuals. The results are discussed in relation to established laws for retinal light perception, and some practical aspects of the employed test design and the chosen test variables are discussed.


Quantitative layer-by-layer perimetry adapted to the Humphrey Field Analyzer. III. Centre-surround interaction produced by transient surround stimulation. Area characteristics of the transient stimulus pattern.

In this paper some qualitative aspects of centre-surround interaction produced by transient surround stimulation are investigated, employing a new design of quantitative layer-by-layer perimetry. Using a rotating windmill pattern, a transient response, believed to be organized in the inner plexiform layer of the retina, is assessed in four normal individuals. The paper considers area characteristics of the stimulus pattern used to produce the transient response, and optimal dimensions for this pattern are proposed.


The cumulative frequency distribution curve of the eye pressure.

Knowledge of the probability of having glaucoma at different levels of eye pressure is a prerequisite for estimating at which eye pressure levels preventive pressure-lowering treatment ought to be applied. The glaucoma tolerance may not be the same in all population groups. Calculation of tolerance distribution curves may be performed if the frequency distribution curves of pressure in eyes with and without glaucoma are known. Regression analysis has been performed to compute curves approaching the cumulative frequency distribution of the eye pressure in different subgroups. Results of a population study including subjects greater than or equal to 65 years of age have been used. An equation describing an asymmetric sigmoid curve has been applied in the curve fitting procedure. The derivative of this equation was used to describe the noncumulative frequency distribution curves. The analysis has been performed in subgroups consisting of normal eyes, glaucomatous eyes, eyes with and without pseudo-exfoliation.


Long-term study of patients with congenital pit of the optic nerve and persistent macular detachment.

During the period 1970-87 we evaluated the changes of the optic disc, peripapillary area, detached macula and visual acuity in 16 cases with congenital pit of the optic nerve and macular detachment. The study revealed in 9 of the 16 cases (56%) an increase of the dimension of the pit or changes in its color, findings which were directly related to the duration of the macular detachment. Chorioretinal scarring, pigment migration, or both, were also noted mainly at the temporal margin of optic disc. In 5/16 cases we found during the follow-up an extension of macular elevation. In altogether 10 out of 16 cases the retinal elevation covered the larger portion of the mid-periphery temporally. In 7/16 cases the final visual acuity remained unchanged, in 9/16 cases deteriorated. The difference, however, in the latter 9 cases between initial and final visual acuity was negligible. During the follow-up period deterioration of the visual fields was also noted.


Polyamine and histopathological changes after unilateral endotoxin-induced uveitis and its contralateral effects.

The polyamines putrescine, spermidine and spermine are essential for normal cell function and proposed to be involved in inflammatory reactions. The polyamines were measured bilaterally in rabbit aqueous humor after unilateral endotoxin-induced uveitis. The contralateral eyes were injected with saline or not touched. Aqueous protein levels and leukocytes were determined and a histological evaluation was performed. Protein, leukocytes, putrescine and spermine increased in the treated eyes, but not in the untouched eyes. When saline was injected in the contralateral eye, a small increase in spermine was seen. Spermidine decreased first, but increased later, in both the endotoxin-injected and the other eye. Histopathologically, the treated eyes showed an infiltration of leukocytes, vasodilatation and in some cases optic nerve involvements. A mild reaction was also seen in the unchallenged contralateral eyes. The results show that polyamines might serve as a marker for acute inflammation in the eye and that the mechanism of putrescine and spermine induction is different from the one of spermidine. Polyamines are suggested to play a role in the cellular immune response.


Serum alpha-1 acid glycoprotein levels in patients with idiopathic peripheral retinal vasculitis (Eales' disease).

Serum alpha-1 acid glycoprotein levels were measured in 27 patients with idiopathic peripheral retinal vasculitis (Eales' disease) and 31 healthy subjects by single radial immunodiffusion technique. The levels were found to be significantly increased in both moderate and severe types of the disease. The serum levels of this protein paralleled the severity of the disease. The increased alpha-1 acid glycoprotein in serum showed a significant fall to near normal levels during the quiescent stage. Our observations support the hypothesis that idiopathic peripheral retinal vasculitis is an immune mediated disease. It is proposed that serum alpha-1 acid glycoprotein may be considered as a reliable parameter of the activity and the degree of severity of the disease, as well as an useful tool for monitoring the efficacy of treatment.


Sucralfate and sodium sucrose sulphate in the treatment of superficial corneal disease in keratoconjunctivitis sicca.

We have studied the effect of the aluminum complex of sucrose sulphate (Sucralfate suspension) and the sodium salt of sucrose sulphate (sodium sucrose sulphate solution) on patients with keratoconjunctivitis sicca. Eyes treated with either of these two drugs showed a decrease in painfulness and blurring of vision. On examination the surface area of the corneal lesions, stained with fluorescein, diminished during treatment. As for the difference in effect between the two eyedrops, the solution was better tolerated.


The effect of indomethacin 1% ophthalmic suspension on the pupil during extracapsular cataract surgery.

Fifty-six patients who underwent extracapsular cataract surgery were randomized in two groups with 28 patients in each group. Group 1 was treated with standard preoperative dilation regime and group 2 received in addition indomethacin 1% ophthalmic solution. Horizontal and vertical pupil diameter measurements were taken before capsulotomy, before exprimation of the lens nucleus and before lens implantation. The size of the pupil at the time of capsulotomy and at the time just before lens exprimation was greatest in the non-indomethacin treated group, but at the time of lens implantation the pupil of the indomethacin treated group was greatest. It is concluded that even though indomethacin seems to be able to inhibit surgically induced miosis, probably through its inhibitory effect on prostaglandin synthesis, the effect is only marginal and from a clinical point of view it cannot be recommended.


Serum transferrin in patients with retinitis pigmentosa.

The CDG syndrome is a newly detected disorder with a carbohydrate defect in glycoproteins such as transferrin. As retinitis pigmentosa is a part of this syndrome, there could also be other subtypes of retinitis pigmentosa with a similar biochemical defect. Isoforms of serum transferrin were therefore analysed in 78 patients from different families with retinitis pigmentosa and showed slightly or moderately elevated values for less glycosylated isoforms in two families. The study suggests that abnormal glycoprotein metabolism manifested by elevated values of carbohydrate-deficient isotransferrins may be present in a small proportion of families with retinitis pigmentosa. The relationship between the glycoprotein defect and retinitis pigmentosa remains to be established.


Fluconazole in the treatment of candida albicans endophthalmitis.

A 29-year-old former drug addict with candida albicans endophthalmitis determined by cultivation was treated with vitrectomy and systemic fluconazole. The infection resolved completely and the patient recovered a visual acuity of 6/6. Fluconazole was well tolerated and a high concentration was found in the vitreous cavity.


Excimer laser treatment of pterygium.

Primary experience with the use of excimer laser in pterygium therapy is presented. Twenty-two pterygia (11 primary and 11 recurrent) were surgically removed using the bare-sclera technique followed by excimer laser ablation to smooth the corneal surface. As recurrence was observed in 20 eyes (91%) during the first year, supplementary excimer laser treatment of a pterygium does not seem to reduce the recurrence rate. The high recurrence rate in this series may to a certain extent reflect the surgical technique used (bare-sclera).


Asymmetry of retinitis pigmentosa-related to initial optic disc vasculitis.

A case of highly asymmetric retinitis pigmentosa is reported. Signs of pigmentary retinopathy appeared in the first eye following optic disc vasculitis or neuroretinitis of unknown etiology. Within 2 years the visual field became markedly restricted and the dark adaptation thresholds elevated. Twelve years later this eye was almost blind and the ERG was non-recordable. In the fellow eye, the first pigmentary changes were observed 5 years after the initial presentation, and the progression was slow. Nineteen years after the initial examination the visual field of the less affected eye was constricted to 30 degrees nasally and 60 degrees temporally, the dark adaptation threshold was only slightly elevated, and the full-field ERG was within normal range. It is possible that neuroretinitis or vasculitis of the optic disc caused the earlier onset and the more progressive course of pigmentary retinopathy in the initially affected eye.


Spontaneous resolution of proliferative vitreoretinopathy.

A case of proliferative vitreoretinopathy that spontaneously regressed, leading to reattachment of the retina, is presented. The importance of such a spontaneous resolution in terms of understanding the pathogenesis, and planning a treatment, is discussed.


[Historical notes on the ethmoid bone].

The intriguing historical exploration of the anatomy of the ethmoid and ethmoidal cells is described. Despite continuing research, the ethmoid remains a puzzling topic.


[Surgical anatomy of the middle meatus and ethmoid].

The evolution of rhino-sinusal endoscopy and the progress in endonasal surgery under endoscopic guidance, justifies a review of the ethmoid anatomy. A simple and logical scheme of the ethmoid bone is presented. The observer has to develop an "endoscopic eye" since the panoramic view offered by the optics modifies the image. Special attention is drawn upon the endoscopic anatomical fine points in the crucial area of the "bullar circus". These are necessary guides in surgical practice.


Nasal septum deviation in newborns.

The patency of the nose is very important for the newborn. Nasal septum deviation (NSD) is one of the most important factors causing disorders of the patency of the nose. It is usually the result of mechanical trauma. The relationship between the course of delivery and deformation, deviation and luxation of the nasal septum is examined. 410 newborns--297 born in natural labour and 113 in Caesarean section, were examined. Also the kind of birth, the position of the fetus during the first and second stages of labour and the weight of the newborns was analyzed. NSD was found in 14.3% of the cases. Follow-up examination of those children was performed 4-6 months after the first check-up. NSD was observed mainly in children born head first.


[Endonasal microsurgery of antro-choanal polyps].

Between 1986 and 1991, 33 patients were operated on by the senior author. Neither sex, nor side prevalence has been observed. In 50% of the cases, the patient was a teenager. In 18% of the cases, a cystic oedematous transformation was the cause of the polyp. Its treatment must be surgical. Five cases were operated on by gingival access, the others by median and inferior meatotomy which is recommended by the authors. They found one recurrence out of the recorded 24 cases.


[Medial maxillectomy in transitional papilloma].

Transitional Papilloma, the formerly inverted papilloma, is a rather rare neoplasm of the nasal cavity. Its origin is still debated. The only constant symptom is unilateral nose obstruction. This lesion is of considerable interest because of the recurrence tendency and its association with malignancy. Although a benign tumor, radical aggressive surgery is advocated. A medial maxillectomy is the treatment of choice. A sublabial incision gives excellent exposure without external facial scar.


[Medico-surgical management of chronic maxillary sinusitis in adults].

Every maxillary sinusitis suspected of chronicity has to be fully investigated by CT-scan. Failure of medical treatment will confirm chronic disease and will lead to surgery. According to the authors, endoscopic middle meatotomy is the treatment of choice, possibly associated with anterior ethmoidectomy and/or inferior meatotomy.


[Sinus mucoceles: diagnostic and surgical aspects (apropos of 8 cases treated with rhino-surgical endoscopy)].

Sinus mucoceles are benign and expansive pseudocystic formations situated in the paranasal sinuses. Their pathogenicity is still misunderstood. Clinical signs are multiple and often delayed due to tumour localisation. CT-scan is the best diagnostical investigation and surgery the treatment of choice. Marsupialization under endoscopic control is becoming widespread.


[Orbital involvement of sinusitis].

Sinusitis can spread to the orbital tissues. 'Preseptal' soft-tissue bacterial infections are relatively common during childhood and with appropriate antimicrobial therapy they usually resolve quickly. 'Orbital' soft-tissue infections, in contrast, are relatively rare and frequently cause serious morbidity. Four cases are presented. Symptomatology and pathogenesis are reviewed. Diagnostic procedures, especially CT-scan, are discussed and recommendations are given for medical and surgical management.


Dysthyroid orbitopathy and orbital decompression. A review.

In the treatment of severe manifestations of dysthyroid orbitopathy, such as optic neuropathy and exposure keratitis, orbital decompression occasionally may be performed if steroids fail. In general, medial and inferior orbital wall decompression gives satisfactory results. The route may be transantral, but the transconjunctival or endonasal approach may be more appropriate for extraocular muscle balance and optic neuropathy respectively.


Optic nerve decompression for indirect posterior optic nerve trauma.

Posterior indirect optic nerve trauma is a rare but possibly dramatic event. Since spontaneous recovery is unlikely, medical treatment by megadose steroid therapy is advocated. Optic nerve decompression may be usefull, but is still controversial. Medial optic canal wall decompression seems best and may be achieved by various approaches.


[Anterior sinusitis: indications for and results of endoscopic surgery].

With the exclusion of posterior or diffuse disease, anterior sinusitis is an inflammatory process affecting one or more cells draining through the middle meatus. When medical treatment fails, functional endoscopic surgery is indicated. Two hundred and three surgical cases are reviewed. Anterior sinusitis forms 44% of the surgical indications. Twenty months later, 80% obtain good or very good subjective and objective results. In 20% the quality is poor with suppuration. When suppuration persists, further endoscopic or radical surgery is indicated. In this series, complication rate is low. Endoscopic surgery advantages are discussed.


[Preoperative radiotherapy and medial maxillectomy. Treatment concept for carcinomas of the nasal cavity and paranasal sinuses].

Multimodal treatment modality for paranasal sinus malignancies is discussed. Therapy consists in pre-operative 50 Gy radiotherapy delivered over 5 weeks, followed three weeks later by a medial maxillectomy. Although local control rate is improved through this treatment, an increase in late metastases is observed.


[Techniques of uvulopharyngoplasty for snoring].

Snoring is considered abnormal even in children. Breathing difficulties can modify the development of the face and provoke upper respiratory dysfunction. Some surgical techniques are presented.


[Medicolegal implications of sinus surgery].

Possible sinus surgery complications are reviewed. The difficult anatomy and its relationship with the orbit, the optic nerve and the olfactory fossa are the main reason of complication. However by technical improvement of imaging and endoscopy, as well as by surgical skill refinement the complication rate decreases. In the patient's interest, and to avoid medico-legal suits, some recommendations are suggested.