Comparison between the pressor response and the rise in plasma catecholamines induced by acutely elevated intracranial pressure. The influence of an abrupt elevation of intracranial pressure (ICP) on arterial blood pressure and on plasma catecholamines was studied and compared both in anaesthetized rats and cats. In rats, the elevation of ICP to 160 mm Hg caused an immediate rise in mean arterial blood pressure (MAP) and heart rate. Plasma noradrenaline and adrenaline also increased, though much slower than the circulatory changes. The duration of the pressor response was reduced after either reserpinization or adrenalectomy and virtually abolished after a combination of both pretreatments. The rise in plasma noradrenaline and adrenaline was virtually abolished in rats pretreated with reserpine or subjected to bilateral adrenalectomy. Acute elevation of ICP up to 160 mm Hg also caused pressor and chronotropic responses in cats, which were reduced by preceding reserpinization and adrenalectomy and abolished by a combination of both pretreatments. The rise in plasma noradrenaline was similar to that in rats, also with respect to its development, which proved to be much slower than that of the circulatory changes. The rise in plasma adrenaline was much less pronounced in cats. Pretreatment with reserpine or adrenalectomy virtually abolished the ICP-induced rise in plasma noradrenaline. Reserpine pretreatment had relatively little influence on the rise in plasma adrenaline but bilateral adrenalectomy virtually abolished it. In venous blood directly obtained from the adrenal gland the rise in plasma noradrenaline ICP elevation caused a rapid increase in plasma catecholamines, which could be reduced by pretreatment with reserpine. Our experiments confirm the hypothesis that the elevation of ICP causes an increase in sympathetic tone. The determination of plasma catecholamines, however, is not an adequate method to study rapidly occurring changes in sympathetic tone.


The effects of drugs and electrical field stimulation on the human lower oesophageal sphincter. Acetylcholine, bethanechol, pentagastrin and dopamine contracted muscle strips cut transversely from the human lower oesophageal sphincter (LOS). In the presence of hyoscine the contraction to acetylcholine was changed to a relaxation; tolerance was observed to the effect of pentagastrin. Metoclopramide and adenosine triphosphate were only partially effective on LOS muscle, some strips were unresponsive, others gave small contractions. Noradrenaline, dimethylphenylpiperazinium and histamine relaxed LOS muscle, relaxations to noradrenaline were blocked by propranolol. In contrast to drug action the response of LOS muscle to electrical field stimulation was dependent on the exact origin of the muscle strip. Muscle cut adjacent to the oesophagogastric junction only relaxed, strips cut progressively more rostral to this point showed a biphasic response with the after contraction becoming more obvious as the distance from the oesophagogastric junction increased. Relaxation of LOS muscle to electrical field stimulation appeared to involve non-adrenergic non-cholinergic nerves. It is suggested that muscle obtained from the terminal oesophagus may be identified as the LOS if it responds to electrical field stimulation with only a relaxation.


The action of acetaldehyde on the intracellular electrical activities of the guinea-pig taenia coli. The effect of acetaldehyde on the membrane potential and the membrane resistance of the guinea-pig taenia coli has been studied with an intracellular recording technique. Application of acetaldehyde in the concentration of between 5 and 20 mM produces reduction or elimination of the spontaneous spike activity and hyperpolarization of the membrane. The amplitude and the rates of rise and fall of the action potential are reduced by the drug. The duration of the spike is slightly prolonged. Acetaldehyde also reduces the amplitude of the evoked action potential produced by externally applied cathodal stimulation in twice hypertonic solution. Electronic potentials induced by anodal current are reduced both in size and time course by acetaldehyde during the stage of hyperpolarization.


Action of S-adenosyl-L-homocysteine on the metabolism of dopamine, norepinephrine and serotonin in rat brain. S-Adenosylhomocysteine (SAH) (0.1 to 30 mg/kg/i.p.) increased 3H-norepinephrine synthesis from 3H-tyrosine in the rat brain stem and mid brain, but did not alter its tissular level. It decreased both the serotonin level and the formation of 3H-serotonin from 3H-tryptophan and increased the formation of 3H-5hydroxyindolacetic acid. Its effects began 1 hr after administration and was still present 6 hr later. It did not alter dopamine metabolism. A correlation between the hynotic effect of SAH and the modification of the metabolism of cerebral monoamines was pointed out.


Cellular uptake and subcellular distribution of two non-steroidal anti-inflammatory drugs: indomethacin and ketoprofen. The cellular uptake and intracellular localization of indomethacin and ketoprofen were studied on rat embryo fibroblasts in vitro. The two drugs are taken up by the cells, but to a lesser extent for ketoprofen than for indomethacin. Inside fibroblasts ketoprofen is rapidly metabolized whereas indomethacin seems accumulated as such inside the cells. After different incubation times, ketoprofen is partly associated to the cytosol and partly to another cellular component, probably the endoplasmic reticulum. Indomethacin on the other hand is almost exclusively distributed inside the cytosol. No clear association of the two drugs can be found with the lysosomes.


The respiratory effects of 1-cis-2-(a-dimethylamino-m-hydroxybenzyl) cyclohexanol-HCl and pentazocine in man. The respiratory effects of 1-cis-2-(a-dimethylamino-m-hydroxybenzyl) cyclohexanol-HCl (WY-15,705) were compared to those of pentazocine when given intramuscularly to man. It was found that WY-15,705 was 2.8 times as potent in terms of its respiratory depressant effects.


Quantitative evaluation of the actions of anticonvulsants against different chemical convulsants. Anticonvulsants were tested on mice for their effectiveness against different chemical convulsants. Ethosuximide is very effective against pentylenetetrazol (PTZ), but ineffective against 3-mercaptopropionate (3-MP) which is an inhibitor of gamma-aminobutyrate (GABA) synthesis. Trimethadione, chlordiazepoxide and mesuximide are less effective against 3-MP than against PTZ. The same tendency was apparent, though falling short of statistical significance, with phenobarbital, mephenytoin, carbamazepine and valproic acid, whereas aminooxyacetic acid (AOAA) appeared to be somewhat more effective against 3-MP than against PTZ. Several anticonvulsants were tested also against bicuculline (BIC), picrotoxin (PIC) and bemegride (BEM), and profiles depicting their relative capacities to antagonize the convulsants were constructed. These show major differences and few resemblances. Likewise the convulsants show little resemblance to each other in their patterns of sensitivity to different anticonvulsants. The data do not support the concept that PTZ, BEM, BIC or PIC induce seizures primarily by blockading GABA-mediated inhibition, since their patterns are so unlike that of 3-MP. The profiles of clinically used anticonvulsants suggest that none of those tested acts primarily on the GABA system, since all are so unlike that of AOAA.


The effects of methyl-3-O-methyl gallate on isolated nerve activity. Methyl-3-O-methyl gallate (M30MG), extracted from Crinodendron hookerianum Gay, decreased both sciatic nerve accommodation and the amplitude of the compound action potential and increased the threshold to rectangular and exponential currents applied to the isolated sciatic nerve in a manner similar to that observed when tetrodotoxin is applied to the nerve. M30MG would act mainly on the large nerve fibres by a mechanism probably resembling that of tetrodotoxin.


Effects of nomifensine on the isolated vas deferens of the rat. The effects of nomifensine on the rat isolated vas deferens was studied. Nomifensine (7.60 X 10(-11) molar--7.60 X 10(-8) molar) enhanced the stimulant effects of dopamine and prevented the inhibitory action of pimozide on dopamine-induced contractions. Higher concentrations of nomifensine blocked the effects of dopamine noncompetitively (pD2' = 7.25 +/- 0.12). Nomifensine (7.60 X 10(-9) molar--3.80 X 10(-6) molar) enhanced noradrenaline-induced contractions and reduced phentolamine-induced antagonism of noradrenaline. Higher concentrations of nomifensine blocked the effects of noradrenaline competitively (pA2 = 5.50 +/- 0.06). Guanethidine induced supersensitivity of the vas to noradrenaline and further enhanced the potentiating effect of nomifensine. The effect of 5-HT was reduced competitively by nomifensine (pA2 = 7.50 +/- 0.10). Desipramine produced a similar preferential enhancement of dopamine-induced contractions and antagonized dopamine at higher concentrations. It is concluded that nomifensine may act prejunctionally by inhibiting uptake of the amines and postjunctionally by blocking the receptors.


Effect of sodium taurocholate on hepatic uptake and biliary excretion of organic anions in rats. Hepatic uptake and biliary excretion of some exogenous organic anions administered simultaneously with sodium taurocholate (TC) have been investigated in anaesthetized (1.2 g/kg urethane i.p.) rats. TC (100 or 200 mumol/kg i.v.) significantly increased the biliary excretion of indocyanine green (ICG), bromcresol green (BCG), rose bengal (RB) and bromsulphthalein (BSP). The biliary excretion rates of eosine (EO) and bromsulphthalein-glutathione conjugate (BSP-GSH) were not affected by TC. However, simultaneously given TC significantly reduced the biliary excretion of amaranth (AM). The effect of TC on the biliary excretion rates of organic anions seems to depend on the properties of the anions investigated. ICG, BCG, RB and BSP depress bile production, inhibit mitochondrial respiration and are excreted at low rates. Biliary excretion of these anions was enhanced by TC. EO, BSP-GSH and AM had no depressing effect on the function of liver cells and showed higher excretory rates than the above-mentioned substances. The changes in biliary flow measured during excretion of drugs did not parallel the changes in biliary excretion rate. The hepatic uptake of all organic anions studied was depressed by TC. This finding indicates that no correlation exists between the effects of TC on hepatic uptake and biliary excretion of organic anions.


In vitro activities of some synthetic substance P analogs. Substance P (SP) and several analogs and fragments have been synthesized and evaluated on non-stimulated and stimulated guinea-pig ileum. In the former test system the potency order was as follows: SP(4--11) greater than SP = [Tyr7]-SP = [Eth11]-SP = [Nle11]-SP greater than [Dala9]-SP greater than SP(7--1) = [Tyr7]-SP(7--11) greater than [Eth11]-SP(7--11) greater than [DAla9]-SP(7--11) greater than [Nle11]-SP(7--11) greater than SP(1--7). The spasmogenic activity of SP and analogs was preserved in the same potency order on stimulated guinea-pig ileum; none of these modifications resulted in an analog with narcotic-like activity. These data are discussed in terms of a hypothetical SP receptor in extravascular smooth muscle.


Antagonism of some contractile responses to prostaglandins by cyproheptadine. In the present study antagonism of the contractile responses to PGE1 and PGF2 alpha, by cyproheptadine on isolated rat stomach strip, rabbit uterus, guinea-pig ileum and rabbit jejunum is documented. Cyproheptadine blocks the responses to PGE1, PGF2 alpha, acetylcholine, 5-hydroxytryptamine in extremely small concentrations varying from 10 ng to 1 microgram/ml. The blockade is persistant, provided the exposure is prolonged. However, it does not antagonise the responses of adrenaline on guinea-pig seminal vesicle. Polyphloretine phosphate was used in the concentration of 2.5 to 100 micrograms/ml on the rat stomach strip, rabbit jejunum and rabbit uterus; it failed to produce any blockade of contractile responses to prostaglandins. It is concluded that cyproheptadine nonspecifically antagonised the responses to acetylcholine, 5-hydroxytryptamine, PGE1 and PGF2 alpha in extremely small concentrations.


Cutaneous vascular histamine H1 and H2 receptors in the guinea-pig: the histamine skin wheal as a cutaneous vascular model. The roles of histamine H1 and H2 receptors in histamine skin wheals were studied in the guinea-pig. Intradermal injections of histamine, 0.125--2 micrograms/0.1 ml, produced wheals in a dose dependent manner. Pyrilamine maleate (3.2 mg/kg p.o., pretreatment for 1 hour) produced a dose dependent shift of the histamine wheal dose-response curve to the right in a parallel fashion. Metiamide, 3, 10 or 30 mg/kg p.o., had no effect on the histamine dose-response curve. However, a combination of metiamide (10 or 30 mg/kg) and pyrilamine (3.2 mg/kg) further increased the effect of pyrilamine. It is concluded that both H1 and H2 receptors are involved in histamine-induced wheals in the guinea-pig.


Effects of lithium on time to onset of aconitine-induced initial arrhythmia and ventricular tachycardia. The effects of lithium on the time to onset of aconitine-induced initial arrhythmia and onset of ventricular tachycardia were determined in mice. The mice were pretreated intraperitoneally with 1.73, 3.0, 5.1 and 8.8 mEq lithium chloride/kg/day for 5 days, or 8.8 mEq LiCl/kg/day i.p. for 1, 3, 5, 7 and 10 days. Lithium prolonged the onset-time to ventricular tachycardia, and this effect was both dose and time dependent. Under these conditions, lithium pretreatment had no effect on the time to onset of aconitine-induced initial arrhythmia. The LD50 was 15.3 mEq/kg. The observed prolongation of the onset of ventricular tachycardia can be explained in part by the influence of lithium on myocardial cations and catecholamines, and the pharmacologic effect of lithium on Purkinje fibers.


Effect of glucocorticoids on cardiovascular reactivity in rats subjected to haemorrhagic shock. The effect of glucocorticoids on the cardiovascular responses evoked by catecholamines and angiotensin in haemorrhagic shock was investigated in rats. In the intact preparation, cardiovascular responses to adrenaline, noradrenaline and angiotensin immediately after induction of haemorrhage improved the pressor responses of all the three pressor agents but it was ineffective when given in late stages of shock. Prednisolone and betamethasone improved selectively more the adrenaline responses. Treatment with all the three glucocorticoids improved the pressor responses evoked by noradrenaline and isoprenaline in isolated perfused hind-quarters of the rat but the pressor response evoked by adrenaline was only potentiated by prednisolone and betamethasone treatment. Glucocorticoid treatment in early stages prevented only the impairment of inotropic responses but did not improve the chronotropic responses in the isolated perfused heart of rat. The present study confirms the clinical observation that glucocorticoids prove beneficial only if administered in early stages of shock, and that this may be due to (i) prevention of the peripheral vasoconstrictor action of vasoactive substances such as catecholamines and angiotensin (released in shock) and (ii) prevention of the release of toxic factors such as a myocardial depressant factor.


The effect of secretin on peripheral arterial blood flow. Arterial blood flow was measured in 18 arteries leading to nearly all major organs in the anesthetized dog, to obtain information about the specificity of the blood flow effects caused by secretin. This gastro-intestinal hormone was administered intravenously in a sequence of bolus injections (0.001--4 U/kg). Blood flow increase in the pancreatico-duodenal arteries was highest of all arteries observed. This flow increase in the superior pancreatico-duodenal artery was also found in its truncal artery (gastroduodenal a.), but to a less extend: the effect was diluted by the other--less reacting--branch (right gastro-epiploic a.) of the same truncal artery. We conclude that secretin preferentially increased blood flow in the pancreatico-duodenal arteries. Since secretin effects on heart rate and arterial pressure were but small, the flow increase in the pancreatico-duodenal area were caused by a lowering of the resistance of the pancreatico-duodenal vasculature. Comparison between the flow responses, elicited by secretin (Boots) and secretin (Karolinska), is discussed.


Effects of propranolol in chronic two-kidney Goldblatt hypertension in rats. Propranolol administered subcutaneously in a dise of 30 mg/kg twice a day for 3 weeks did not significantly lower systolic tail blood pressure (STBP) in chronic two-kidney Goldblatt hypertension in rats. Plasma renin activity (PRA) measured at the end of the treatment was not significantly different in propranolol treated and dextrose treated rats, although there was marked bradycardia in propranolol treated rats. However, 3 out of 10 propranolol treated hypertensive rats had pressures in the normotensive range during the last week of therapy. PRA values in these three rats were significantly lower than those in dextrose treated hypertensive rats. STBP on day 20 showed a positive correlation with PRA in both propranolol (r = 0.90, p less than 0.01) and dextrose (r = 0.85, p less than 0.01) treated hypertensive rats. Hypertension was associated with an increase in heart weight, which was significantly blunted but not abolished by propranolol treatment. Thus, propranolol did not decrease blood pressure in most rats with chronic two-kidney Goldblatt hypertension; when it did lower blood pressure, its antihypertensive effect appeared related to its renin suppression effect. Furthermore, propranolol mitigated hypertension induced cardiac hypertrophy, independently of its antihypertensive effect.


Protective effect of cetraxate, a new antiulcer drug, against serotonin-induced ulcer. Cetraxate increased gastric mucosal blood flow and inhibited the decrease in blood content of the rat gastric preparation, as induced by serotonin. In addition, this compound decreased the inside pressure of the rat stomach and the tone of the rat fundus strip and inhibited the increase in gastric emptying rate induced by serotonin. Further effects of the drug were decrease in the tone of isolated rabbit aorta and inhibition of platelet aggregation as induced by thrombin. Decrease in the vascular resistance was apparently related to increase in the gastric blood flow. These experimental results suggest that the antiulcer effect of cetraxate is due to the improvement of blood circulation in the gastric mucosa.


Chenodeoxycholic acid-induced diarrhea in rats: effects of atropine and codeine. Orally administered chenodeoxycholic acid (300 mg/kg) produced diarrhea and accumulation of gastro-intestinal fluid in rats. The fluid in the stomach and small intestine remained accumulated even after the accumulated colonic fluid and the diarrheal excretion decreased. When instilled into an intestinal closed-loop, chenodeoxycholic acid caused a marked inhibition of fluid absorption in the colon and jejunum but less effect in the ileum. On the contrary, an intravenous administration of chenodeoxycholic acid caused neither diarrhea nor impairment of colonic absorption of fluid. Atropine and codeine (10 mg/kg s.c.) blocked or at least delayed the diarrhea produced by oral administration of chenodeoxycholic acid. The antidiarrheal activity of codeine was found to be more potent and longer-lasting than that of atropine. Both drugs delayed the passage of chenodeoxycholic acid containing gastric fluid into the duodenum, but neither of them prevented chenodeoxycholic acid-induced jejunal secretion of fluid and electrolytes. These results indicate that the diarrheal excretion by chenodeoxycholic acid was ascribable to the impairment of fluid absorption in the colonic mucosa and partly to the activation of gastro-intestinal propulsive motility.


Lactic acidosis and liver disease.

Lactic acidosis and liver disease. Both acute and chronic hepatic insufficiency can result in lactate accumulation and lactic acidosis; data from both types of patients were compared. In the chronic group, an acute precipitating event was identified in seven of nine subjects. Four had sepsis and three had gastrointestinal hemorrhage. In these patients, results from most tests of hepatic function were not altered dramatically. There were no long-term survivors in this group. In contrast, patients with acute hepatic failure had striking alterations in their results of hepatic function tests. Notable prolongation of the prothrombin time was always present initially and antedated other abnormalities of hepatic function. Three of seven patients in this group survived. Hypoglycemia was seen in both groups and in two subjects with acute hepatic insufficiency, glucose administration alone resulted in rapid lowering of lactate levels.


Short-term therapy of severe hypertension. Hemodynamic correlates of the antihypertensive response in man. Ten severely hypertensive patients were randomized into five treatment groups: vasodilators; vasodilators plus diuretics; sympatholytics; sympatholytics plus diuretics; and sympatholytics, diuretics, and vasodialtors. Cardiac index was measured daily by echocardiography, and total peripheral resistance (TPR) calculated. Plasma renin activity (PRA) and creatinine clearance (CCR) were measured every other day. There was no difference in antihypertensive response. Seven patients, whose initial TPR was high, responded to treatment with a fall in TPR, regardless of regimen. Three patients with a high pretreatment cardiac index responded with a fall in cardiac index. Changes in TPR or cardiac index were not related to changes in CCR. There was no correlation between PRA and either blood pressure or TPR. It is concluded that the pretreatment hemodynamic status of severely hypertensive patients is the major determinant of the hemodynamic response to antihypertensive therapy.


The 'CREST' syndrome. Comparison with systemic sclerosis (scleroderma). The CREST syndrome refers to a disorder comprising the manifestations of calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia. Thirteen CREST patients (two with CRST) were compared with 26 patients with systemic sclerosis but without the full manifestations of the CRST syndrome. No significant difference was found between the groups in the age of onset of Raynaud's phenomenon, degree of multiphasic digital color changes, ulcerations of fingers, sclerodactyly, or in the frequency of abnormal esophageal peristalsis or dysphagia. Laboratory results were similar, including the frequency of an elevated ESR. However, the CREST patients had a significantly lower frequency of arthralgia (54%) and arthritis (15%) than did those with scleroderma (88% and 65%, respectively). All but one of the CREST patients were women, which was a greater proportion than found among scleroderma cases (69%), and all were white (P less than .05). Most patients with the CREST syndrome had rather severe acrosclerosis. At last evaluation, four patients were chronically ill and three had died. The CREST and CRST syndromes are closely related disorders that seem to be part of the spectrum of systemic sclerosis.


Gonococcal endocarditis in the antibiotic era. Since the introduction of penicillin in 1942, there have been only 11 culture-proven cases of gonococcal endocarditis in the English literature. Most patients are under 30 years of age and have no history of heart disease. The aortic valve is often involved and aortic regurgitation is common. The bacteriologic diagnosis can be difficult and may require more than six blood cultures and a long incubation period. Circulating immune complexes appear to be the cause of many of the extracardiac manifestations. The three new cases reported herein and review of the literature emphasize the distinctive features of gonococcal endocarditis.


Bacteremic infection in hemodialysis.

Bacteremic infection in hemodialysis. This is a retrospective study of 133 episodes of bacteremic infection in 112 hemodialysis patients. The frequency of bacteremic infection was 9.5% in patients with chronic renal failure and 10.9% in patients with acute renal failure. In patients with acute renal failure, pneumonia and intra-abdominal abscess were the most frequent sources of septicemia. Sepsis was usually due to Gram-negative organisms and mortality was high. In patients with chronic renal failure, infection of the shunt or fistula was the most common cause, was frequently due to Staphylococcus organism, and had a more favorable survival rate. Gram-negative septicemia from a nonaccess source in patients with chronic renal failure was associated with a higher mortality. Bacterial endocarditis and septic pulmonary emboli occurred in 3.6% of septic episodes and 0.35% of patients at risk and had very low mortality. A low threshold for obtaining blood cultures and early antibiotic treatment are believed to be important in the treatment of bacteremic infections in patients undergoing long-term hemodialysis.


The role of growth hormone in the pathogenesis of postmenopausal osteoporosis. The secretory response of somatotropic hormone (STH) to arginine hydrochloride stimulation (0.5 g/kg) was studied in 13 postmenopausal women. Eight showed evidence of osteoporosis, based on clinical and morphoradiological data and on metacarpal cortical thickness measurement, and five had normal bone mass. In addition, the response to levodopa (500 mg) was determined in four of the osteoporotic patients. Baseline STH concentrations in the osteoporotic subjects did not differ from those in the nonosteoporotic group, but the latter showed a significant increase over the former at 45, 60, 90, and 120 minutes after stimulation. Similar findings were obtained with levodopa stimulation. Without necessarily implying a cause-effect relationship, our data appear to support the hypothesis that the poor secretory response of STH may be to some degree responsible for the osteopenia observed during the climateric.


Comparison of nonseptic and septic bursitis. Further observations on the treatment of septic bursitis. Of 30 cases of olecranon and prepatellar bursitis, ten were septic. Fever, tenderness, peribursal cellulitis, and skin involvement over the bursa were more common in the septic cases. A high leukocyte count, low bursal-to-serum glucose ratio, and positive Gram-stained smear of the bursal fluid distinguished septic from nonseptic bursitis. Rheumatoid arthritis and gout may be accompanied by nonseptic bursitis. Septic bursitis may be associated with a sympathetic sterile effusion in a neighboring joint or adjacent fascial space. The duration of antibiotic treatment necessary to sterilize bursal fluid was proportional to the length of time infection had been present. A prospective antibiotic program disclosed an average of 12 days for successful therapy. A bactericidal agent against penicillin-resistant Staphylococcus aureus is the drug of choice.


Carotid sinus syncope induced by malignant tumors in the neck. Emergence of vasodepressor manifestations following pacemaker therapy. Three patients had carotid sinus syncope secondary to malignant neoplasms in the neck. Pacemaker therapy controlled the cardioinhibitory reflex with bradycardia, but the patients manifested varying episodes of hypotension due to a vasodepressor reflex that most likely resulted from persistent irritation of the carotid sinus by the tumor. These episodes seemed to be self-limiting. Surgical treatment in resistant cases is a possibility.


Acute viral hepatitis with bridging hepatic necrosis. An overview. Bridging hepatic necrosis in the setting of acute viral hepatitis (BHN/AVH) represents an enigmatic syndrome inasmuch as its incidence, significance, course, and therapeutic response have not been clearly defined. It has been thought that this histologic finding carries a high risk of early mortality or evolution to chronic active hepatitis and/or cirrhosis. The data are sparse, and largely based on retrospective studies in selected populations. Steroids have not proved to be effective thus far, while drugs used in other forms of serious liver disease (eg, penicillamine, colchicine) have not been tried. A recent prospective study indicates that BHN/AVN may be a far more benign entity than was previously suspected. Further prospective studies are needed to clarify the significance of this lesion as well as the need for and response to medical therapy.


Hypercalcemia associated with chronic lymphocytic leukemia. A patient with chronic lymphocytic leukemia (CLL) is described in whom hypercalcemia occurred in association with elevation of the peripheral lymphocyte count and expansion of total tumor mass. Hypercalcemia was ameliorated with the institution of chemotherapy for the leukemic process and subsequent fall in WBC count and decrease in total tumor burden; hypercalcemia recurred with relapse of the leukemic process. The serum immunoreactive parathyroid hormone (iPTH) concentration, when measured, was inappropriately elevated for the degree of hypercalcemia. The hypercalcemia would appear to be a direct consequence of the leukemia, and possibly involved secretion of a parathyroid hormone-like polypeptide by the CLL cells. Although a possible role for either an osteoclast-activating substance or prostaglandins was not excluded, they would not account for the elevated serum iPTH levels observed.


Pituitary pseudotumor. Mimicry of recurrent prolactinoma by a chronic intrasellar hematoma. In the increasing cohort of patients being observed after pituitary microneurosurgery for prolactin-secreting adenomas, tumor recurrence remains a concern. We describe a patient with a prolactinoma treated by transsphenoidal pituitary surgery who resumed cyclic menses for one year postoperatively before manifesting progressive headaches, intermittent diplopia, secondary amenorrhea, and anterior pituitary failure. Invasive and noninvasive neuroradiologic procedures suggested recurrent tumor with suprasellar extension. However, reoperation of the pituitary disclosed a chronic intrasellar hematoma expanding under increased pressure within the enclosed sellar space. We discuss a putative mechanism for the pathophysiology of this syndrome, and tentatively designate it "pituitary pseudotumor". Recognition of this entity is important not only because reoperation is required for accurate diagnosis, but also because treatment with radiotherapy or bromocriptine mesylate for presumptive tumor progression or recurrence would be ineffective.


[Relation of the energy content of fats and proteins as an indicator of energy-protein potential of population diets]. The protein-calorie (Po/o) and the protein value (NDpCalo/o) have been proposed as indices to evaluate the potentiality of diets to meet protein and calorie needs of a given population. The fat-calorie to protein-calorie ratio (G/P) is presented as a complementary index, considering the possibility that the values of Po/o and NDpCalo/o can be adequate but that the energy density of the diets is too low, as might be the case in many rural communities of the developing countries. On the basis of the evidence discussed in this paper, the G/P ratio estimated as adequate is 2.5, and values lower than 2 can be considered as nutritionally unacceptable.


[Attempts to influence birth in swine with dexamethasone. 2. Effect of DXMS on adrenal mass and cell nuclear volume of the fascicular zone in piglets]. The adrenal weights of spontaneously born piglets, immediately after parturition, were significantly higher than those of piglets from sows in whom parturition had been induced by DXMS. The differences between mean values went down with DXMS treatment started later in advanced pregnancy. Mean absolute and relative adrenal weights of the DXMS groups came closer to those of the untreated controls on the tenth day of piglet age. Cell nucleus volumes of the zona fasciculata were normal in all groups and did not reveal any influence of DXMS treatment in any of the newborn piglets. The mean values were 89.9 micron3 in the control group and 87.6 micron3 in experimental group V (75 mg DXMS per animal and die on 109th through 111th days of pregnancy).


[Pathomorphological changes in the skeletal muscles (musculus longissimus dorsi) in swine following varied transport stresses and resting periods prior to slaughter]. The M. longissimus dorsi of 171 pigs were histologically examined for pathological signs. Acute hyaline-plaque degenerations and necrosis (hsD/N) in various degrees of manifestation were recorded from 42.7 and hyaline transverse ligaments (hQb) from 22.8 per cent of all cases. The occurrence of hsD/N following container transport was lower with significance (33.3 per cent) than that following lorry transport (50.5 per cent). The form of transport failed to have any substantive effect on the occurrence of hQb, the figures being 20.5 per cent for container and 24.7 per cent for lorry. Short resting periods, between 0.5 and 1.2 hours, were followed with significantly higher occurrence of hsD/N, as compared to longer resting periods, between five and eight or 23 hours. These pathological findings were not further reduced by extending the resting period from something between five and eight to 20 hours. The pathological hsD/N and hQb findings were recordable from both PSE pork (hsD/N = 51.4 per cent, hQb = 25.7 per cent) and from pork without any quality shortcomings (hsD/N = 39.7 per cent, hQb = 22.1 per cent), but the number of hsD/N cases in the context of PSE pork tended to be higher than that in high-quality pork. No sex dependence was established. The results are discussed under the aspect of aetiopathogenesis of stress-borne myopathy.


[Glutathione peroxidase activity in erythrocytes and selenium concentration in blood of untreated and selenium-treated rabbits]. White New Zealander rabbits were tested for erythrocyte-borne reference values of glutathion peroxidase Px activity, with correlations being established between that activity and selenium content of the blood. The average glutathion peroxidase Px activity in untreated clinically intact rabbits was 11.8 K/g Hb. That value doubled following five selenium applications in therapeutic dosage. The values empirically determined were well adapted to normal distribution. Selenium concentrations recorded from organs of control animals were in fair agreement with values established in earlier studies (Wiesner et al., 1978). The correlation coefficient was r = 0.7117 (n = 44, alpha less than 0.001). The equation of regressive straight line Y oder X (ŷ) was ŷ = -5.3 + 59.94x, and that of X over Y (ŷ) was ŷ = 0,27 + 0,0095y, when Y defined the activity of glutathion peroxidase Px and X the selenium level in the blood.


[Critical remarks on the investigation methods of coergistic effects of acute oral toxicity of combination insecticides]. Often the application of fractions of the LD50 (e.g. 1/4 LD50, 1/2 LD50) is unavoidable due to technical conditions in the experiment (e.g. in case of substances with low toxicity and in case of very steep slope functions). But if ever possible, dosage of equitoxic amounts (LD10, LD50 etc.) should be prefered, because of higher reliability in the choice of dosage and evaluation of the results. Benefits and disadvantages of the two experimental principles are demonstrated by results of own investigations.


Carbon as an implant material in orthopaedic surgery. Carbon is a material of proven value in many fields of medicine. It has only minor reactions compared with other materials, but does have unfavourable mechanical characteristics. New kinds of carbon with similar physical characteristics to other materials, e.g. steel and ceramic, have now been developed.


Total replacement of the femur and its adjacent joints. We report three cases of alloplastic replacement of the femur and its adjacent joints. The indications and operative technique are described. The femoral shaft of polyethylene can be manufactured within a short time and may be individually adapted to standard replacements of the hip and knee. The operation may be performed even on older patients, it preserves the limb and allows early mobilisation with full weight bearing.


Fibrous dysplasia in the light of new diagnostic methods. Various screening tests provide a detailed representation of fibrous dysplasia: thermography, scintigraphy, computer tomography, scanning electron microscopy, X-ray microanalysis, microradiography and fluorescence microscopy. The stationary nature of clinical and X-ray findings contrasts with the intensive structural changes that occur. The above-mentioned methods are examined with regard to differential diagnosis.


The morphology of polymethylmethacrylate (PMMA) bone cement: surface structures and causes of their origin. This study deals with the correlation between the polymerizing bone cement and the surrounding tissue. The surface structures of bone cements, polymerized in air, in tissue medium (in vitro) and in human bone during implantation were investigated and compared with the contours of the tissue of the implant bed. Basing on the dimensional differences it was differentiated between contours of 1st order and 2nd order: contours of 1st order are within the macroscopic range, contours of 2nd order within the microscopic range. The surface of bone cement polymerized in living human tissue differed essentially from samples polymerized under laboratory conditions. The differences are to be seen macroscopically in the coarse relief as well as microscopically in the shape and the connection of the superficial methylmethacrylate beads. Bone cements, polymerized in air show an ideal, even and closed surface. Bone cements, polymerized in tissue medium exhibit macroscopically some wrinkles, in the microscopic range their contours are either closed (samples prepolymerized at 22 degrees C) or partly open and partly closed (samples prepolymerized at 24 degrees C). The surface of bone cement implants, retrieved from human bones are characterized macroscopically by a marked wrinkled and papillary relief, microscopically by flattened beads, and most often by an irregular, rough and open surface with isolated beads giving almost the impression of a porous surface structure. The character of the surface of the bone cement originates from external, mechanical influences, from changes in the volume of the bone cement and from effects of the surrounding tissues. The surface of the bone cement implanted in human bone conforms exactly with the contour of the adjacent tissue; the tissue contour is infact a negative of the cement surface. The incomplete connection between the superficial PMMA beads seems to be of some practical value: In areas, where the PMMA beads are largely isolated, the mechanical stressability of the "polymer composite" is relatively low. Under high load, beads and bead-clusters may break off the surface. Shattering of bone cement implants possibly may start from such an open, porous surface area where PMMA beads are extensive isolated.


Surgical treatment of malignant secondary tumors of the humerus: report of 45 cases. Data from a series of 45 internal fixations for malignant secondary tumors of the humerus are analyzed. The tumors occurred late in the evolution of the cancer, and represented 24% of appendicular bone metastases for which operations were performed. Statistics of the patients, fractures, treatment, and results are presented and conclusions drawn. Prognosis should be related to the types of primary tumor. Blind nailing or pinning is recommended, and indications for preventive osteosynthesis are discussed.


[Indications and complications in the treatment of infected femur pseudarthroses (author's transl)]. Indications given, the adequately dimensioned plate osteosynthesis must be preferred to any other treatment for stabilizing an infected femur pseudarthrosis, regardless of the osseous support. Otherwise the fixateur externe is indicated. Its assembly on the upper leg requires a special knowledge which reflects the individual bone- and soft-tissue-assessments. We distinguish between fixateur type I to IV on the upper leg, all of which are exemplified. Complications are at first mainly loss of blood and infective activity, later chronic soft-tissue fistulae, abscesses, osteomyelitic residual cavities, and spontaneous fractures. A study analyses the treatment and the late results of 96 infected femur pseudarthroses.


Adhesive capsulitis of the ankle (frozen ankle). Adhesive capsulitis or "frozen ankle" is a syndrome resulting from repeated ankle sprains, or perhaps following immobilization after trauma. Ankle arthrography is a useful and safe diagnostic procedure in this syndrome. Typical arthrographic features are described together with case histories of two patients with frozen ankle. We suggest that early mobilization of the patient following trauma is particularly important in preventing the development of a forzen ankle syndrome.


Chronic compartmental syndrome of the abductor pollicis longus and extensor pollicis brevis muscles: report of a case treated with fasciotomy. A 32-year-old man with a chronic compartmental syndrome of the muscle bellies of the abductor pollicis longus and the extensor pollicis brevis muscles was successfully treated by fasciotomy of the muscle sheath. It is pointed out that this condition was primarily due to hypertrophy of the muscles combined with overuse edema. This condition should be differentiated from De Quervain's disease.


Epidemiologic profile of long-term stroke disability: the Framingham study. One hundred forty-eight long-term stroke survivors and 148 control persons matched for age and sex, from the Framingham Study cohort, were examined for residual functional disability. Prevalence rates for 9 specific types of functional deficit ranged from 15% for institutionalization, to 63% for decreased vocational function in the group of stroke survivors. The comparable rates in the control group were significantly lower. Cardiovascular comorbidity was greater in stroke survivors than in controls. Removal of its apparent effects on function decreased the magnitude, but not the overall pattern, of documented disability in both groups. The most severe disabilities, institutionalization, dependence in mobility, and dependence in self-care, were the least prevalent. The more frequently documented types of functional deficit were those in which psychosocial and environmental factors are significant determinants.


Training sensory awareness and spatial organization in people with right brain damage. Building on a methodology to improve scanning and academic skill performance behavior in persons with acquired right brain damage due to stroke, this study presents 2 additional treatment methods: training in sensory awareness and spatial organization. The 53 patients studied were divided into two groups, experimental (N = 30) and control (N = 23). The experimental group received a treatment program incorporating the 2 new methods as well as a condensed version of the original program. The controls received standard rehabilitation. Both groups were retested after 1 month. Analyses revealed that the performance of those in the experimental group exceeded that of the controls, that those patients in the experimental group with severe impairments improved more than those with mild impairments, and that combined multiple-treatment produces greater generalization than the original single treatment program.


Positional feedback and electrical stimulation: an automated treatment for the hemiplegic wrist. Positional feedback (PF) and electrical stimulation were combined in a new treatment modality for facilitating wrist extension in stroke patients. Thirty adult hemiparetic patients lacking normal voluntary wrist extension were randomly placed in control and study groups. The control group received conventional therapy while the study group received positional feedback stimulation training (PFST) in addition to conventional treatment. At the end of the 4-week program, study patients showed a 280% increase in isometric extension torque when the wrist was positioned in 30 degrees of extension and 70% increase when positioned in 30 degrees of flexion. Control patients showed no significant changes in torque. Study patients made an average 200% gain in selective range of motion over their starting levels while controls made only a 50% increase. Treatment using automated PFST equipment allows controlled repetitive isotonic exercise and facilitation of wrist extension without continuous one-on-one therapist/patient supervision.


Dysarthria in adults: physiologic approach to rehabilitation. A case study is used to illustrate a physical approach to the speech rehabilitation of adults with dysarthria. The approach emphasizes the component-by-component analysis of the peripheral speech mechanism, where the selection and sequencing of treatment procedures follow directly from the physiologic nature and severity of involvement in each component. The selection and sequencing of procedures also are conditioned by the inherent physical interdependencies of these component parts. Several biofeedback procedures of our own are incorporated that have not been reported previously. The case illustration is of a young man injured in an auto accident whose speech intelligibility improves from approximately 5-10% to 95% during the rehabilitation period. Effects of treatment upon individual components of the speech mechanism are illustrated.


Burke stroke time-oriented profile (BUSTOP): an overview of patient function. A simple multidisciplinary time-oriented computer-compatible functional profile is described for the quantitative assessment of stroke patients and their progress during rehabilitation. The reasons for developing a new rating scale as well as the implications for computer analysis of the data collected are discussed.


Time-oriented functional profile: practical applications in a stroke data-base model. The feasibility of transferring data from a large computerized stroke data-base system (BUSTOP) to an existing time-oriented system of proven utility (ARAMIS) is demonstrated. Potential advantages of a time-oriented data-base system include: determination of prognostic indicators, suggestions for therapeutic intervention, analysis of experimental treatment programs, development of units of cost effectiveness and provision for uniform methods of auditing stroke care. This demonstration project shows that a large-scale stroke data-base system is feasible using existing computer models which are currently collecting and analyzing data-base statistics.


Post-void residual alerting device.

Post-void residual alerting device. A simple, inexpensive device is described which alerts nursing staff upon spontaneous voiding by a patient with spinal cord injury. This facilitates measurement of the post-void residual urine volume which is useful in the management of neurogenic bladder.


[Utilization of alimentary ribonucleic acid in calf N-metabolism]. In order to get hints concerning the utilisation of nucleic acids in the N-metabolism of ruminants, a N-balance experiment with not yet ruminating calves was carried out. An admixture of 0, 1.875 and 3.75% yeast ribonucleic acid (groups I-III) was given to a milk substitute feed with low purine and pyrimidine contents. The RNA admixture amounted to 10 resp. 20% of the diet protein-N. The daily feed per animal amounted to 1710 g. Apart from the N-balance the digestibility of RNA and some N-fractions in urine were registered. The excretion of nitrogen, RNA or desoxy ribonucleic acid in the feces of the calves was hardly changed by the RNA intake. Thus an extensive digestibility of RNA can be stated. The renale nitrogen excretion increased in group II by an amount which nearly corresponded to the RNA intake, and in group III it even increased overproportionally. As the N-balance showed, there was a low utilisation of the RNA-N of 12% (non-significant), whereas in group III the N-increase was negatively influenced. The N-excretion in urine connected with the RNA-intake could mainly be traced back to increased urea and allantoine values. The conclusions from these results were that nucleic acids of 10 to 20% of the feed protein are only of a low resp. no nutritive nitrogen value.


[Metabolism of colostomized laying hens with 15N-labeled wheat. 3. Incorporation of 15N into and its distribution over follicles of various stages of development, the restovar and the oviduct]. Of colostomised hens fed with labelled wheat protein the atom-% 15N-excess (15N') was ascertained in the bigger follicles, the restovar and the oviduct from the total N, the lysine-N, histidine-N and arginine-N. The labelling of the basic amino acids decreases the smaller the follicles are. In contrast to the yolk, in which a constant relation between the three amino acids was found, the relations were inconsistent and typical of the individual hens. In the atom-% 15N' in the three amino acids in the restovar and the oviduct there were greater differences between the hens. In the lysine, histidine and arginine we found, on an average, 21.2% of the total labelled N of the follicles.


[Performance dependence of the lysine requirement of fattening sows. 1. Effect of energy and amino acid consumption on fattening performance]. Seven variants with graduated energy and amino acid levels were tested at 105 growing sows in a live weight range between 30 and 120 kg. The weight increase and the energy expenditure showed a distinct dependence on the energy level of the ration and are mainly determined by the energy intake. Up to a live weight of 90 kg a 20% lysine over- or undersupply in comparison with the norm had no influence on the growth intensity of the animals. On the low and medium energy levels there was a tendency of superiority of the animals which received feeds rich in protein in the section between 90 and 120 kg. In the variant with a high energy level, however, a diminishing increase was detected in the last third of the fattening period in connection with the growing lysine level. The overall most suitable result was achieved in variant M 120 with a daily increase of 675 g and an energy expenditure of 2.04 kilo energetic feed units for pigs per kg increase.


[Utilization of 15N-labelled urea by laying hens. 1. Survey of the literature, 15N-excretion in feces and urine]. Three colostomated leghorn hybrids with an average laying performance of 75% received a ration with 17.7% crude protein and an energy content of 519 energetic feed units for hens per kg mixed feed over a period of 8 days. In the first six days of the experiment the 1%-supplement of urea to the ration was labelled. Its atom-% 15N excess (15N') amounted to 96.06%. During the last two days the urea supplement was not labelled. The total N, trichloracetic acid (TCA)-soluble N and the ammonia N were determined in the feces samples collected daily. In the urine samples collected daily the total N, urea N and ammonia N per hen were determined as well. In all samples the atom-% 15N excess (15N') was measured. The percentage of 14N in feces of the 14N dose was, on an average of the three hens, 21.3% and the analogous quota of 15N' 4.6%. The quota of ammonia 14N of the total 14N in feces had an average of 2.5%, the corresponding 15N' quota was 10.1%. The atom-% 15N' of the urea N in urine was considerably above that of the total urine N and had a maximum of more than 50%. The quota of urine 14N of the 14N taken in had an average of 44.4%, and the corresponding 15N' quota was 56.9%. On an average of the three hens, 61.6% of the 15N' were excreted in feces and urine during the 8-day test period.


[Lysine requirement of fattening sows depending on their performance. 2. Relations between energy consumption and live weight increase]. 105 growing sows in the live weight range were fed with 7 test rations with graduated energy and amino acid levels. The growth intensity was very much influenced by the daily energy consumption. On the basis of regression analysis the following linear relation between daily weight increase (y in g per kg live weight0,75) and the daily energy consumption (x in energetic feed units for pigs per kg live weight0,75) was calculated: y = -13,79 + 0,7037 x (r = 0,84, sb -0,0295). The interpolation with regard to live weight balance resulted in a maintenance requirement of 19,8 energetic feed units for pigs resp. 70 kcal net energy fat for pigs per kg live weight0,75. The methods of assessment chosen showed an increase of the energy requirement per 100 g additional live weight increase per day of a constant amount, independent of the live weight, of 142 energetic feed units for pigs resp. 497 kcal net energy fat for pigs.


[Protein digestibility and the absorption of amino acids in various segments of the digestive tract of pigs. 3. Results of the fractionation of ileum chyme after feeding various rations]. Growing female pigs provided with re-entrant ileum resp. ileocecal cannulae received 6 different rations (fattening feed I and II for pigs, rations with dried skim milk, wheat gluten + lysine resp. wheat + wheat gluten + lysine, N-free mixture). The ileum chyme was separated into the fractions supernatant 1 and sediment 1 and by a treatment of supernatant 1 with trichloracetic acid and subsequent centrifuging into supernatant 2 and sediment 2. In the complete chyme as well as in all fractions the crude protein and amino acid contents were determined. The distribution in per cent of the crude protein and the amino acids over the fractions was calculated as well. The influence of the rations, in particular rations of dried skim milk, on the amino acid pattern of the complete chyme and the chyme fractions could be established. An influence of the rations could not be recognised on sediment 2 only, which indicates a uniform amino acid pattern of these probably endogenous proteins. The percentage of crude protein and amino acids in the fractions was also influenced by the rations.


On the mechanism of arginine requirement for adenovirus synthesis. The effects of arginine deprivation on the synthesis and processing of viral proteins and the assembly of incomplete and complete virions were studied during infection with human adenovirus type 2. Arginine deprivation greatly reduced the synthesis of all viral proteins, particularly the precursor to core protein VII. The inhibition was completely reversible by the addition of arginine to the medium. Arginine deprivation between 7 and 20 hours post-infection inhibited the processing of PVII to VII, suggesting that PVII is not cleaved autocatalytically. The assembly of incomplete virions was sensitive to arginine deprivation only prior to 20 hours, while the assembly of complete virions was dependent on the continuous presence of arginine. This observation supports the hypothesis that incomplete virions are precursors of complete virions. The experiments on the PVII-specific endoprotease activity showed that arginine deprivation caused only slight reduction in the in vitro activity, although no activity was observed in vivo. The present results lead to the hypothesis that arginine deficiency inhibits the synthesis of a functional protein essential for virion maturation, other than the synthesis or processing of PVII.


[Protein digestibility and the absorption of amino acids in various segments of the digestive tract of pigs. 4. Digestibility of crude protein and amino acids and rate of passage through the duodenum and ileum and the total digestive tract of growing pigs]. The crude protein digestibility and the amino acid absorption of six female pigs (average live weight 61 kg) with duodenal and ileocecal re-entrant cannulae, which were fed with a wheat + wheat gluten + lysine ration and an N-free ration, were determined in various segments of the intestines. Comparative experiments concerning the N-metabolism with pigs without and with cannulae showed that the animals renormalised their metabolism 14 days after narcosis and fistulation of the intestines. The extents of secretion and absorption of the various amino acids vary as it is shown from the values of the apparent and true digestibility resp. rate of passage through various segments of the intestines. While for methionine and glutamic acid absorption exceeds endogenous secretion already in the duodenum, the amino acids with a high endogenous quota (glycine, alanine, threonine, tryptophan) are, even at the terminal ileum, not as well absorbed as the others. Methionine is obviously synthesised on a large scale by the colon flora and excreted in feces. The fractionation of the duodenal and ileum chyme after feeding wheat + wheat gluten + lysine as well as N-free mixture, into the fractions "solid particles", "peptides-free amino acids" and "proteines precipitable by trichlor-acetic acid" supplies information on the degree of protein degradation in various segments of the intestines.


Effect of trisodium phosphonoformate in genital infection of female guinea pigs with herpes simplex virus type 2. A genital herpesvirus type 2 infection in guinea pigs has been used to evaluate the inhibitory effect of phosphonoformate on the infection. An early topical treatment prevented the appearance of vesicles and histopathological changes and no virus could be recovered. When treatment, either topical or both systemic and topical, was delayed to 24 hours post infection no therapeutic effect was observed.


[Interaction between the temperature of the surroundings, performance and level of feed for growing pigs]. Investigations of the performance of growing pigs in the live weight range of 30 to 60 kg kept individually and in groups with ad libitum and rationed feeding were carried out in two air-conditioned rooms. The air temperature in the individual experiments was 20 degrees C, 10 degrees C and 5 degrees C, the relative atmospheric moisture in all experiments was between 70 and 80%. A diminished growth of 24 g per day per degrees C below 20 degrees could be ascertained for pigs kept individually. The diminishing of the growth can be compensated by an increase of the feed intake of 1.3 g per kg live weight, day and degrees C resp. the intake of metabolisable energy of 4 kcal per kg live weight, day and degrees C until the capacity of feed consumption is reached.


[Participation of bile and pancreatic juice in the secretion of endogenous nitrogen into the digestive tract of sheep]. The amount of bile and pancreas juice excreted and the amount of urea-N and total-N discharged by the bile and pancreas juice into the duodenum was established in eight experiments with two full-grown sheep of the merino species and with a live weight of 50 kg. For this purpose they had permanent cannulae for the measuring of the passage of bile and pancreas juice which was carried out at 1-hour intervals in the course of 24 hours beginning at 7 o'clock in the morning. During 24 hours 245.3 +/- 6.3 mg urea and 4,418.1 +/- 85.8 mg total-N were discharged with bile and pancreas juice, of which 186.9 +/- 9.6 mg urea and 2,095.3 +/- 119.7 mg total-N were discharged in the bile and 58.5 mg urea-N and 2322.8 +/- 52.9 mg total-N were discharged in the pancreas juice. The amount of pancreas juice secreted and its nitrogen is constant in the course of the day (between 7 a.m. and 7 p.m.) and of the night (between 7 p.m. and 7 a.m.) In the daytime the secretion of bile and its nitrogen is significantly higher than at night. (p less 0.05). The concentration of urea-N and of total-N remained constant throughout the whole day. The amount of bile and pancreas juice secreted correlated greatly significantly with the amount of nitrogen (urea-N and total-N) discharged in bile and pancreas juice. The results indicate that, within the enterohepatalous circulation of endogenous urea, its secretion in bile and pancreas juice is quantitatively less important. The amount of total-N which gets from the endogenous pool into the duodenum is high and corresponds to approximately one third of the metabolic nitrogen which the animals consume daily with their feed.


[Localization of the lamellated corpuscle neurons of the cat large intestine mesentery]. Electrical activity and ultrastructure of lamellated corpuscles (Pacinian corpuscles) of the cat large intestine mesentery were studied 10 days after uni- and bilateral extirpation of the lumbar spinal ganglia. Terminal degenerated in all the receptors, and there were no electrical reactions at bilateral extripation of ganglia L3-L4, they were preserved in some receptors at bilateral extirpation of ganglia L2-L3 and L4-L5 and at unilateral extirpation of ganglia L3-L4. Structure of the receptors and electrical reactions were preserved in all the lamellated corpuscles at bilateral extirpation at the level of L1-L2 and L5-L6. After enucleation of the corpuscles from the large intestine mesentery, in some neurons of ganglia L3-L4, chromatolysis was observed. After the caudal mesenteric nerve was sectioned, there were no electrical reactions in the lamellated corpuscles of the large intestine mesentery. Hence, the sensitive neurons-theri peripheral processes participate in the formation of the lamellated corpuscles of the cat large intestine mesentery-are situated in the lumbar ganglia L3 and L4.


Protease treatment and chemical crosslinking of a flavivirus: tick borne encephalitis virus. Tick-borne encephalitis virus was treated with pronase or thermolysin. The resulting particles were banded in sucrose gradients and analyzed for polypeptide composition. Both enzymes caused a reduction in particle density from 1.19 to 1.15--1.16 g/cm3. No loss of viral lipid or nucleic acid could be observed. SDS-polyacrylamidegel electrophoresis showed that only the core protein V2 was unchanged whereas the envelope proteins V3 and V1 had disappeared from their original positions in the PAGE profile. Instead a new peptide(s) with molecular weight of 4000--6000 was found in which hydrophobic amino-acids were enriched. Crosslinking by dimethyl-3.3'-dithiobispropionimidate (DTBP) made the virus resistent to solubilization of the envelope proteins by TX-100. This could be interpreted by the formation of a dense envelope protein network around the nucleocapsid preventing its liberation by TX-100. Some data however indicate that direct crosslinking of at least one of the envelope proteins with the core cannot be excluded.


[Fascia canals of the greater sciatic foramen and their practical importance]. Fasciae and fat tissue spaces in the gluteal region, topography of the suprapiriform and infrapiriform foramina have been studied by means of a complex anatomical experimental technique. The suprapiriform foramen should be considered as a fascialosseous canal, as it is 4-4.5 cm long and 0.6-1.0 cm wide. It is formed by the upper margin of the greater sciatic notch covered with a thin fascia, fasciae of the gluteal and piriform muscles and the parietal layer of the pelvic fascia. The proper fascial vaginae of the upper gluteal vessels and nerves are adhered to fascial walls of the canal. This peculiarity is used for the method of ligation of the superior gluteal artery within the limits of the suprapiriform canal. The infrapiriform foramen is either narrow or wide enough (up to 2.0 cm in diameter). Inferior gluteal vessels at the level of the sacrospinous ligament go from the parietal layer of the pelvic fascia into the duplicature of the deeper layer of musculus gluteus maximus. The inferior gluteal nerve, above the lower margin of the piriform muscle, ajoining the vessels gets into the fissure of the parietal layer of the pelvic fascia, under the lower margin neurovascular fasciculus also goes through the fissure of the pelvic fascial parietal layer, downward and parallel to the inferior gluteal vessels. The knowledge of possible ways of connections through the canals of the greater sciatic foramen, fat tissue spaces at the subperitoneal level of the small pelvis and the gluteal region is of great practical value.


[Feed value of straw materials in the in vitro system. 3. Measurement of in vitro protein synthesis on the basis of the incorporation of 15N in the TCA-precipitable fraction of rumen fluid]. For several reasons the utilisation of 15N for the characterisation of the microbial protein synthesis in the artificial rumen seems to be, in contrast to the incorporation of 35S, not very suitable in order to characterise the feed value of straw materials.


[Differentiation of mesothelial cells during their reparative regeneration]. The investigation on regenerative processes of mesothelium of the parietal peritoneum was performed in 120 white mice under the effect of certain irritants producing lesions various in depth and intensity. Nuclear-cytoplasmic relations and ultramicroscopic cellular rearrangement were studied during the process of differentiation of the mesothelial regenerate. Two periods of the regenerative process are stated and it is demonstrated that rearrangement of the mesothelial cells and the mode of their division depend on intensity of the lesions. When the peritoneal lesion is severe, at the first stages of regeneration (the 1st period) rearrangement of cells towards their hypertrophy and increased functional activity is predominant in the mesothelium. Further (the 2d period), the number of mitotically dividing cells is increasing in the mesothelial regenerate and in rearrangement of the mesothelial cells the processes connected with a partial loss of their signs of specialization predominate. The transition from one period into another is gradual and duration of each depends on intensity of the lesion.


[Information of the structuro-functional characteristics of sympathetic afferents]. Visceral nerves have a lot of sensitive conductors of double nature. One of them are presented by dendrites of pseudounipolar cells of cerebrospinal nodes, others - in the form of amyelinic (or, sometimes, fine myelinic) fibres - are axons of peripheral sensitive neurons (of the IId Dogil's type). By means of experimental morphological and electrod physiological analyses performed in 36 dogs, a possible connection of intraenteric neurons of the IId Dogiel's type with the spinal cord is demonstrated, at least with in the level of 5-10 thoracic segments. The centripetal fibres from the jejunum go together with the intestinal, coeliac nerves, intranodular, white and grey connective branches of the sympathetic trunk and, further - with posterior and anterior roots of the cerebrospinal nerves. The coeliac nerves serve as an important collector of the sympathetic afferents along their way from the peritoneal cavity. A part of axons of the peripheral sensitive neurons end in presynaptic buds of a terminal type on the motoneurons in the prevertebral (coeliac plexus) and the paravertebral (thoracic sympathetic trunk) sympathetic ganglia accepting the positoin of the afferent link in the systems of extracentral reflex arcs. Owing to this sign, sensitive cells of the IId Dogiel's type are justly named "sympathetic afferent neurons". Elements of the peripheral (sympathetic) afferent system are remarkable for their diffuse localization, that is corroborated by: an extreme dispersity of trophic centers (cells of the IId Dogiel' type); their axons form synapses with motor cells of numerous and sometimes unstable, individually changeable sympathetic ganglia; transfer of the centripetal sensitive fibres into the spinal cord via posterior and anterior roots.


[Effective factors for the reduced feed intake of milk cows fed with rations containing urea]. In two experiments with milk cows with permanent rumen fistula it was investigated whether, apart from urea being unpalatable, further physiologic parameters are responsible for the reduced feed intake. In experiment I the cows received 2, 3 resp 4% urea orally with barley coarse meal, or an equivalent amount was given continuously from the beginning of the feeding over a period of three hours through the fistula. When 2, 3 resp. 4% urea were given orally, the consumption went down in the first 30 min to 58, 52 resp. 40%. When urea was given rumenally, no depression of the consumption could be observed. There were distinct relations with the NH3-concentration in the rumen fluid. At 20 to 35 mg per 100 ml there was no resp. a slight depressioon only and at 40 mg a significant depression. When the concentration rose to greater than 50 mg, consumption was stopped. In experiment II the rumenal application of urea began two hours before the feeding. The high NH3-level shortly after the beginning of feeding (58 mg/100 ml) caused a stop in the feed consumption. No relation could be observed between the urea concentration in veinous blood and the feed intake.


[Reaction between the mechanocytes of hematopoietic organs in collagen gel]. Interactions between stromal mechanocytes of hemopoietic organs were studied at their cultivation in three-dimentional collagen gel. It was demonstrated that cellular cords appearing between fibroblast colonies and between fragments of hemopoietic organs are of fibroblastic nature. They are not resulted from organic or specific peculiarities, or from discharge of substances attracting fibroblasts. A linear dependence between the amount of fibrorow or spleen was noted. Fibroblast colonies formed by the hamster bone marrow and splenic cells, as well as by passaged fibroblasts of the guinea pig bone marrow were obtained. In order to form colonies by the passaged fibroblasts it is necessary to add of irradiated cells. Its effect, besides the medium conditioning, is evidently, in restriction of fibroblast mobility in collagen gel.


Pseudostereoscopic illusion caused by interhemispheric temporal disparity: clinical and experimental observations. An extension of Pulfrich's pseudostereoscopic illusion to a situation without interocular disparity, ie, even under purely monocular circumstances, was clinically observed and experimentally produced. The perceived distortion of the movement of a swinging pendulum was found to depend on different combinations of interhemispheric disparity induced by selective prolongation of the conduction time from the nasal or temporal retina to the corresponding hemisphere. In patients, tumor pressure caused the slower conduction time. In normal subjects, neutral density filters covering different visual fields produced similar conduction delays under experimental conditions. Recording the visually evoked response from over each hemisphere provided an objective tool for demonstration and measurement of interhemispheric differences of retinocortical conduction times in various clinical and experimental setups.


Identifying epileptic foci on contrast-enhanced computerized tomographic scans. There is a statistically significant association between lateralization of interictal epileptic foci and lateralization of numerical changes between enhanced and unenhanced grossly normal computerized tomographic (CT) scans in the area of the suspected focus. This CT change, lateralized to the side of the focus compared to the homologous opposite brain, is a relative increase in CT values after enhancement. This change is seen in both right or left frontal and temporal foci, and is independent of the time of the last seizure, but is not reliably present if there is a gross abnormality on the CT scan. The technique provides additional evidence of lateralization in epileptic patients without clearly lateralized EEG findings.


Effects of taurine on seizures and growth hormone release in epileptic patients. Oral taurine at doses of 375 to 8,000 mg/day (16 to 150 mg/kg/day) was administered to six patients with mixed seizure disorders refractory to standard anticonvulsant treatment. No improvement in seizure control was observed. During taurine tolerance testing, a substantial rise in plasma growth hormone concentration was noted in four of the six patients. Mean baseline concentrations of 3.0 +/- 2.3 and 1.3 +/- 0.9 ng/mL were increased to mean peak concentrations of 17.1 +/- 2.4 (P less than .005) and 20.4 +/- 5.1 ng/mL (P less  than .025), respectively. Cerebrospinal fluid homovanillic acid (HVA) concentration was also noted to be higher in two of three patients two weeks after initiation of tauerine. Initial HVA concentrations of 20.3 and 28.2 ng/mL increased to 37.2 and 54.2 ng/mL, respectively. The possible effect of taurine on central dopaminergic mechanisms is discussed.


Unilateral visual loss in bright light. An unusual symptom of carotid artery occlusive disease. Five patients with carotid artery occlusive disease had unilateral visual loss in bright light. All five had reduced retinal artery pressure on the side of the visual loss, and arteriograms showed either an occlusion or a high-grade stenosis of the ipsilateral internal carotid artery. Unilateral visual loss in bright light may indicate ipsilateral carotid artery occlusive disease and may reflect the inability of borderline circulation to sustain the increased retinal metabolic activity associated with exposure to bright light.


Spontaneous internal carotid dissection, hemicrania, and Horner's syndrome. We describe five patients with angiographic features of dissecting aneurysm of the cervical portion of the internal carotid artery who were seen initially with unilateral headaches and ipsilateral oculosympathetic paresis. This combination of symptoms is a rather common mode of manifestation of this entity.


Effect of intracerebral vasculitis on regional cerebral blood flow. Regional cerebral blood flow was measured by the xenon 133-inhalation method in a 40-year-old man during an acute exacerbation of intracranial vasculitis. Neurologic function was quantitated by the Halstead-Reitan Neuropsychological test battery. The patient was also studied during remission that was induced by steroid therapy. Vasculitis produced a diffuse encephalopathy with generalized reduction in cerebral blood flow. During remission, only local symptoms secondary to a small cerebral infarction remained and regional cerebral blood flow returned to the normal range. There seems to be a close correlation between the severity of symptoms in cerebral vasculitis and reduction of flow through diseased vessels.


Retinal hemorrhages. Its significance in 100 patients with acute encephalopathy of unknown cause. A total of 94 patients had subarachnoid hemorrhage and it was strongly suspected in the remaining six patients. Acute encephalopathy associated with independent ocular hemorrhage due to hypoxia, multiple emboli, or bleeding tendencies was not a diagnostic problem during this study. Aneurysms occurred in 64 patients (combined with vascular malformations in four), isolated vascular malformations in four; "spontaneous" hematomas in 13, evidence of cryptic head trauma in six, hemorrhage from a glioblastoma in one, and no cause was identified in six patients. Retinal hemorrhages were more prominent ipsilateral to the site of intracranial bleeding. No single aneurysm location predominated and multiple aneurysms were common. The high mortality of 56% supports previous conclusions that retinal hemorrhages tend to accompany severe intracranial bleeding.


Amitriptyline in migraine prophylaxis.

Amitriptyline in migraine prophylaxis. In a controlled trial of amitriptyline hydrochloride in migraine prophylaxis, 100 patients received placebo for a four-week baseline period and then were randomized in double-blind fashion to therapy with amitriptyline (47 subjects) or placebo (53 subjects) for another four to eight weeks. Subjects received up to four 25-mg tablets of amitriptyline hydrochloride or identical placebo per day. Comparing the first and second four-week periods for each patient, the conditions of 55.3% of amitriptyline subjects as opposed to 34.0% of placebo subjects were greater than or equal to 50% improved and the difference between amitriptyline and placebo response rates was significant (P less than .05). Nondepressed subjects with severe migraine and depressed subjects with less severe migraine responded best to amitriptyline, whereas depressed subjects with severe migraine had little headache relief. Amitritryline is an effective antimigraine agent and the antimigraine effect seems relatively independent of antidepressant activity.


Biphasic periodic paralysis.

Biphasic periodic paralysis. A young man with episodes characteristic of familial normokalemic periodic paralysis was restudied after a change in the nature of his attacks. He now has spontaneously occurring and provokable episodes of both hyperkalemic and hypokalemic periodic paralyses that are superimposed on a persistent myopathy. Hypokalemia seems to be associated with facilitated entry of glucose and potassium into muscles, whereas resistance to glucose and potassium entry accompanies hyperkalemia. The possibility that episodes of both hypokalemic and hyperkalemic weaknesses can occur in one person should be considered in pathogenic postulates regarding periodic paralysis.


Asterixis in focal brain lesions.

Asterixis in focal brain lesions. Asterixis was observed in 20 cases of focal brain lesions. Metabolic or toxic factors were excluded. An electromyogram study of asterixis was carried out in nine cases to establish the diagnosis. The site of the focal lesion was either parietal or mesencephalic and was always contralateral to the asterixis. "Focal asterixis" could result from a dysfunction of the sensorimotor integration in the parietal lobe and the midbrain.


Quadriparesis and nuclear oculomotor palsy with total bilateral ptosis mimicking coma: a mesencephalic 'locked-in syndrome"? Upper lid and vertical eye movements are usually preserved in patients with the "locked-in" syndrome, a condition manifested by anarthria, spastic quadriparesis, and intact mental function, and caused by lesions in the ventral portion of the pons. We describe a presumed mesencephalic "locked-in" syndrome in a patient who had total bilateral ptosis at the onset of his disease and later on experienced complete bilateral oculomotor nerve paralysis.


Basal ganglia calcification in Kearns-Sayre syndrome. The Kearns-Sayre syndrome (KSS) appears to be a distinctive disorder characterized by progressive external ophthalmoplegia, pigmentary degeneration of the retina, heart block, and elevated CSF protein levels. Recent reports have suggested that abnormalities of muscle mitochondria may also be a consistent finding in KSS. We recently examined a patient with KSS whose skeletal muscle contained abnormal mitochondria. In addition, a computerized tomographic scan of the head showed cerebellar and brain stem atrophy, as well as calcification in the region of the basal ganglia.


Trial of baclofen in amyotrophic lateral sclerosis. A trial of the antispastic drug baclofen was made in amyotrophic lateral sclerosis. Some patients noted reduction of tonus and spasticity; but others had no benefit, nor was the course of the disease altered by long-term administration of baclofen. No major side effects occurred.


Primary glioblastoma of the pineal gland. A 68-year-old woman had Parinaud's syndrome, difficulty in walking, and dementia. A diagnosis of pineal tumor was based on clinical as well as arteriographic and computerized tomography findings. At operation, the tumor was found to be limited to the pineal gland. Histologically, it had the features of a classical glioblastoma.


Sciatic nerve entrapment by pentazocine-induced muscle fibrosis: a case report. A progressive bilateral sciatic neuropathy appeared in a 52-year-old man as an unusual complication of pentazocine-induced muscle fibrosis. Surgical neurolysis showed that the sciatic nerves were firmly compressed by large fibrous bands involving the entire gluteal musculature.


Cerebral mucormycosis: an unusual case.

Cerebral mucormycosis: an unusual case. A 36-year-old obese woman with hyperglycemia and immunosuppression died of bilateral internal carotid artery occlusion associated with mucormycosis. This report describes a rare case in which cerebral mucormycosis occurred without the usual preceding clinical evidence of nasal and orbital infection.


Brainstem auditory-evoked responses. Normal variation as a function of stimulus and subject characteristics. Brainstem auditory-evoked responses (BAERs) were elicited from 64 neurologically and audiometrically normal adults and 77 normal, full-term neonates with broadband rarefaction or condensation clicks at sensation levels (hearing levels in neonates) of 30 to 70 dB and at rates of ten and 80 clicks per second. In addition to the known effects of rate, previously unrecognized effects of acoustic phase and stimulus intensity on BAER interpeak latencies (IPLs), and an interaction of all three stimulus parameters, were found. Stimulus characteristics, age, and sex can account for much of the inter- and intrasubject variability of BAER IPLs and morphology. The BAER effects of many of these variables and their interactions have not been appreciated in clinical applications of BAER. Recognition and control of such reducible, methodological sources of BAER variability will enhance the sensitivity and specificity of the test in neurologic diagnosis.


Phenytoin and carbamazepine in production of cleft palates in mice. Comparison of teratogenic effects. The teratogenic activity of two anticonvulsant drugs, phenytoin sodium and carbamazepine, was studied in pregnant mice fed phenytoin and carbamazepine during days 8 to 13. Incidence of palatal defects and other abnormalities correlated with increasing dosages and blood levels of the drugs. Phenytoin produced a much higher incidence of teratogenic effects than carbamazepine.


Facial recognition in patients with focal brain lesions. The performances of patients with radiologically or surgically verified focal lesions on a test requiring the identification of unfamiliar faces were investigated. Nonaphasic patients with posterior right hemisphere lesions and aphasic patients with substantial impairment in language comprehension showed a notably high frequency of defect. The frequency of defective performance in nonaphasic patients with right anterior lesions was higher than normal but less than that of the previously mentioned groups. Nonaphasic patients with left hemisphere lesions and aphasic patients without substantial impairment in language comprehension performed on a level comparable with that of control subjects. It is concluded that the identification of unfamiliar faces is a bihemispheric process, possibly involving linguistic as well as visuoperceptive components.


Adult polysaccharidosis. Clinicopathological, ultrastructural, and biochemical features. An abnormal polysaccharide in the form of cytoplasmic spheroids was found in the nervous system and systemic organs of a man with a progressive neurological disorder characterized by onset at 47 years of age, severe weakness, sensory loss, and dementia. Results of biochemical analysis showed a marked increase in brain and heart polysaccharide that was resistant to digestion by a mixture of glucosidases and that exhibited an iodine-complex spectrum higher than that of normal glyocgen. Results of histochemical studies were consistent with the results of biochemical analysis and further defined the branching characteristics of the stored polysaccharide. Electron microscopy showed the cytoplasmic location of the spheroids, which were granular and filamentous.


Short latency somatosensory evoked potentials in patients with neurological lesions. Short latency somatosensory potentials following median nerve stimulation were recorded in patients grouped according to anatomic location of neurological lesion. Patients with cerebral lesions causing severe sensory deficit lacked a major positive wave of cortical origin that in normal subjects peaked at a mean latency of 20.5 ms. Patients with severe cervical spinal cord disease lacked all of the normal somatosensory response except for the earliest component attributed to peripheral nerve activity. Patients with brain-stem lesions showed delayed latencies of later waves and prolonged interwave latencies. However, auditory evoked potentials measured in the group with brain-stem lesions were more helpful in localization. Analysis of short latency somatosensory potentials can discriminate between peripheral nerve, spinal cord, brain-stem, and cerebral lesions. Further experience and refinement of technique of measurement should increase the value of this procedure.


Subacute sclerosing panencephalitis in only one of identical twins. A seven-year follow-up. We report a seven-year follow-up of identical twins, in one of whom subacute sclerosing panencephalitis (SSPE) developed. Primary measles infection occurred simultaneous in both twins at age 4. The affected twin sustained a grade 1 closed head injury within six months of her primary measles infection. At age 13, SSPE was diagnosed following the onset of personality change and myoclonic seizures. Measles antibody level was elevated in the serum and CSF. After remaining in stage 2 for five years, rapid mental and neurological deterioration occurred. Measles antibody level remained elevated, and oligoclonal IgG was present in both serum and CSF. Results of neurological examination as well as virological and immunological tests were normal in the unaffected twin. Besides the occurrence of head injury, factors known to be associated with SSPE were not obviously different in the twins. We have been unable to determine a difference that would easily explain the occurrence of SSPE in only one of two identical twins.


Myoclonus with electrocerebral silence in a patient receiving penicillin. Multifocal myoclonus is a well-recognized complication of high doses of penicillin. In man, the site of origin of penicillin-induced myoclonus has not been clearly established, but there is evidence from animal studies that it may originate at a cortical, subcoritcal, or spinal level. We report a case of multifocal myoclonus occurring in a patient receiving large doses of penicillin. The myoclonus appeared when there was no clinical or EEG evidence of upper brain stem or cerebral function. The observations reported suggest that penicillin-induced myoclonus may occur in man and may originate at a caudal brain stem or spinal level.


Bicycle ergometry and gas exchange measurements in neuromuscular diseases. Using bicycle ergometry with computerized respiratory gas exchange measurements, we compared exercise capacities in patients with various neuromuscular diseases to those in normal controls. As expected, male and female patients had significantly reduced maximum work capacities (kilopond-meters per minute per kilogram of body weight) and maximal oxygen consumptions. The oxygen cost of exercise was normal in the majority of patients, although some appeared to have abnormally high oxygen consumptions during exercise. Breathing patterns during exercise, particularly in regard to onset of hyperventilation, were similar in patients and controls.


Frequency-amplitude gradient: a new parameter for interpreting pediatric sleep EEGs. We describe an EEG pattern in pediatric sleep records, called the frequency-amplitude gradient (FAG). This pattern is a progressive decrement in voltage from occipital to frontal areas, with an accompanying decrease in slow frequencies in the same posterior-anterior direction. We report the results of examining 100 sleep records of children between birth and 10 years of age, with a review of the clinical diagnoses. There is a positive correlation between the severity of illness and the presence or absence of FAG. Furthermore, acute illnesses appear to be associated with the transient loss of the FAG, and with its return to normal with clinical recovery. The presence or absence of a FAG should be incorporated into the criteria for determining the normality of pediatric sleep EEGs.


Spongy degeneration of the CNS: an instance of the rare juvenile form. To our knowledge, the juvenile form of spongy degeneration of the CNS (SD-CNS); van Bogaert-Bertrand disease) has been described previously only three times. We report the case of 21 1/4-year-old Japanese woman who was first seen at the age of 11 with growth retardation, ptosis, and ophthalmoplegia. Her progressive neurodegenerative disease included retinitis pigmentosa, blindness, partial deafness, cerebellar dysfunction, hyporeflexia, and muscle wasting. Simultaneous endocrine defects were diabetes mellitus and probable hyperaldosteronism. Heart block developed later. She died of bronchopneumonia. Autopsy showed CNS stigmas typical of spongy degeneration. Additional findings included peripheral nerve demyelination, neurogenic muscle atrophy, pituitary and pancreatic atrophy, right adrenal agenesis, and a left adrenal coritcal lipid-cell adenoma. To our knowledge, our patient was the oldest survivor, the first patient of Japanese ancestry, and had a unique concurrence of certain oculoendocrine defects.


Periodic EEG activity in subcortical arteriosclerotic encephalopathy (Binswanger's type). Serial EEGs with early and progressive bilateral periodic activity were recorded from a patient with clinically "atypical" but pathologically confirmed subcoritcal arteriosclerotic encephalopathy (Binswanger's type). This disease should be considered as a diagnostic possibility when periodic EEG activity is encountered, particularly when dementia, hypertension, and focal neurologic signs coexist. At times, white matter lesions may contribute to the production of periodic EEG activity.


Chronic relapsing experimental allergic encephalomyelitis: clinicopathological comparison with multiple sclerosis. Clinical and neuropathological observations in chronic, relapsing experimental allergic encephalomyelitis (EAE) are reported and compared with data available for multiple sclerosis (MS). Clinical, relapsing EAE was found in 95 of 119 of the strain 13 and 22 of 57 of the Hartley guinea pigs immunized. Examination of the brains and spinal cords of the guinea pigs showed a high incidence of macroscopically visible, demyelinated plaques. The topographic distribution of lesions resembled a pattern similar to that described in MS. Microscopic features of the lesions consisted of perivenous inflammation, primary demyelination, oligodendrocyte loss, and reactive gliosis. It is concluded that, with the exception of minor differences, the clinical and pathological alterations in chronic, relapsing EAE closely resemble those found in MS.


Effect of physostigmine on constructional and memory tasks in Alzheimer's disease. We performed a double-blind study of the effect of physostigmine vs saline on the performance of memory and constructional tasks in a patient with probable Alzheimer's disease. On the days of physostigmine administration, a remarkable improvement in copying figures was observed. However, physostigmine administration had only a limited effect on memory performance. The results are interpreted in the context of recent biochemical studies of the brain in Alzheimer's disease, which suggest selective loss in the central cholinergic system.


Delayed hyperbaric treatment of cerebral air embolism: report of a case. A 23-year-old woman with Eisenmenger's complex had a cerebral air embolism with resultant severe neurologic impairment while undergoing phlebotomy for secondary polycythemia. She was treated with hyperbaric therapy 29 hours after the original accident with almost complete recovery of neurologic function.


Apraxic agraphia with neglect-induced paragraphia. Agraphia may result from the loss or unavailability of the memory of movements necessary to form written letters. For this mechanism to be invoked, it must first be demonstrated that there is no language deficit and that there is no disconnection between language and motor areas. A left-handed patient demonstrated bilateral agraphia and apraxia, but not aphasia, following a right parietal infarction. Preservation of the ability to type with the left hand demonstrated that the right hemisphere was not disconnected from language input. In addition, paragraphic errors while typing were shown to be secondary to left hemispatial neglect.


Unusual anomaly of the anterior cerebral artery: report of a case. The rare occurrence of a low intracavernous internal carotid bifuraction is reported. The anterior cerebral blood supply emanated from this source. Two separate aneurysms at the bifurcation of the anomalous single anterior cerebral artery were operated on one year apart.


Paralysis of divergence in an adult with aqueductal stenosis: case report. Paralysis of divergence was observed in an adult with membranous aqueductal stenosis. This association has not previously been reported, although the clinical syndrome of divergence paralysis has been described in several other neurologic disorders, which are reviewed. Recognition of the clinical syndrome of paralysis of divergence is important, since it may occur as an early sign of increased intracranial pressure and since it has been observed in several conditions that are amenable to treatment.


CNS listeriosis: rhomboencephalitis in a healthy, immunocompetent person. A previously healthy woman had a febrile illness resembling aseptic meningoencephalitis. With the exception of mild increase in both CSF pressure and protein concentration, initial findings were normal, including negative bacterial cultures. Bilateral pyramidal and cerebellar signs with multiple lower cranial nerve pareses developed over a 48-hour period beginning on the tenth hospital day. Repeated blood and CSF studies had previously been nondiagnostic, but at that time, cultures became positive for Listeria monocytogenes. No underlying systemic disease or immunodeficiency was discovered. With appropriate antibiotic and supportive therapy, she made slow but significant improvement and, by the time of discharge from the hospital, had only minimal residual neurologic deficit. Clinical aspects of CNS listeriosis including the rare pontomedullary involvement are discussed.


Massive spinal cord necrosis in schistosomiasis. Spinal cord lesions are rare in schistosomiasis. Schistosomal ova usually elicit a granulomatous myelitis in which necrotic foci are sometimes observed, but necrotic foci are sometimes observed, but extensive cord necrosis is exceptional. A 19-year-old Brazilian woman had transverse myelitis that ended fatally one month and a half thereafter. Autopsy disclosed a total myelonecrosis below T-4, and ova at Schistosoma mansoni were demonstrated in the necrotic cord tissue and leptomeniges. This is, to our knowledge, the most extensive necrosis of the spinal cord reported to date in schistosomiasis.


Continuous muscle fiber activity: a case with unusual clinical features. A patient with continuous muscle fiber activity is described. From our search of the literature, we believe this is the oldest patient with a reported case of this disorder, and the symptoms and treatment varied from previously reported cases in these respects: symptoms remained confined to the lower extremities after 18 months had elapsed, there was no response to phenytoin sodium or carbamazepine, and the patient required a full dose of tubocurarine chloride to stop the abnormal myoelectric potentials. A site of dysfunction in the unbranched motor axon is suggested as the locus of generation of the stimulus for the abnormal myoelectric activity.


Proliferative endotheliopathy with iris abnormalities. The iridocorneal endothelial syndrome. Sixteen cases of essential iris atrophy and two of iris nevus (Cogan-Reese) syndrome were reviewed retrospectively by light and electron microscopy. Varying degrees of corneal endothelial proliferation onto the trabecular meshwork and anterior iris were seen in all cases. The demonstration of an endothelial-abnormal basement membrane complex on the anterior iridic surface, deep to synechias in over half the cases, indicates that endothelialization may be primary, since it precedes the formation of anterior synechias. Pathologic and clinical evidence suggests that the iris nevus syndrome, Chandler's syndrome, and essential iris atrophy represent a continuum of clinical manifestations of a single disease process involving proliferation of the corneal endothelial and characteristic iris abnormalities; the latter may be secondary to variations in the pattern, rate, and extent of endothelial proliferation. We suggest the term "proliferative endotheliopathy" to emphasize the common pathogenetic role of corneal endothelial proliferation in all three entities (iris nevus syndrome, Chandler's syndrome, and essential iris atrophy). A more succinct alternate term is "the iridocorneal endothelial (ICE) syndrome."


Corneal decompensation in Chandler's syndrome. A scanning and transmission electron microscopic study. A corneal button obtained from a 58-year-old woman with Chandler's syndrome was studied by light and electron microscopy. Clinically, the patient had mild unilateral glaucoma, slight changes in the iris, endothelial dystrophy, and corneal edema that was increasingly sensitive to intraocular pressure. Corneal pathology included loss of large numbers of endothelial cells with consequent exposure of Descemet's membrane. Endothelial cells demonstrated irregular shape, partial loss of tight junctions, and increased numbers of cytoplasmic filaments. Some endothelial cells appeared metaplastic or perhaps were replaced by cells from some source other than the cornea. Proliferation of cells was not apparent. A thin layer of acellular tissue, containing long-spacing collagen and 15-nm-wide fibrils, was interposed between normal Descemet's membrane and the endothelium. These observations suggest a basis for the corneal edema that distinguishes Chandler's syndrome from other forms of essential iris atrophy.


Rieger's syndrome. A case report with a 15-year follow-up. A 15-year follow-up examination of a boy with Rieger's syndrome showed that the anterior segment changes in this disease may be slowly progressive in the absence of glaucoma or miotic treatment. The patient also had two recently recognized systemic features of the syndrome, umbilicus cutis and hypospadias.


Subretinal fibrosis in retinal detachment. In a series of 629 consecutive retinal detachments, 20 (3%) eyes had preoperative subretinal fibrosis without preretinal fibrosis. The incidence varied in a linear fashion with the duration of the detachment, varying from 0.8% in cases less than one month old to 22% in cases estimated to be more than two years old. Nineteen of the 20 detachments were anatomically cured by scleral buckling.