Benign hereditary nephritis.

Benign hereditary nephritis. The diagnosis, prognosis, and heredity of glomerulonephritis, in 207 members of one family over five generations was determined. No evidence of significant renal insufficiency or renal associated mortality was found. A history of urinary tract infections was obtained from 58 percent of those with hematuria. Several of those with nephritis also had high-frequency hearing losses. Two females with histories of urinary infections had elevated levels of serum creatinine. Many cases will probably be discovered if families are tested when a patient presents with benign recurrent hematuria with or without red blood cell casts. There may not be an obvious history of kidney disease or hematuria. Hereditary nephritis is not always a progressive renal disease.


Genetic aspects of manic-depressive disease in family practice. Bipolar affective disorder (manic-depressive disease) is a mental disturbance characterized by phases of both depression and mania. Mania is essential to the diagnosis and is characterized by elevated mood, flight of ideas, and increased psychomotor activity. Current psychiatric literature not only shows that this disease is familial but has also demonstrated, through linkage studies, that an X-linked dominant mode of inheritance adequately explains the strong prevalence of bipolar affective disorder in some families. The family discussed here shows many of the known clinical aspects of bipolar affective disorder. It serves as an example consistent with the X-linked dominant mode of inheritance. Knowledge of the genetic background of this disease aids the family physician by helping to identify members of the family likely to have acquired this condition. The family physician can then look for future problems in them and in their offspring, leading to earlier diagnosis and more effective management. Thus, a member of a  bipolar family with supposed unipolar illness (depression only) might be better served with the prophylactic use of lithium carbonate because of his likelihood of possessing a bipolar genotype. The prophylactic use of this drug has been shown effective in reducing the frequency, duration, and intensity of both manic and depressive mood swings.


Evaluation and management of suicidal behavior. The danger of suicide is highest in depressed older people, especially men who have sustained a loss, who have an attitude of hopelessness, and who have not resolved feelings of grief. Factors associated with greater risk are chronic or serious illness, divorced, separated or widowed marital status, white race, drug abuse, excessive use of alcohol, unemployment, and poor living conditions. Commonly, those who commit suicide have made previous attempts and have directly or indirectly communicated their intention to others. The family physician is in the front line in the recognition and prevention of suicide. In the treatment of the suicidal, the physician should maintain a strong positive relationship to the patient and be consistently dedicated to his care including availability to see the patient frequently and to receive phone calls in the middle of the night. Those with the most serious risk should be referred to a psychiatrist and hospitalized to protect them from their suicidal impulses. Psychotherapy, antidepressant and tranquilizer drugs, and electric shcok treatment are the main therapeutic approaches. The physician's capacity for empathy and emotional commitment is of greater importance than his professional credentials.


Practical aspects of prescribing drugs for ambulatory patients. One of the largest areas of concern in ambulatory medicine is the treatment of patients with drugs. This is of importance in short-term, acute processes and is especially vital in treating long-term, chronic problems. There are three primary areas of concern in treating ambulatory patients: dosage forms, compliance to the prescribed regimen, and the multiplicity of drugs. This paper discusses the proper use of the various dosage forms available: liquid, tablets, suppositories, and ointments. The physician should be knowledgeable about the drugs he uses and should take a rational approach to the selection and prescription of drugs in everyday practice.


Strategy for defining the clinical content of family medicine. The clinical content of family medicine is yet to be defined and arranged into a structured system of knowledge. To provide this systematic approach, it is suggested that a set of problem "profiles" could be identified as basic to family medicine, and binary decision and problem-solving chains identified for each. In addition, each problem profile might be expected to provide a consistent "masquerading" format for specific unusual problems. Certain "red flags" would be expected to be relevant to specific uncommon problems of medicine. A method of identifying these "masquerades" and "red flags" is proposed.


Effective use of patient resources: a training guide for family physicians. Effective use of resources available to patients in their homes, in their neighborhoods, and in their communities can give the family physician much assistance in the provision of total health care to his patients and their families. Patients' resources can be divided into two broad categories--"Personal" and "Institutional". Examples of the former are family, church, neighbors, unions, etc. Institutional resources can be public or private, and they cover a broad spectrum of services. Patients' needs for dignity and independence are best served by Personal resources. Institutional resources should be used only for those services that cannot be met any other way. Success in using any resource requires an orderly five-step process which is presented and discussed in this paper.


Behavioral science in family practice: an ethical imperative. Behavioral science confronts at least three major problems within American medicine that must be overcome if the family physician of the future is to receive an adequate graduate education and maintain his professional integrity. Through increasing specialization, the once unified biological perspective of man was severely fragmented, and with increasing emphasis on the science of medicine, the disease process was objectified and reified. Twentieth century man joined his myth of technological mastery with medicine's desire to eliminate pain and suffering. This gave rise to the idea that life could be medically managed and existential dilemmas anesthetized. To overcome these problems behavioral science has two ethical issues to address in family medicine. First, behavioral science must restore the physician's sense of personhood by recognizing the person of the physician as the primary diagnostic and therapeutic "tool" of family practice. Second, behavioral science must help family practice refocus its professional responsibility on the social problems of the day. This will happen through a critical review of the custodial aspects of the physician's role and an emphasis on role innovation. Approaches to these two ethical issues at the Medical University of South Carolina family practice residency are described.


The Teacher Interest Profile Registry of AAFP: implementation and effectiveness. In order to assist in the recruitment of physicians from practice into teaching during a period of rapid expansion in family practice education in the United States, the Division of Education of the American Academy of Family Physicians developed a computerized listing of members of the Academy who were interested in being contacted about available faculty positions. This computerized list, containing pertinent information about the professional qualifications of the registrants, became known as the Teacher Interest Profile Registry and was made available upon request to recruiting program administrators in 1974-1975. An evaluation of the utilization and effectiveness of the registry was conducted by staff of the Division of Education in the spring of 1975 by means of mailed questionnaries to the two groups utilizing the service: program administrators and physician-registrants. Results of these surveys revealed that one out of every eight programs using the registry was successful in recruiting one or more new faculty members, with a total of 27 new faculty reported as having been recruited through the use of this service. In view of the relative  success of this program in identifying potential faculty members and the continued interest and utilization of the service, academy leaders have decided to continue this service until it is no longer effective and/or needed.


Use of video tape in teaching psychological medicine. Video tapes have been used extensively in medical education and especially in training for family practice. This article describes the use of video-tape equipment in rural health centers at the Rockford School of Medicine, University of Illinois, College of Medicine. The video camera was incorporated into clinical transaction by having it operated by a psychiatrist-preceptor in the presence of the patient. This method makes available an intimate glimpse of the clinical situation, less disturbed by intrusive gadetry than has heretofore been possible. Patients seem mostly unaffected by the taping, so long as clinical personnal sanction it, and the function is firmly placed within the supportive bounds of the doctor-patient relationship.


The CR Alpha Diagnostic Coding System for ambulatory care. A three-digit code system for patient encounters in ambulatory care was constructed to meet the criteria of integrity, retrievability, flexibility, and acceptability. The system is distinguished from other comparable codes by the use of an alphabetical letter as a category designator, the provision of "open" areas within each category for the addition of new rubrics in appropriate sequence, and the availability of "open" categories for use in research or expansion. The system has the capacity to expand from 22 primary categories to 97 subheadings and to a maximum of 3,200 rubrics. The system uses both diagnostic and symptom-oriented rubrics. The diagnostic terms are adopted from the International Classification of Diseases, Adapted, Eighth Revision (ICDA-8) and the symptoms from the National Ambulatory Medical Care Survey Symptom Classification.


The female hysterical personality disorder. It is not uncommon in family practice for the family physician to encounter the female patient with a hysterical personality disorder. A case presentation and interview are provided to help the family physician recognize the problem. A formulation of this case stresses psychosexual development, which will provide the reader with insight that can be generalized to other patients. Major emphasis is given to practical guidelines for the clinician for management of this frequently difficult problem in a medical setting.


Tail regeneration in the plethodontid salamander, Plethodon cinereus: induced autotomy versus surgical amputation. Regeneration of the tail in the plethodontid salamander, Plethodon cinereus, occurs following either surgical amputation or induced autotomy. Autotomy may occur along any one of the caudal myosepta which form natural cleavage planes. The distally attached myofibers break away from the myoseptum which then becomes part of the stump surface remaining intact during subsequent regeneration of the distal segments. Under these conditions, therefore, muscle fibers do not normally participate in tail regeneration. If, however, the myofibers of a caudal myotome are interrupted as in mid-segment amputation, the damaged fibers undergo hyaline degeneration and are largely replaced by connective tissue often as far proximally as the next myoseptum. Other tissues at the amputation surface are concurrently engaged in the epimorphic regeneration of the tail, including myogenesis, though at a slower initial rate than that following autotomy. Muscle cells, therefore, appear not to participate in epimorphic tail regeneration in Plethodon cinereus following either surgical amputation or induced autotomy.


The nature and development of sex attractant specificity in cockroaches of the genus Periplaneta. IV. electrophysiological study of attractant specificity and its determination by juvenile hormone. The antennae of male Periplaneta americana acquire a large number of olfactory receptors at the adult stage. Electrophysiological methods (single unit and electroantennogram recording) show that a portion of the receptors added at the adult ecdysis are sex attractant receptors. Sex attractant receptors are not present in large numbers on larval and adult female antennae. The differentiation of pheromone receptors is inhibited during normal larval development by juvenile hormone. Topical application of juvenile hormone-mimic to male antennae during the terminal larval instar inhibits their development. Comparative electrophysiological studies indicate a high degree of cross-reactivity of the P. americana sex attractant among four other species within the genus Periplaneta.


Factors influencing ovulation in the Mexican axolotl as revealed by induced spawnings. Axolotl females may be induced to spawn by injecting them with small doses of FSH prior to mating. Data on the different categories of spawnings obtained by this procedure have established the following points. (1) Spawnings of injected females completely without fertile eggs are small (173 eggs average). Courtship occurred in some of the matings (spermatophores found) but not in all. Spawnings of injected but uninseminated females re-mated with a second (or third) male, not becoming inseminated, but all having some eggs fertilized by contact with spermatophores (showing courtship) are likewise small (219). It can be concluded that courtship of the injected female, even by two successive males, does not stimulate ovulation of additional eggs. (2) Insemination of injected females induced additional ovulation more or less frequently, depending upon whether the female was inseminated by the first, or a subsequent male with whom she was mated. Insemination by the first male, within 15 hours after the female had been injected with FSH, resulted in stimulation of ovulation in 36 of 54 spawnings (67%). The 36 spawnings averaged 593 eggs per spawning. In contrast, insemination by a second or third male, more than 15 hours after the female was injected with FSH, resulted in stimulation of additional ovulation in only 4 of 21 spawnings (19%). (3) Survival time of spermatozoa in inseminated females has been established. Considerable numbers of spermatozoa capable of fertilizing eggs survive for about one week. A few survive for 11 to 12 days, but none was found after 14 days.


A sexual aggregating pheromone system in the zebrafish, Brachydanio rerio (Hamilton-Buchanan). Zebrafish, Brachydanio rerio, when placed in a T-maze demonstrated preference for, or avoidance of, donor water produced when specified numbers of conspecifics of either sex were kept in holding systems for specific lengths of time. Inter- and intrasexual attractions were found to occur in different ranges of concentration of the attractant material(s). Insufficient or excessive concentrations of the attractant(s) failed to elicit the attractant response. The proposed pheromone attractant was shown to be removable from the aquatic environment. Its possible role in the behavioral aspects of schooling and spawning is discussed.


Ureotelism in the slug, Limax flavus Linné. The slug, Limax flavus, excretes both urea and purines. 1. Urea and purines account for up to 59 and 41% of the excretory nitrogen, respectively. 2. Of the purines excreted uric acid predominates (64%) with quanine (22%) and xanthine (14%) usually being voided in lesser amounts. Neither adenine or hypoxanthine was detected. 3. Urea was excreted in urine while the purines were deposited irregularly, as semi-solid, yellowish nubs.


Neurotrophic stimulation of DNA synthesis in the regenerating forelimb of the newt, Triturus. The effect of infusions of soluble newt brain extracts on deoxyribonucleic acid (DNA) synthesis in the denervated, regenerating newt blastema has been studied. When moderate early to early regenerates are denervated for 48 hours, DNA synthesis normally drops to about 40% of that found in contralateral, innervated blastemas. Infusion of brain extract halfway through the denervation period (at 24 hours) approximately doubles the rate of DNA synthesis in denervated regenerates.


Alterations in lipid composition of liver cell plasma membranes during development. Liver plasma membranes of Swiss-Webster CFW mice ranging in age from 5 to 165 days were isolated employing a two-phase dextran/polyethylene glycol polymer system. Electron microscopy revealed low mitochondrial and microsomal contamination. Lipids were quantitatively extracted and subjected to two dimensional thin layer chromatography. Individual lipids were eluted and phosphorus was measured by the Malachite green method. Cholesterol was quantitated by the micro Liberman-Burchard method and sphingolipids were quantitated fluorometrically with fluorescamine. During development, phosphatidylethanolamine levels decreased from 43.2% to 19.5% whereas phosphatidylcholine levels rose from 26% to 45.2%. The ration of phospholipid/cholesterol remained essentially constant during development; but the sphingolipid/cholesterol and sphingolipid/phospholipid ratios increased from 0.75 to 1.79 and 0.11 to 0.34, respectively.


Kinetic analysis of pancuronium interaction with sodium channels in squid axon membranes. The interaction of pancuronium with sodium channels was investigated in squid axons. Sodium current turns on normally but turns off more quickly than the control with pancuronium 0.1-1mM present internally; The sodium tail current associated with repolarization exhibits an initial hook and then decays more slowly than the control. Pancuronium induces inactivation after the sodium inactivation has been removed by internal perfusion of pronase. Such pancuronium-induced sodium inactivation follows a single exponential time course, suggesting first order kinetics which represents the interaction of the pancuronium molecule with the open sodium channel. The rate constant of association k with the binding site is independent of the membrane potential ranging from 0 to 80 mV, but increases with increasing internal concentration of pancuronium. However, the rate constant of dissociation l is independent of internal concentration of pancuronium but decreases with increasing the membrane potential. The voltage dependence of l is not affected by changine external sodium concentration, suggesting a current-independent conductance block, The steady-state block depends on the membrane potential, being more pronounced with increasing depolarization, and is accounted for in terms of the voltage dependence of l. A kinetic model, based on the experimental observations and the assumption on binding kinetics of pancuronium with the open sodium channel, successfully simulates many features of sodium current in the presence of pancuronium.


Responses of paranoid and nonparanoid schizophrenics in a dichotic listening task. Differences in attentional processes between normals, paranoid schizophrenics, and nonparanoid schizophrenics were studied by delivering dichotically presented digits for identification. Thirty paranoid schizophrenics (20 acute and 10 chronic), 30 nonparanoid schizophrenics (20 acute and 10 chronic), and 20 normal controls were tested. The data were analyzed in terms of the overall level of correct identification of stimuli presented to the two ears, the number of shifts in report from one ear to the other, and the magnitude of ear differences in recall. The results showed that overall level of performance was higher for the normals than for the schizophrenics; the number of ear shifts was greater for normals and nonparanoid than for paranoid schizophrenics; and ear differences were biggest for the paranoid schizophrenics and smallest for the normals. The results were interpreted in terms of differences in attentional style and rate of information processing.


A-B status and sex stereotyping among psychotherapists and patients. Toward a model for maximizing therapeutic potential. Previous studies indicate that mental health professionals, when evaluating the mental health of males and females, sex role stereotype to the disparagement of females. Some feminists have further assumed that male therapists in particular discourage self-actualization of females, and have argued that female patients should be seen by female therapists only. This study examined the major hypothesis that among both male and female therapists and among both male and female patients, there may be identifiable kinds of therapists and patients who sex role stereotype more than others. A total of 240 subjects (male and female) were recruited from three populations: professional psychotherapists, medical and nursing students, and psychiatric patients. Each subject was administered an A-B therapist scale and a sex role stereotyping questionnaire. Analysis of variance of this 3 x 2 x 3 factorial study revealed: a) patient groups stereotyped significantly more than professional therapist groups (p less than .01), with student groups stereotyping intermediately; b) within each major group, male subjects stereotyped significantly more than their female counterparts (p less than .01); and c) within each male group and within each female group, A status subjects stereotyped significantly more than B status subjects (p less than .01), with AB status subjects stereotyping intermediately. Previous research has indicated that A status psychotherapists are more effective in treating schizophrenic disorders, while B status therapists are more effective in treating neurotic disorders. Since our results reveal a strong relationship between A-B status and degree of stereotyping, our discussion explores the possibility of differentially matching psychotherapists and patients in order to maximize therapeutic potential. Matching could be done according to complementary differences between psychotherapist and patient (in terms of A-B status and sex role stereotyping) or according to similarities between psychotherapist and patient, depending on whether reconstructive or supportive therapy is the objective. Sex of patient and therapist as well as diagnosis of the patient are other variables considered in the model for maximizing the therapeutic potential.


Occult presenile dementia.

Occult presenile dementia. The medical records of 50 patients with a diagnosis of presenile dementia supported by radiological evidence of cerebral atrophy were examined for antecedent manifestations of depressive illness. Symptoms consistent with major affective disorder were present in one half and depressive spectrum diagnoses were made in one fourth of the cases prior to final diagnosis. A history of psychiatric treatment was common and was significantly more frequent in females than males, suggesting the possibility of sex-related bias. The findings demonstrate that presenile dementia is often occult, masked by superimposed symptoms and signs of depressive disorder.


Levodopa, parkinsonism, and recent memory. Much controversy has existed concerning behavioral changes attributed to L-dopa treatment in parkinsonian patients. Disagreement existed pertaining to the question of whether improved functioning was temporally limited. The present study proposed to research the shorter and longer range effects of L-dopa onmemory. It was hypothesized that equated nonparkinsonian individuals would perform better than parkinsonian patients on all memory measures, and that shorter range L-dopa would perform better than longer range L-dopa patients. It was also hypothesized that the greater the functional deficiency, and the greater the symptom severity, the poorer memory functioning would be. Level of dosage was hypothesized to have no differential effect on memory functioning. Three groups of 20 subjects were tested. The short term (20 parkinsonian patients on L-dopa for 22 months or less) and the long term (20 parkinsonian patients on L-dopa for 40 months or more) patients were chosen from the neurological clinic at St. Barnabas Hospital, Bronx, N.Y. Testability was assessed by the neurologis and by WAIS Vocabulary performance. The third group consisted of spouses of the patients. All groups were equated with regard to sex, age, education, and where applicable, length of illness, functional status, and symptom severity. The instruments used to measure memory consisted of the Guild Memory Test, the Memory Span for Objects, the Knox Cube, and the Tactile Memory Test. WAIS Vocabulary scaled score was used as a covariate in an analysis of covariance on each of the nine memory subtests. Statistically significant differences were obtained at the .01 level among groups on all measures. Orthogonal comparisons resulted in significant differences at the .01 level between parkinsonian patients and nonparkinsonian subjects on all measures. Short term and long term L-dopa patients differed significantly on six of the nine measures, notably those testing verbal types of memory. Significant correlations were obtained between functional deficiency and eight measures; however, symptom severity correlated with only one measure. None of the memory measures correlated significantly with level of dosage. The major conclusion was reached that all of the initial improvement shown following L-dopa initiation is not sustained permanently; the elevated level of memory functioning appears to be temporally limited.


Changes in schizophrenics' word association commonalities durigh hospitalization. Good premorbid (GP) schizophrenics have been found to have higher word association commonality scores than poor premorbid (PP) schizophrenics when both groups had been hospitalized over 5 years but not with shorter hospitalizations. There has been no previous study of changes in commonality in schizophrenics from beginning to end of hospitalization. The present study was a longitudinal investigation of word association commonality in GP and PP schizophrenics from admission to discharge from the hospital and at 3-month follow-up. Subjects were 16 GP and 16 PP schizophrenics. The two groups were equal in age, education, intelligence, and length of hospitalization. Commonality scores consisted of number of common responses to 50 Kent-Rosanoff stimulus words. GP and PP groups were not significantly different in commonality at admission, discharge, or follow-up. The combined groups showed a significant (p less than .01) increase in commonality from admission to discharge but no further change from discharge to follow-up. Taken separately, the GP group showed a significant increase in commonality from admission to discharge (p less than .02), while the PP difference was not statistically significant. The change in the GP group was significantly greater than in the PP group (p less than .05, one-tailed test). These results suggest that schizophrenics' word association commonalities may increase with improvement in clinical status and that GP schizophrenics show greater increases than PP schizophrenics.


Conversion reaction. Differential diagnoses in the light of biofeedback research. The criteria for differentiating between psychophysiological disorder and hysterical neurosis, conversion type, have been reviewed in the light of recent biofeedback research. The data strongly support the view that a single process, instrumental learning, can explain functional disorders mediated by either the voluntary or autonomic nervous systems, so that a differential diagnosis should probably not be based on the autonomic/voluntary dichotomy. On the contrary, both biofeedback findings and a case history support the definition of conversion reaction broadened to include fantasied bodily sensations that develop into either behavioral or physiological dysfunctions. It is a central consideration that instrumental learning depends on a system of rewards, and that, in clinical observations of conversion reactions, it also is apparent that the conversion sympton is rewarding: the sympton provides the patient with a relatively gratifying adaptation to a frustrating stressful life experience. Classification of many, if not most, functional disorders mediated by the autonomic nervous system as conversion reactions has the advantage of emphasizing the primary and secondary gain characteristics of these symptoms. Thus, the use that the patient makes of his illness becomes salient in the therapeutic process at the same time that the diagnosis is established.


Narcolepsy, paranoid psychosis, and tardive dyskinesia: a pharmacological dilemma. The case history of a 54-year-old man with concomitant narcolepsy, paranoid psychosis, and tardive dyskinesia is presented. These disorders may all result from alteration in catecholamines, serotonin, and/or acetylcholine in the central nervous system. The interactions of the various psychopharmacological agents usually used to treat the disorders when they occur separately are considered in terms of current neurotransmitter hypotheses. The management of this case creates a pharmacological dilemma; the agents used for treatment of each of the disorders separately exacerbate one or both of the other two syndromes.


Lateralisation of speech dominance by spectral analysis of evoked potentials. A computerised evoked potential test for the lateralisation of speech dominance was compared with the intracarotid sodium amylobarbitone test in 22 epileptic patients. Based on spectral analysis, the computer test correctly predicted the speech dominance of 15 of 16 left speech dominant and five of six right speech dominant patients. This non-invasive test is simple, quick, and innocuous and can be easily implemented on a small laboratory computer.


Reciprocal continuous inhibition in rigidity of Parkinsonism. A reciprocal continuous inhibition by flexor on extensor muscles was proved during Parkinsonian rigidity. Extensor motoneurone excitability was tested by Hoffmann's reflex and flexor activity was altered by lidocaine anaesthesia of the peroneal nerve (PN). During PN anaesthetic block, a gradual increase of Hoffmann's reflex was noted. It was statistically significant at the 15th minute after lidocaine injection, and was maximum at the 30th minute. The reciprocal inhibition was considerable in 16 patients with Parkinsonism, as recorded before treatment. In normal subjects, it was small and non-significant. After one month's treatment with L-dopa at the usual therapeutic dose, this reciprocal inhibition greatly decreased in the same patients. The origin of this reciprocal continuous inhibition is discussed.


A short essay on posture and movement.

A short essay on posture and movement. Certain statements concerning the relation of posture and movement which have become traditional are re-examined--in particular, the statement 'Movement (that is, pysiological movement) consists of a series of postures. The theme of the essay is the posture--that is, postural activity--should be regarded as a function in its own right and not merely as a component of movement and, secondly, that expressions such as a' series of postures' or 'a change of posture' are not valid as definitions of physiological movement is general, but describe only movement which is part of the postural function. Voluntary movement consists of much more than a series of postures and its significance, ordinarily, is not postural.


C0-contraction and stretch reflexes in spasticity during treatment with baclofen. Surface electromyograms were recorded from the quadriceps and hamstring muscles of 11 spastic patients during cyclical flexion and extension movements of the knee. A potentiometer strapped to the knee recorded the angle of the joint, the output signal being displayed on an oscilloscope. The patient used this signal to track a sine wave target for 20 cycles. The observer then moved the patient's limb through a further 20 cycles tracking the same target. Recordings were repeated at intervals for four hours after an oral dose of baclofen. Analysis of the recordings showed that the response of a spastic muscle to lengthening is not the same during passive movement as during voluntary movement. In mild spasticity stretch reflexes appear to be suppressed by voluntary effort whereas in severe spasticity they are enhanced. Baclofen suppressed the response to passive stretch by over 30% at plasma concentrations of over 250 ng/ml and by 50% at concentrations of over 400 ng/ml, but this effect was largely extinguised during voluntary movement.


Altered peripheral nerve function resulting from haemodialysis. The amplitudes of muscle and nerve action potentials evoked median nerve stimulation were recorded just before and immediately after haemodialysis. These revealed a growht of action potential amplitude during dialysis. It is suggested that some component of the defective peripheral nerve function that inevitably accompanies uraemia is temporarily improved during dialysis.


Abnormalities in sensory and mixed evoked potentials in ataxia-telangiectasia. Electromography, motor, sensory and mixed nerve conduction velocity, and H reflex were studied in four patients with ataxia-telangiectasia. The earliest and most striking electrophysiologial finding was the reduced amplitude of evoked nerve potentials. In the oldest patient, findings suggestive of spinal atrophy and mild reduction of the motor and sensory nerve conduction velocities were found. Reduced amplitude in the evoked nerve potentials can be observed without clinical evidence of peripheral neuropathy. Electrophysiological abnormalities are more severe in older than in young patients. Sural nerve biopsy in one patient showed mild changes: loss of the largest myelinated fibres and demyelination of some fibres. The ratio between maximum conduction velocity of the sural nerve and the diameter of the largest fibres was in the lower limits of the normal range. The resemblance between electrophysiological abnormalities in Friedreich's ataxia and ataxia-telangiectasia is discussed.


Palinopsia.

Palinopsia. Three cases of palinopsia (visual perseveration) are described. In case, evidence pointed to a lesion in the right occipitotemporal region. Pathological findings are reported in one of the three. Previous reports have stressed the importance of posteriorly placed cerebral lesions, more commonly right sided than left, but have not demonstrated more precise localisation within the hemisphere.


Blink reflexes and the state of arousal. Blink reflexes were studied in 40 subjects at rest and during the performance of a task. The early reflex (R1) showed an increase of amplitude of action potential during the task, the late reflex (R2) did not. The latency of R1 did not change within the 45 minutes test period; R2 showed an increase of latency during task. R1 showed a systematic decrease in amplitude within rest and task periods, presumably because of habituation. R2 amplitudes decreased throughout the whole experiment, independent of task or rest.


Safety of carotid ligation and its role in the management of intracranial aneurysms. By using measurements of cerebral blood flow and internal carotid artery pressure it is possible to select patients in whom carotid ligation can be performed with a very low risk of post-operative cerebral ischaemia. A study has been carried out in 100 patients comparing this method with clinical predictions of the type used in aneurysm surgery based on age of the patient, arterial hypertension, time from latest subarachnoid haemorrhage, and neurological status on a modified Botterell scale. These clinical factors were found to be of little value in predicting which patients would and would not develop cerebral ischaemia after carotid occlusion.


Syndrome of normal pressure hydrocephalus: possible relation to hypertensive and arteriosclerotic vasculopathy. A patient with clinical features of idiopathic normal pressure hydrocephalus, who responded dramatically to shunting, was found a necropsy to have a severe hypertensive and arteriosclerotic vasculopathy with multiple lacunar infarcts. There was no pathological evidence of thickened leptomeninges, fibrosis of the arachnoid villi, or Alzheimer's disease. An abnormal absorption mechanism was demonstrated with cisternography and by an increase in the concentration of homovanillic acid in the cerebrospinal fluid. It is suggested that vascular changes may play an important role in the pathophysiology in some cases of normal pressure hydrocephalus.


Three cases of communication syringomyelia secondary to midbrain gliomas. Three cases of midbrain gliomas are descrbied clinically and pathologically. In each case high pressure symptoms were followed by visual disturbance and the onset of syringomyelia symptoms before death. All the patients had hydrocephalus. In one case with concomitant syringobulbia, the syrinx appeared to due to CSF communicating with the cord cavity through the tissues of the brain stem. In the other cases the communication between the CSF pathways and the syrinx was at the usual site, through the central canal at the obex.


Transient ischaemic attacks and increased platelet aggregability associated with oral contraceptives. Treatment with dipyridamole and aspirin. A 24-year old woman after using birth control pills for two months began to suffer from frequent migraine-like attacks, which turned eventually into typical transient ischaemic attacks (TIAs). A significant increase in spontaneous platelet aggregation was found, and combined treatment with dipridamole and aspirin was started. After two months of treatment spontaneous platelet aggregation rate fell to normal limits and TIAs disappeared. A causal relationship between increased platelet aggregability and TIAs is supposed.


EEG features associated with the occurrence of epilepsy after surgery for intracranial aneurysm and acoustic neuroma. An investigation was carried out on 199 postoperative EEGs from 83 patients who underwent surgery for ruptured intracranial aneurysm or acoustic neuroma removal. The tracings were quantified without knowlege of the diagnostic group and whether or not epilepsy had supervened. The number of spikes and sharp components and slow waves at the site of the operative brain lesion were substantially and often significantly greater in the tracings from patients who developed epilepsy than from those who did not.


HLA (SD and LD) in patients with amyotrophic lateral sclerosis (ALS). Twenty-five patients with a definite diagnosis of amyotrophic lateral sclerosis (ALS) were HLA-typed for the serologically detectable antigens A, B and C and MLC-typed for 7 HLA-D-determinants. No significant deviation was found neither in the A, B, and C-series nor in the HLA-D-series as compared to normal controls. The aetiological problem of ALS is discussed.


F-wave studies on the deep peroneal nerve. Part 1. Control subjects. An electrophysiological method is described for estimating the conduction velocity in the proximal segments (anterior horn cells to the knee) of the motor fibres of the deep peroneal nerve. The method utilizes large numbers of F-waves which are late muscle responses due to antidromically activated motoneurones. The results in 58 healthy subjects are presented. A detailed literature review concerning the nature of F-wave is presented.


F-wave studies on the deep peroneal nerve. Part 2.--1. Chronic renal failure 2. Limb-girdle muscular dystrophy. The F-wave has been used for estimations of motor nerve conduction velocity (MNCV) along the proximal segment (anterior horn cells to the knee) of the axons of the deep peroneal nerve in patients with renal failure and limb-girdle muscular dystrophy. MNCV and terminal latencies with conventional methods have also been estimated. Patients with chronic renal failure show marked F-chronodispersion (i.e. F-wave temporal dispersion) and impaired conduction along proximal and distal segments of the deep peroneal nerve. There is no evidence of motor nerve impairment, with conventional and F-wave methods, in patients with limb-girdle muscular dystrophy. It is shown that F-wave measurements are useful in electrophysiological studies of patients and may be more sensitive than conventional MNCV methods.


Suppression of acute and chronic experimental allergic encephalomyelitis in Strain 13 guinea pigs. A clinical and pathological study. Adult inbred Strain 13 guinea pigs develop an acute, fatal form of experimental allergic encephalomyelitis (EAE) about 2 weeks after a single injection of isologous spinal cord in complete Freund's adjuvant (CFA), but similarly injected juveniles develop a delayed, rarely fatal chronic form. Thirty-seven sensitised adult Strain 13 animals were separated into 2 groups. One group was permitted to develop acute EAE. The other group was injected intramuscularly with 1 mg of guinea pig or bovine myelin basic protein (MBP) in incomplete Freund's adjuvant (IFA) on day 2, 7 or 10 post-inoculation (PI) followed by 0.2 mg in IFA every third day for a total of 10 doses. Animals in the unsuppressed group succumbed to acute EAE 13-16 days post-sensitisation. No animal in the suppressed group died during this period. Animals treated with MBP beginning 2 days PI showed no clinical signs, but mild clinical manifestations occurred in animals suppressed from days 7 and 10 PI. These signs remitted by 21 days post-sensitisation. One suppressed animal (out of 21) died during the fourth week postsensitisation. The other 20 suppressed animals appeared clinically normal towards the end of the course of MBP injections and remained so for the 6 months of study. Morphological examination revealed that CNS lesions occurred in all animals. In animals suppressed with MBP beginning on day 2 PI, lesions consisted only of a few meningeal inflammatory cells. Animals given MBP beginning on day 7 or 10 PI and sampled 1-2 weeks later, had lesions which could not be distinguished from those occurring in the non-suppressed acute EAE group. In time, the suppressed animals developed lesions which were typical of chronic EAE with remyelination as a predominant feature. Preliminary experiments on the suppression of chronic EAE in 5 juvenile Strain 13 guinea pigs have revealed that 3 MBP-injected animals failed to develop clinical disease over a 28-week period of study although lesions typical of chronic EAE were present. Simultaneously, 2 non-suppressed juvenile animals developed clinical signs by 12 weeks. These were associated with both acute inflammation and demyelination superimposed upon regions of chronic demyelinative activity.


Correlation of single fibre EMG and muscle histochrmistry using an open biopsy recording technique. Single fibre electromyographic (SFEMG) recordings were carried out during open muscle biopsy. Nine patients were studied, including 5 with Duchenne muscular dystrophy, 2 with spinal muscular atrophy and 1 each with limb-girdle dystrophy and myotonic dystrophy. Correlations were possible between the SFEMG fibre density determinations and histochemical evidence of grouping in some biopsies, particularly involving Type I fibres. This combined technique permits an improved assessment of the functional state of abnormal muscle.


The exclusion of L-isoleucine or of L-leucine from the brain of the rat, caused by raised levels of L-valine in the circulation, and the manner in which this exclusion can be partially overcome. The amino acids L-isoleucine, L-leucine and L-valine appear to compete for a shared transport carrier for entry into the brain of the living rat, since high concentrations of L-valine in the plasma reduced the influx both of L-isoleucine and of L-leucine into the brain to 10-15% of the normal. The exclusion of L-isoleucine or of L-leucine from the brain by a raised level of L-valine in the circulation can be partially overcome by simultaneously raising the concentration of L-isoleucine or of L-leucine in the circulation. These results indicate the important role played by a saturable shared carrier-mediated transport system in ensuring that an adequate supply of these amino acids reaches the brain from the circulation during life. The bearing of our findings on two inborn errors of amino acid metabolism, maple-syrup-urine disease and hypervalinaemia, is discussed.


Effect of a synthetic polypeptide (COP 1) on patients with multiple sclerosis and with acute disseminated encephalomeylitis. Preliminary report. Three patients with acute disseminated encephalomyelitis (ADE) and 4 patients in the terminal stages of multiple sclerosis (MS) were subjected to treatment with Cop 1, a synthetic copolymer of amino acids, which had previously been shown to have a beneficial effect in the treatment of experimental allergic encephalomyelitis (EAE). Under the treatment, the ADE patients recovered completely within 3 weeks, but 1 of 2 control cases treated with steroids showed complete recovery as well. The MS patients did not show any significant change in their motor function; however, 2 of them showed some improvement in vision and speech capacity. It is too early to conclude whether this improvement is related to the treatment. No side effect was observed in any of the patients treated with Cop. 1.


Topographic organization and convergence in corticotectal projections from areas 17, 18, and 19 in the cat. 1. Electrical stimulation in areas 17, 18 and 19 of the cat's visual cortex activated neurons in the superficial gray layer of the superior colliculus. The threshold for such excitation was lowest when the receptive fields of cells at the stimulus site lay inside the receptive field of the collicular cell under observation. 2. A substantial percentage of the recorded collicular cells received convergent excitatory input from more than one of the stimulated cortical areas. When stimuli could be applied in parts of areas 17, 18, and 19 related retinotopically to a collicular cell, over half of the units were activated from all three cortical areas by low-intensity stimulation. 3. Cells located near one another in the colliculus received excitatory cortical input from regions of areas 17, 18, and 19 which were not identical in size. This may be attributable to the disparate dimensions of collicular dendritic fields, which permit neighboring cells to sample dissimilar regions of the topographically organized cortical input. It is argued that this projection system preserves the functional unity of cortical and tectal cell groups processing information from a given retinal point.


Relationship between Müller cell responses, a local transretinal potential, and potassium flux. 1. In the Necturus retina, light-evoked field potentials, Müller (glial) cell responses, and extracellular potassium ion concentration ([K+]0) were recorded and found to exhibit the three-way correlation characteristic of these variables elsewhere in the nervous system. 2. Müller cell responses to a flashed spot or annulus consist primarily of slow depolarizations at both light onset and offset. The responses are maximum to 0.5-mm-diameter spots and decrease with larger diameters. Responses to stimulus intensity and flicker were also used to characterize Müller cell behavior. 3. In response to long-duration stimuli, the initial Müller cell depolarization is followed by a very slow hyperpolarization, which is likely the origin of slow PIII. 4. A new extracellular potential is described, the M-wave, the basic properties of which suggest that it is generated by Müller cells. Moreover, the M-wave and Müller cells show remarkably similar behavior to a wide variety of stimulus parameters. 5. In the proximal retina, [K+]0 increases at both light onset and offset with a time course similar to that of Müller cell depolarizing responses. This K+ increase also behaves similarly to the Müller cell depolarization in response to changes in stimulus parameters. 6. It is concluded that light stimulation leads to an increase in [K+]0 in the proximal retina and that this increase depolarizes Müller cells whose associated currents, in turn, generate the M-wave.


Discrimination of orientation and position disparities by binocularly activated neurons in cat straite cortex. 1. We have examined and compared the ability of binocularly activated striate neurons to make both position disparity and orientation disparity discrimination in the anesthetized (N2O/O2) and paralyzed cat preparation. 2. Accurate knowledge of eye position is essential for disparity studies. Using a retinal projection technique able to detect eye drifts of less than 3' arc per retinal landmark and less than 18' arc cyclorotation disparity, we determined eye drift during the course of 2- to 4-day experiments. After the initial eye rotation due to the anesthesia and the onset of paralysis (see below), rotational drift thereafter was mainly excyclorotatory and, from all causes, rarely totaled more than 4 degrees disparity. All our data have been corrected for this residual cyclorotatory drift. 3. Optimal stimulus orientation disparities were determined from quantitative monocular orientation tuning curves for 74 binocularly activated striate cells (37 simple, 3 hypercomplex I, 31 complex, 3 hypercomplex II) from nine cats. Without exception, the mean optimal stimulus orientation disparity in each of our animals showed a departure from zero disparity equivalent to an incyclorotation of the eyes (mean, 9.2 degrees; range, 2.7 degrees-15.9 degrees). 4. We attribute this mean optimal stimulus orientation disparity shift to ocular cyclorotation as a result of the initial anesthesia and paralysis. Assuming equal intortion, incyclorotation for each eye averages 4.6 degrees. On the assumption that the mean optimal stimulus orientation disparity is zero in normal life, we pooled results from the nine animals about their individual means. For the 74 cells the resulting distribution of the optimal stimulus orientation disparities had a range of about +/-15 degrees (simple cells: SD 4.9 degrees; complex cells: SD 7.4 degrees). 5. We examined the relationship of the sharpness of the orientation tuning curves to ocular dominance, to absolute orientation preference, and to other unit properties. The striking observation was the high correlation between the sharpness of orientation tuning curves for the two eyes of a binocular neuron. For simple cells the mean difference for the half-widths of half-height was only 2.54 degrees, with sharpness showing a high correlation between the two eyes (r=0.915) over half-width at half-heights ranging from 8.5 degrees to 41.8 degrees. Complex cells showed a similar, albeit weaker, correlation. 6. Having shown that, assessed monocularly binocular units show different orientation tunings in the two eyes, we undertook binocular experiments to ascertain if these differences were the optimal disparities of sharply tuned stimulus orientation disparity channels. Using a matrix stimulation paradigm to minimize the effects of spontaneous changes in responsiveness, we have simultaneously extracted bionocular stimulus orientation disparity and position disparity tuning curves from single striate neurons...


Role of pontine tegmentum for locomotor control in mesencephalic cat. 1. An attempt has been made to elucidate how direct stimulation of the mesencephalic locomotor region (MLR, with Horsley-Clarke coordinates P2, L4, and H0) is transmitted through the pons to the spinal cord where a stepping generator is presumed to exist. 2. A longitudinal strip, termed the "pontine locomotor region" (PLR), was identified. It extends ventrocaudally throughout the lateral pontine tegmentum (P3-P9, L4 and about 2 mm beneath the floor of the IVth ventricle). 3. Stimulation of this locomotor strip at P4-5 and P8-9 levels generated hindlimb stepping or four-legged locomotion on a treadmill similar to that elicited by MLR stimulation. However, "PLR stepping" was more often accompanied by spasticity of the hindlimbs. Stimulation of the pontine strip at the P6-7 level produced stepping accompanied by an opening of the mouth. 4. Subthreshold MLR stimulation together with subthreshold PLR stimulation generated locomotion. Ipsilateral and contralateral MLR-PLR stimulations were of equal effectiveness for the generation of locomotion. 5. Stimulation of rostral (P3-6), but not caudal (P6-9), parts of the PLR evoked field potentials in the MLR with two negative components. The points at which these potentials were evoked with minimum current were usually coincident with the best points for eliciting locomotion. Short-latency monophasic negative potentials were evoked in the rostral part of the PLR by MLR stimulation. 6. Locomotion elicited by stimulation of either the MLR or the PLR was suppressed by stimulation within a midpontine region, 1.5-2.0 mm beneath the floor of the IVth ventricle (P6-7, L0-0.5, H-5 to -6). Stimulation applied to the close vicinity of this "inhibitory" region did not evoke field potentials in the MLR. 7. In some animals stimulation between the inhibitory region and the underlying PLR could facilitate locomotion elicited by MLR stimulation, although no stepping was produced by such stimulation alone.


Functional organization of lateral cell groups of cat superior olivary complex. 1. Single-unit discharges to auditory stimuli were recorded extracellularly from superior olivary complex (SOC) units located lateral to the medial superior olive. Stimuli consisted of monaurally or binaurally presented tone bursts. The response measures obtained were effective ear, nature of effect, stimulus-frequency representation, maximum output, latency of response, and temporal pattern of tone burst-elicited discharges. Electrolytic marks were made at the unit studied or at the end of the electrode tract and in the medial superior olive. Following each experiment the locations of the units studied were determined histologically. An atlas of the laterally located SOC cell groups was developed to permit classification of units on the basis of localization within cell groups. Units were also classified according to the effects of stimulating the two ears. 2. All SOC units located lateral to the medial superior olive were excited by stimulation of the ipsilateral ear. Stimulation of the contralateral ear either excited, inhibited, had no effect, or had a potentiating effect on the discharges elicited by stimulating the ipsilateral ear. 3. Most lateral superior olivary (LSO) units were inhibited by contralateral stimulation, were narrowly tuned, produced low to high levels of maximum output, had short latencies, and produced regular discharge patterns characterized by chopper PST histograms with narrow initial peaks. 4. Most units within the caudal margins of the LSO (pLSO) were not affected or were inhibited by a contralateral stimulus; many were broadly tuned and exhibited intensity functions with large dynamic range and low slope. These units also had long latencies and produced chopper PST histograms with wide initial peaks. 5. Most units located dorsal to the LSO (DPO and DLPO) were not affected by the contralateral stimulus, were narrowly tuned, produced moderate levels of maximum discharge, had long latencies, and produced chopper PST histograms with wide initial peaks. 6. Units located ventral to the LSO appeared to have response characteristics related to unit location. Most units below the ventral hilum of the LSO (VLPO) were inhibited by the contralateral stimulus and many were broadly tuned VLPO units produced wide or poorly defined narrow-chopper discharge patterns and intensity functions with high maximum output. Most units located ventral to the lateral loop of the LSO (LNTB) were not affected by the contralateral stimulus and had response characteristics that may be related to the rostrocaudal location of the unit. 7. The cell groups located dorsal and ventral to the LSO were tonotopically organized with low-frequency-sensitive units located laterally and high-frequency-sensitive units located medially. The units located along the caudal margins of the LSO had a tonotopic organization similar to that of the LSO.


Interconnections of identified multiaction interneurons in buccal ganglia of Aplysia. 1. The 26 identified neurons of Aplysia buccal ganglia include 4 interneurons and their follower cells. Each interneuron makes cholinergic synaptic connections on eight identified ipsilateral follower neurons. Each interneuronal action potential also produces a zero-latency, Mg-intensitive electrotonic coupling potential in one cholinergic and electrotonic input from the interneurons. Electrotonic connections are bidirectional and nonrectifying. 2. Ipsilateral pairs of interneurons receive extensive common synaptic input from several unidentified neurons: each interneuron also receives some input not received by the other. These pairs are linked by bidirectional nonrectifying electronic coupling which is insensitive to high Mg. As a consequence of this organization, ipsilateral interneuron pairs can fire a) independently, or b) synchronously, or c) one active interneuron can depolarize the other. 3. Each follower receiving synaptic input from one ipsilateral interneuron also receives similar input from the other interneuron. Common follower cells thus receive a) asynchronous PSPs, or b) large summated PSPs, or c) an increased number of PSPs from each interneuron. The latter two modes constitute feed-forward summation of interneuronal action. 4. Interneuronal output is confined to ipsilateral neurons. Symmetric pairs of interneurons are coordinated by common inputs and are not directly interconnected by either chemical or electrotonic synapses. Synchrony of firing of symmetric pairs is, therefore, looser than that of ipsilateral pairs.


Visual receptive-field properties of single neurons in cat's ventral lateral geniculate nucleus. 1. Visual receptive-field characteristics were determined for 154 cells in the ventral lateral geniculate nucleus (VLG) of cats anesthetized with nitrous oxide. All cells were verified histologically to be within the VLG. Responses of 182 cells from laminae A and A1 of the dorsal lateral geniculate nucleus (DLG) were tested for comparison. 2. The VLG cells could be grouped into one of seven classes according to their responses to light stimulation. Twenty-seven percent of the cells had uniform receptive fields. They responded maximally to stationary stimuli flashed on or off anywhere within the receptive field and showed no evidence for antagonistic surround mechanisms. About 19.5% of the VLG cells had concentric receptive fields. They were similar to the uniform type, with the addition of a concentric inhibitory surround. Eight percent of the VLG cells had ambient receptive fields. These cells were characterized by an unusually regular maintained discharge which varied in rate in relation to the level of receptive-field illumination or of full-field ambient illumination. About 4% of the VLG cells were movement sensitive. They gave little or no response to stationary stimuli flashed on or off in the receptive field, and responded best to a contour moving across the receptive field in any direction. An additional 2.5% of the VLG cells were direction sensitive. Their response was dependent on the direction of stimulus movement through the receptive field. Sixteen percent of the VLG cells had indefinite receptive fields. They responded to whole-eye illumination or to localized visual-field stimulation; however, specific receptive-field properties could not be adequately defined. Approximately 23% of the VLG cells studied gave no convincing response to visual stimulation. 3. Responses of DLG cells agreed with those reported in previous studies. Almost all (97%) had concentric receptive fields, and a few (3%) had uniform receptive fields with no apparent antagonistic surround. None of the DLG cells had receptive fields like those in the other classes found for VLG cells. 4. The VLG cells tended to have large receptive fields; mean diameter was 10.6 degrees of visual arc. This was substantially larger than the diameter of receptive fields for DLG cells. In addition, VLG cells generally required larger stimuli than DLG cells to respond. There was no consistent relationship between receptive-field size and visual-field eccentricity for VLG cells, in contrast to the DLG. Most (57%) VLG cells were driven only by the contralateral eye, 30% were binocularly driven, and 13% were driven only by the ipsilateral eye. 5. A systematic visuotopic organization was present in the VLG. The lower visual field was represented anteriorly in the nucleus and the upper visual field posteriorly. The vertical meridian was represented along the dorsomedial border of the VLG where it abuts the DLG, and the temporal periphery was represented ventrolaterally. 6. Responses to electrical stimulation of the optic chiasm were studied for 55 VLG cells...


Familial intracranial aneurysms and cerebral vascular anomalies. The author reports a family in which four members had intracranial aneurysms and one additional member was suspect. One member had multiple aneurysms that were successfully treated surgically. Elective angiography on five asymptomatic members of the family disclosed asymptomatic aneurysms in two. In addition, cerebrovascular anomalies were found in many of the family members. The parents of the family were consanguineous. High incidence of these associated anomalies and consanguinity in the parents tend to suggest the hereditary basis of the disease. Banding analysis of chromosomes in three siblings with aneurysms and three siblings without aneurysms was carried out. Elective investigation of the asymptomatic members should be considered where there are already two or more affected in a family. The indications for surgical prophylaxis on asymptomatic aneurysms in other members of the family are discussed.


Aneurysmal tumors of the basifrontal region. The authors report the cases of three men who presented for evaluation of a rapidly progressing dementia. All were found to have a giant aneurysmal mass in the basifrontal region, and all were successfully treated by surgical excision of the mass. The presenting syndrome included rapidly progressive and severe loss of recent memory associated with confusion, chronic headache, wide-based staggering gait disturbance, urinary urgency, frequency, and incontinence, and a fine tremor of the hands exacerbated by purposeful movements. The clinical presentation, radiological assessment, and surgical treatment are discussed.


Effects of subarachnoid hemorrhage on cerebral blood volume, blood flow, and oxygen utilization in humans. Forty-five studies of regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), and regional cerebral oxygen utilization (rCMRO2) were performed in 30 patients undergoing diagnostic cerebral angiography for evaluation of a subarachnoid hemorrhage due to a ruptured intracranial aneurysm. Tracer methods employing radioactive oxygen-15 were used to measure rCBV, rCBF, and rCMRO2. The patient studies were divided into groups based on their neurological status and the presence or absence of cerebral vasospasm. Subarachnoid hemorrhage, with and without vasospasm, produced significant decreases in CBF and CMRO2. In general, patients with more severe neurological deficits, and patients with more severe degrees of vasospasm, had a more marked depression of CBF and CMRO2. The most striking finding was a significant (p less than 0.001) increase in CBV (to 58% above normal) in patients with severe neurological deficits associated with severe cerebral vasospasm. This large increase suggests that cerebral vasospasm consists of constriction of the large, radiographically visible extraparenchymal vessels accompained by a massive dilation of intraparenchymal vessels.


Pathogenetic role of no-reflow phenomenon in experimental subarachnoid hemorrhage in dogs. The real pathogenetic role of no-reflow phenomenon in clinical situations such as the acute stage of subarachnoid hemorrhage (SAH) is not yet known. To study this problem, we carried out the following experiment in dogs: SAH was induced by withdrawing a needle previously inserted into the internal carotid artery through a small craniectomy in the lateral base of the skull. Complete dural repair and cranioplasty was done to avoid cerebrospinal fluid leakage. Cortical cerebral blood flow (CBF) changes, measured by a double-needle type thermocouple, intracranial pressure (ICP), electroencephalogram (EEG), and sensory evoked response were monitored under controlled ventilation of 3 hours after SAH. At the end of the experiment, the brain was perfused with carbon black solution at a pressure of 120mm Hg. The 32 episodes of SAH thus induced yielded two basic patterns of ICP changes which simulated those previously reported with human SAH. In the first pattern, reactive hyperemia was always observed, followed by complete or incomplete recovery of cerebral function. Perfusion defects were frequently seen in the thalamus, basal ganglia, and parietooccipital cortex symmetrically. In the second pattern, prolonged elevation of ICP resulted in failure of recovery of both CBF and EEG. Carbon black filled only the pial arteries and the rest of the brain was totally unperfused. From the results, the pathogenetic role of the no-flow phenomenon in the acute stage of SAH as influencing the prognosis is strongly suspected.


Hospital-acquired bacterial meningitis in neurosurgical patients. The authors review 23 cases of hospital-acquired meningitis occurring over a 15 year period in neurosurgical patients. Factors associated with the development of meningitis include recent craniotomy, cerebrospinal fluid leak, the presence of ventricular or lumbar drainage tubes, and skull fracture. Four cases were caused by Staphylococcus epidermidis; one of these patients died. In 19 cases, Gram-negative enteric bacteria were the etiologic agents, most commonly members of the Klebsiella-Enterobacter-Serratia group. Eleven of these patients died. The particular antibiotic or group of antibiotics used and the route of administration made no difference in the outcome of Gram-negative bacillary meningitis.


Use of microfibrillar collagen as a topical hemostatic agent in brain tissue. Microfibrillar collagen, a recently introduced topical hemostatic agent, was used to obtain hemostasis in suction-evacuation lesions of canine cortex. Gelatin foam was used as a control in identical lesions on the opposite side. Microfibrillar collagen was found to be faster acting and more effective than gelatin foam. Histological evaluation of the lesions at 2,4, and 6 months postoperatively showed no significant difference in the amount or type of tissue reaction to the two agents.


Delayed paralysis after cervical fracture-dislocation. Case report. The authors describe the late development of ascending damage to the spinal cord after a cervicothoracic fracture-dislocation that produced no evidence of cord or nerve injury other than transient mild paresthesia in the arms. After 16 years, progressive quadriplegia developed with subsequent ascending dissociated sensory loss in the upper cervical dermatomes. The presence of a central syrinx was verified at operation 18 years after the injury.


Intracranial and extracranial neurogenic hamartoma. A case of neurogenic hamartoma involving the middle cranial fossa, nasopharynx, and left anterior cervical region and presenting at birth as an obstructive oropharyngeal mass is described. Special management included Gelfoam embolization of the vascular supply, control of airway and feeding, assessment of biological activity of the mass, and appropriate staging of the procedure with neurosurgical, head and neck surgical, and radiological support.


Visual loss from optochiasmatic arachnoiditis after tuberculous meningitis. Case report. While recovering from tuberculous meningitis, a 5-year-old boy developed a profound visual deficit because of optochiasmatic arachnoiditis. Following microneurosurgical decompression of the optic nerves and chiasm, prompt visual recovery occurred.


Transsphenoidal chiasmapexy for correction of posthypophysectomy traction syndrome of optic chiasm. Case report. Postoperative improvement occurred as a result of transsphenoidal chiasmapexy in a patient with posthypophysectomy visual loss. Traction injury of the optic chiasm may have been caused by a deficient diaphragma sellae and inadequate packing and repair of the sella floor. A cartilaginous seal is recommended.


Aspergillus infection complicating trassphenoidal yttrium-90 pituitary implant. Report of two cases. Diagnosis proved difficult in two cases of Aspergillus infection complicating yttrium-90 ablation of the pituitary. This serious complication occurs rarely. Whatever the initial organism obtained from cases with meningitis of late onset, Aspergillus infection should be considered and cerebrospinal fluid should be cultured for fungi.


Excision of multiple intracranial metastatic hypernephroma. Report of a case with a 7-year survival. The authors report a case of cerebral and cerebellar metastatic renal carcinoma with 7-year survival without present evidence of recurrence following excision of both intracranial lesions and the primary lesion (by radical nephrectomy).


Traumatic lumbosacral meningocele. Case report. A case of traumatic avulsion of the L-5 and S-1 nerve roots is described. Surgical intervention was undertaken and long-term functional recovery obtained.


Posttraumatic hematoma beneath the epineurium of a branch of the median nerve. Case report. A very rare case of a posttraumatic hematoma, localized beneath the epineurium of a branch of the median nerve, is described and a probable mechanism of its development if given. Full recovery of nerve function followed surgery.


Microsurgical anatomy of the upper basilar artery and the posterior circle of Willis. The microvascular anatomy of the posterior part of the circle of Willis, important in surgery of pituitary tumors and basilar aneurysms, was defined in 50 cadaver brains. Significant findings were as follows: 1) Anomalies of the posterior half of the circle of Willis were found in 46% of cases. 2) Hypoplastic P-1 (posterior cerebral segment) and posterior communicating segments gave origin to the same number and size of perforating arteries, having the same termination as normal-sized segments. Thus hypoplastic segments should be handled with care and divided to aid in exposure of the basilar bifurcation only after careful consideration. 3) An average of four perforating branches arose from P-1; most from the superior and posterior sufaces. No branches arose from the anterior surface of the basilar bifurcation. The most proximal P-1 branch originated 2 to 3 mm distal to the basilar bifurcation. It was most commonly a thalamoperforating artery. The largest P-1 branch was usually a thalamoperforating  or a posterior choroidal artery. 4) An average of seven branches emerged from the superior and lateral surfaces of the posterior communicating artery. The anterior half was a richer source of perforators than the posterior half. The largest communicating branch in 80% of specimens supplied the premamillary area. 5) The anterior choroidal artery originated from the carotid artery on both sides in all cases. A double anterior choroidal artery was present in 4% of cases.


Early surgical treatment for hypertensive intracerebral hemorrhage. The authors review 38 cases of hypertensive intracerebral hemorrhage operated on within 7 hours after the apoplectic attack. Microsurgical technique was used for hemostasis and evacuation of the hematoma. At the 6-month follow-up study, 34 patients could walk unaided or with a cane, one was confined in bed, and three had died.


Intracranial hypertension in patients with ruptured intracranial aneurysm. Simultaneous continuous recording of intracranial pressure (ICP) and systemic blood pressure was carried out in 26 patients admitted within 1 week after subarachnoid hemorrhage (SAH) due to a ruptured intracranial aneurysm. The patients were graded as described by Hunt and Hess. Recordings were made for 1 to 5 days. The more impaired the consciousness, the higher the rate of ICP. In Grade III, IV, and V patients, the mean ICP level was in the range of 15 to 40 mm Hg, 30 to 75 mm Hg, and exceeded 75 mm Hg, respectively. A definite correlation between vasospasm shown by cerebral arteriogram and the clinical grade was not observed. In our series of ICP recordings, we never observed a typical plateau wave. The variations of ICP seen in Grade III and IV patients were the B- and C-waves (15 to 45 mm Hg in amplitude) described by Lundberg, and those in Grade V patients were the high amplitude monotonous waves synchronous with the arterial pulses (15 to 40 mm Hg in amplitude). These phenomena may indicate that Grade III and IV patients with SAH are in a condition of cerebral vasomotor instability, and Grade V patients have cerebral vasomotor paralysis.


Microsurgical technique in the treatment of intracranial aneurysms. A consecutive series of 137 patients with cerebral aneurysms operated on with microsurgical techniques is presented. Occlusion of the aneurysm was performed in 133 patients. Good results were obtained in 85.5% of the entire series and in 92.6% of the patients who were in satisfactory condition preoperatively. The overall mortality rate was 5.8%, and 3.7% for the patients in satisfactory condition. The preoperative and operative factors that influenced the results are discussed.


On the origin and nature of the pituitary gland capsule. Observations under the operating microscope confirming the presence of a pituitary capsule are reported. This capsule envelops the anterior lobe of the pituitary, the neurohypophysis, and the pituitary stalk. It merges along the stalk with the intracranial pia mater. The origin and nature of this capsule are discussed in light of the known facts of development of the pituitary gland and surrounding structures. It is concluded that the pituitary gland capsule is a derivative of the primitive pia mater.


Pituitary abscesses. Report of seven cases and review of the literature. Seven cases of pituitary abscess are presented and the relevant world literature is reviewed. An enlarged sella co-existing with bacterial meningitis, or bacterial meningitis coinciding with a known or suspected pituitary tumor should suggest the diagnosis of pituitary abscess. Visual field defects should evoke similar suspicion when present in a patient with meningitis. This reasoning enabled us to make the first reported preoperative diagnosis of pituitary abscess. Therefore, in the management of purulent meningitis, we recommend the following: first, skull films are mandatory; second if the sella turcica is abnormal, the correct presumptive diagnosis is pituitary abscess; and third, if prompt improvement does not follow appropriate antibiotic therapy, the suspected abscess should be explored and drained via the transsphenoidal approach.


Terminal ventriculostomy for syringomyelia. The clinical course of 12 patients who underwent terminal ventriculostomy for syringomyelia is presented. Opening the central canal at the tip of the conus medullaris is a relatively benign procedure that improves the symptoms of syringomyelia and syringobulbia. This canal normally terminates at the tip of the conus, but in each of the 12 surgical specimens it continued into the filum terminale for distances up to 8 cm. In most cases the tip of the conus was located more caudally than normal, indicating some degree of tethering in fetal life. This belief is supported by the fact that the newborn, whose conus is tethered to a lipoma at the sacral level, may develop syringomyelia in adult life.


Posterior partial rootlet section in the treatment of spasticity. Twenty-six patients were operated on using a techinal modification of Förster's method of treating spasticity, which consists of a partial section of the roolets constituting the posterior roots. Many patients had mild cerebral spastic quadriplegia or spastic diplegia: several of them were nearly independent when standing or walking, and two of them completely independent. The spastic disorders that were not made worse by voluntary movements were reduced or abolished in all but one patient, in whom rootlet section was insufficient. The spastic disorders that were made worse by voluntary movements were only partially reduced; after operation they were scarcely evident or absent in a static position, but evident during voluntary movements. No improvement was observed in one patient who suffered from spastic disorders that were evident only during voluntary movements, or in one patient suffering from dystonia. The procedure caused no sensory disorders. The operation was especially useful in patients who were acquiring or had already acquired independence when standing or walking.


Hemorrhage from a previously undemonstrated intracranial aneurysm as a late complication of carotid artery ligation. Case report. A case is reported in which the patient underwent ligation of the common carotid artery as treatment for a ruptured intracranial aneurysm. Nine years later a second subarachnoid hemorrhage occurred form a new or previously undemonstrated intracranial aneurysm. Recannulation of the ligated carotid artery was demonstrated by arteriography. Similar cases are cited from the literature.


Intracanalicular meningioma with normal tomography. Case report. A middle-aged woman presented with the typical symptoms and signs of a compressive optic nerve lesion. Plain skull films, tomography of the optic canals, and selective angiography with magnification and subtraction were normal. Computerized transaxial tomography clearly showed the tumor, which was a meningioma of the optic nerve sheath. At surgery the tumor was found within the optic canal with intracranial and orbital extensions. It was strictly intradural and did not involve the surrounding bone at any point. This case documents the fact that an intracanalicular meningioma may be associated with normal tomograms of the optic canal.


Traumatic atlantooccipital dislocation. Case report. A case of traumatic atlantooccipital dislocation is presented and the literature reviewed. This type of traumatic dislocation is probably produced by violent hyperextension of the upper cervical spine. Cranial nerve injuries and spinal cord injuries are common. Early fusion is recommended.


"Bicycle test" of van Gelderen in diagnosis of intermittent cauda equina compression syndrome. Case report. The authors describe a simple clinical adjunct to the routine neurological examination of patients with intermittent cauda equina compression syndrome. The "bicycle test" helps exclude intermittent claudication due to vascular insufficiency and frequently confirms the relationship of posture to radicular pain.


Skull tumor simulating sinus pericranii. Case report. A case of skull tumor simulating sinus pericranii is presented. The tumor was situated in the occiput near the midline and it was thought to satisfy the diagnostic criteria of sinus pericranii. At operation the tumor proved to be eosinophilic granuloma with intratumorous hemorrhage associated with epidural hematoma.


Abnormal movements with hydrocephalus. Case report. The author reports the case of a pituitary dwarf with choreoathetoid movement of the tongue and both arms as results of a shunt malfunction. He had undergone craniotomy for excision of a suprasellar craniopharyngioma, and 13 years later complete cerebral angiography and Conray ventriculography showed massive hydrocephalus with no evidence of tumor recurrence. Revision of the shunt was followed by complete recovery of the movement disorder.


Agenesis of the left internal carotid artery associated with an aneurysm on the right carotid syphon. Case report. A case is reported with congenital absence of the left internal carotid artery associated with an aneurysm on the contralateral carotid syphon. Eight similar cases are reviewed in brief. The possibility of hemodynamic abnormality as the cause of the aneurysm is discussed.


Traumatic arteriovenous fistula of the vertebral artery with spinal cord symptoms. Case report. The authors report a case of a traumatic vertebral arteriovenous fistula with spinal cord symptoms. Direct closure of the fistula was followed by rapid improvement.


Nontraumatic assessment of left ventricular wall motion and regional stroke volume after myocardial infarction. The regional contraction patterns of the left ventricle, shortly after myocardial infarction, were assessed from computer-processed scintigraphic images and histograms of the first transit of an intravenously injected radionuclide bolus. Seventy-seven patients with documented myocardial infarction were injected with a compact bolus of 99mTc-pertechnetate which was coordinated with the ECG so that it arrived in the superior vena cava during diastole. Precordial activity during the initial passage was recorded in 50-msec intervals with a multicrystal scintillation camera interfaced to a dedicated minicomputer. Data frames of 4-7 cardiac cycles were summed into one representative cardiac cycle. In 73 of the 77 patients the images of the representative cycle, along with the corresponding time-activity curves, indicated wall-motion and stroke-volume anomalies corresponding with the electrocardiographic location of the infarct. This nontraumatic, essentially noninvasive technique permits serial examinations of the acutely ill patient for the spatial identification and estimation of suspected myocardial infarcts.


Comparative accumulation of 99mTc and 131I in thyroid nodules: case report. Imaging was performed with both pertechnetate and 131I in 58 patients with thyroid nodules. Pertechnetate concentrated in all 12 follicular carcinomas, in two out of seven papillary carcinomas, and in some benign nodules that did not accumulate 131I in the 24-hr images.


Positive (99mTc) diphosphonate and 67 Ga-citrate scans in ameloblastoma: case report. Technetium-99m-diphosphonate scintigrams and 67Ga citrate bone scans were performed in a patient with known ameloblastoma of the right mandible. The tumor concentrated both radionuclides avidly. The lesion was larger on the gallium scans, presumably due to inflammation of adjacent soft tissue and to poorer instrument resolution for 67Ga than for technitium. If a single radionuclide is to be selected for evaluating the extent of tumor in ameloblastoma, the bone-imaging agent is preferable.


99mTc-thiomalic acid complex: a nonstannous chelate for renal scanning. Thiomalic acid (monomercaptosuccinic acid) has been labeled with 99mTc without the use of an intermediary reducing agent. Tissue distribution studies in rats following the injection of 99mTc-tagged thiomalic acid (99mTc-TMA) showed 40-48% of the injected dose in the kidneys. Renal incorporation of this compound was influenced by various parameters such a pH, quantity of thiomalic acid, heating time, and the preparation-injection interval. Scintigrams of a midline kidney slice showed that the 99mTc activity concentrated mainly in the renal cortex. As a proposed renal-imaging agent 99mTc-TMA compared favorably with 99mTc-Sn-dimercaptosuccinate and 99mTc-penicillamine regarding the precent incorporation into the kidney and was superior in this respect to 99mTc-Sn-glucoheptonate and 99mTc-Sn-diethylenetriamine pentaacetic acid. The 99mTc-TMA was also shown to be highly stable through 24 hr. The reagent can be made available in kit form and is easily combined with 99mTc in two steps. Finally, the absence of stannous ion in the 99mTc-TMA complex should avoid the problem of interference with other procedures involving pertechnetate 99mTco4- as the imaging agent.


Estrogen derivatives for the external localization of estrogen-dependent malignancy. Four radioiodinated estrogen derivatives were studied to determine their affinity for the estrogen-binding protein found in the cytosol of rabbit and rat uteri. In vitro determination of the binding properties by competitive-binding experiments and by sucrose-gradient centrifugation indicates that one of the derivatives, iodohexestrol, binds to the cytosol estrogen-binding protein. This in vitro behavior was related to in vivo distribution. Studies in immature female rats showed high uterine uptake of iodohexestrol at 2 hr (1.69% dose/gm). Iodohexestrol also has a high nonspecific binding in both the blood and the uterine cytosol. Thyroxine can diminish the nonspecific binding in vitro; in vivo the prior injection of thyroxine increased the 2-hr uterus-to-blood ratio from 1.9 to 10.4 The in vitro receptor-assay system was helpful in predicting in vivo distribution.


Biochemistry of metalocenes. I. Distribution of 59Fe or 103Ru-labeled metalocene carboxylic acid in mice. Metalocene carboxylic acids labeled with 59Fe or 103Ru were administered to mice and the organ distributions and amounts of label excreted were determined. Both metalocenes were excreted approximately 90 times faster than the respective inorganic chlorides 59FeCl3 or 103RuCl3. The metalocenes showed an extremely high kidney-to-muscle ratio (up to 1,000). 99mTc-labeled renal agents, tested for comparison, showed lower ratios. Retention of radioactivity in blood and the presence of free iron in urine indicate that the ferrocene derivative is degraded in vivo, but the ruthenocene analog is not.


Radionuclide emission computed tomography of the head with 99mCc and a scintillation camera. To investigate the potential application of radionuclide computed tomography (RCT) to nuclear medicine imaging using 99mTc, a tomographic system using a lightweight scintillation camera for brain imaging was constructed, and lesion contrast with RCT and conventional scintigraphy were compared. The detector revolves once around the patient's head at constant angular velocity, requiring approximately 20 min. Nine sections are reconstructed from the data, using either a Fourier transform or a filtered back-projection algorithm. In a phantom simulating the radionuclide distribution observed during brain imaging, quantitative lesion contrast was far superior in the RCT images. In a series of 25 patients with intracranial lesions, the average RCT lesion contrast was superior to that of standard scintigraphy by a factor of more than 2. An RCT image of an experimentally infarcted dog's heart, taken after the injection of 99mTc-MAA into the left atrium, also showed excellent correspondence to the gross anatomic defect. Although problems of photon absorption may occur in imaging larger body areas, RCT imaging in this feasibility study produced surprisingly good results that warrant further investigation of the technique.


The Humongotron--a scintillation-camera transaxial tomograph. An emission transaxial tomographic system using a scintillation camera as the detector is described. The unit allows accurate positioning of a scintillation camera's detector at any angle around a patient in order to obtain the multiple projection images needed for transaxial tomography, and it is capable of imaging any area of the body. The camera can also be used for all types of conventional imaging procedures. Image processing is performed by a small on-line computer. A convolution algorithm and a mathematical technique for approximate absorption correction are used to obtain high-resolution and high-contrast images with good quantitative accuracy. The operation of the system is described and representative phantom and patient studies are presented to illustrate the capabilities of the system.


A radiometric microbiologic method for vitamin B12 assay. A radiometric microbiologic method was developed for assaying vitamin B12 in human serum. In the presence of 14C-arginine and cyanocobalamin, Lactobacillus leichmannii produced significant amounts of 14CO2 within 16-20 hr. The amount of 14CO2 evolved was optimized with the use of guanido-labeled arginine and is proportional to the amount of cyanoco-balamin added. The method gave satisfactory recovery of added vitamin B12 to sera, and it gave values comparable to the standard microbiologic (turbidimetric) method using L. leichmannii. The radiometric microbiologic method allowed elimination of several steps considered essential in the standard microbiologic methods: (A) Extraction of vitamin B12 bound to serum proteins could be accomplished in one autoclaving step with the assay medium at 15 psi for 3-5 min; (B) The precipitated serum proteins did not need to be separated, since they do not interfere with this assay,


Effects of excess dietary l-methionine and N-acetyl-l-methionine on growing rats. We have determined the effects of excessive dietary intakes of L-methionine and N-acetyl-L-methionine by measuring parameters which are known to be affected by excess methionine. Male Sprague-Dawley weanling rats were fed complete diets containing 10% protein supplied as isolated soybean protein and graded levels of supplemental L-methionine (from 0.30% to 5.0%) or equimolar levels of N-acetyl-L-methionine. The basal diet without supplemental methionine contained 0.15% methionine. Rats fed diets containing 0.3% supplemental L-methionine or the equivalent levels of supplemental N-acetyl-L-methionine grew best. Higher dietary levels of either L-methionine or N-acetyl-L-methionine caused progressive decreases in weight gain. However, L-methionine at 1.8% and above tended to more severely depress growth than did equivalent amounts of N-acetyl-L-methionine. L-Methionine at levels of 1.2% and above, or equivalent levels of N-acetyl-L-methionine caused comparable hypertrophy of the spleen and comparable increases in spleen iron levels. Hematocrits were not affected by either L-methionine or N-acetyl-L-methionine at the levels used in this experiment. We have concluded that N-acetyl-L-methionine is no more detrimental than L-methionine and is less detrimental at very high levels as evidenced by weight gain.


Osmotic and peroxidative fragilities of erythrocytes from vitamin E-deficient lead-poisoned rats. Weanling male rats were fed either a vitamin E-deficient Torula yeast diet fortified with selenium or the same diet supplemented with 100 ppm vitamin E. One group of rats fed each diet received plain distilled water, whereas another group received 250 ppm lead as lead acetate in the drinking water. After a 3 month feeding period, erythrocyte osmotic and peroxidative fragilities were determined in an osmotic test recorder. Dietary vitamin E had little or no effect on the osmotic fragility of red cells. Lead in the drinking water, however, decreased the osmotic fragility of red cells from deficient rats. Lead poisoning also markedly decreased the elevated peroxidative fragility characteristic of erythrocytes from vitamin E-deficient rats. This effect of lead in reducing the peroxidative fragility of red cells from deficient rats could be seen at levels as low as 25 ppm lead in the drinking water. Lead added in vitro decreased the peroxidative fragility of red cells from vitamin E-deficient non-poisoned rats, whereas neither mercury nor cadmium had such an effect. Lead may decrease the osmotic and peroxidative fragility of erythrocytes from vitamin E-deficient rats by "tanning" the red cell membrane. These results suggest that the peroxidative fagility test as carried out with an osmotic test recorder may not be a valid indicator of the vitamin E status of animals exposed to lead.


Comparative effects of selenium and vitamin E in lead-poisoned rats. Weanling male rats were fed a Torula yeast diet supplemented with selenium, vitamin E, or both for 3 months. Of rats fed each diet, one group received 250 ppm lead in the drinking water and another group did not. In rats not poisoned with lead, neither vitamin E nor selenium deficiency affected spleen weight, hematocrit value, or erythrocyte mechanical fragility. Vitamin E deficiency increased the splenomegaly, anemia, and mechanical fragility of red cells of lead-poisoned rats, whereas selenium deficiency did not. Addition of 0.5 ppm selenium to the vitamin E-supplemented diet increased slightly the splenomegaly and anemia in lead-poisoned rats. Excess levels of selenium (2.5 and 5 ppm) in the vitamin E-deficient diet had little or no effect on spleen size or hematocrit of rats not receiving lead, but partially prevented the splenomegaly and anemia of red cells from either non-poisoned or lead-oisoned vitamin E-deficient rats, but not as effectively as vitamin E. These results show that vitamin E status of rats is more important that selenium status in determining response to toxic levels of lead. Excess dietary selenium did protect partially against lead poisoning in vitamin E-deficient rats, but the levels of selenium used were toxic in themselves.


Fasting-induced hypoglycemia in experimentally malnourished rats. The ability to withstand a fasting stress as related to glucose homeostasis was studied in malnourished rats. Young male Wistar rats were fed a low-protein (D), or a low-protein, low-energy diet (M) containing, respectively, 4% protein with 70% carbohydrate (D) and 4% protein and 45% carbohydrate (M). They were compared with rats fed a control diet with 18% protein and 70% carbohydrate (C). All diets contained 8% fat. After consuming the respective diets for 4 weeks, the rats were either killed or fasted for 24 or 48 hours. Hypoglycemia developed in the malnourished rats upon fasting, but not in those receiving a complete diet. Malnourished rats had a higher blood glycine level after 4 weeks of dietary treatment. There was a marked decrease of circulating alanine and glutamate-glutamine after 48 hours of fasting in all rats. There were no differences in lysine, histidine, glycine and serine-valine. Protein malnutrition produced an increase in brain lysine, gamma-aminobutyric acid, glycine and alanine, and of glycine and alanine in liver. In contrast, D and M rats showed a depletion in muscle lysine, alanine, serine-valine and glutamate-glutamine. The fasting stress produced no changes in brain or muscle glycogen. However, liver glycogen of rats fed the D and M diets was below that of rats fed the C diet for 4 weeks. In addition, after 48 hours of fasting the C rats mobilized more exhaustively their glycogen stores that the M rats. These data suggest that in chronic malnutrition, rats may maintain their glucose homeostasis by mobilization of muscular gluconeogenic amino acids through proteolysis or de novo synthesis. Rats which were fed protein and protein-energy-deficient diets lacked adequate liver glycogen stores and their overall gluconeogenic capacity was exceeded during fasting with resultant hypoglycemia.


Influence of diet on lactate, alanine and serine turnover and incorporation into glucose in the dog. Four diets containing 0 to 62% of energy from carbohydrate and 24% to 48% of energy from protein were fed to young dogs. The influence of these diets on the turnover of [U-14C]-L-lactate, [U-14C]-L-alanine and [U-14C]-L-serine and on the incorporation of these gluconeogenic precursors into plasma glucose of the dog was established. Blood lactate levels were lowered when high-protein diets were fed but were not influenced by the level of carbohydrate in the diet or by a 48-hour fast. Plasma alanine and serine levels were elevated in dogs fed the high-protein diets and were lowered by a 48-hour fast. Turnover of lactate was increased in dogs fed high-carbohydrate diets whereas turnover of alanine and serine was increased in dogs fed the high-protein diets. Following a 48-hour fast, 14C-lactate conversion to plasma glucose was lower in dogs fed the high-protein diets than in dogs fed the lower protein diets whereas 14C-alanine and 14C-serine conversion to plasma glucose was increased in dogs fed the high-protein. Thus, the diet consumed altered the relative importance of these gluconeogenic precursors to the maintenance of plasma glucose.


Nitrogen retention of young men who consumed isonitrogenous diets containing normal, opaque-2 or sugary-2 opaque-2 corn. Three isogenic lines of corn provided two levels of nitrogen for young men, but the diets were isonitrogenous at 5.5 g. Mean daily nitrogen balances were -0.28 +/- 0.34, +0.31 +/- 0.23 and 0.40 +/- 0.08 g, respectively, when normal, opaque-2 and sugary-2 opaque-2 corn furnished 5.5 g of nitrogen; and -0.07 +/- 0.17, +0.38 +/- 0.21 and -0.04 +/- 0.25 g when corn supplied only 4.4 g of nitrogen. Although these values were not significantly different, both high-lysine varieties tended to be superior to normal corn at 5.5 g of nitrogen and opaque-2 corn caused improvement even at 4.4 g of nitrogen. Lysine and tryptophan were higher and leucine lower in both opaque-2 and sugary-2 opaque-2 than in normal corn. Coefficients of apparent digestibility were between 65.5% and 68.8%.


Effect of different postnatal periods of protein-energy malnutrition in young rats upon subsequent protein utilization. Previously it had been shown that rat pups, malnourished during the 3-week suckling period and the nutritionally rehabilitated for about 30 weeks, showed an increase in the efficiency of dietary protein utilization of the protein was fed at a less than optimal level and if the protein was of poor nutritional quality (J. Nutr. 103, 273, 1973). The present study extends this observation to growing rats malnourished during the first 3 weeks of life and then rehabilitated with a 25% casein diet for 4 weeks. The test proteins were casein, fed at a level of 12%, and wheat gluten, at a level of 25%. Efficiency of nitrogen retention was greater for both proteins in rats previously malnourished than for control, non-malnourished rats. Malnutrition was then imposed on rats malnourished by feeding a low protein diet either during the first 4 weeks postweaning or from the 7th to 11th week of life. After these periods of malnourishment, the rats were rehabilitated for 4 weeks and efficiency of utilization measured for both casein and wheat gluten fed at 10% of the diet. No change in utilization was found for either protein fed to rats rehabilitated from either of these periods of malnutrition.