Kinetic characteristics of the excitability-inducing material channel in oxidized cholesterol and brain lipid bilayer membranes. The kinetic characteristics of the opening and closing of the excitability-inducing material (EIM) channel in oxidized cholesterol and in brain lipid bilayers are compared. The kinetics of the opening and closing of individual ion-conducting channels in bilayers doped with small amounts of EIM are determined from discrete fluctuations in ionic current. The kinetics for approach to steady-state conductance are determined for lipid bilayers containing many channels. Steady-state and kinetic characteristics for the EIM channel incorporated in brain lipid bilayers can be accounted for by the model developed for the EIM channel incorporated in oxidized cholesterol membranes. Relaxation time, calculated from rate constants of single-channel membranes or directly measured in many-channel membranes is strongly temperature dependent, and is always shorter in brain lipid membranes. Changes in temperature do not affect the interaction of the electric field and the open channel, but the open configuration of the EIM channel in brain lipid bilayers is stablized with increasing temperature. The configurational energy difference between the open and closed channel, calculated from temperature studies, is larger in brain lipid bilayers. The energy barrier which separates the two configurations of the channel is larger in oxidized cholesterol bilayers.


Effect of diameter on membrane capacity and conductance of sheep cardiac Purkinje fibers. Membrane electrical properties were measured in sheep cardiac Purkinje fibers, having diameters ranging from 50 to 300 mum. Both membrane capacitance and conductance per unit area of apparent fiber surface varied fourfold over this range. Membrane time constant, and capacitance per unit apparent surface area calculated from the foot of the action potential were independent of fiber diameter, having average values of 18.8 +/- 0.7 ms, and 3.4 +/- 0.25 muF/cm2, respectively (mean +/- SEM). The conduction velocity and time constant of the foot of the action potential also appeared independent of diameter, having values of 3.0 +/- 0.1 m/s and 0.10 +/- 0.007 ms. These findings are consistent with earlier suggestions that in addition to membrane on the surface of the fiber, there exists a large fraction of membrane in continuity with the extracellular space but not directly on the surface of the fiber. Combining the electrical and morphological information, it was possible to predict a passive length constant for the internal membranes of about 100 mum and a time constant for chaning these membranes in a passive 100-mum fiber of 1.7 ms.


Retinal mechanisms of visual adaptation in the skate. Electrical potentials were recorded from different levels within the skate retina. Comparing the adaptive properties of the various responses revealed that the isolated receptor potential and the S-potential always exhibited similar changes in sensitivity, and that the b-wave and ganglion-cell thresholds acted in concert. However, the two sets of responses behaved differently under certain conditions. For example, a dimly iluminated background that had no measurable effect on the senitivities of either of the distal responses, raised significantly the thresholds of both the b-wave and the ganglion cell responses. In addition, the rate of recovery during the early, "neural" phase of dark adaptation was significantly faster for the receptor and S-potentials than for the b-wave or ganglion cell discharge. These results indicate that there is an adaptive ("network") mechanism in the retina which can influence significantly b-wave and gaglion cell activity and which behaves independently of the receptors and horizontal cells. We conclude that visual adaptation in the skate retina is regulated by a combination of receptoral and network mechanisms.


Pores formed in lipid bilayer membranes by nystatin, Differences in its one-sided and two-sided action. Nystatin and amphotericin B induce a cation-selective conductance when added to one side of a lipid bilayer membrane and an anion-selective conductance when added to both sides. The concentrations of antibiotic required for the one-sided action are comparable to those employed on plasma membranes and are considerably larger than those required for the two-sided action. We propose that the two-sided effect results from the formation of aqueous pores formed by the hydrogen bonding in the middle of the bilayer of two "half pores," whereas the one-sided effect results from the half pores alone. We discuss, in terms of the flexibility of bilayer structure and its thickness, how it is possible to have conducting half pores and "complete pores" in the same membrane. The role of sterol (cholesterol and ergosterol) in pore formation is also examined.


Growth yield of a denitrifying bacterium, Pseudomonas denitrificans, under aerobic and denitrifying conditions. The effciency of denitrification, or anaerobic respiration, in Pseudomonas denitrificans was investigated, using growth yield as an index. Glutamate was mainly used as the sole source of energy and carbon. In batch culture, the growth yield per mole of electrons transported through the respiratory system under denitrifying conditions was about half that under aerobic conditions. Similar figures were also obtained in chemostat cultures under glutamate-limited conditions. The decrease in growth yield under denitrifying conditions could be due to the restriction of phosphorylation associated with nitrate reduction to nitrogen gas.


Studies on the 'osmophilic' yeast saccharomyces rouxii and an obligate osmophilic mutant. An obilagte osmophilic mutant (strain BI/4) of Saccharomyces rouxii has been isolated that fails to grow at osmotic pressures corresponding to 20 per cent (w/v) sucrose or less. In 30 percent sucrose the yeast is filamentous and grows slowly. In 40percent sucrose it is mainly filamentous and has over twice the normal diameter. In 60 percentsucrose it grows in the yeast form with a growth rate twic that of the cultrue in 40 per cent sucrose. This mutant is lysed by a suddren drop in the osmotic pressure of the environment. Cell enveoples of the parent strain contained glucose and manose in the ratio I.2; Iand contained 3-8percent (w/v) hexosamine, whereas the envelopes of the mutatn contained 0-8 percent hexosaime. Cell envelopes of  the mutant grown in 40 per cent sucrose contained glucose and mannose in the ratioI.9; I, wheras for envelopes of the yeast grown in 60 percent sucrose the ratio was I.2; I. Neutral lipids from whole cells and those from the envelopes of the mutant strain generally contained more unsaturated fatty acids than the corresponding fractions from the parent strain.


Energy yield of denitrification: an estimate from growth yield in continuous cultures of Pseudomonas denitrificans under nitrate-, nitrite- and oxide-limited conditions. The molar growth yields of Pseudomonas denitrificans, for nitrate, nitrite and nitrous oxide, were determined in chemostat culture under electron acceptor-limited conditions. Glutamate was used as the source of energy, carbon and nitrogen. The catabolic pattern was identical, irrespective of the terminal electron acceptors. The molar growth yields, corrected for maintenance energy, were 28-6 g/mol nitrate, 16-9 g/mol nitrite and 8-8 g/mol nitrous oxide. The energy yield, expressed on an electron basis, was proportional to the oxidation number of the nitrogen: nitrate (plus 5), nitrite (plus 3) and nitrous oxide (plus 1). It was concluded that oxidative phosphorylation occurs to a similar extent in each of the electron transport chains associated with the reduction of nitrate to nitrite, nitrite to nitrous oxide and nitrous oxide to nitrogen.


The genetics of tetracycline resistance in Staphylococcus aureus. Eighty-one strains ofStaphylococcus aureus that appeared to be tetracycline resistant on the basis of a preliminary disc-diffusion test were examined fro resistance to tetracycline and to the semi-synthetic tetracycline, minocycline. Minimum inhibitory concentration (m.i.c.) values for both drugs were determined after induction of the strains by growth for 2 h in sub-inhibitory concentrations fo tetracycline. Forty-seven strain (58 percent) had m.i.c. values for minocycline of I2.5 MUg/ml or greater, and were considered to be minocycline resistant. An additional ten strains had m.i.c.r greater, and were considered to be minocycline resistant. An additional ten strains had m.i.c.values for minocycline of 3.I25 to 6-25 MUg/ml and were classified as low-level resistant strain. It appears, therefore, that a faily high proportion fo tetracycline-resistant strains isolated at the present time are resistant of concentrations of minocycline unattainbale in vivo with the recommended dosage forthis antibiotic (Fishk & Tunevall, 1969). Transductioal analysis of the genetic determinantswo types of resistance to high concentrations of tetracycline. Strains in the first categroy (A)were inducibly resistant to tetracycline but sensitive to minocycline; in these strains  the resistance determinant was plasmid-borne. Strains in the second categroy (B) were resistant to both tetracycline and minocycline and had low induction ratios for tetracycline resistance; the genetic determinant for resistance in these strains was chromosomal. In addition, certain strains incategroy A  were found to carry a chromosomal gene controlling low-level resistance to tetracycline and minocycline. This low-level resistance to tetracycline was masked in the presence of the tetracycline plasmide but could be demonstrated after loss of the plasmid. The results suggest that more than one mechanism of resistance to tetracyclines may exist in staphylococci.


The preparation of large-scale synchronous cultures of the trypanosomatid, Crithidia fasciculata,by cell-size selection: changes in respiration and adenylate charge through the cell-cycle. Large-scale synchronous cultures of Crithidia fasciculata were prepared by a sedimentation-velocity-size-election method using a non-somotic gradient in a zonal rotor. Synchrony indices of up to 0-68 were obtained (average length of cell-cycle, 5-1h). Dry weight, protein and RNA increased continuously so as to double in one cell-cycle. Rates of oxygen uptake/ml culture increased overall so as to double over a cell-cycle, but rose to maxima at five periods in the cell-cycle. KCN gave a similar degree of inhibition throughout, and so did not alter the periodicity or amplitude of the oscillations. Total adenylates doubled over a cycle, and complex changes in pool sizes of ATP, ADP and AMP were temporally interrelated and were correlated with changes of oxygen uptake rates rather than with changes in biosynthetic requirements. Adenylate charge varied between 0-47 and 0-66 Discontinuous respiratory activity of mitochondria through the cell-cycle and possible mechanisms for its control are discussed with reference to previous data.


The specificity of enzymes adding amino acids in the synthesis of the peptidoglycan precursors of Corynebacterium poinsettiae and Corynebacterium insidiosum. A soluble extract from Corynebacterium poinsettiae able to synthesize the nucleotide precursor of ite peptidoglycan was prepared. This extract contained all the enzymes necessary for the synthesis of the peptide side-chain. The spedificity of these enzymes was determined and compared with the specificity of similar enzymes extracted from the closely related Corynebacterium insidiosum. In both organsims, addition of the third amino acid of the peptide side-chain was specific for the amino acid and nucleotide dipeptide involved in peptidoglycan synthesis in the parent organism. L-Diaminobutyric acid, which is found as the acetyl derivative in the precursor nucleotide and in the completed peptidoglycan of C. insidiosum, was added as the free amino acid and not as the acetylated compound.


The preparation of immunogenic cell walls from a highly protective strain of Clostridium chauvoei. Conventional methods for the preparation of cell walls of a highly protective strain of Clostridium chauvoei destroy the protective antigen. Bacteria were therefore lysed by the enzyme pronase instead of by the mechanical disintegration methods commonly employed. Final purification and separation of cell walls and membranes was achieved by equilibrium density-gradient centrifugation with sodium iodide in a zonal rotor. The resultant cell walls had a two-layered structure when seen in ultra-thin section and were highly immunogenic when used to immunize mice against challenge with C. chauvoei. Rabbit antisera raised against the cell walls provided passive protection against challenge in mice and the level of protection was not diminished by the absorption of all agglutinins from the sera. These results confirm previous observations that the protective antigen is a heatlabile cell wall antigen which stimulates the production of non-agglutinating protective antibody.


Unstable generalized transduction in Achromobacter. Six auxotrophic markers of a halotolerant collagenolytic strain of Achromobacter were transduced by four alpha hages. Abortive transduction was also demonstrated. The generalized transduction system is unusual as the transductants were unstable, characteristic of transduction by lysogeny. The Achromobacter strain is a cryptic lysogen for alpha and purified transductants were either sensitive or resistant to alpha. Purified clones from four resistant transductants and one sensitive transductant liberated phage spontaneously. The host ranges of these spontaneous phage differed from that of the alpha phage used for the transduction experiment. Some initially resistant transductants became simi-sensitive to alpha (efficiency to plating) e.o.p. (10minus-1 to 10minus-2) after repeated cloning.


Microbiodies in methanol-grown Candida boidinii. Intracellular structures were observed in Candida boidinii grown in a medium containing methanol as the sole source of carbon and energy; these structures were absent in the same organism grown in the presence of glucose or ethanol. These substrate-specific structures are ultrastructurally similar to microbodies. Studies with sphaeroplast and a mutant lacking alcohol-oxidase activity indicate that the alcohol may be located in these microbodies.


Deoxyribonucleic acid metabolism and nuclear division during spore germination in Fusarium oxysporum. Ungerminated microconidia of Fusarium oxysporum have a mean cell DNA content of 0-134 times 10--12 g/cell with a guanine-plus-cytosine composition (%GC) of 50-75%. During germination, the first dry weight increase of the spore population was defected after 3 h incubation and the first germ tube appeared after 4 h. The total DNA of the culture sharply increased after 5 h, followed by a pause at 6 h. At this time the DNA content per nucleus was maximal and the first nuclear divisions were detected.   auses in the rise of total DNA of the culture and in the [14C]adenine incorporation pattern suggest that there is partial synchrony in DNA synthesis at the beginning of incubation. This is also supported by the fact that until 8 h, only hyphae with 1, 2 and 4 nucleic were observed. [14C]adenine incorporation into DNA averaged 2-68% of the total taken up in 10 h incubation.


Specialized transduction of kanamycin resistance in a Providence strain. Properties of a transducing system with a phage able to transduce a kanamycin-resistance marker of the T compatibility group plasmid R394 at a frequency of 2 times 10(-2)/plaque-forming unit adsorbed are described. The phage was detected in Providence strain P29 transduced to kanamycin resistance by Providence phage PL25 grown on this strain harbouring the R factor. Four P29 transductants, specially selected at the lowest multiplicities of infection of the high frequency transducing (HFT) phage, were defective lysogens. They plated PL25 with an efficiency of I and only one liberated low-titre phage spontaneously or on u.v. induction. The defect in maturation function could be corrected by introduction of a wild PL25 prophage. The transducing phage was serologically frequency was increased by the simultaneous presence of homologous non-transducing phage. Transductants did not transfer the kanamycin-resistance marker by conjugation, and produced kanamycin-sensitive segregants at a moderate rate. These segregants could be transduced to kanamycin resistance by the HFT phage. Irradiation of HFT lysates by u.v. produced an exponential fall in transduction frequency. It was concluded that the defective phage transduced by lysogenization. Kanamycin-resistant transductants could themselves be transduced by streptomycin resistance by PL25 reared on a streptomycin-resistant mutant. Lysogenic transductants produced by the HFT phage did not always liberate HFT phage on u.v. induction. Possible explantations are considered.


Envelope proteins in Salmonella minnesota mutants. Envelope proteins of one smooth (S) strain and seven rough (R) mutants of Salmonella minnesota were examined by sodium dodecyl sulphate-polyacrylamide gel electrophoresis. All strains gave similar band patterns although some consistent differences were detected. A major polypeptide band at 54k, which coincided with the flagellar component, was more prominent in S, Ra and Rb than in the Rc, Rd and Re chemotypes. The latter strains, however, showed more prominent bands at 48, 19 and 18k. The stage of growth at which the cultures were harvested was also found to affect the band patterns, particularly in the 54 and 40k regions. A closer examination of S, Ra and Re strains suggested that the levels of the major 40 and 37k bands were slightly reduced in Re. It is concluded that the progressive loss of lipopolysaccharide components which occurs from the S chemotype through various degrees of roughness to Re is accompanied by a change in the envelope protein composition, apparently between Rb and Rc.


Characterization and messenger activity of poly(A)-containing RNA from Chlorella. Poly(A)-containing RNA was isolated by cellulose column chromatography from total RNA extracted from Chlorella fusca var. vacuolata 211/8p. RNA retained by the column was identified as poly(A)-containing RNA because it contained ribonuclease-resistant tracts, 25 to 55 nucleotides in length, from which not less than 80% of base was found to be adenine after acid hydrolysis. The base composition of poly(A)-containing RNA differed from that of RNA (largely ribosomal) which did not adsorb to cellulose, having a higher adenine content and a lower guanine content. Poly(A)-containing RNA was polydisperse including molecules with mobilities from 10S to 40S with a mean of about 20S. In an in vitro system derived from wheat-germ, protein synthesis was stimulated by adding poly(A)-containing RNA from Chlorella. Optimum conditions were established in this system with respect to the amount of poly(A)-containing RNA added and the concentration of KCl and Mg-2+. It is proposed that, in Chlorella, poly(A)-containing RNA includes cytoplasmic mRNA as has been shown for some other eucaryotic organisms.


Effect of actinomycin D and chloramphenicol on the induction of the malate decarboxylase system in Lactobacillus thermobacterium 5 (CNRZ) 313. This paper presents data on the induction of malate decarboxylase in Lactobacillus thermobacterium and the effect of chloramphenicol and actinomycin D on the induction.


Cost-financed mental health facility. II. Utilization profile of a labor union program. Specific data are presened concerning the utilization profile of a cost-financed mental health facility. The utilization is enhanced by a mental health education campaign, but total utilization remains within manageable limits (13 per 1000). The visit rate is 8.5 units per patient and remains well within the plan's dollar limits. Comparison between utilizers and the population from which they are drawn shows disproportionate numbers of males in contrast to other outpatient insurance studies. This may be a unique feature of work-related  programs. "Acting out" disorders are more common among these workers than in other psychiatric programs in the same geographic area.


Cost-financed mental health facility. III. Economic issues and implications for future patterns of health care. Data are presened concerning the economics of a cost-financed mental health facility and a lobor union  insurance program. The total cost per insured enrolle for all mental health services did not exceed $5.41 per year. The cost per treated patient per year remained under $490. These data strongly support the feasibility of including mental health benefits in national health insurance. Costs are then compared between fee-for-service insurance and cost financing. Average costs per treated patient in the cost-financed facility were $302 over a 4-year period. Similar computations under fee-for services financing showed costs of $824. The difference reflects much greater use of hospitalizations in the fee-for-service system. These data and the data from the preceding two papers on the clinical and utilization partterns of cost-financed facilites suggest that these facilities are practical clinical forms. Implications for national health insurance, HMO legislation, and community mental health centers are explored.


An optimum A-B scale of psychotherapist effectiveness. On the basis of the original Whitehorn-Betz data collected over a 16-year period, it is shown that all previously derived A-B scales of psychotherapist effectiveness using Strong Vocational Interest Blank (SVIB) items are deficient in terms of correlation with the original criterion and, frequently, in terms of reliability as well. The reasons for these deficiencies are discussed, and a new experimental A-B scale is formulated and tested for adequacy. This scale is shown to possess substantial internal consistency reliability and to have a high degree of correlation with the criterion even after the removal of possible contaminating factors such as use ofancillary teatments, differences in patient prognosis, and changing practices and interest over time. It is further shown that none of the A-B scales has any validity with respect to female therapists in the original data pool. Exploration of the factor-analytic structure of this new scale and two other widely used A-B measures in terms of the occupationa scales of the SVIB reveals differential loadings on four dimensions labeled verbal/comceptual vs. manual/practical, scientific vs. sales, social concern, and artistic vs. business-oriented. It is concluded that although male therapists' scores on the best of the A-B scales  may , under certain circumstances,be related to short term judged improvement in patients treated, there is little evidence that high scoring therapists are more likey than low scoring ones to have a favorable, long range impact on diagnosed schizophrenics.


A-B therapist characteristics vs. psychotherapy outcome: current status and prospects. For more than 10 years much of the research into the effects of therapist characteristics on psychotherapy outcome has focused on the "A-B" variable. Various A-B scales have been used to predict differential process and outcome of A and B therapist with schizophrenics and neurotics, respectively. Although significant results frequently have been reported, findings of different studies have seemed to contradict each other, and most independent replication attempts have failed. Since reliable differences in outcomes achieved by various therapists-patient pairings have not been demonstrated, the confusing proliferation of theories concerning what A-B factors "make the difference" seems rather premature. A review of outcome and process studies in this area indicates that the phenomena under investigation are much more complex than is reflected in the previous A-B hypotheses. Therapist A-B scores do not predict every kind of success with every kind of patient generically labeled "schizophrenic" or "neurotic" in every kind of treatment program. This conclusion need not arouse pessimism regarding the value of further A-Bresearch, but it clearly demands greater specificity in hypotheses and in research design. The failure of many recent studies to include true B type therapists has made their findings irrelevant to the A-B hypotheses, and has raised the question of whether the B therapist has become "extinct." To provide further information about this phenomenon of the vanishing B therapist, the present authors conducted a survey of all Seattle psychiatrists in private practice. The survey yielded a total distribution of A-B scores which is not significatly skewed in either the A or B direction. However, most of the B's had graduated from residency training prior to 1960, while most of the A's had graduated in more recent years. These results suggest that, although current residency programs may not have enough B doctors for meaningful A-B research, such doctors do exist in the community.


Factor analy of orality and anality in selected patient groups. Responses of 150 outpatients, suffering from physical or emotional problems to a 186-item questionnaire concerning their possession of behavioral traits that have been associated with anal and oral personality structures, as well as their practices and concerns about mouth and bowel function, were factor analyzed. Results were comparable with those from an earlier study involvine Army recruits as subjects, in showing some factors that resembled aspects of oral and anal character as described in psychoanalytic theory. These factors were not strong, nor were they clearly related to mouth and bowel behavior. Comparisons among clinical sub-groups showed that on five factors that significantly differentiated the groups, mean factor scores of proctological and ulcer patients resembled each other more than they did those of obsessive-compulsive patients, who were quite similar to passive-dependents. A control group of other types of psychiatric patients mixed with dermatological patients was intermediate between the physical and neurotic groups of patients. As seen in these factors, the somatic patients were relatively easy-going, slipshod, and accepting of change. Proctological and obsessive-compulsive patients, both linked to anal fixations by psychoanalytic theory, were the most dissimilar of all groups.


Temporal lobe epilepsy and aggression.

Temporal lobe epilepsy and aggression. Research on temporal lobe epilepsy (TLE) and aggression is reviewed in order to learn why it has not contributed more to our understanding of the neural basis of aggression. The research problem can be resolved into two questions: Are temporal lobe epileptics more aggressive? What inferences can be drawn about the factors underlying aggression in TLE? Difficulties in finding suitable operational definitions for TLE and for aggression have, to date, received insufficient attention. In published studies, sample bias and lack of regard for the validity and reliability of behavioral assessments prevent our deciding whether an association exists between interictal aggressive behavior and TLE. Even if this association were demonstrated, one could not draw direct neurobehavioral inferences from it, since a variety of social and psychological, as well as neurophysiological variables could contribute to the association. These would have to be controlled. Methodological refinements could lead to more satisfactory answers to the first question, but the second is considerably more difficult. Some sources of complexity and apparent contradictions in the experimental literature on the neurology of aggression are discussed. They consist of technical problems, the complexity of the neural substrate of aggression and the influence of environmental cues and learning. The combined use of electrophysiological and interview techniques has yielded some interesting results with TLE patients.


Alcoholism and the hyperactive child syndrome. Comparisons were made between alcoholics and nonalcoholics in a sample of Danish adoptees (mean age 30) and it was found that the alcoholics, as children, were more often hyperactive, truant, antisocial, shy, aggressive, disobedient, and friendless. The literature suggesting a relationship between the hyperactive child syndrome and subsequent alcoholism is reviewed, as well as a possible relationship between these disorders and antisocial behavior. The adoptive parent of the two groups did not differ with regard to socioeconomic class, psychopathology, or drinking histories. However, 10 of the 14 alcoholics had biological parents who were alcoholic, with no known alcoholism among the biological parents of the nonalcoholics. As adults, the alcoholics differed from the nonalcoholics only with regard to drinking history, use of drugs, and overt expression of anger.


Referential speaker processes in male and female process-reactive schizophrenics. Research done comparing normal and schizophrenic speaker performance is analyzed in light of research evidence showing process-reactive differences on conceptual-verbal tasks. An experiment is reported which looks at male and female process and reactive schizophrenic performance on a speaker task, with results indicating sexual as well as schizophrenic-normal differences. It is emphasized that future research on schizophrenia must ignore neither the sexual nor the process-reactive distinctions.


Crisis, psychology and tranquilizer use. Three hypotheses are presented relative to life crisis and tranquilizer use. Somewhat surprisingly, only the first hypothesis proves out: that the greater the degree of psychological impairment, the greater the probability of tranquilizer ingestion. No relationship between tranquilizer use and the nature of crisis experienced or the number of crises experienced was found.


Hypnosis and the EEG. A quantitative investigation. A quantitative investigation of the EEG during hypnosis was made by analyzing the analogue power frequency spectrum of one group of subjects in the awake and hypnotized conditions, and another group (random sample) in the awake condition. Individuals of the first group were thoroughly experienced in self-hypnosis and highly hypnotizable, whereas those of the second group had never been hypnotized and were low in waking suggestibility. There were no statistically significant differences in mean power of the whole EEG spectrum between the awake and hypnotized conditions of the experimental group, although a trend toward increased theta (4 to 8 Hz) density during hypnosis was apparent. This group, however, exhibited significantly more theta activity during both the hypnotized and the awake conditions than the random sample of controls in the awake condition, irrespective of whether the eyes were closed or open. We suggest that this increased theta density in the EEG is related to frequent experience of self-hypnosis, high hypnotizability, or both.


Marijuana-produced impairments in coordination. Experienced and nonexperienced subjects. The effects of marijuana and a placebo on perceptual-motor coordination, motor ability, and visual perception were compared in cannabis-experienced and naïve subjects. Impairments in coordination were observed in both groups. However, the impairment was greater in the experienced than in the naïve group.


Outpatient alcoholics give valid self-reports. Thirty-nine male alcoholics in a voluntary outpatient treatment program were interviewed individually on two separate occasions about their social and drinking history. Critical test questions were identical for both interviews but embedded among different filler items. The validity of the subjects' self-reports about both alcohol and nonalcohol-related questions was assessed through official records and documents. Self-reports of life history data provided by this group of outpatient alcoholics under specified interview procedures were highly reliable and valid. Differential item reliability and validity were obtained. Further, the value of using the technique of double interviews to predict valid and invalid self-reports is discussed. Suggestions for future research are offered.


Cinematic neurosis following "The Exorcist". Report of four cases. Following the distribution and release of the movie, "The "Exorcist," much publicity concerning the psychiatric hazards of the film was reported. Numerous cases of traumatic neurosis and even psychosis were supposedly noted. This report confirms the hypothesis that traumatic "cinema neurosis" can be precipitated by viewing the movie in previously unidentified psychiatric patients. The paper will examine an early reported case by Freud, investigate some underlying psychological principles in the book, and then report on the presentation and treatment of four cases. This movie seems to be directly related to traumatic neurosis in susceptible people. Classical symptoms and disability were observed following viewing the movie. There are elements in the movie, such as possession with resultant loss of impulse control, that are likely to threaten people with similar problems, and to exceed their "stimulus barrier." Suggested treatment recommends brief, early access treatment, using the movie to help each patient to explore where he identified and to understand some of his ambivalent conflicts with either parents or spouse.


Lithium-responsive hyperaldosteronism in manic patients. Plasma aldosterone levels of seven untreated manic-depressive patients in the manic phase were compared to five untreated schizoaffective patients in the excited phase and 18 controls. Aldosterone was significantly elevated in the manic patients, and elevated in the schizoaffective patients. After 14 days of lithium carbonate therapy, both psychiatric groups showed a significant reduction in plasma aldosterone and a marked clinical improvement. These data suggest that elevated aldosterone is associated with the manic phase of manic-depressive psychosis.


Transcendental meditation, altered reality testing, and behavioral change: a case report. This paper presents the case of a 39-year-old woman who, several weeks following initiation into transcendental meditation (TM), experienced altered reality testing and behavior. We discuss the course of this episode, present evidence for a causal relationship between her practive of TM and altered behavior, and discuss the appropriate treatment of such phenomena.


The simulated drinking gang: an experimental model for the study of a systems approach to alcoholism. I. Description of the model. This two-part paper deals with an experimental model for studying interactional behavior from a systems point of view. The experimental model incorporates a research strategy utilizing both a token economy and the simulation of a naturally occurring clinical phenomenon, the alcoholic drinking gang. The model is primarily geared to do two things: a) study the changes in clinical behavior that occur when experimental conditions are manipulated to facilitate the formation of the behavioral "system" as opposed to experimental conditions which interfere with system formation; and b) build into the model tasks which produce measurable performance data as a method of monitoring behavior deemed essential for the successful development of an operational system. The experimental model involved admitting up to six alcoholic individuals to a research ward specifically designed for studies utilizing experimentally induced intoxication. Each study was divided into a 7-day predrinking period, a 10- to 14-day drinking period, during which time alcohol was available to research subjects, and a 5- to 7-day withdrawal period. A token economy was established which allowed for the following essential features to be present: a) a group of chronic alcoholic individuals who desire to go through a drinking experience together; b) the pooling of resources in order to purchase alcohol; c) rules established by the group for the sharing of whatever alcohol becomes available to the group; and d) the opportunity to earn money for the purchase of additional alcohol after the initial supply runs out, in order to keep the group drinking experience going. All "money", or tokens, could be earned only via successful performance at the Cooperative Task Device (CTD), a cooperative, two-person game, and tokens could be utilized to purchase three types of commodities from an automated dispensing machine, alcohol, cigarettes, and television time. Automated data recording provided detailed data about CTD performance and commodity-purchasing records. The discussion centers around difficulties inherent in a simulated model of natural behavior. It is pointed out that laboratory simulation vs. natural setting, as the preferred site for carrying on behavioral research, remains an active controversy, and the arguments on both sides are presented. Difficulties inherent in doing "systems" research are also discussed. A series of alternative hypotheses to explain behavior within the simulated drinking gang are listed, and the data that would be necessary in order to substantiate these alternative hypotheses are also listed. It is maintained that the simulated drinking gang is an advantageous experimental model in that it closely approximates the basic criteria of the naturally occurring phenomenon, while at the same time allowing subjects a range of behaviors, each of which substantiates a different hypothesis about the central organizing feature in alcoholic groups.


The simulated drinking gang: an experimental model for the study of a systems approach to alcoholism.  II. Findings and implications. Data analysis involved data from three different sources, the Cooperative Task Device (CTD), the commodity dispensing machine, and a Stephenson Breathalyzer (for blood alcohol determinations). Data were analyzed on three different levels: individual, dyadic, and whole group. Results are presented for work performance, role performance, commodity purchase patterns, comparisons of work and purchase patterns, and correlations of work time with work efficiency and blood alcohol levels. Marked discrepancies in individual and dyadic work performance were found in all three groups and there was no relationship between chips earned and chips spent. The "drinking gangs" seemed quite willing to tolerate "freeloading" when it occurred. Role performance at the CTD was inconsistent; individuals for the most part fluctuated in their role performance rather than remaining in a stable role, e.g., leader. There was no demonstrable correlation between work time at the CTD and either work efficiency or blood alcohol levels. Lastly, dyadic formation vis-à-vis work performance showed considerable fluctuation over time. Group members did not pair off into consistent and stable dyads when playing the CTD. These findings are discussed from the point of view of the series of alternative hypotheses presented in part I. It is maintained that the data are inconsistent with all of these hypotheses, but that they do help to substantiate and are consistent with the concept of the "drinking system."


Autonomic responses of paranoid, nonparanoid schizophrenic, and normal subjects to affective visual stimulation. This investigation utilized a procedure designed to determine patterns of cognitive appraisal, and autonomic reactivity which characterize groups of normals, and paranoid and nonparanoid schizophrenics.  Results indicated that both groups of schizophrenics evidenced electrodermal habituation and increased finger pulse constriction.  Normals indicated that stress stimuli became less disturbing over trials and displayed both electrodermal and digital vasomotor habituation.  Electrodermal habituation curves for paranoids and normals were similar, with nonparanoids evidencing slower habituation.  Paranoids tended to under-rate or deny their emotional reactions.


The use of hypnosis in the treatment of a case of multiple personality. The literature regarding the use of hypnosis in the therapy of multiple personality is reviewed.  Cautions of other authors are noted which intend to protect the patient from further "splitting" of the personalities involved.  A case of a 25-year-old woman is described in which, several months after leaving therapy abruptly, a second personality appeared and prompted her re-entry into treatment.  Hypnosis was employed several weeks after restarting therapy on four separate occasions.  Therapeutic outcome was favorable with coalescence of the personality into a new whole.  A rationale for the use of hypnosis in this case is presented.


Distorting judgments of mental health.

Distorting judgments of mental health. Labeling bias refers to subjects judging normal individuals as mentally ill as a function of diagnostically irrelevant stimuli (e.g., suggestions of mental illness made by a prestige figure).  Three studies investigating the generality of the labeling bias effect are reported.  Experiment 1 failed to find the effect with undergraduates, but demonstrated that these subjects can discriminate an audio tape recording of a psychiatric patient from a tape of a normal person.  Experiment 2 demonstrated labeling bias in mental health service workers.  Experiment 3 produced labeling bias in undergraduates by manipulating the "relevance" of the prestige figure.  The data from the three studies were interpreted as indicating that, contrary to previous interpretation, professional identity is not a necessary condition for producing labeling bias.  Reanalysis of the data of previous research supported the hypothesis that labeling bias is extremely general, and probably related to attractiveness of the communicator who gives the suggestion of mental illness, setting, ambiguity of desired response, and other similar variables well documented in the social psychology literature.


Effects of messages reported to be out of awareness upon the body boundary. A series of studies demonstrated that out-of-awareness taped messages produce boundary decrement, as measured by the Barrier score, in men.  The messages variously included hostility, depression, body, vulnerability, and reassurance themes.  All themes, when properly primed, resulted in boundary decline in men.  Nonprimed and control conditions did not affect the boundary.  Contrastingly, no significant boundary changes were produced by the primed out-of-awareness themes in women.  It was proposed that men are more disturbed than women by feeling that material has gained entrance to them in a fashion which they cannot control.


Elevated serum dopamine-beta-hydroxylase activity in rats with inherited diabetes insipidus. The activity of dopamine-beta-hydroxylase, the enzyme that catalyzes the conversion of dopamine to norepinephrine, was measured in the serum of a strain of Wistar rats homozygous and heterozygous for a genetic form of hypothalamic diabetes insipidus and in Wistar control rats. Serum dopamine-beta-hydroxylase activity and water intake was highest in the homozygous affected rats and lowest in normal controls. Treatment with pitressin tannate reduced serum enzyme activity and water intake in rats with diabetes insipidus to levels which did not differ from controls. Thus serum dopamine-beta-hydroxylase activity appeared to vary directly with changes in sympathetic nerve activity in response to intravascular volume depletion and repletion.


Electron histochemistry of thiamine pyrophosphatase activity in the neuronal golgi apparatus observed after axotomy and transneuronal deprivation. Thiamine pyrophosphatase activity of the neuronal Golgi apparatus exhibits specific patterns, characterizing nerve cell types of the rat spinal cord at the light microscopal level. Electron histochemistry reveals TPPase activity within cisterns of the internal part of the dictiosomes and in vesicles associated with the Golgi system. According to electron microscopical studies performed on semi-thin (0.5 mu) sections, TTPase activity outlines a three-dimensional system of fenestrated cisterns and cisterns and vesicles. In accord with literature data, asotomy of motoneurones results in a light microscopic decrease of dictiosomal TTPase activity and in an electron microscopic hypertrophy  of the Golgi system. Electron histochemically, TTPase in the hepertrophied cisterns exhibits a sporadic, patchy localization, which is completely restored only in the state of restitution. On the contrary, transection of dorsal roots does not induce any light- or electron microscopic alterations in the TPPase activity of cells in the substantia gelatinosa Rolandi. Alterations of neuronal TPPase reaction offer a methodological possibility for hodological studies.


Rotational behavior in gerbils following unilateral common carotid artery ligation. Unilateral cerebral infarctions are produced in 30-50% of all gerbils subjected to ipsilateral ligation of a common carotid artery. It has previously been shown that this infarction is associated with a major depletion if ipsilateral brain dopamine. The present studies characterize the spontaneous and drug-induced rotational behavior manifested by these animals and attempt to relate it to the functional activity of dopaminergic synapses. The tendency of animals to turn towards the side of the lesion 2-3 hours after surgery was found to correlate highly with the unilateral dopamine depletion observed after 24 hours. Two patterns of rotational responses were observed among animals showing symptoms that were treated with d-amphetamine or apomorphine; these could be correlated with mortality 24 hours after surgery.


The acetylcholine-dopamine balance in the basal ganglia of rhesus monkeys and its role in dynamic, dystonic, dyskinetic, and epileptoid motor activities. Behavioural analyses have been made of effects brought about by both single and combined injections of dopamine, haloperidol, carbachol and atropine into the caput nuclei caudati of rhesus monkeys. High doses of dopamine produced the subsequent development of three types of behavioural changes: an increase in the number of skilled manipulation movements (the dynamic phase); the appearance of a dystonic torticollis (the dystonic phase); and, finally, the appearance of an oro-lingual-facial dyskinesia and a number of dyskinetic activities in the extremities (the dyskinetic phase); low doses of dopamine solely produced the dynamic phase. Haloperidol only inhibited the dopamine-induced dynamic and dystonic phase: it did not suppress the dyskinetic phase. High doses of carbachol produced the subsequent development of four phases: a dynamic, dystonic, dyskinetic and epileptoid phase; the last one was marked by the appearance of secondary generalized epileptic seizures. Low doses of carbachol solely produced the dynamic phase. Atropine inhibited the carbachol-induced dynamic, dystonic and epileptoid phase; it did not suppress the dyskinetic phase. High doses of dopamine strongly modified the carbachol-induced phases: dopamine intensified the dystonic phase on the one hand, but it abolished the generalized epileptic seizures on the other hand. Apart from the fact that the data presented have confirmed that both dopaminergic and cholinergic mechanisms within the basal ganglia of rhesus monkeys are involved in the elicitation and modulation of both normal and abnormal motor activities, they have also revealed that the simple concept of a stristal acetylcholine-dopamine "see-saw" has to be revised. Furthermore, the data have suggested that development of supersensitive dopamine-sensitive sites is not the only mechanism that underlies the elicitation of the oro-lingual-facial dyskinesia. And finally, the present experiments have given clearcut evidence that an intrastriatal acetylcholine-dopamine "see-saw" fulfils and essential role in the process involved in the generalization of epileptic seizures.


Abnormal brain scans in multiple sclerosis. A 25 year old man, with a family history of multiple sclerosis in two preceding generations, developed transient sensory changes and incoordination, initially on the left side, and then several months later on the right side in association with an elevated CSF gamma globulin. This was followed by an acute optic neuritis. During the latter episode he developed a positive brain scan which was unaccompanied by any clinical findings explained by a lesion in that area. Cerebral arteriography was normal and the brain scan returned to normal four weeks later, possibly as a result of blood brain barrier restoration. Abnormal brain scans appear to occur only during acute exacerbations of demyelinating disease, and multiple sclerosis should be part of the differential diagnosis of a positive brain scan in a person in the appropriate age range.


Monoamine acid metabolites and cerebrospinal fluid dynamics in normal pressure hydrocephalus: preliminary results. Lumbar and ventricular CSF concentration of homovanillic acid (HVA) and 5-hydroxy-indole-acetic acid (5-HIAA) have been determined in 13 patients admitted to hospital for suspected normal pressure hydrocephalus. Low values of HVA in lumbar CSF were found in all patients with reduced CSF absorption and CSF flow inversion. The HVA lumbar concentration remained low after shunt procedure; it increased if obstruction of the shunt occurred. The ventricular CSF concentration of HVA was normal before surgery; it became higher, in two cases, after surgery. No important variations were found in the lumbar and ventricular CSF concentration of 5-HIAA. The possible mechanisms and diagnostic value of these findings are discussed.


Malignant meningioma metastasizing through the cerebrospinal pathways. A 53-year old man presented with a malignant meningioma which was incompletely removed. The tumour subsequently metastasized through the cerebrospinal pathways causing clinical signs through invasion of the cranial nerve roots. Microscopically, the metastatic deposits displayed a papillary pattern and increased anaplastic cytological features.


Mechanism of production of gait unsteadiness by tumours in the posterior fossa. The hypothesis is put forward that the disturbance of gait seen with tumours of the posterior fossa is largely due to subacute dilatation of the ventricular system and not to the involvement of midline cerebellar structures concerned with balance or the coordination of truncal muscles, as is widely taught. This hypothesis is examined in the light of the clinical evidence provided by the symptomatology and treatment of 19 consecutive cases of intracranial mass lesions exhibiting truncal ataxia.


Clinical course and prognosis of acute post-traumatic coma. The clinical course and prognosis of 282 cases of acute post-traumatic coma have been studied. Death occurred in 140 cases (49 percent), and, of survivors, about two-thirds achieved complete social reintegration, while one-third were partially reintegrated or not at all. The quality of survival did not depend only on the nature of the physical sequelae, but also on other factors, particularly social ones. With regard to early prognosis, the authors believe it is possible to predict the final outcome of the patient by using the indices of age, level of coma, and the nature of the intracranial lesions.


Studies on the receptor responsible for vibration induced inhibition of monosynaptic reflexes in man. A further attempt has been made to define the receptor responsible for the inhibition of monosynaptic reflexes by vibration in man. Vibration of the tendo Achillis will produce inhibition of the H reflex even when the muscles of the anterior compartment of the leg are denervated or blocked with local anaesthetic, implying that there are receptors in the posterior compartment capable of producing this effect. However, there is evidence that vibration spreads through the limb. The inhibition is greater when the anterior compartment is innervated indicating that there is a contribution from receptors in this compartment. Stretching the muscles of the posterior compartment alone, or the muscles of the anterior and posterior compartments reciprocally does not influence the inhibition of the monosynaptic reflex by vibration. These observations support the contention that the reduction of the monosynaptic reflex by vibration in man is due to presynaptic inhibition resulting from activation of primary spindle endings.


Evidence for a monosynaptic mechanism in the tonic vibration reflex of the human masseter muscle. Vibration of the masseter and temporalis muscles in normal human adult subjects elicits a tonic vibration reflex with unexpected features. The electromyographic response is not asynchronous as in the limb muscles, but involves well-defined spikes with a one-to-one temporal relation to the vibration cycles. The effect of various parameters such as muscle stretch, vibration frequency or amplitude, etc, has been investigated. The small latency fluctuation of the vibration-induced spikes is compatible with a monosynaptic reflex mechanism which is considered to be assisted by a polysynaptic facilitatory background of proprioceptive origin.


Peripheral neuropathy detected on electrophysiological study as first manifestation of metachromatic leucodystrophy in infancy. A case of infantile metachromatic leucodystrophy is described in which symptoms started at 1 year of age with weakness and hypotonus in the lower extremities. The electrophysiological status was typical of a polyneuropathy, showing fibrillation and a reduction of the nerve conduction velocity to 30 percent of the average for normal children of the same age. Clinical signs of a central lesion and mental regression were not evident until a year later. Nerve biopsy showed metachromatic granules in the phagocytes and in the Schwann cells, confirming the diagnosis of metachromatic leucodystrophy. In peripheral neuropathy in infancy without obvious cause, a nerve biopsy is the most appropriate method for diagnosis of the metachromatic leucodystrophy.


Respiratory and cardiac abnormalities in brain-stem ischaemia. Two patients are presented who had suffered episodes of ischaemia of the brain-stem, mainly affecting one side of the pons. In addition to the more usual neurological signs, these two patients had cardiac arrhythmia: one had a sinus arrhythmia, the other a wandering pacemaker. In both patients the hemidiaphragm on the side ipsilateral to the lesion was transiently elevated. The mechanisms responsible for the arrhythmia and the elevated hemidiaphragm are discussed.


Treatment with acetazolamide of brain-stem and spinal paroxysmal disturbances in multiple sclerosis. Nine cases of multiple sclerosis with paroxysmal disorders were treated with acetazolamide. In most cases a brain-stem origin of the seizures was suggested by their particular pattern: crossed syndromes (facial spasm associated with contralateral weakness of the arm and leg, paroxysmal paraesthesiae in one side of the face and weakness of the contralateral leg), paroxysmal dysarthria, and ataxia. One patient with a Brown-Sequard syndrome complained of paroxysmal paraesthesiae in the lower limbs, for which a spinal origin was admitted. In all patients the paroxysmal disorders were promptly suppressed or markedly reduced by acetazolamide.


Intracranial tuberculoma--an increasing problem in Britain. Ten cases of intracranial tuberculoma are described. These were investigated and treated at one centre in a 20 year period. The last five cases have occurred in immigrant Asians in the last five years, suggesting an increasing incidence. Diagnostic pointers are discussed and the value of brain scanning emphasized.


Studies in man of phenytoin absorption and its implications. The absorption of phenytoin was studied in man. It is concluded that phenytoin absorbed from the intestine is recirculated via the bile, so that blood levels do not accurately reflect absorption. Phenytoin is loosely bound to serum proteins and is found in red cells in concentrations similar to those in plasma. It is rapidly lost from the blood stream after intravenous administration, which is an important factor to be considered in the treatment of status epilepticus.


Pallido-pyramidal syndrome treated with levodopa. Two siblings are reported who developed classical signs and symptoms of Parkinsonism in the first decade of life. In addition, they had evidence of cortical spinal tract disease, thus putting them in the category of Davison's pallido-pyramidal syndrome. Both deteriorated to the point of a non-productive existence until the institution of levodopa treatment, at the ages of 18 and 20 years. The response of the extrapyramidal signs plus the lack of response of the pyramidal tract signs demonstrate the specificity of a pharmacological agent in certain areas of the nervous system. The rapid response of the female patient to very low doses of levodopa is unusual in our experience. Both patients have remained well for eight months after initiation of treatment.


Electrophysiological findings in diphenyl poisoning. The fungistatic agent diphenyl caused fatal poisoning with signs of neurotoxicity in a worker in a Finnish paper mill. This initiated a neurophysiological study of 24 workers occupationally exposed to diphenyl. Ten men showed EEG abnormalities, mainly diffuse or generalized ones. The abnormalities persisted on re-examination one and two years later. Nine subjects had EMG abnormalities; seven also exhibited fibrillations in some muscles. One subject showed a long rhythmic series of fasciculations similar to the spontaneous activity described in infantile spinal muscular atrophy. Nerve conduction velocity, especially that of slower motor fibres, was reduced in several cases. Electroneuromyographic abnormalities also persisted on re-examination. Although diphenyl is considered a comparatively safe chemical, it showed evidence of neurotoxicity when workers were exposed to concentrations in excess of the presently accepted threshold limits. Electrophysiological methods should be applied for the early detection of occupational hazards.


Intention tremor--a method of measurement. A method of measuring and analysing intention tremor using a linear accelerometer is described. Reasons are given for measuring this particular parameter of the tremor, for using this specific energy conversion device, and for employing the particular form of analysis. A comparison of the numerical values obtained for the amount of tremor activity, compared with a corresponding clinical grading, is made for 30 patients with intention tremor due to a variety of pathological causes. It is shown that the method gives clear correlation with the clinical assessments, although certain discrepancies are noted, and their importance discussed.


Application of an objective method of assessing intention tremor - a further study on the use of weights to reduce intention tremor. Thirty-one patients with intention tremor due to a variety of causes were subjected to measurements of their intention tremor. The effect of varying amounts of lead weights on the amount of limb tremor recorded was noted. It is concluded that simple methods of treatment may be of benefit, and that an objective method of measuring intention tremor overcomes many of the difficulties of a clinical trial of this type. The method described yields quantifiable data which can be subjected to statistical analysis to help overcome the problem of variability. Bias in the results due to practice or fatigue effects has proved negligible. An optimum amount of lead, which was usually between 600 and 840 g, has been noted.


Cystic degeneration of the telencephalic subependymal germinal layer in newborn infants. Cystic lesions were found in the telencephalic germinal layer of 12 newborn babies. According to their location, the cysts could be divided into three groups: anterior, middle or thalamostriate, and posterior. The histological appearance of all cysts was essentially the same, but in three cases the germinal layer had a peculiar alveolar type of microcystic degeneration. A constant feature was the presence in the cyst wall of small white granulations composed of germinal cells and/or glial tissue. Cystic degeneration of the germinal layer was usually bilateral and sometimes quite extensive. After the involution of the germinal layer, these lesions are likely to persist as subependymal cysts, characterized by their specific location and the presence of glial granulations.


Clinical experience with automatic midline echoencephalography: cooperative study of three neurosurgical clinics. Computerized midline echoencephalography was developed in order to make the determination of the midline more objective. In a group study involving the neurosurgical clinics in Berlin, Erlangen, and Munich, a total of 1,889 patients with various intracranial diseases was examined by this method. An exact analysis of the results obtained is presented: 18 percent were unsatisfactory.


Sylvian aqueduct syndrome as a sign of acute obstructive hydrocephalus in children. Eight cases of obstructive hydrocephalus manifesting palsy of upward gaze and other features of the Sylvian aqueduct syndrome are reported. During the crisis of intracranial hypertension, all of them developed upward gaze palsy and variable abnormalities of the convergence mechanism such as paralysis, spasm, and convergence nystagmus. The frequent apparent blindness was probably related to gaze paralysis, since visual evoked responses were present. All these ocular abnormalities disappeared after shunting. Periaqueductal dysfunction on the basis of raised intracranial pressure is postulated as the possible mechanism for the above ocular manifestations. The 'setting sun' sign is frequently seen in infants and children with hydrocephalus and has been considered in the past to result from displacement of eyeballs by pressure from the orbital roof plate. Our observations would suggest periaqueductal dysfunction rather than the mechanical displacement as the possible mechanism for this sign.


Myopathy in hypophosphataemic osteomalacia presenting in adult life. Three cases of hypophosphataemic osteomalacia presenting in adult life, in which a myopathy was a prominent presenting feature, are described. In one, a nasopharyngeal haemangioma was also present. Possible mechanisms underlying the myopathy are discussed briefly.


Computer method for the analysis of evoked motor unit potentials. 2. Duchenne, limb-girdle, facioscapulohumeral and myotonic muscular dystrophies. Single motor unit potentials recorded from surface electrodes over the extensor digitorum brevis muscle and evoked by stimulation of the anterior tibial nerve at the ankle were obtained by a computer subtraction method. Their latencies, durations, amplitudes, and areas were measured in control subjects and patients with Duchenne, limb-girdle, facioscapulohumeral, and myotonic muscular dystrophy. Lateral popliteal motor nerve conduction velocities were also recorded. In the muscular dystrophies there was a significant increase in both the latencies and durations of motor unit potentials, the latter in notable contrast with the findings of conventional needle electromyography. Fastest motor conduction velocities were significantly reduced in the limb-girdle, facioscapulohumeral, and myotonic muscular dystrophy patients, while the shortest distal motor latencies were significantly prolonged in these patients and those with Duchenne muscular dystrophy. The results support the presence of a definitive neurogenic influence in the muscular dystrophies.


Cerebellar abscess. A review of 47 cases. Forty-seven cases of cerebellar abscess have been reviewed, 93% of which were secondary to otogenic disease. There has been little change in the annual incidence during the period of time under review. The overall mortality was 41%, but with successive decades the mortality has increased. Three factors appear to be of importance in determining survival: the patient's ability to control his infection; reduction of the effect of the posterior fossa mass, preferably by complete excision of the abscess under antibiotic cover; and, in the case of otogenic abscess, an adequate radical mastoidectomy with bone removal to the site of attachment of the abscess to the dura mater.


Observations on cortical blindness and on vascular lesions that cause loss of recent memory. Two long-surviving cases of cortical blindness are described, one total and the other total except for detection of sudden transitions from light to darkness and darkness to light. Both suffered from severe defect of recent memory, which lasted a month in one, and till death after nearly six years in the other. One patient survives. Necropsy findings on the other are given.


Retraining of dysgraphia - a case study. A patient with dysgraphia resulting from a gunshot wound of the brain is presented. Analysis of the functional status of component operations involved in the skill of writing is described. A retraining scheme based on this analysis brought about a significant improvement in the patient's handwriting.


Contractility and supersensitivity to adrenaline in dystrophic muscle. In the adductor pollicis muscle of patients with limb-girdle and facioscapulohumeral muscular dystrophies and possible carriers of Duchenne type muscular dystrophy, abnormal active state properties were found at the time when there was no alteration of needle electromyography and evoked muscle action potentials. Adrenaline induced a marked reduction of incomplete tetanus via beta receptors without change in neuromuscular transmission.


Meningioma after contralateral hemispherectomy for malignant glioma: case report. A patient is described who successfully underwent cerebral hemispherectomy for malignant glioma and whose death nine months later, wrongly ascribed to recurrent malignancy, was in fact due to a subsequently-developing benign meningioma in the remaining hemisphere. The possible advantages of a modification of standard hemispherectomy technique are also discussed.


Receptors in focal reflex myoclonus.

Receptors in focal reflex myoclonus. The findings in a patient with focal reflex or action myoclonus suggest that the cortical somatosensory evoked response and the long loop reflex of the finger flexor muscles evoked by extension of the index finger at the volar surface of the distal phalanx occur largely through stimulation of touch or pressure receptors with evidence of a lesser contribution by joint receptors or muscle stretch receptors. Touch or pressure in the absence of movement is an adequate stimulus, whereas muscle stretch by itself is not.


Timing as a prominent factor of the Jendrassik manoeuvre on the H reflex. The influence of the Jendrassik manoeuvre on the myotatic reflex was analysed using a strain gauge as an indicator of the upper extremity movement and the H reflex of the soleus muscle as the test reflex. The most prominent factor responsible for the enhancement was not the speed or the strength of the manoeuvre but the timing from the instruction.


Mitogen and muscle extract induced in vitro proliferative responses in myasthenia gravis, dermatomyositis, and polymyositis. We have compared the lymphocyte in vitro proliferative response induced by muscle extract, phytohaemagglutinin, and pokeweed mitogen in peripheral blood lymphocytes of patients with myasthenia gravis, polymyositis, dermatomyositis, and normal subjects. Similar mean responses to antigen and mitogen were seen in cells of all groups of patients. The proliferative responses induced by muscle did not differ in thymic cells from myasthenics as compared with those from cardiac surgery controls. Our findings do not support the hypothesis that cell-mediated immunity to muscle or major impairment of lymphocyte responses to mitogens occurs in these diseases.


Analysis of intellectual and cognitive performance in patients with multi-infarct dementia, vertebrobasilar insufficiency with dementia, and Alzheimer's disease. A prominent feature in dementia is intellectual deterioration. Review of the clinical literature indicates a lack of suitably quantitated studies of specific intellectual defects in dementia. The present study investigated the performance of patients with multi-infarct dementia (MID), dementia due to Alzheimer's disease (AD), and vertebrobasilar insufficiency (VBI) with dementia using the Wechsler Adult Intelligence Scale (WAIS). Forty-two patients ranging in age from 45 to 85 years (x 66) were included. Significant differences in cognitive and intellectual performance were found between patients with dementia due to VBI and MID versus neuronal atrophy of the Alzheimer's type. The group with AD performed significantly and consistently lower on all measures. There were no significant differences between the two cerebrovascular disease groups, even though the MID group performed consistently more poorly than the VBI group. A discriminant function analysis classified 74% of the patients correctly based on the individual WAIS scores. The diagnosis was more easily made when tasks measuring visual motor coordination and abstract reasoning were included in the analysis.


Investigation of cerebral dominance in 'left-handers' and 'right-handers' using unilateral electroconvulsive therapy. Twenty-four patients receiving unilateral electroconvulsive therapy for depression were given the first treatment with electrodes on the left or right side of the head and the second treatment with electrodes on the opposite side. They were tested with the Word Associate Learning subtest of the Wechsler Memory Scale when fully responsive after the first ECT and after the same time interval following the second ECT. Twelve were left-handed and 12 were right-handed writers. In both groups, better scores were usually obtained after right-sided treatment. Redistribution of patients into sinistral, mixed, and dextral groups showed that this difference between the effects of left and right-sided ECT was significant only in dextrals. Only two right-handed writers had scores indicating right-sided dominance for speech; both were 'shifted sinistrals'. Left hemisphere dominance was indicated in 67% of all non-dextrals. Eight of nine patients in whom testing was repeated after a second pair of treatments on alternate sides obtained scores favouring the same side in both pairs of testing. Findings indicate the need for closer inquiry into handedness than is often made before unilateral ECT is prescribed. Further development of unilateral ECT for establishing cerebral dominance in individuals is supported by the results.


Role of ligamentum flavum in the symptomatology of prolapsed lumbar intervertebral discs. Hypertrophy of the ligamentum flavum has been reported to occur in the prolapsed intervertebral disc syndrome. The ligaments from 28 patients were compared with a necropsy control group (18). Only minor histological anomalies were noted in two patients and the ligament was not thickened in cases of disc prolapse. In addition, there was no evidence to suggest previous trauma to the ligaments associated with disc protrusion or that the elastic fibres in the ligament degenerate with age, although some degeneration of the collagen fibres had apparently occurred in the two oldest control cases.


Acute vertebral collapse and cauda equina compression in tertiary syphilis. A patient with observed acute collapse of a lumbar vertebral body developed cauda equina compression. He was known to have contracted syphilis some 20 years before and, while he may well have suffered from tabetic spinal neuroarthropathy, histology of the collapsed vertebra showed features which indicate that an intra-osseous gumma could also have been responsible for his vertebral collapse and subsequent neurological deficit.


Disseminated intravascular coagulation and head injury. Blood coagulation tests were performed on admission to the hospital and on consecutive days after severe and moderate head injury in 34 patients. Platelet counts and fibrinogen were normal at admission and raised thereafter. The partial thromboplastin time was shortened at admission and lengthened in the following days. Fibrinolytic activity was enhanced at admission. The ethanol gelation test was negative in all patients during the post-traumatic time course. It was concluded that, in the first 24 hours after injury, activated coagulation was present after head injury. In contrast with data of other authors, disseminated intravascular coagulation did not occur in these series.


Brain creatine kinase in blood after acute brain injury. Severe cold injury of the brain increased significantly both total creatine kinase and the corresponding brain isoenzyme (CKBB) activity in confluens sinuum samples. CKBB could be detected also in peripheral blood a few hours after severe brain injury in eight of 12 patients. Finding of CKBB in human plasma may prove a useful indicator of severe brain injury.


Spontaneous extradural haematomas.

Spontaneous extradural haematomas. Spontaneous extradural haemorrhage may be due to neighbourhood infections, vascular malformations of the dura mater, and disorders of blood coagulation. Two cases are described here: in one, infection was present; in the other, there was a berry aneurysm of the middle meningeal artery with a small parietal dural angioma. Operation was successful in both patients.


Disturbances of sexual potency in patients with basilar impression and Arnold-Chiari malformation. Sexual impotence is common in patients with basilar impression and/or Arnold-Chiari malformation. There is no evidence of hypogonadism and testicular biopsy is usually normal. An autonomic disturbance is postulated.


Role of cerebral angiography in vertebrobasilar occlusive disease. The authors attempt to separate clinical subgroups of patients within the larger category of vertebrobasilar artery disease, and to indicate the present role of angiography in their recognition and management. Angiography is of use in separating posterior fossa occlusive vascular  lesions from space occupying lesions. In addition, by defining the locus and nature of the occlusive process, it may result in more rational treatment and prognostication. Subgroups of vertebrobasilar ischaemia which have a favourable prognosis may be separable clinically or, in unclear cases, angiographically.


Prevalence of migraine.

Prevalence of migraine. The prevalence of migraine in the general population has been calculated using a standard mailed questionnaire, which inquired about headache and the individual features of migraine, and which previously had been compared with a clinical diagnosis. In three separate epidemiological surveys the prevalence in the preceding year was found to be between 23 and 29% in women and between 15 and 20% in men. The prevalence declined with age in both men and women. These surveys show that migraine is much more prevalent than the frequently quoted figure of about 10% of the population which does not seem to be based on any particular survey.


Paroxysmal symptoms in multiple sclerosis. The clinical features of paroxysmal symptoms occurring in 26 patients with multiple sclerosis are reviewed. The findings are considered to provide further support for the concept of lateral spread of axonal excitation within demyelinated plaques.


Cell counts in the human cerebral cortex using a traditional and an automatic method. This study compares the results of cell counting in the human cerebral cortex by a traditional and an automatic procedure. Four blocks were taken from standard areas of each of 10 brains from individuals aged 18-95 years and showing no neurological abnormality. Sections from each block were counted by traditional and automatic methods, both of which are described. The traditional method used photomicrographs and the automatic procedure used the quantimet 720 Image Analysing Computer. The degree of reproducibility of each method was measured and the results are discussed and tabulated. Comparison are made of the total cell counts, and the counts of cells measuring greater than 20 um across. The results show a high level of correlation between the two procedures but the manual count yields higher number for total cells and smaller numbers for large cells than the automatic method. The reasons for these discrepancies are discussed and examples of the arterfacts which produce them are giver. Using the traditional method described the amount of meterial examined took about 4 months to study. The sane tissue can be assessed in 1 day using the automatic apparatus. The high speed and close correlation achieved by the automatic procedure makes it a valuable aid in quantitative cell studies in the central nervous system.


The onset and progression of the lesion in multiple sclerosis. The active established plaque in multiple sclerosis is characterized by hypercellularity at its edge and lipid phagocytosis (gitter cells). The hyperactive early plaque shows cells throughout the lesion. Active plaques seems to extend at their edges; proteolysis of myelin basic protein is perhaps an important factor in the myelin breakdown at the rim of these lesions. The hyperactive early plaque usually shows infiltration with monocytes, lymphocytes and plasma cells around its central vein. The phagocytic element is presumably a response to myelin breakdown but the significance of the lymphocytes in these lesions in uncertain. Perivenular infiltrates that are predominantly composed of lymphocytes are seen around veins and venules in the vicinity of established lesions in some patients who died during an acute episode...


Glucose metabolism and insulin response in the plasma and CSF in motor neurone disease. Plasma glucose and insulin values and insulin values were measured during an OGTT test in patients with MND and matched controls. CSF insulin and glucose levels were measured in the fasting state in 11 patients and 1 hr after a glucose load in 3 patients. There was no significant difference between the values found in the plasma or CSF of the MND patientsand controls. The possible mechansim causing anterior horn cell death in MND is discussed.


Morphological changes in skeletal muscle after transplantation. A light and electron-microscopic study of the initial phases of degeneration and regeneration. The morphological changes in subcutaneously implanted muscle homografts in mice were studied by light and electron microscopy 1-23 days after transplantation. The initial degenerative changes were identical in isografts and allografts and were essentially thesame as those found in muscle explants in tissue culture and aftervarious forms of muscle injury. Regnerative changes were prominent at the periphery of graftsby 48-72 hr beforeevidence of graft revascularization could be demonstated by India ink perfusion. Active regeneration occurred in isografts and in allografts during the first week resulting in the formation of  a new population of muscle fibres. Rejection subsequently occurredin allografts between days 7-14. Regeneration was  retarded or completely inhibitied by exposure of the donor animal to 1,500 rad of X-irradiation 1-2 hours prior to transplantationsuggesting that regeneration is brough about by  cells dervied from the graft. Eectron-microscopic observations in 48-72 hr grafts suggested that primitive mononucleated myogenic  cellsmay form within degeneratiang muscle fibres by a process of myonuclear sequestration. Inactive satellite cells were present in the muscle from which grafts were taken in some  donoranimals but no definite conclusions could be reached as to the role of these cells in graftsregeneration.


Neural abnormalities in the dystrophic mouse. Neural abnormalities (area of amyelination) have been found in the cranial nerves and in the ventral cervical and lumbosacral roots and in the mixed spinal nerves of bar harbor dystrophic mice of both the severe (129 Re/J dy/dy) and benign (dy-2J DY-2J) forms. The significance of these findings is discussed.


Ultrastructural studies of normal and degenerating mouse neuromuscular junctions. A quantitative study of the ultrastructural changes occurring at degenerating motor axon terminals of the mouse hemidiaphragm in the first 26 h following unilateral phrenicotomy has been made. Several ultrastructural characteristics of axon terminals from normal diaphragms and phrenicotomized and control hemidiaphragms of phrenicotomized preparations were analyzed. Considerable swelling and disruption of mitochondria occurred in terminals of control hemidiaphragms at 3, 6 and 9 h postphrenicotomy after which no more damage than that seen in normal terminals after fixation for electron microscopy was observed. At terminals of the phrenicotomized hemidiaphragm, much mitochondrial damage was observed from 3 h post-phrenicotomy onwards. In phrenicotomized hemidiaphragms all terminals had completely degenerated by 26 h post-phrenicotomy. Reduced synaptic vesicle population densities occurred during degeneration. At many axon terminals on phrenicotomized hemidiaphragms the population densities of synaptic vesicles were reduced compared with controls and vesicle aggregates were noted in many engulfed or partially engulfed nerve terminals. These results are discussed with respect to the vesicle hypothesis for nerve-muscle transmission. The mechnisms underlying Schwann cell hyperactivity are also considered.


Studies on the control of myelinogenesis. I. Myelination of regenerating axons after entry into a foreign unmyelinated nerve. The proximal stump of a predominantly myelinated nerve (sternohyoid) was anastomosed in a tube to the distal stump of a largely unmyelinated nerve (cervical sympathetic) in order to explore the role of the axon in activating Schwann cells to produce myelin. The two nerves were examined after being united for periods between 3 and 15 weeks. At these times, regenerating myelinated and nonmyelinated fibres, originating from the proximal stump, were seen within the original fascicle in the distal stump of the sympathetic trunk. There was a significant (P less than 0.01) increase in the mean number of myelinated fibres in the anastomosed sympathetic nerves from the mean number of myelinated fibres in the normal sympathetic nerve. The histological and ultrastructural features of the anastomosed nerves are described and the differences between the morphology of the intratubal and extratubal regions are highlighted. The results of this study may indicate that the axon instructs the Schwann cell to produce myelin, but before this conclusion is reached, the origin of the myelinating cells has to be determined.


The femoral chordotonal organs of a grasshopper, Orthoptera, Acrididae. The fine structure of the prothoracic and mesothoracic femoral chordotonal organs of a grasshopper, Romalea microptera, is described. A single chordotonal organ may contain more than 300 sensory units. Each unit includes the cell bodies and dendrites of two neurons, together with sheath cells of several kinds. The cytoplasm of the sheath cells is packed with microtubules and filaments. These cells surround the cell bodies of the neurons and anchor them to the inner surface of the femoral wall. The dendrites from the two neurons are enclosed by a scolopale cell. At the distal end of this cell they traverse the extra-cellular space within the scolopale and their tips are fitted into cavities in the scolopale cap. The ciliary region of each dendrite is dilated for about one fourth of its total length. The cap is embedded in an elongate cap cell which is attached, in turn, to a ligament cell. The ligament cells are, themselves, attached to an apodeme that extends in from the tibia. When the tibia is flexed, the chordotonal organ is stretched and when it is extended, the organ is relaxed. It is postulated that the mass of the dilated region affects the character of the vibration that is induced when the dendrite is stretch or relaxed.


Type I cells of carotid body from rats treated with 5-OH-dopa and L-dopa: an electron microscopical study. The ultrastructure of the Type I cells in rat carotid bodies was studied after treatment with 5-OH-Dopa and L-Dopa. Type I cells from the L-Dopa treated rats were also analysed by morphometric methods. After 5-OH-Dopa treatment, the majority of dense-cored vesicles of the Type I cells were almost completely filled with very electron-dense material. The vesicles were mainly distributed close to the plasma membrane. After L-Dopa treatment, the ultrastructure of the Type I cells resembled that after 5-OH-Dopa treatment, except that the increase in electron density of the vesicle content was less pronounced. The morphometric analysis revealed, as previously described for normal carotid bodies, two subclasses of Type I cells, small vesicle cells (SVC) and large vesicle cells (LVC). Compared to those of normal rats, the mean profile diameter of the vesicles in the L-Dopa treated rat carotid bodies were enlarged (for SVC from 47 to 55 nm and for LVC from 63 to 76-78 nm). Furthermore, the volume density of vesicles in both SVC and LVS was increased. The mean volume of the SVC was markedly increased after L-Dopa treatment for 60 h. These observations indicate that the Type I cells possess mechanisms for uptake of amine precursors and synthesis of monoamines. Though the vesicle may be involved in an 'endocrine-like' function, they may also be related to the chemoreceptor function of the carotid body.


Complex tight junctions of epithelial and of endothelial cells in early foetal brain. ?The morphology of epithelial and of endothelial intercellular junctions in human foetal (9-15 weeks gestation) and sheep foetal (50, 60 and 125 days gestation, term 147 days) brain has been studied using the freeze-fracture technique and thin section transmission electronmicroscopy. Freeze-fracture replicas of the choroid plexus of both early human and sheep foetuses showed that the choroidal ependymal cells are linked at the ventricular surface by tight junctions. Freeze-fracture replicas of foetal cortical endothelial cell junctions showed that they are still more complex than those of choroidal epithelial cells, in all specimens so far examined. In some 60 day sheep foetuses the dye Alcian blue, which binds to plasma albumin and which iselectrondense when treated with osmium tetroxide, was injected intravenously a few minutes prior to fixation. The dye penetrated from blood into brain extracellular space and c.s.f. but apparently not by an intercellular route. The dye was found in a tubular system (endoplasmic reticulum) in both choroidal epithelial and cortical endothelial cells. The possibility that protein penetrates into the foetal brain and c.s.f. by a transcellular route is discussed. The possible significance of these findings in relation to previous ideas and studies of the development of blood-brain barrier mechanisms is also considered.


Morphology of spinal electromotor neurons and presynaptic coupling in the gymnotid Sternarchus albifrons. Spinal electromotor neurons in the gymnotid Sternarchus albitrons were studied by light and electron microscopy. In this species, the electric organ discharge, which is of high and relatively constant frequency, is generated by specialized axons which arise from the spinal electromotor neurons. The cell bodies are located in medial regions of the spinal cord. They are round to ellipsoid in outline and dendrites are not peresent. The initial myelin segment often extends partially over the cell body. Fine glial lamellae are interposed between closely adjacent cells, and somato-somatic gap junctions are not observed. The large majority of axosomatic synapses are characterized by gap junctions. Single axons are commonly found to establish gap junctions with two adjacent neurons. Only a few synapses have the chracteristics associated with chemically mediated transmission. The morphological data provide evidence for electrotonic soupling between electromotor neurons by way of presynaptic fibres. The absence of dendrites in these neurons may provide a morphological correlate for their simple relay function.


An ultrastructural study of methionine sulphoximine-induced glycogen accumulation in astrocytes of the mouse cerebral cortex. Glycogen distribution in the mouse cerebral cortex was examined with electron microscopy following treatment with the experimental convulsant, methionine sulphoximine (M.S.O.). Both at 24 and 48 h followed administration of M.S.O., accumulation of particulate glycogen was prominent in astrocytes throughout the cerebral cortex. In astrocyte cell bodies and in subpial, pericapillary and perineuronal astrocyte processes the glycogen often completely filled the cytoplasm, crowding the remaining organelles and inclusions. The present findings correlate well with biochemical studies of M.S.O. effects of glutamine synthetase activity and energy metabolism. It is suggested that the glycogen may be derived from glutamate which under normal conditions would be converted to glutamine.


Neurofilament and glycogen changes during cold acclimation in the trochlear nucleus of lizards (Sceloporus undulatus). In lizards (Sceloporus undulatus), long term (13 or 19 weeks) acclimation to an environment of 6 degrees C produces a striking increase in the argyrophilic neurofibrillar network in most large perikarya of the trochlear nucleus. In electron micrographs the cells contain numerous bundles of 10-30 regularly-spaced 90 A neurofilaments. In the cells from warm acclimated animals, a plexus of neurofibrils is seen by light microscopy. The electron micrographs show scattered neurofilaments and fewer, thinner bundles than in the cold. Within the cell bodies of the cold animals, glycogen particles are organized in regional accumulations from which other organelles are excluded except for the bundles of neurofilaments which are distributed throughout the cytoplasm. The aggregations of rough endoplasmic reticulum (RER) are also penetrated by the neurofilament bundles. The increased neurofilamentous network in the cold is not accompanied by obvious changes in the amount or distribution of RER or of microtubules which are present in limited numbers in both conditions. The dendrites of trochlear cells and axon terminals within the nucleus also show a cold induced increase in neurofilaments, as well as in the distinctive accumulations of glycogen particles.


Normal position of the aqueduct of Sylvius. Part 1: significance of aqueduct to dorsum sellae measurements. The author describes a method for estimating the position of the aqueduct of Sylvius based on the ratio of the measured distance from surface to aqueduct (A) to that from the surface to dorsum sellae (B). The normal ratio A:B is 0.72 with a range from 0.68 to 0.75. Values below 0.68 indicate a dorsally displaced aqueduct.


Normal position of the aqueduct of Sylvius. Part 2: evaluation of two preaqueductal proportional methods. Two new proportional methods for determination of the normal or abnormal position of the cerebral aqueduct are described. The position of the iter is expressed by the quotients (see article) and (see article), when d-aq represents the distance between the upper posterior surface of the dorsum sellae and the dorsal center of the air-filled aqueduct. Ts equals aq is the distance from the tuberculum sellae to the same point, and TW is Twining's line. The normal value of the dorsum to aqueduct ratio was 0.32 plus or minus 0.02 standard deviation (SD) and of the tuberculum to aqueduct ratio 0.44 plus or minus 0.03 SD. Both proportional methods are independent of skull dimensions. These are compared to another proportional method described in Part 1 of this report.


Echoencephalographic A-scan study of the aqueduct and brain stem. The author utilizes autopsy models and normal clinical subjects with and without pneumoencephalography to demonstrate the value of echoencephalography in delineating the position of the aqueduct of Sylvius. Echoes from the dorsum sellae, the anterior wall of the sella turcica, and the aqueduct proved consistently identifiable, while echoencephalographic examination of 25 normal subjects revealed in all instances well-defined aqueduct echoes. Thus the aqueduct echo method may be a diagnostic aid in determination of the anterior-posterior position of the brain stem.


Clinical and electrophysiological studies on sensory conduction mediated by the accessory rootlets of the human trigeminal nerve. The authors present records of potentials evoked in the roots of the trigeminal nerve by stimulation of its cutaneous branches. Records were made during nine operations for tic douloureux in which the main sensory root of the trigeminal nerve was totally sectioned under the microscope by the transcerebellar route. In every case, the accessory (aberrant) and motor roots were easily identified and spared. Records before and after total main sensory root division showed persistence of evoked potentials in the aberrant and motor fibers. Partial preservation of sensation and blink reflex in these cases reinforced the impression that there is somatic sensory conduction through true aberrant sensory fibers running between the motor and main sensory roots.


Radical one-stage correction of craniofacial anomalies. The authors present their experience in the surgical treatment of 66 patients with craniofacial anomalies, and discuss selection of patients, surgical technique, complications, and results.


Contrecoup skull fractures.

Contrecoup skull fractures. The authors describe the frequency, pathological features, and significance of contrecoup fractures of the anterior cranial fossae, which occur commonly when falls with occipital or temporal impacts cause fatal head injuries.


Giant cell tumors of the calvaria.

Giant cell tumors of the calvaria. The authors report and discuss four rare cases of primary, giant cell tumor of the cranial vault, a usually benign tumor that develops in young patients and has an extremely low rate of latent malignancy. The authors believe the preferred treatment to be total surgical removal of the tumor; only in rare cases of malignancy when the tumor is impossible to remove totally should this be combined with radiotherapy. Associated minor trauma played only a tumor-revealing role and was not involved in the etiology.


Microsurgical anatomy of the jugular foramen. The authors conducted an autopsy study of 50 jugular foramina and surrounding tissue, using the dissecting microscope. Anatomical findings from this study are presented.


Value of sequential postoperative brain scans in patients with anaplastic gliomas. The authors analyze the postoperative course of 30 patients with anaplastic supratentorial gliomas to evaluate the usefulness of sequential brain scanning as an adjunct to clinical neurological examinations in the early detection of tumor recurrence. The correlation between sequential scanning and clinical evaluation was excellent; no examples of divergent resu;ts were seen. With the exception of scans made very early in the postoperative period or when postoperative scalp flap infections were present, initial postoperative scans were easily interpreted in terms of both the superficial (postcraniotomy) and parenchymal changes. The specific type of postoperative therapy (radiation therapy, chemotherapy, or both) could not be correlated with whether scan or examination ultimately changed first. However, analysis of original tumor location revealed that while sequential postoperative scanning offered no advantage over repetitive neurological examinations in the detection of recurrent tumor in the neurologically dominant left hemisphere, scan changes preceded examination changes in eight of 17 cases involving tumors of the neurologically nondominant right hemisphere.


Metal prosthesis of the cervical vertebra. The authors successfully used a newly-devised metal prosthesis anchored by acrylic cement in four patients with cervical spinal tumor. Two of these patients suffered incomplete quadriplegia due to epidural infiltration of the tumor and required laminectomy. Severe neck pain was relieved in all cases, and neurological improvement was maintained until death.


Selective sacral rootlet rhizotomy for hypertonic neurogenic bladder. The authors describe a highly selective transsacral microsurgical procedure for sacral nerve rootlet interruption in five patients with hypertonic neurogenic bladder. Magnification and systematic stimulation of sacral roots provided accurate identification of motor fibers supplying bladder detrusor muscle and differentiation of efferent components to the legs and anal sphincter. Although the technique prevented incontinence and adverse effects of nerve section on rectal and lower extremity function improvement in voiding patterns and diminution of urinary sepsis was of brief duration in three of the five patients. Physiological data from these procedures reaffirms the importance of S-3 and S-4 motor roots in detrusor innervation, but clinical responses bring into question the possibility of sustained improvement from such a highly selective procedure at the sacral level. The authors suggest that alternative pathways, not apparent on initial stimulation, may develop after section of sacral root components, and that dissection and stimulation of fibers at the level of the conus medullaris should be investigated as an alternative procedure.


Penetrating gunshot wounds of the cervical spine in civilians. Review of 38 cases. The authors present a series of 38 civilian patients with cervical gunshot injuries, and compare neurological recovery in patients with complete lesions and patients with incomplete lesions according to whether therapy was surgical or nonsurgical. In patients with incomplete injury, ultimate recovery was a function of the initial injury more than surgical or nonsurgical therapy; nor did patients with complete lesions show significant change in outcome with either mode of therapy. Cord pathology at laminectomy rarely provided a clue about neurological recovery, and fural decompression did not alter neurological outcome. The authors conclude that the sole indication for routine surgical intervention appears to be progressive neurological deficit.


Carotid-cavernous sinus fistula presenting as a posterior fossa mass. Case report. The authors report a case in which trigeminal neuralgia and hearing loss developed 14 years after a severe head injury. Arteriography demonstrated a carotid-cavernous sinus fistula producing a large venous mass in the posterior fossa.


Bilateral giant carotid-ophthalmic aneurysms. Case report. The authors describe a patient with bilateral giant aneurysms of the internal carotid artery in the region of the ophthalmic artery. This care illustrates the feasibility of successful intracranial surgical treatment for this unusual combination.