[Diagnosis and therapy of the narrow lumbar spinal canal]

In 30%-40% of the patients who are operated on for herniation of lumbar discs, osseous stenosis plays a certain role. However, only in one-third of them are special operative measures such as laminectomy necessary with or without additional lumbar fusion. When spondylodesis is carried out after laminectomy it is often combined with metal implant, which can drastically reduce the time a patient requires perioperative treatment. In younger patients showing typical signs of nerve root compression due to osseous stenosis of lateral recess, only segmental decompression in the form of foraminotomy is done. On the other hand, in cases of narrow spinal canal, which is found in elderly patients, neurogenic intermittent claudication is the predominant clinical picture. Kyphosis, scoliosis, and vertebral displacement can lead to local spinal stenosis. On addition, local pressure and tension on unstabile segments in combination with secondary fibrosis can lead to compression of the neural structures. The diagnosis is based on the clinical history and myelography. Computed tomography helps reveal the presence of herniation of a lumbar disc, which should be simultaneously operated upon. For the operative treatment there is no age limit. All in all, the operative results are so good that one is inclined to decide in favour of operation.

The insanity defense before 1800

The earliest context in which madness is treated as an excuse for crime is Justinian's Digest. The Christian church brought this feature of Roman law to pre-Norman England. Madmen were probably not regarded as triable by ordeal, but were simply left to be guarded by their kinsfolk. When trial by ordeal was abandoned, and juries had to determine guilt, juries were at first expected to find madmen guilty but refer their cases to the king for pardon. It was not until about 1500 that juries seem to have begun to acquit on grounds of insanity. The reasoning varied: madmen were “punished enough by their madness”; they “lacked the will to harm”; they could not “tell good from evil.” How strictly the tests of insanity were applied depended on the crime. The rejections of the defense that figured in the State Trials series were not typical, but gave historians the impression that the defense hardly ever succeeded before Hadfield's trial in 1800. In fact, as the Old Bailey Sessions Papers show, it often succeeded in the eighteenth century. Nor was this the result of empire building by the medical professions. Laymen's evidence was often accepted without any testimony by mad-doctors.

Uterine growth responses of the mature castrate rat to estradiol-17B

To examine estrogen-stimulated uterine growth we have monitored changes in uterine DNA synthesis, ornithine decarboxylase (ODC) activity and protein content as well as luminal epithelial (LE) cell mitotic index and ultrastructural changes. We have utilized this model to examine castrate mature rat uterine growth as a function of time between 18 and 40 hours following a single injection of 25.0 ug of estradiol-17B. LE cell mitotic index and protein content increases were maximally elevated as early as 18 hours postinjection while uterine ODC activity was maximal at 28 hours; uterine DNA synthesis increases continued throughout the experiment. In addition, the infusion of either 1 or 2 ug E2 plus progesterone over a 24 hour period, stimulated elevated ODC activity under both treatment regimens and LE cell mitotic index which was inversely related to E2 dose.

Identification by direct photoaffinity labeling of an altered phosphodiesterase in a mutant S49 lymphoma cell

Extracts of a mutant S49 lymphoma cell line, termed K30a, hydrolyze cAMP and cGMP at rates much faster than do wild type S49 extracts. This elevated phosphodiesterase activity, called K-PDE, elutes as a single peak of activity on DEAE-cellulose columns (Brothers, V. M., Walker, N., and Bourne, H. R. (1982) J. Biol. Chem. 257, 9349-9355). Direct photoaffinity labeling of K30a extracts with [32P]cGMP results in radiolabeling of a unique polypeptide, not observed in wild type extracts, which migrates in sodium dodecyl sulfate polyacrylamide gels with an Mr = 106,000. The 106-kDa band was identified as the catalytic K-PDE polypeptide based on the following observations: competitive inhibitors and substrates of K-PDE inhibit photolabeling of the 106-kDa band, indicating that [32P] cGMP photolabels the enzyme at its catalytic site; on DEAE-cellulose chromatography the polypeptide that is susceptible to photolabeling co-elutes with K-PDE activity; the 106-kDa band is detectable in extracts of WT X K30a hybrids (where WT denotes wild type) in amounts proportional to the K-PDE activity in the hybrids, but is undetectable in wild type. The hybrid phenotype strongly suggests that the K30a phenotype is not due to mutations that affect either a diffusible regulator of transcription or an enzyme that modifies K-PDE. Although wild type cells contain a minor cGMP phosphodiesterase activity distinct from the major cAMP phosphodiesterase, the wild type cGMP phosphodiesterase is not susceptible to radiolabeling with [32P]cGMP; this rules out the possibility that the K30a phenotype is caused by overexpression of a wild type phosphodiesterase. We conclude that the K30a mutation produced expression of a new species of phosphodiesterase molecule that is not detectably expressed in the parental S49 wild type cell line.

A guanine nucleotide-sensitive adenylate cyclase in the yeast Saccharomyces cerevisiae

Adenylate cyclase in particulate extracts of Saccharomyces cerevisiae utilized either MnATP or MgATP as substrate. A mutation in the CYR1 gene, which codes for the catalytic unit of yeast adenylate cyclase (Matsumoto, K., Uno, I., and Ishikawa, T. (1983) Cell 32, 417-423), eliminated utilization of both MgATP and MnATP, indicating that a single enzyme was responsible for both activities. GTP and guanylyl-5'-imidodiphosphate stimulated yeast adenylate cyclase, while a GDP analog, guanosine-5'-O-(2-thiodiphosphate), competitively inhibited this stimulation. Thermal inactivation studies distinguished putative guanine-nucleotide regulatory protein (N) from the catalytic unit (C) of yeast adenylate cyclase. Yeast N, which conferred guanine nucleotide regulation and the ability to utilize MgATP on yeast C, was quickly inactivated by incubation of particulate extracts at 30 degrees C. In contrast, yeast C, which apparently utilized MnATP as substrate in the absence of a functional N protein, resisted inactivation at 30 degrees C. These observations suggested that physically distinct protein components mediated the catalytic activity of yeast adenylate cyclase and its regulation by guanine nucleotides. These findings indicate a striking homology between the adenylate cyclase systems of S. cerevisiae and those of vertebrate cells.

Comprehension and recall of sentences by mentally retarded and nonretarded individuals

A cued sentence-recall task was used to determine the extent to which 24 mildly mentally retarded adolescents and 24 equal-MA nonretarded children differed in their ability to recall sentences and to infer and utilize particular exemplars of general nouns as retrieval cues. We found that the sentence recall performance of the retarded adolescents was poor relative to that of the nonretarded children; however, both groups found general and particular cues to be equally effective retrieval aids for target sentences. Differential sentence reconstruction and editing strategies were suggested as possible sources of the obtained recall differences.

Carcinoma in situ of the vulva. The search for viral particles

Biopsy specimens taken from eight women with squamous-cell carcinoma in situ of the vulva were studied with transmission electron microscopy for the presence of viral particles. In one of the specimens a 150-nm-diameter viruslike particle was found. The exact nature of this particle was not clear, but it could have represented an immature herpesvirus particle. In seven specimens no evidence of viral particles was detected. These findings provide further evidence that the positivity of vulvar carcinoma in situ for herpesvirus antigen is not due to the presence of whole virus particles.

[Treatment of femur head necrosis using a total hip prosthesis following kidney transplantation]

From 1972 to 1978 we implanted 30 total hip prostheses in 20 patients with kidney transplant and femoral head necrosis. All were patients who still had immune suppressing drug therapy. To reduce the infection risk the patients had a special preoperative treatment -- single room -- always the same surgeon, short operative procedure in the greenhouse of 45 minutes on an average and only 4 blood infusions. Thereby, we had no complications peroperative and none were observed during the following checks extending from 4 months to 6 years. Hence, we believe that the implantation of total hip prostheses in high risk patients with kidney transplants and femoral head necrosis is recommendable.

Dermatological reactions to lithium: a critical review of the literature

This article reviews clinical reports of dermatological reactions to lithium. Such reactions include maculopapular, acneiform, and follicular eruptions, psoriasis, and other manifestations. Standard psychiatric texts offer the psychiatrist little information concerning the prevalence or seriousness of these reactions, nor do they discuss the effectiveness of various treatment alternatives. More surprisingly, most dermatology texts do not even describe skin reactions to lithium. Dermatological reactions to lithium may occur more commonly than previously documented, but with the exception of some psoriatic cases, management without the need for lithium discontinuation is usually possible.

Use of categorical knowledge to aid recall

Recall performance of 84 mildly retarded adolescents and 84 non-retarded fourth graders was compared under various encoding conditions. The seven encoding conditions consisted of the following format-cueing combinations: simultaneous-subject cues, simultaneous-experimenter cues, sort-subjects cues, sort-experimenter cues, sequential-subject cues, sequential-experimenter cues, and sequential-no cues. Stimuli were 24 colour pictures from six categories. Results indicated generally comparable levels of performance for retarded and non-retarded subjects. However, retarded subjects were less responsive to sort and experimenter cue conditions, which led to increased recall in the non-retarded subjects. It was suggested that retrieval difficulties may be interfering with the ability of retarded individuals to utilize categorical knowledge to facilitate recall.