Evaluation of instrumented force platform as a test to measure residual effects of anesthetics

Recovery from anesthesia was assessed in a controlled manner in 38 healthy student volunteers, using two psychomotor tests (perceptual speed and tapping board) and an instrumented force platform 1, 3, 5 and 7 h after intravenous injection of 0.3 mg/kg diazepam, 2.0 mg/kg methohexital, 6.0 mg/kg thiopental or saline. Postural stability remained unaltered but the performance on psychomotor tests improved when the tests were repeated after saline injection. Methohexital did not induce any changes in body sway or psychomotor performance at the time periods tested when compared with saline. Postural stability of subjects receiving thiopental or diazepam was imparied (P less than 0.001) for 1 and 7 hours after anesthesia, respectively, when compared with saline. The impairment on performance in the psychomotor tests induced by thiopental or diazepam was of smaller magnitude and for diazepam of shorter duration than balance disturbances measured with the body sway tests. Further clinical studies on the use of the instrumented force platform as a fast and easily interpretable guideline for discharge from hospital after different modes of outpatient anesthesia are warranted.

Intrathecal interferon reduces exacerbations of multiple sclerosis

Ten patients with multiple sclerosis who were treated with human fibroblast interferon (IFN-B) for 6 months showed a significant reduction in their exacerbation rates compared with their rates before treatment (P < .01). The IFN-B was administered intrathecally by serial lumbar punctures. There was no significant change in the exacerbation rates of ten multiple sclerosis control patients before and during the period of observation. The IFN-B recipients have now been on the study a mean of 1.5 years, the controls, 1.2 years. The clinical condition of five of the IFN-B recipients and one of the control patients has improved, whereas the condition of five of the controls and one of the IFN-B recipients has deteriorated (P < .036). These findings warrant cautious optimism about the efficacy of intrathecal IFN-B in altering the course of multiple sclerosis and support concepts of a viral or dysimmune etiology of the disease.

A test of the Broen-Storms theory of cognitive deficit in schizophrenia

Broen and Storms have developed a popular behavioristic theory to explain schizophrenic thought disorder. It holds that thought disorder results from schizophrenics' having higher drive levels and lower response-strength ceilings than non-schizophrenics. As a result, the strength of appropriate (usually strong) responses is rivaled by that of inappropriate, ordinarily-weak responses. This, in Broen and Storms' theory, is the cause of disorganized, schizophrenic behavior. We tested several hypotheses derived from Broen and Storms' assumptions that schizophrenics have higher drive and lower response strength ceilings than controls in a paired-associates learning study. We did not find support for our hypotheses that schizophrenics would show better early-trials learning than controls, that a presumably drive-inducing threat of pain would enhance early trials learning in schizophrenics or controls, that either threat of pain or schizophrenia would be associated with a low learning asymptote, or that either the positive or negative effects of pain would be accentuated in schizophrenics. The results did not support the theory.

An eye movement disorder in amyotrophic lateral sclerosis

Defective pursuit eye movements were recorded by electrooculography (EOG) in 11 of 18 patients (61%) with amyotrophic lateral sclerosis. Pursuit defects consisted of a breakdown of smooth tracking into saccadic motions that were grossly in excess (frequencies and amplitudes) of saccadic interruptions of pursuit in normal subjects. In nine patients, defective pursuits cogwheeling) were obvious by visual inspection as well as by EOG; in two, this abnormality was seen only by EOG. In eight patients, the pursuit defect was the only abnormality of oculomotor function; in three, there were also saccadic defects (optokinetic nystagmus or conjugate gaze) discerned by EOG. Autopsy revealed neuronal degeneration in substantia nigra and demyelination in integral capsule in one patient with the pursuit defect but not in another patient without the defect. The pursuit defect may be a sign of extrapyramidal or supratentorial pyramidal involvement in ALS.

Synthesis of subgenomic mRNA's of mouse hepatitis virus is initiated independently: evidence from UV transcription mapping

The target sizes of the templates for the synthesis of the genome-sized RNA and the six subgenomic RNAs found in cells infected with mouse hepatitis virus strain A59 were determined by UV transcription mapping. Infected Sac(-) cells were irradiated at 6 h postinfection, the time when virus-specific RNA synthesis starts to increase exponentially. The effect of increasing UV doses on the synthesis of the individual RNAs was determined by quantitation of these RNAs after separation by agarose gel electrophoresis. The UV target sizes calculated for the templates were almost identical to the physical sizes of the RNAs. The results of these experiments seem to exclude the possibility that the subgenomic RNAs are processed or spliced from a common precursor. The data are consistent with independent initiation of transcription on a genome-sized, negative-stranded template or on smaller templates.

Disappearing palatal myoclonus

Two patients had palatal myoclonus that disappeared. In one, the palatal myoclonus disappeared completely during all stages of natural sleep only to return again when he awoke, persisting as long as he remained awake. In the other patient, palatal myoclonus was continuous for 2 years, became erratic for 6 months, and then disappeared completely, although she could induce it voluntarily. These cases demonstrate that palatal myoclonus is not always: independent of the sleep-waking cycle, persistent throughout life, and independent of cortical control.

Diazepam effects and kinetics in Caucasians and Orientals

Mental and psychomotor effects and diazepam kinetics were studied in Caucasian and Orientals. 12 Caucasian and 13 Oriental young adults received on one of two occasions, separated by 2 weeks, either 0.2-mg/kg diazepam or saline intravenously. Serum diazepam and desmethyldiazepam concentrations were measured by electron-capture gas-liquid chromatography in samples drawn up to 72 hr after injection. Serum protein binding was measured by equilibrium dialysis. Subjects were tested on a battery of psychological tests before and 0.5, 2, and 4 hr after treatment. While the free fraction of diazepam was identical in both races (0.02), volume of distribution at steady state (Vdss) was different when calculated as absolute volume (Vdss = 76.55 +/- 9.63 l in Caucasians and 54.96 +/- 4.55 l in Orientals, p = 0.04) and marginally significant when corrected for body weight (Vdssl/kg = 1.10 +/- 0.11 in Caucasian and 0.88 +/- 0.05 in Orientals, p = 0.07). total body clearance (Cl), but not elimination half-life (t 1/2), was higher in Caucasians than Orientals, p less than 0.01; t 1/2 = 37.70 +2- 5.53 hr in Caucasians and 41.77 +/- 3.80 in Orientals). Desmethyldiazepam levels were higher in Orientals than Caucasians. Mental and psychomotor effects were maximal at the first session (0.5 hr), followed by complete recovery by the 4-hr session. Effects were similar in both groups. If repeated dosing causes a higher rate of cumulated diazepam serum levels in Orientals, as expected, there might be deeper brain depression in that group.

Auditory-visual synesthesia: sound-induced photisms

Nine patients with visual loss due to lesions of the optic nerve or chiasm experienced photisms induced by sound. Descriptions of these varied from simple flashes of white light to complicated colorful hallucinations likened to a flame, a petal of oscillating lines, a kaleidoscope, or an ameba; they always appeared within a defective portion of the visual field as demonstrated by perimetry. The provoking sounds were usually those of normal daily life, ranged from soft to loud, and always seemed to be heard by the ear ipsilateral to the eye in which the photism was seen. Sound-induced photisms occurred under circumstances that would promote a startle reaction to sound, and each patient was startled when the photisms occurred. Visual evoked responses demonstrated partial deafferentation of the eye in which photisms were seen in seven patients tested. The phenomenon may occur when the patient with a partially deafferent anterior visual pathway is startled by sound.

Time course of mental and psychomotor effects of 30 per cent nitrous oxide during inhalation and recovery

Two experiments were conducted testing the duration of action of nitrous oxide on human performance. In the first experiment, 11 subjects inhaled 30 per cent nitrous oxide for two periods of 40 min each, 45 min apart. Their mental and psychomotor skills were measured using free recall, tapping board, arithmetic and flicker fusion tests before and 2, 12, 22 and 32 min after establishing and end-tidal concentration of N2O of 30 per cent. Recovery was tested using the same tests 2, 12, 22 and 32 min after discontinuation of N2O. Eleven additional subjects inhaled oxygen only and served as a control group. In the second experiment, 8 subjects received both 30 per cent N2O and oxygen in cross-over fashion, and their flicker fusion threshold was measured. When compared to baseline or oxygen administration, N2O significantly impaired tapping rate, number of words recalled, and performance in arithmetic tests. The effects of N2O were maximal at 2 min and remained similar throughout the entire administration. In flicker fusion tests, the effects of N2O were similar to those of stimulant drugs; N2O improved the subjects' ability to discriminate the fusion of flickering light. Recovery was complete in 22 min. The effects of, and recovery from the second administration of N2O were similar to those of the first experiment. There was no evidence of development of tolerance to mental and psychomotor effects of the drug.

Visual allesthesia

A patient with a right parietooccipital arteriovenous malformation experienced paroxysmal illusory left homonymous transpositions of objects viewed in the right homonymous field. The illusory images were palinoptic, persisting for up to 15 minutes after the real objects were no longer in view. She had left homonymous hemiachromatopsia and a right parietooccipital epileptogenic focus. Episodes of visual allesthesia were accompanied by other manifestations of seizures. Administration of anticonvulsant medications resulted in cessation of electroencephalographic epileptogenic activity and disappearance of all clinical manifestations of seizures, including visual allesthesias. Cerebral irritation and seizures, a defective but not blind half-field of vision, and experience of palinoptic images are essential components of some cases of visual allesthesia. The phenomenon may result from interhemispheric transfer of a visual percept from a normal to an irritated parietooccipital lobe, which then retains it as a palinoptic image.

Metoprolol in essential tremor

The tremor of a patient with debilitating essential tremor who could not take propranolol (because of severe asthma) was dramatically reduced when metoprolol tartrate was administered in standard doses. Metoprolol appears to be an excellent alternative antitremor drug to propranolol in such patients.

Gray matter enhancement: a computerized tomographic sign of cerebral hypoxia

An important computerized tomographic (CT) pattern is described, in which selective enhancement of cerebral gray matter occurs after intravenous administration of contrast medium. Analysis of 76 cases displaying the enhancement pattern revealed that the phenomenon occurs in diseases characterized by hypoxia, and may be attributed to regional vascular dysautoregulation. Eighty percent of these patients had primary cerebrovascular disease (infarctions or transient ischemic attacks); 20% with other disorders also had evidence of cerebral ischemia or infarction. When hypoxia progressed to infarction, the enhancement was accompanied by one or more parenchymal areas of decreased density. However, in transient ischemic attacks, it occurred without other parenchymal abnormality and represents the first recognized CT sign of cerebral hypoxia. Enhancement was observed within 3 weeks of onset in 80% of cases, but in 20% it persisted for up to 4 months, indicating a protracted state of dysautoregulation.

Three primitive reflexes in normal adults

One or more of three primitive reflexes (palmomental, snout, and corneomandible) was elicited in 50.5% of 105 normal subjects in the third through the ninth decades of life. The reflexes appeared in a patterned fashion with advancing age. The palmomental reflex appeared earliest and was the most frequent reflex elicited at all ages. The snout and corneomandibular reflexes appeared at later ages and were elicited less frequently. The palmomental and snout reflexes often occurred alone, but the corneomandibular was elicited only when one or both of the other reflexes was also present. These reflexes appear to be normal phenomena in a significant proportion of the healthy population.

Three primitive reflexes in parkinsonism patients

One or more of three rimitive reflexes (palmomental snout, and corneomandibular) was elicited in 63.8% of 58 parkinsonism patients in the sixth through ninth decades of life. The incidences of the palmomental and snout reflexes in parkinsonism patients did not differ significantly from the incidences in 60 normal subjects of similar ages. The incidence of the corneomandibular reflex in parkinsonism patients was approximately 2 1/2 times greater than the incidence observed in the normal subjects. The high incidence of the corneomandibular reflex in parkinsonism appears to be related to the disease, but the incidences observed for the palmomental and snout reflexes can be attributed to aging.

Interrelationships and correlates of four measures of pleasure deficit

Compared the utilities of four measures currently used to assess pathological deficit in the ability to experience pleasure (N = 56). The Watson Anhedonia Interview scale was less reliable than the others, but was correlated as often with measures of pleasure-seeking as they were after correction for attenuation. It was more heavily correlated with measures of psychopathology than the others. The Chapman, Chapman, & Raulin (1976) Social and Physical Anhedonia scales demonstrated superior reliability and more correlations with pleasure-seeking ratings than the other scales, at least before correction for attenuation. However, their relatively modest relationships with measures of psychopathology suggested that the pleasure-deficits they measure best may not be as characteristic of psychiatric conditions as that reflected by the Anhedonia Interview. The Zuckerman General Sensation Seeking scale showed less reliability than the Chapman scales and fewer correlations with both pleasure-seeking and psychopathology than the others.

Fibroblast alpha-galactosidase A activity for identification of Fabry's disease heterozygotes

The identification of female carriers of Fabry's disease is important for genetic counselling since prenatal diagnosis of affected fetuses is possible. The activities of either total alpha-galactosidase or alpha-galactosidase A in cultured fibroblasts were similar in Fabry carriers and controls and cannot therefore be used for carrier detection. Better discrimination between carriers and controls was found when total alpha-galactosidase activity was expressed as a ratio to beta-galactosidase activity, but overlap still occurred. However, there was complete discrimination between the ratio of alpha-galactosidase A to beta-galactosidase in cultured fibroblasts from five carriers of Fabry's disease and either 11 controls, seven hemizygote affected males or two of their female relatives.

A note on the pathology of anhedonia

Tested the hypotheses that anhedonia afflicts only a minority of schizophrenics and is bimodally distributed among them by comparing the Anhedonia scale distributions of schizophrenic and psychiatric control samples (N = 90). Only 45% of the schizophrenics produced scores higher than those characteristic of the controls. While the schizophrenics' distribution appeared to be bimodal, its irregularity precluded a definitive assessment of the bimodality hypothesis. The correlation between age and Anehodina was positive for anhedonics but not for non-anhedonic schizpohrenics or controls; these findings suggest that anhedonia is a mildly progressive disorder among those schizophrenics who experience it.

Correlates of alpha, beta and theta wave production

Studied the correlations of alpha, beta and theta time densities with psychological and psychophysiological variables in a psychiatric population (N = 76). The correlations of the EEG variables with measures of adjustment were small and barely exceeded chance expectations. Alpha and beta were correlated positively with pain threshold, while beta was related inversely to blood pressure. Theta was correlated positively with blood pressure and negatively with pulse rate. The implications of these findings for EEG biofeedback treatment were discussed.

The prediction of outcome from anhedonia and process-reactive scales

Earlier researchers have suggested that the ability of process-reactive measures to predict future adjustment may result from their relationships to the anhedonia dimension. In the present study the abilities of process-reactive and anhedonia measures, independent of one another, to predict rehospitalization data were compared. After anhedonia scores had been partialed out, schizophrenics' process-reactive scores were correlated modestly with length of the patients' next hospitalization and reclassification as nonschizophrenic. No such significant correlations appeared between anhedonia and adjustment measures after process-reactive scores had been partialed out. Among nonschizophrenics, a sizeable correlation between anhedonia and the probability of later diagnosis of schizophrenia appeared, which suggests that anhedonia may be a useful prodromal marker for schizophrenia.

Systems releasing action therapy with alcoholics: an experimental evaluation

Described Systems Releasing Action Therapy (SRAT) and a controlled study that evaluated its effectiveness. The therapy combines physical and fantasy exercises and has its roots in the Bioenergetic and Gestalt traditions. To evaluate its effectiveness, 56 patients who were receiving treatment for alcoholism were assigned randomly to therapy and control groups. On 3-week follow-up, the therapy sample showed significantly more improvement than the controls on measures of blood pressure, physical symptoms, anxiety, hysteroid tendencies, disturbed feelings and self-image. Suggestive differences (interactions significant only at the .20 level) in favor of the therapy group also appeared on measures of vital capacity withdrawal, excessive drinking, anhedonia and four neurosis-oriented MMPI scales. However, 6-month follow-up data were relatively unimpressive. The results suggest this type of therapy is an effective one, at least for the short term.