An MMPI sign to separate organic from functional psychiatric patients

Evaluated the utilities of all 90 possible unweighted additive/subtractive two-scale MMPI combinations as indices to separate brain-damaged from functional patient groups in a Veterans Administration psychiatric hospital. One index, Hs-PT, showed more promise than any of the other 89. Hs-PT mean scores were significantly higher among organics than among alcoholics, neurotics, affective psychoses, character disorders, process schizophrenics or reactive schizophrenics. Interpretative information on the Hs-PT index was presented.

Quantification of chemical mutagenesis in diploid human fibroblasts: induction of azaguanine-resistant mutants by N-methyl-N'-nitro-N-nitrosoguanidine

The toxic and mutagenic effects of N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) on cultured diploid human fibroblasts were studied. When 10(5) cells per 60 mm dish were exposed to MNNG for 4 h in Ham's medium F10 containing 0.02 M HEPES buffer at pH 6.8, MNNG concentrations of less than 1 X 10(-6) M resulted in cell survivals near 100%, while the average survival was less than one percent at concentrations greater than 5 X 10(-6) M. After treatment with MNNG, cells were subjected to selection using optimal conditions for the detection of diploid human fibroblasts that are resistant to the guanine-analogs AG and TG because they contain altered or deficient HPRT. The induced mutant frequency was maximized by allowing a 5 to 7 day post-treatment interval for the expression of the mutant phenotype and by replating the cells at the beginning of selection at a population density of less than 450 cells per cm2. Careful attention was given to counting statistically adequate numbers of mutants and to accurately determining cell survival and replating cloning efficiencies. Independent dose-response experiments gave induced mutant frequencies as high as 7.0 X 10(-4) to 8.8 X 10(-4) mutants per viable cell at about 5% survival, compared to a spontaneous mutation rate of 3.7 X 10(-6) to 7.2 X 10(-6) mutants per cell generation. The AGr mutants observed after treatment with MNNG were phenotypically stable and closely resembled prototype AGr cultures derived from humans who have inherited mutant X-chromosomal alleles for HPRT.

'Silent' brain metastasis from lung carcinoma determined by computerized tomography

Computerized tomography (CT) was utilized as a preoperative screening procedure in a series of 50 patients with lung carcinoma who were neurologically asymptomatic and whose radionuclide brain scans and skull roentgenograms were normal. Three patients (6%) were discovered to have metastasis (cerebellum, occipital, corpus callosum). The metastatic lesions were only directly visualized after administration of contrast substance. The CT findings greatly influenced the therapeutic planning in these patients, and surgery was avoided in two. When feasible, patients with lung carcinoma should have CT examinations (with contrast administration) prior to thoracic surgery even if they do not have neurologic symtoms.

Myelopathy due to spinal metastasis from adenocarcinoma of the gallbladder

The first case of a gallbaldder carcinoma with metastasis to dura and epidural space causing myelopathy is described. The mode of metastasis remains obscure because there was no involvement of liver or retroperitoneal veins. It is possible that the spread was by the vertebral venous plexus, which could account for a spinal metastasis in the absence of liver involvement.

Ectopic lacrimal gland in the orbit identified by computerized axial transverse tomography

A case of ectopic lacrimal gland within the orbit causing progressive exophthalmos and visual loss is presented. The orbital mass, identified by computerized axial transverse tomography, had characteristics which were different from other orbital tumors identified to date by this technique.

Diabetes mellitus in normal pressure hydrocephalus

Seventeen of 33 patients (51.5%) with normal pressure hydrocephalus were discovered to have diabetes mellitus. This was significantly greater than the 12.1% incidence found in age-matched control subjects. The diabetes was not accounted for either by the patients' ages nor by their physical inactivity due to hospitalisation. Diabetes mellitus concurrent with normal pressure hydrocephalus may result from involvement of hypothalamic and brainstem autonomic structures by the expanding ventricles during the evolution of hydrocephalus.

Pain adaptation and emotional deficit

The pain adaptation rates of high- and low-emotional deficit schizophrenics were compared. Electrical stimulation pain thresholds were calculated and retaken at four intervals after administration of shocks in a learning task. Low scorers on the General Sensation-Seeking and Thrill/Adventure Seeking scales showed significantly less pain adaptation than did their high sensation-seeking counterparts. No differences in level of adaptation appeared between high and low scorers on the Anhedonia scale or three other sensation-seeking scales. The results suggested that the neurotic emotional deficit defined by the sensation-seeking scales may be mediated by inadequate adaptation to painful stimuli.

Evidence for a dual-factor concept of psychopathological emotional deficit: anhedonia and sensation-seeking

Correlations between measures of anhedonia and sensation-seeking were calculated in two psychiatric samples. The correlations indicated that, despite their conceptual similarity, the two represent different motivational deficits. Ther correlates appeared to indicate that sensation-seeking represents neurotic inhibition, while anhedonia reflects a separate motivational deficit apparently characteristic of process schizophrenics.

Autopsy correlations of computerized tomography: experience with 6,000 CT scans

Seventy-nine autopsy correlations of CT scans showed (1) excellent correlations in normal brains, but the size of the lateral ventricles consistently larger during life than after death; (2) a distinctive pattern differentiating obstructive from nonobstructive hydrocephalus; (3) infarctions appearing as areas of decreased densities of parenchyma in vascular distributions; (4) distinctive high density appearances of hemorrhages that differentiated them from infarctions and, in general, all other pathologic processes; (5) supratentorial, intraventricular, and posterior fossa tumors appearing as masses that displaced, distorted, collapsed, and enlarged normal spaces and structures such as ventricles and pineal gland; (6) 11 false-negative CT scans in some cases of brain stem infarction, brain stem hemorrhage, and small metastasis; and (7) an overall accuracy of 86.2 percent of CT scanning in correctly identifying pathology of the brain.

Changes in size of normal lateral ventricles during aging determined by computerized tomography

One hundred thirty-five normal volunteers were examined by computerized tomography (CT) and their ventricular size was measured by planimetry. A pattern of change in ventricular size from the first through the ninth decades was discerned and quantified. A gradually progressive increase in ventricular size from the first through sixth decades was followed by a dramatic increase in the eighth and ninth. The range of normal ventricular size was relatively more wide in the eighth and ninth decades than in the first seven; thus, abnormalities of ventricular size may be more easily identified in younger than older subjects. These data are more valuable than those from pneumoencephalography or autopsy studies because CT is not subject to the artifact inherent in those procedures.

Computerized axial transverse tomography in cerebrovascular disease

One hundred eleven patients with supratentorial cerebrovascular disease were studied by computerized axial tomography (CT scanning). With one exception, every patient who had a normal scan 48 hours after the onset of symptoms was ultimately diagnosed as having had transient ischemic attack, although in nearly one-third, the clinical diagnoses at the time of the scan was infarction. A normal CT scan, therefore, augurs a good outcome of supratentorial cerebrovascular disease. Ninety-eight percent of the patients with infarction had abnormal scans, with areas of decreased density in a vascular distribution. Pitfalls in the diagnosis of infarction were (1) initially normal CT scans that changed to abnormal after 48 hours, and (2) mass effect of infarction leading to misdiagnosis of brain tumor. Serial studies eliminated both pitfalls. Intracerebral hemorrhages had a distinctive high density appearance. In 43 percent of patients whose scans showed hemorrhage, the clinical diagnosis was thrombosis. Many did not have symptoms, signs, or outcome of cerebral hemorrhage, and the diagnosis would not have been suspect were it not for the CT scan.

Role of selective attention to emotional and neutral stimuli in schizophrenic affective deficit

A test of the hypothesis that psychopathological emotional deficit involves selective attention to unemotional stimuli was made. The attention of schizophrenics ( n = 100) with high and low scores on measures of anhedonia and sensation-seeking to pleasant, unpleasant and neutral stimuli was contrasted. No differences in the mean attention scores of the groups appeared. The results do not support the hypothesis. Emotional deficit in schizophrenia does not seem to result from selective attention to nonemotional stimuli.

Computerized axial transverse tomography in normal pressure hydrocephalus

Twenty patients with normal pressure hydrocephalus were examined by computerized axial transverse tomographic (CT) scanning and the results were compared with pneumoencephalographic findings and clinical responses to ventricular shunting. The CT scan revealed significant cortical atrophy, not demonstrated by pneumoencephalogram in seven patients. The cortical atrophy was confirmed by autopsy in one case. This examination also revealed greatly enlarged ventricles (25 to 40 per cent of intracranial volume) in eight patients up to 4 years after ventricular shunting. There was no relationship between the presence or absence of cortical atrophy, or the postoperative ventricular size, and the clinical responses to ventricular shunting. Current concepts of normal pressure hydrocephalus must be revised in view of these findings.

Palato-ocular synchrony during eyelid closure

The effects of eyelid closure on oculomotor function was examined in 11 patients with palatal myoclonus. In eight patients, eyelid closure induced gross rhythmic vertical or almost oscillatory movements of the globes, which were synchronous with the rhythmic beat of the palatal myoclonus. The rhythmic vertical ocular movements induced by eyelid closure replaced calorically induced or spontaneous horizontal nystagmus present when the lids were open. Vertical ocular motions persisted during some stages of slow-wave sleep and reappeared during each stage of rapid eye movement. The physiologic basis of the palato-ocular synchrony may be similar to the eyelid closure, vertical eye movements, and palatal myoclonus that occurs in monkeys on stimulation of the central tegmental fasciculus.

Computerized axial transverse tomography in the diagnosis of orbital tumors

CT scanning demonstrated orbital tumors in 15 patients with progressive unilateral proptosis in whom the diagnosis was confirmed by surgery or biopsy. The CT scan was the only abnormal study in 13 patients. In two patients, standard roentgenogram studies and CT scan were both abnormal, but the CT scan was of greatest value in identifying the tumor. Orbital structures are clearly demonstrated when scans are performed at lower level than those used in standard cerebral studies. The large fat content of the orbit is of low density and appears dark on the cathoderay tube. The tumors were of higher densities and appeared as white homogenous or speckled masses against the dark background. Surgical findings confirmed the accuracy of CT scanning in determining the tumor size and location. A new 160X160 grid provides remarkable resolution of orbital structures such as the optic nerve and extraocular muscles. Moreover, it is now possible to visualize ten consecutive ventral to dorsal slices of orbital tissue providing greater detail of orbital pathology. CT scanning will probably be an indispensable tool in the diagnosis of orbital tumors.

"Normal-pressure" hydrocephalus. Relationship of clinical and radiographic findings to improvement following shunt surgery

Analysis of 25 patients who fulfilled clinical and radiographic criteria for the diagnosis of "normal pressure" hydrocephalus (NPH) demonstrated (1) a significant relationship between presence of motor signs with good outcome and absence of motor signs with poor outcome following ventricular shunting, (2) symptoms and signs of parkinsonism in 40% of patients in whom the diagnosis of NPH was made, and (3) no reliable relationship between radiographic measurements or cisternogram appearance and outcome following shunting. The clinical picture is the most important factor in selection of NPH patients for surgery.

Mechanisms of bronchial hyperreactivity in normal subjects after upper respiratory tract infection

Inhalation of histamine diphosphate aerosol (1.6 per cent, 10 breaths) produced a 218 +/- 54.6 per cent (mean +/- SE) increase in airway resistance in 16 normal subjects with colds compared with a 30.5 +/- 5.5 per cent increase in 11 healthy control subjects (P less than 0.01). There was no significant difference in mean baseline airway resistance between the two groups. Inhalation of saline produced no significant change in airway resistance in either group. Isoproterenol hydrochloride (0.5 per cent, 1 breath) or atropine sulfate aerosol (0.2 per cent, 20 breaths) each reversed and prevented the increase in airway resistance by histamine, indicating that the bronchoconstriction was caused by smooth muscle contraction and that post-ganglionic, cholinergic pathways were involved in the mechanism. In 6 subjects with colds, citric acid aerosol (10 per cent, 5 breaths) caused bronchoconstriction that lasted up to 30 sec after inhalation, a significantly greater effect than that observed in control subjects or in the same subjects after recovery (P less than 0.05). Prior inhalation of atropine aerosol (0.2 per cent, 20 breaths) prevented the bronchoconstriction after citric acid aerosol in all 6 subjects. The threshold concentration of citric acid that produced cough in 7 subjects with colds was significantly lower than that in control subjects or in the 7 subjects after recovery (P less than 0.05), suggesting that the exaggerated cholinergic response was due to a decreased threshold for stimulation of the rapidly adapting sensory receptors in the airways. We have provided evidence that respiratory viral infections that produce airway epithelial damage temporarily cause these subjects to develop more bronchoconstriction after inhaling smaller doses of histamine than do healthy subjects. The fact that atropine prevents this response and that the threshold to cough is temporarily decreased is compatible with our hypothesis that airway epithelial damage by infection exposes and, thus, "sensitizes" the rapidly adapting airway receptors to inhaled irritants, causing increased bronchoconstriction via a vagal reflex. Damage to the airway epithelium may occur as a result of mechanical factors, inhaled chemicals, and pollutants, such as ozone, infections, or perhaps as a result of the action of materials released endogenously (e.g., from mast cells, white blood cells, or platelets). "Sensitization" of rapidly adapting sensory receptors in the airways may be an important factor in asthma and in other diseases of airways.

Toxoplasma gondii: parasitology and transmission

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