Patterns of thought disorder associated with right cortical damage, schizophrenia, and mania

The authors used the Thought Disorder Index to measure thought disorder in 23 patients with unilateral right hemisphere cortical damage, 20 patients with bipolar mania, and 25 patients with schizophrenia. There were no differences in the total amount of thought disorder in these groups, but each showed a unique pattern of thought disorder. Patients with right hemisphere damage displayed fragmented thinking, manic patients displayed playful thinking, and schizophrenic patients displayed idiosyncratic thinking. These findings support the view that thought disorder is manifested in different forms that are relatively specific to psychiatric or neurological condition.

A single dominant gene can account for eye tracking dysfunctions and schizophrenia in offspring of discordant twins

Eye movement dysfunctions (EMDs), detectable during smooth pursuit, occur in a majority of schizophrenics and in 45% of their first-degree relatives. Previous data suggest that they represent a biologic marker for schizophrenia. To determine the mode of transmission of the schizophrenia-EMD complex, the eye movements of offspring of monozygotic and dizygotic twins were recorded. One group of twins was discordant for schizophrenia; the other group for manic depression or reactive psychosis. The data suggest that EMDs and at least some schizophrenias can be considered expressions of a single underlying trait that is transmitted by an autosomal dominant gene.

Structural changes of the gastrointestinal mucosa induced by prostaglandins

Prostaglandins of the E series, which have been proposed as therapeutic agents for the treatment of peptic ulcers and other gastrointestinal diseases, cause hyperplasia of the gastrointestinal mucosa in experimental animals. The changes are most evident in the stomach, especially the antrum, in which the wall is thickened by hyperplasia of surface mucous cells and/or submucosal edema. In rodents, the non-glandular forestomach becomes hyperplastic and hyperkeratotic. Affected stomachs are heavier and may have a larger surface area than control stomachs. Small intestines may be heavier and have a thicker mucosa, with elongation of villi and crypts. Colonic mucosa may exhibit mild hyperplasia at very high dosages. Conflicting data exist as to whether the gastrointestinal mucosal hyperplasia is more related to increased production or decreased loss of epithelial cells.

A comparison between the Minnesota Multiphasic Personality Inventory and the 'Mensana Clinic Back Pain Test' for validating the complaint of chronic back pain

Reports on the efficacy of the Minnesota Multiphasic Personality Inventory (MMPI) for selecting patients with valid complaints of pain have been equivocal. The Mensana Clinic Back Pain Test (MPT) was able to predict, with some degree of success, patients who had a definite organic pathologic condition. However, the MMPI measures personality traits, whereas the MPT measures the impact of pain on a patient's life. To determine which of the two tests would be a better predictor of actual physical abnormalities, and hence valid pain complaints, a comparison was undertaken between the two tests. The charts of 83 patients admitted to the Neurosurgery Service of Johns Hopkins Hospital with complaints of back pain were assessed. MMPI test results, as well as test results for the MPT, were compared to the presence or absence of pathologic conditions on electromyography, nerve conduction velocity studies, thermography, myelogram, or computerized axial tomography scan. The MPT had a correlation factor of -.59700, that was significant as P = .000005. Of the 52 patients scoring 17 points or less on the MPT, 85% had objective physical abnormalities, considered moderate or severe by blind review. Of the 31 patients scoring 18 points or greater on the MPT, only 26% had objective physical findings that were considered moderate or severe. Only the F scale (faking badly) of the MMPI correlated with objective physical abnormalities (r = .21340, P less than .033). However, 60% of the patients with T scores of less than 70 on the F scale had objective findings, whereas 75% of patients with T scores greater than 70 had objective physical findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Two rare complications of simultaneously occurring placenta praevia and placenta percreta

Simultaneously occurring placenta praevia and placenta percreta is a well known yet rare obstetric complication. Cases in which invasion of chorionic villi lead to asymptomatic perforation of the uterus or bladder, rarely occur. This paper describes two such cases.

Smooth pursuit eye movements in schizophrenics: quantitative measurements with the search-coil technique

Eye movements of five schizophrenic and five normal subjects were measured with the magnetic-field search-coil technique. Subjects followed targets moving smoothly at various speeds, either unpredictably in a step-ramp fashion or predictably in a triangular wave. The tracking stimulus was either a small dot or a large, richly-textured image that occupied a large portion of the visual field. Tracking by schizophrenics was abnormal; it was punctuated by catch-up saccades that corrected for smooth following movements of inadequate velocity. We did not, however, find saccadic intrusions, such as square wave jerks. Under all tracking conditions steady-state gains (eye velocity/target velocity) and, in the case of step-ramps, average acceleration in the first 120 ms were lower in patients than in normal subjects. The differences were most pronounced for tracking of the small target, moving at the highest speed tested (30 degree/s), in the nonpredictable, step-ramp waveform. With this stimulus mean steady-state gain was 0.36 (SD +/- 0.12) for the schizophrenic patients and 0.73 (SD +/- 0.11) for the normal subjects. When the target was changed to the large-field stimulus or moved in a predictable (triangular-wave) fashion, tracking improved in both patients and normal subjects, and even more so when these features were combined.

Immunologic dysregulation in a patient with familial hemophagocytic lymphohistiocytosis

A 6-year-old Jewish Iranian girl with familial hemophagocytic lymphohistiocytosis (FHLH) is described. The course of the disease fluctuated with partial initial response to antibiotics, steroids, and supportive treatment. Subsequent cytotoxic treatment, including VP-16, Velban (vinblastine sulfate), and methotrexate (MTX) controlled the disease for a few months but the child died with a clinical picture of meningocephalitis 1.5 years later. Benign-looking lymphohistiocytic infiltrates with varying degrees of hemophagocytosis were present in the bone marrow, pleural effusion, cerebrospinal fluid (CSF), liver, and brain. Clinical and laboratory evidence of immunologic dysregulation during the disease could be demonstrated. Frequent and intense viral and bacterial infectious diseases were encountered. The laboratory examination most consistently found was the absence of natural killer (NK) cell activity against K562 target cells. The impaired activity of NK cells persisted during all stages of the disease including remission, although NK cell numbers, determined morphologically and immunophenotypically (by Leu-11, Leu-7), were normal. Natural killer activity could not be restored by interferon. Moreover, the interferon system appeared to be intact. Impaired monokin interleukin 1 (IL-I) production by peripheral blood monocytes was found and could not be restored by indomethacin. Lymphopenia, a mild decrease in T4 numbers, and subsequently, decreased proliferative response to mitogens was noted. Elevated immunoglobulin levels were found during exacerbations and viral episodes, at times accompanied by the presence of auto-antibodies. The exaggerated fatal lymphohistiocytic response typical for FHLH could be attributed to a underlying genetic pathologic dysregulation of the various immunological response pathways.

Towards a general theory of adaptive walks on rugged landscapes

Adaptive evolution, to a large extent, is a complex combinatorial optimization process. In this article we take beginning steps towards developing a general theory of adaptive "walks" via fitter variants in such optimization processes. We introduce the basic idea of a space of entities, each a 1-mutant neighbor of many other entities in the space, and the idea of a fitness ascribed to each entity. Adaptive walks proceed from an initial entity, via fitter neighbors, to locally or globally optimal entities that are fitter than their neighbors. We develop a general theory for the number of local optima, lengths of adaptive walks, and the number of alternative local optima accessible from any given initial entity, for the baseline case of an uncorrelated fitness landscape. Most fitness landscapes are correlated, however. Therefore we develop parts of a universal theory of adaptation on correlated landscapes by adaptive processes that have sufficient numbers of mutations per individual to "jump beyond" the correlation lengths in the underlying landscape. In addition, we explore the statistical character of adaptive walks in two independent complex combinatorial optimization problems, that of evolving a specific cell type in model genetic networks, and that of finding good solutions to the traveling salesman problem. Surprisingly, both show similar statistical features, encouraging the hope that a general theory for adaptive walks on correlated and uncorrelated landscapes can be found. In the final section we explore two limits to the efficacy of selection. The first is new, and surprising: for a wide class of systems, as the complexity of the entities under selection increases, the local optima that are attainable fall progressively closer to the mean properties of the underlying space of entities. This may imply that complex biological systems, such as genetic regulatory systems, are "close" to the mean properties of the ensemble of genomic regulatory systems explored by evolution. The second limit shows that with increasing complexity and a fixed mutation rate, selection often becomes unable to pull an adapting population to those local optima to which connected adaptive walks via fitter variants exist. These beginning steps in theory development are applied to maturation of the immune response, and to the problem of radiation and stasis. Despite the limitations of the adaptive landscape metaphor, we believe that further development along the lines begun here will prove useful.

Immune impairments and antibodies to HTLVIII/LAV in asymptomatic male homosexuals in Israel: relevance to the risk of acquired immune deficiency syndrome (AIDS)

We have studied 288 Israeli asymptomatic male homosexuals (MHS) to determine the prevalence of antibodies to HTLVI and HTLVIII and their correlation with impairments of the immune system and serum interferon (IFN). Seropositivity for HTLVI, HTLVIII, or both was found in 1.4, 8.3, and 0%, respectively. Significant decreases in the total peripheral T cells, TH cells, and TH/TS ratio as well as elevated alpha IFN serum levels were found in the MHS group in comparison with normal controls. Although no difference in the prevalence of either immune derangements or elevated serum IFN was observed between HTLVIII/LAV-seropositive and HTLVIII/LAV-seronegative MHS, the decreases in total T cells, TH cells, and TH/TS ratios were significantly greater in the seropositive MHS. These results indicate that (a) immune impairments and IFN system activation occur commonly in homosexuals, precede their exposure to HTLVIII/LAV, and probably reflect this group's increased risk for AIDS and (b) HTLVIII/LAV infection of MHS aggravates further their preexisting immune impairments.

A pseudoepidemic due to atypical mycobacteria in a hospital water supply

We describe a pseudoepidemic due to atypical mycobacteria contaminating the water used by a pathology laboratory and bronchoscopy suite on two floors of the same hospital building. Inspection of laboratory procedures revealed that contamination occurred during specimen processing in pathology and while obtaining the bronchoscopic specimens. Mycobacterium gordonae, Mycobacterium avium complex, and Mycobacterium scrofulaceum were identified. During an eight-month period, a total of 22 (31%) of 70 patients with positive acid-fast smears had either an illness inconsistent with tuberculosis or a known alternate diagnosis. Control was easily obtained by insertion of a 0.2-micron polymer filter into the outflow tubing of our pathology tap water-deionizing unit and the tap water source in the bronchoscopy suite. The pseudoepidemic led to additional diagnostic-therapeutic intervention, but no patient experienced delay in appropriate diagnosis. Pseudoepidemics due to atypical mycobacteria will likely be of increased importance in institutions providing care to patients with acquired immunodeficiency syndrome.

Advanced papillary adenocarcinoma of unknown origin as tumor previa during late pregnancy

A 41-year-old woman with advanced abdominal adenocarcinoma presented at term pregnancy. The tumor was presented as previa and obstructed the delivery. A cesarean section was performed and a healthy child was born. At surgery diffuse metastatic disease was detected throughout the pelvis and abdomen and was partially resected. Combined chemotherapy consisting of cis-platinum, adriamycin and cytoxan was administered for 5 months. At second-look laparotomy no residual disease was found. We present an unusual presentation of metastatic abdominal undifferentiated carcinoma treated as ovarian cancer.

Early-onset hay fever in Israeli children

In order to investigate the influence of climate and vegetation on the age of onset and clinical picture of hay fever (HF), we examined 116 children with typical HF living in a single climatic area: fifty-four were from rural farming settlements and sixty-two from towns and cities. Overall age of onset was low; 72% of rural children developed HF between the ages of 2 years and 4 years compared to only 24% of urban children (P less than 0.005). At the same time, 57% of rural children had positive skin tests to more than three pollen extracts out of nineteen allergens tested, compared to 19% of urban children (P less than 0.005). There were no significant differences between the rural and urban groups with regard to the incidence of asthma as part of their HF, nor were there differences in total IgE levels. The results of this study suggest that Israeli children develop hay fever earlier than generally reported in the literature, and that this is most marked in the rural areas. This can be explained by their specific environment, which consists of a basically dry, desert-like climate where lawns, crops and trees are extensively irrigated, leading to the dissemination into the environment of large amounts of pollen grains, which are not washed away because of the lack of rain.

Successful long-term exocrine and endocrine function of the autotransplanted pancreas in humans

Segmental pancreatic autotransplantation has been performed to prevent the severe metabolic complications of total pancreatectomy. To date 15 segmental pancreatic autotransplants have been reported, 11 of which have been performed for relief of the abdominal pain of chronic pancreatitis. The major problem with segmental pancreatic graft relates to the handling of the pancreatic duct and its secretion. In all the reported cases, the autotransplanted duct was either ligated, stapled, or occluded with synthetic polymers. In this article we present a patient who has undergone a total pancreatectomy with segmental pancreatic autotransplantation and subsequent Roux-en-Y anastomosis to the transplanted duct. Physiologic studies indicate normal endocrine function 7 years following transplant. The patient is insulin-independent and tolerates a normal meal, requiring no oral pancreatic enzyme supplementation. To our knowledge this is the first long-term report of a patient with an autotransplanted pancreas who is presently both insulin sufficient and with intact exocrine function.

The office approach to the sexually transmitted diseases: Part II

All physicians share a responsibility for educating the public in the expanding risks of sexually transmitted diseases, and in the vital importance of safe sexual practices. Both the public health implications of undiagnosed STDs and the adverse social consequences of an incorrect diagnosis emphasize the need to comprehensively and precisely diagnose these diseases, despite the problems encountered in obtaining material for culture. Current interest in AIDS should not obscure the facts that genital herpes continues to increase in prevalence, and that syphilis no longer is declining. The many extragenital syndromes associated with STDs, such as perihepatitis, polyarthritis, and acute septic states make it necessary to evaluate all sexual contacts.

Herpes simplex viral hepatitis in adults: two case reports and review of the literature

Herpes simplex viral (HSV) hepatitis is uncommon in adults. Two new cases are reported herein; a literature review revealed an additional 33 patients. Ages ranged from 13 to 87 years; the mean age was 32.6 years, and the median was 28 years. HSV hepatitis usually occurs as part of disseminated HSV infection and is characterized by fulminant hepatic necrosis with serum transaminase levels frequently elevated 100- to 1,000-fold. Disseminated intravascular coagulation was present in 90% of the cases. Outcome was poor; 86% of the patients died. Eighty-six percent of the patients had an underlying condition associated with impaired host defenses. Renal transplantation (26%), steroid use other than in renal transplant patients (26%), and pregnancy (23%) were the most frequent underlying conditions. Early recognition and prompt initiation of antiviral therapy may offer a chance for improved survival rates.

The office approach to the sexually transmitted diseases: Part I

Sexually transmitted diseases (STDs) are diagnosed in 10 million patients per year in the United States. The infected individuals come from all walks of life and all age groups. They may present with either genital or nongenital signs and symptoms. Most individuals are treated as outpatients, but more than a quarter of a million hospital admissions for STDs are necessary each year. These numbers will rise precipitously as the number of AIDS cases increases. More than 10,000 deaths per year are caused by STDs, primarily because of AIDS, cervical carcinoma, and hepatitis B induced cirrhosis and hepatoma. Physicians must become highly skilled in the diagnosis and treatment of the common STDs caused by herpes simplex virus, Neisseria gonorrhoeae, and Chlamydia trachomatis. Simple office microscopic skills are needed for the diagnosis of vaginitis, cervicitis, and urethritis, and all physicians should be encouraged to develop these skills. Physicians will need to keep abreast of the rapidly evolving changes in the diagnosis and treatment of STDs.

Atopic babies with wheezy bronchitis. Follow-up study relating prognosis to sequential IgE values, type of early infant feeding, exposure to parental smoking and incidence of lower respiratory tract infections

Clinical course and sequential IgE values were recorded in a 4-year prospective study of 80 atopic wheezing babies at ages from 6 months to 4-5 years. At final assessment, 68% of the children had been symptom-free for at least 1 year whilst 32% still suffered from wheezing attacks. Total IgE levels from the first visit until final assessment were greater than 2 SD above normal for age in 63% of all children, but no significant correlation could be found between sequential IgE levels and the clinical picture or course of the disease. In all cases IgE levels rose steadily with increasing age, independently of whether wheezing disappeared or persisted. The most significant rise in IgE values occurred between 1 and 2 years of age, and IgE levels at 4 years could be predicted by the value at the age of 2 years (r = 0.97). In the group of children that lost their wheezing tendency there was: a significantly greater number of infants that were breast-fed during at least the first 3 months of life (P less than 0.01), a lower incidence of exposure to parental smoking (P less than 0.01), and a lesser incidence of lower respiratory tract infections (P less than 0.01). Though there was no correlation between increase of IgE levels and type of feeding or exposure to cigarette smoke, statistical data confirms that bottle feeding and parental smoking lead to persistence of wheezing in atopic children.

The association between eye-tracking dysfunctions and thought disorder in psychosis

The relationship between the presence of smooth-pursuit eye-movement dysfunctions and degree of thought disorder was assessed in four groups: schizophrenics, manics, atypical psychotic patients, and normal persons. A positive relationship, constant for all groups, was found to be significant but low. Impaired eye tracking accounted for 4.22% of the total variance of thought disorder. Diagnosis accounted for over 10% of the thought-disorder variance. Although there is a tendency for those persons with poor eye tracking to have higher amounts of thought disorder than those with unimpaired eye tracking, all psychotic patients, regardless of diagnostic class, tended to have thought disorder scores in the pathological range, as measured by the Thought Disorder Index. Although the data may be viewed as supporting similar hypothetical processes that underlie pursuit dysfunctions and thought disorder, the greater likelihood exists that the coupling of thought disorder and eye-tracking dysfunctions may be explained differently in the schizophrenia and in the major affective disorders.

Significance of mirex-caused hypoglycemia and hyperlipidemia in rats

Treatment of rats with mirex (40 ppm in diet) caused hypoglycemia, liver enlargement, and inhibition of adrenal corticosteroid-synthesizing enzyme activity. At toxic dosages (20,000 ppm mirex in diet, which has a lethal toxicity-50 [LT-50] of ten days) poisoned female rats showed severe hypoglycemia, fatty liver, adrenal hyperplasia, hypophagia, lipid mobilization, and body weight (bw) loss. A 50 micrograms/kg intraperitoneal (IP) dose of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in male rats caused similar effects two days posttreatment. Hypoglycemia could be overcome by prednisone (which also inhibited adrenocorticoid-synthesizing enzyme activities) but not by streptozotocin treatment, indicating that hypoglycemia may be related to glucocorticoid deficiency resulting from inhibition of their synthesis and not by direct effects on pancreatic beta-cells. Glucocorticoid deficiency could also cause increased release of adrenocorticoid hormone (ACTH), which may enhance fat mobilization caused by hypophagia.

Immunoreconstitution of T-cell impairments in asymptomatic male homosexuals by thymic humoral factor (THF)

The feasibility of using Thymic Humoral Factor (THF) for immunomodulation in asymptomatic male homosexuals was evaluated in a study on fifteen subjects with T-cell impairments, selected on the basis of a 2SD reduction in T helper/inducer (T4+) cells and one additional lymphocytic defect. Following two biweekly courses of treatment, mean relative increments of T4+ (P less than 0.002), T3+ (P less than 0.02) and total lymphocyte (P less than 0.05) populations of the group receiving THF (n = 7) were significantly increased when compared to the placebo group (n = 8). In addition, a transient increase in T4+ lymphocytes was observed after the first course in the two individuals of the THF-treated group who were seropositive for HTLV-III/LAV but not in those who were seronegative. No difference was found between the groups in fluctuations of serum interferon (IFN) or proliferation of peripheral mononuclear cells to mitogens. The results of this limited trial demonstrate that THF is capable of correcting T-cell impairments that may predispose asymptomatic homosexuals to infection by HTLV-III, without affecting IFN production. These findings suggest that future strategies for AIDS prevention in high-risk groups should include institution of large controlled trials in immunodeficient, asymptomatic, HTLV-III/LAV-seronegative male homosexuals to study the potential of selective immunoreconstitution as a preventive measure against HTLV-III/LAV infection.

Aberrant expression of HLA-DR antigen on valvular fibroblasts from patients with active rheumatic carditis

Immunofluorescence and immunoperoxidase staining was used to investigate the expression of Class II major histocompatibility antigens in myocardial tissue of 16 patients with acute rheumatic carditis. Aberrant expression of HLA-DR was examined using monoclonal anti-Ia antibodies and was detected on the valvular fibroblasts of those valves with ongoing active carditis. Sections of myocardial and valvular tissue from normal controls or from patients dying of other cardiac diseases did not express HLA-DR. The aberrant expression of HLA-DR on valvular fibroblasts could be important in triggering autoimmune destruction in that these cells could present self-antigens to sensitized T-lymphocytes which could initiate autoantibody production or direct destruction of local tissue.

Tuberculous esophagitis with erosion into aortic aneurysm

An 87-year-old woman with a known atherosclerotic thoracic aneurysm died suddenly from a massive esophageal hemorrhage. Prior to death, tuberculous esophagitis was diagnosed by biopsy. At autopsy, a fistulous tract was found extending from the esophagus to the aortic aneurysm; this fistula proved to be the site of fatal hemorrhage. The tract was surrounded by a granulomatous inflammatory reaction, in which acid-fast bacilli were found. To our knowledge, this is the first reported case of tuberculous esophagitis extending to an aortic aneurysm resulting in hemorrhage and death.