Adult-onset acid maltase deficiency: a postmortem study

In a postmortem study of a patient with adult-onset acid maltase deficiency (AMD), morphological abnormalities were confined to skeletal muscle and consisted of a vacuolar myopathy. Acid maltase activity, however, was approximately 6% of normal in muscle, liver, and brain, and 3% of normal in heart. Kinetic characteristics, and inhibition by antibodies and Zn++, showed that the residual activity was "authentic" acid maltase. Neutral maltase activity was normal in muscle and liver, but decreased in brain (55% of normal) and heart (19% of normal). Although the relative decrease of acid maltase was similar in different tissues, absolute residual activity was lowest in skeletal muscle: this may explain the selective involvement of this tissue in late-onset AMD.

The in vivo development of plasma cells: a morphologic study of human cerebrospinal fluid

This is a case study of a patient with the clinical diagnosis of meningoencephalitis. It demonstrates the in vivo development of plasma cells in the central nervous system. All the stages of in vitro mitogen-induced lymphocyte transformation previously described by light and electron microscopy are recapitulated in this analysis of cerebrospinal fluid. It is postulated that this represents a local humoral immune reaction in the central nervous system and provides morphologic support for the concept that the gamma globulin in cerebrospinal fluid is produced locally in part, in addition to its origin from the plasma proteins.

Basophilic meningitis secondary to lymphoma

In this case report of basophilic meningitis, the patient was a 5-year-old girl under treatment for a diffuse lymphocytic lymphoma. She presented with headache and bilateral papilledema. Cerebrospinal fluid examination showed 60 percent basophils. Subsequent specimens showed a rare blast. It is postulated that after the lymphoma cells had spread to the meninges, a cell-mediated immune reaction was initiated with the appearance of basophils in the exudate.

Incontinentia pigmenti achromians

A patient with incontinentia pigmenti archromians, who was born to consanguineous parents, is described. This is the first reported case from Iran, to our knowledge. A number of features of this disease belong more properly to classical incontinentia pigmenti.

Hyperthyroid myopathy. Intracellular electrophysiological measurements in biopsied human intercostal muscle

Morphological and electrophysiological studies were performed on intercostal muscle biopsies from 2 thyrotoxic patients. The diseased fibers had numerous areas of subsarcolemmal glyogen accumulations and abnormal membranous projections. Both Type I and Type II muscle fibers were atrophied. Diseased fibers were substantially depolarized and when artifically hyperpolarized showed earlier inactivation of the sodium conductance as a function of membrane potential, and a critical depolarization potential more depolarized than in normal fibers. When stimulated at 20 pulses/sec, or faster, the diseased fibers could not generate normal action potentials due to membrane depolarization and the appearance of a marked after-hyperpolarization. Muscle weakness associated with hyperthyroidism is attributed to the reduced membrane excitability.

Predicting offender-patients' reconvictions

In 1963–4 the Oxford University Penal Research Unit managed to collect information about 90 per cent of the offender-patients who were admitted to N.H.S. and Special Hospitals under hospital orders made by criminal courts: this cohort has been described in Crime and Insanity, Vol. II, by Walker and McCabe (1973). One of the by-products of the follow-up of these offender-patients was a rough and ready scoring system for predicting reconvictions (within a two-year follow-up) of 456 offender-patients who were allowed to leave hospital within a year of admission. A prediction system can be used to assist human decision-making (though it should not be a substitute for it)∗ and can also be used to assess the efficacy of measures—such as after-care—by seeing whether individuals with equal predicted reconviction-rates do better with than without the measure (Mannheim and Wilkins, 1955).