Clinical and magnetic resonance imaging in optic neuritis

We found 23 of 48 patients (48%) with isolated monosymptomatic optic neuritis (ON) to have 1 to several brain lesions by MRI. All the brain lesions were clinically silent and had characteristics consistent with multiple sclerosis (MS). During 4 years of follow-up, 9 patients (19%) developed definite MS on clinical grounds. Six of the converting patients had abnormal MRIs; the other 3 had MRIs that were normal both initially (when they had ON only) and when repeated after they had developed MS. The other 17 patients with abnormal MRIs have not developed symptoms or signs of MS during follow-up. Thus, an abnormal MRI does not auger development of clinical MS within a mean of 4 years, nor does a normal MRI protect against development of disseminated disease. It is not prudent to give a patient with isolated monosymptomatic ON the diagnosis of MS (probable or definite) because of an abnormal MRI (with or without other laboratory abnormalities).

Setting priorities for diverse equipment acquisition and program proposals with automated multiattributed utility functions

This article reports on a computer-based multiattributed utility function methodology applied in one region of the VA to rationally assign priorities to new proposals for expanding health services. Based on assessing their costs, quality, and benefits, the methodology demonstrated validity across diverse proposals.

Investigation by scintigraphic methods of neutrophil kinetics under normal and septic shock conditions in the experimental baboon model

The purpose of this study was the correlation of neutrophil kinetics with the pathogenic course of septic shock in the baboon model. Radioactively labelled neutrophils were traced in vivo in normal baboons (n = 6) and in Escherichia coli-infected baboons, which were reinjected with labelled autologous neutrophils either 2 h after the onset of the E. coli infusion (procedure A) (n = 3) or simultaneously with the infusion (procedure B) (n = 3). Cell isolation was done according to a method developed in this laboratory. The cells were labelled with tropolonate In 111, resuspended in 1-2 ml plasma and reinjected. One-minute images were taken every 5th min and then hourly for 4 h with a gamma camera and analysed with a data processor. Time-activity curves were obtained for neutrophil washout from the lungs and neutrophil accumulation in the liver and spleen. These curves were compared for normal baboons and for those treated according to procedures A and B. A significant retention of neutrophils in the lungs of baboons with E. coli-induced septic shock was noted as well as an abnormally slow rate of accumulation in the liver and spleen. It also seems that any lung injury which could be attributed to changes in neutrophil behaviour should be traced back to events during the early exposure of neutrophils to bacterial infection.

The construct validity of an aftereffect-based subtyping system for alcoholics

In an earlier project, we identified five alcohol-consumption aftereffect factors, which were named Hangover, Euphoria, Flushing, Seizures, and Sleepiness. In this study (N = 100) we assessed the construct validities of the five, using 47 MMPI, self-report, and recidivism criteria. The number of significant relationships between the factors and the criteria substantially exceeded chance. The Hangover factor related to social maladjustment and to the MMPI Psychopathic Deviate, Paranoia, Psychasthenia, Hypomania, and Masculinity-Femininity scales. The Euphoria factor was associated with a high number of job losses, but a low incidence of certain physical sequelae. The Flushing factor was associated with high consumption, late development of alcoholism, many physical complaints, and older age. The Seizure factor correlated with high consumption, facial puffiness, tremors, and lack of defensiveness on the MMPI. The Sleepiness factor was associated with a good prognosis and several mild MMPI elevations. These findings suggest that the factors may provide the basis for a useful alcoholism subtyping system and that additional research on them should prove fruitful.

Epitope analysis of glycoprotein I of pseudorabies virus

A panel of 11 monoclonal antibodies (MAbs) raised against pseudorabies virus (PRV) was used to map epitopes on the virus glycoprotein I (gI). We employed three approaches to map epitopes on gI. By a competition binding assay, six groups of MAbs were defined as reacting with distinct antigenic domains on gI. To identify regions along the gI polypeptide chain encompassing the domains recognized by these MAbs, DNA fragments derived from the gI-coding region were cloned into pEX expression plasmids. The antigenic reactivity of the fusion proteins expressed in Escherichia coli was analysed by immunoblotting. Five antigenic domains were mapped within the first 238 amino acids of gI: domains A, B and D were mapped between amino acids 52 and 123 and domains C and E between amino acids 78 and 238. One MAb, representing domain F, did not react with the expressed fusion proteins. To assess the precise location and amino acid sequences of the epitopes, overlapping nonapeptides covering the amino acid sequence 52 to 238 were synthesized. The antibody-binding activity of these peptides was tested by an ELISA (Pepscan-method). Three antigenic domains were mapped: domain A was localized to amino acids 64 to 73 and 75 to 84, domain B to amino acids 52 to 67 and domain D to amino acids 68 to 82. Four MAbs representing antigenic domains C, E and F did not react in the Pepscan. Finally, sera from pigs infected experimentally with PRV reacted with the fusion protein of plasmid ps 1 (amino acids 52 to 238).

Additional evidence of autoxidation as a possible mechanism of neutrophil locomotory dysfunction in blunt trauma

Previous studies in victims of blunt injury suggest that the observed neutrophil (PMN) locomotory dysfunction is, in part, due to autoxidation. To further clarify the occurrence and significance of autoxidation, we studied changes in levels of glutathione in PMN and of ascorbic acid and alpha-tocopherol in serum and blood cells of postsurgical and blunt trauma patients. Levels of total, reduced, and oxidized glutathione in PMN from trauma patients were similar to normal controls. Serum and cellular ascorbic acid and alpha-tocopherol levels dropped significantly after injury and remained below normal control levels during the 7 to 8-day study period. Low serum alpha-tocopherol was partially explainable on the basis of changes in serum lipids. When serum samples of trauma patients were thawed unprotected without pyrogallol, there was significant loss of recoverable alpha-tocopherol, whereas no significant losses occurred with unprotected thawed normal sera. Less total reducing capacity was observed in PMN of trauma patients compared with normal controls. These findings indicate that synthesis and regeneration capacity of glutathione are intact but that the levels of the consumable antioxidants, ascorbic acid, and alpha-tocopherol are compromised after injury. These results add further support to the hypothesis that autoxidation occurs in trauma.

Scintigraphic phase analysis of abnormal A-V conduction in a baboon

During an interventional cardiac investigation on an anaesthetised baboon (Papio ursinus) the animal developed A-V block. Scintigraphic phase analysis leading to quantified intraventricular delays and histogram characteristics pointed to abnormalities which persisted even after A-V block was replaced by nodal tachycardia as was reflected by the electrocardiogram. This indicated towards an increased diagnostic sensitivity with the use of phase analytical methods.

The comparative recidivism rates of voluntary- and coerced-admission male alcoholics

The outcomes of inpatient alcoholics who reported that they had been coerced into treatment by commitment or pressure from others were compared in a follow-up study to those of alcoholics who described themselves as voluntary admissions. Ten assessments of control over drinking, number of drinking days in the past week, and intoxication since previous appraisal were made by collaterals between 2 weeks and 18 months after treatment. Even though the data were analyzed in several ways, the number of significant differences did not exceed chance expectations. This suggests that the prognoses of alcoholics who present for treatment under court order or interpersonal pressure were not substantially different from those of men who claim to have entered without coercion. However, the differences between the groups' Control over Drinking ratings, even though not statistically significant, consistently favored the coerced admissions, which raises the possibility that their outcomes may have been slightly better than those of the voluntary admissions.

Cholesterol screening in general practice

Serum cholesterol levels were measured in 250 men and 250 women aged 25-60 years attending a general practice. Seventy three per cent of the sample had levels above 5.2 mM and of these 98 patients agreed to follow a low cholesterol/low saturated fat diet for six months. The overall reduction in serum cholesterol level among these patients was 13%, suggesting that lipid screening in general practice could be worthwhile.

Neuropsychological improvement following endarterectomy as a function of outcome measure and reconstructed vessel

30 patient receiving right or left carotid reconstruction and 15 medically matched controls were compared pre- and post-surgically on measures of motor speed, sustained vigilance, verbal memory and verbal and nonverbal intellectual function. The group receiving right sided vessel reconstruction demonstrated the largest post-operative improvement in intellectual function in any of the groups. The findings suggest that increased blood perfusion following right sided endarterectomy facilitates the right hemisphere's exclusive control of bilateral attention/arousal responses. In addition, findings suggest that detection of post-endarterectomy improvement may be dependent on the specific task dimension sampled, e.g., speed vs. cognitive ability and verbal-graphic vs. nonverbal symbol manipulation.

Synthesis of long cDNA from viral RNA template

Methods to make long and reliable cDNA from viral RNA template have been optimized. The conditions of the denaturation of the viral RNA template were most critical. For synthesis of the first DNA strand, the concentration of the primer and the presence of an RNase inhibitor were important. During the synthesis of the second strand, the incubation temperature was found to have effect on the length of the transcripts. Application of our optimized conditions on coronaviral genomic RNA as template resulted in cDNA libraries with inserts in the range of 0.5-5 kb without a separate cDNA size selection. Furthermore, a convenient variant of the alcohol precipitation and the analysis of single-stranded DNA on neutral agarose gels are described.

Central nervous system lupus erythematosus: the value of magnetic resonance imaging

Magnetic resonance imaging was sued to examine the brains of 13 patients with systemic lupus erythematosus (SLE) who had experienced symptoms and signs of encephalopathy. All the patients had normal computerized tomographic scans. Four patients with abnormal magnetic resonance imaging studies had active central nervous system disease. None of the 9 patients with normal scans had active nervous system involvement at the time of study. Parenchymal lesions were usually located in the region of the corticomedullary junction or in the deep periventricular white matter. In coronal sections, some of the corticomedullary lesions extended centripetally as thin irregular lines into the white matter approximating the course of penetrating arterioles of the brain. The parenchymal lesions resolved in 4 months in 1 patient, but persisted unchanged in the others despite clinical improvement or a stable clinical course. It is likely that the parenchymal lesions of these patients represent intrinsic vasculopathy of small cerebral vessels and perivascular microinfarctions associated with SLE.

Scintigraphic Phase Analysis of Abnormal A-V Conduction in a Baboon

During an interventional cardiac investigation on an anaesthetised baboon (Papio ursinus) the animal developed A-V block. Scintigraphic phase analysis leading to quantified intraventricular delays and histogram characteristics pointed to abnormalities which persisted even after A-V block was replaced by nodal tachycardia as was reflected by the electrocardiogram. This indicated towards an increased diagnostic sensitivity with the use of phase analytical methods.

The nucleotide sequence of the peplomer gene of porcine transmissible gastroenteritis virus (TGEV): comparison with the sequence of the peplomer protein of feline infectious peritonitis virus (FIPV)

The amino acid sequence of the peplomer protein of transmissible gastroenteritis virus (TGEV) has been derived from the cloned cDNA sequence. The gene encodes a protein of 1447 amino acids with a molecular weight of 159 574. Comparison with the primary structure of the peplomer protein of feline infectious peritonitis virus (FIPV) (de Groot et al., 1987b) revealed one domain, from amino acids 1 to 274, in which the nucleotide homology was 39%, whereas in the second domain (from residues 275 to 1447) the homology was 93%.

Cardiopulmonary complications after major surgery: a role for epidural analgesia?

Improvement in postoperative pulmonary mechanics with epidural analgesia has been described. Data on the hemodynamic effects of this technique are absent from the surgical literature. To provide such data we have evaluated two groups of patients undergoing aortic reconstruction: group I (n = 25), general anesthesia and group II (n = 6), general anesthesia with adjunctive epidural analgesia. The groups were comparable preoperatively as judged by the incidence of cardiac history, preoperative ejection fraction, and measured hemodynamic parameters. Postoperatively there were no significant differences in the pressure-related parameters; however, rate-related factors including heart rate and double product were significantly decreased in group II with no reduction in cardiac index. Postoperative increases in total body oxygen consumption were also markedly attenuated by epidural analgesia. Epidural analgesia reduces the hemodynamic demands on the heart after major surgery and is a useful adjunct, especially in patients with coronary artery disease.

Intrathecally administered natural human fibroblast interferon reduces exacerbations of multiple sclerosis. Results of a multicenter, double-blind study

A randomized, double-blinded, placebo-controlled, two-year multicenter study demonstrated that natural human fibroblast interferon (interferon beta) administered intrathecally (IT) is effective in reducing the exacerbations of exacerbating-remitting multiple sclerosis (MS). The mean reduction in exacerbation rate of 34 patients with MS who received interferon beta administered IT was significantly greater during the study than that of 35 control patients who received placebo. The prestudy exacerbation rates were comparable for both patients who received interferon beta and control patients, but the exacerbation rate of patients receiving interferon beta at the end of the study was significantly lower than that of the control patients. Interferon beta was administered by nine or ten lumbar punctures for the first six months of the study, and observations were continued for two years. In 95% of the recipients, interferon beta therapy was well tolerated, and the side effects experienced were clearly acceptable for the benefits achieved. Low doses of indomethacin dramatically reduced the toxicity of interferon beta therapy and played an important role in successful double blinding. This study confirms a preliminary report on 20 patients that initially suggested that interferon beta administered IT was of benefit in patients with MS. The number of treatments was fewer and the dosage of interferon beta administered was less in the present study than in the preliminary one. It is possible that even fewer treatments with lower doses of interferon beta administered might provide a similar degree of prophylaxis against exacerbations.

Multicentre double-blind study of effect of intrathecally administered natural human fibroblast interferon on exacerbations of multiple sclerosis

In this randomised, double-blind, placebo-controlled, 2-year multicentre study intrathecally administered natural human fibroblast interferon (IFN-B) was effective in reducing exacerbations of multiple sclerosis (MS) in patients with exacerbating/remitting disease. The mean reduction in exacerbation rate of 34 patients who received IFN-B (recipients) was significantly greater during the study than that of 35 patients who received placebo (p less than 0.04). The prestudy exacerbation rates were comparable in recipients and controls, but the rate at the end of the study was significantly lower in recipients than in controls (p less than 0.001). IFN-B was given by nine or ten lumbar punctures over the first 6 months of the study, and patient observations continued for 2 years. IFN-B was well tolerated in 95% of the recipients, and the side-effects experienced were clearly acceptable for the benefits achieved. Low doses of indomethacin reduced the toxicity of IFN-B and played an important role in successful double-blinding.

Silent brain lesions in patients with isolated idiopathic optic neuritis. A clinical and nuclear magnetic resonance imaging study

Eight of 16 patients with isolated idiopathic optic neuritis were found to have one to several brain lesions by nuclear magnetic resonance scanning. The brain lesions were predominantly located in the periventricular white matter; their appearances, locations, and extents were similar to those seen in recent nuclear magnetic resonance studies of patients with definite multiple sclerosis. All of these brain lesions were clinically silent and were missed by computerized tomography. Idiopathic optic neuritis may be the only manifestation of a multicentric disease process that is disseminated in the central nervous system in the majority of cases.

Isolated idiopathic optic neuritis. Analysis of free kappa-light chains in cerebrospinal fluid and correlation with nuclear magnetic resonance findings

There is controversy about the frequency with which patients with isolated optic neuritis (ON) subsequently develop clinically definite multiple sclerosis. Furthermore, at the time of isolated ON, there are no features that are both sensitive and accurate in predicting which patients will develop clinically definite multiple sclerosis. We analyzed cerebrospinal fluid (CSF) samples from eight patients with isolated ON and compared the result with the presence of clinically silent brain lesions demonstrated by nuclear magnetic resonance imaging. The single most common laboratory abnormality was an elevated level of free kappa-light chains in CSF. This abnormality was present in five (63%) of eight patients with isolated ON and correlated with the presence of clinically silent brain lesions demonstrated in four of the five patients by nuclear magnetic resonance. The only other laboratory abnormality that correlated with disseminated disease was the presence of oligoclonal bands, but this finding was observed less frequently than was an elevated level of free kappa-chains. Thus, the presence of free kappa-chains in CSF appears to correlate with disseminated disease in patients with isolated ON and may have prognostic value.

Characterization and translation of transmissible gastroenteritis virus mRNAs

Three protein species were identified in purified transmissible gastroenteritis virus particles (strain Purdue). They are thought to represent constituents of the peplomer (E2; molecular weights of 280,000 and 240,000), the envelope (E1; molecular weights of 28,000, 31,500, and 33,000), and the nucleocapsid (N; molecular weight of 48,000). In infected cells, proteins with molecular weights of 195,000 (E2), 48,000 (N), and 28,000 (E1) were detected. Tunicamycin, an inhibitor of N glycosylation, prevented the appearance of polypeptides with molecular weights of 195,000 and 28,000 in infected cells; instead, proteins with molecular weights of 160,000 and 25,000 were observed. One minor and five major mRNA species were detected in porcine cells after infection. Their size was determined to be 23.6 kilobases (kb) (RNA1), 8.4 kb (RNA3), 3.8 kb (RNA4), 3.0 kb (RNA5), 2.6 kb (RNA6), and 1.9 kb (RNA7). The RNAs were translated in vitro. RNA7 was shown to code for the N protein. Although complete separation of RNA6 could not be achieved, it was shown to encode an unglycosylated (molecular weight of 25,000) precursor of E1 (molecular weight of 28,000). RNA4 was translated into a nonstructural protein with a molecular weight of 24,000. Translation of RNA3 resulted in proteins with molecular weights of 250,000 and 130,000 and smaller molecules which could be precipitated with a monoclonal antibody directed against E2.

Nuclear magnetic resonance imaging in patients with stroke

In contrast to CT, NMR imaging revealed a high percentage of abnormalities in the TIA-RIND population studied. The various patterns of abnormalities identified should provide further insight into the pathophysiology of ischemic cerebrovascular disease. Age and hypertension appeared to be the most significant clinical risk factors for TIA-RIND. Although periventricular hypodensities have been visualized by CT for many years, their clinical significance has only recently been appreciated. NMR shows the same periventricular changes as increased signal (long T2), but shows it in a more dramatic fashion. These periventricular abnormalities, seen both by CT and NMR, have been shown in some cases to be compatible with the pathologic diagnosis of SAE, or Binswanger's disease. Watershed abnormalities both with and without corresponding cerebral infarctions have been presented. At present, this appears to be a ubiquitous group of cerebrovascular disease with multiple underlying causes. NMR is superior to CT for demonstrating watershed infarctions, not only because it reveals ones missed by CT, but also because it shows a fuller extent of involvement than does CT. The evolution of cerebral infarctions as seen by CT and NMR has been presented. NMR demonstrates abnormalities earlier than CT. The region of infarction appears more extensive than by CT and chronic infarctions show an associated rim of prolonged T2 that may correspond to the ischemic penumbra or regions of ischemic demyelinization. CT phenomena, such as fogging and GME, have their NMR correlates. To date, all regions of GME shown by CT have also been demonstrated by NMR. Cortical infarctions, thought in many instances to be due to emboli have been frequently demonstrated by NMR. NMR imaging is clearly superior to CT for recognizing these lesions because it is not hampered by artifact from bone adjacent to cortex, as is CT. Similarly, posterior fossa and brainstem infarctions may be seen to advantage by NMR.

Correlations of nuclear magnetic resonance imaging, computerized tomography, and clinical profiles in multiple sclerosis

Nuclear magnetic resonance (NMR) imaging was superior to CT for imaging the brain lesions of 27 patients with MS. The incidence of abnormal examinations was 78% by NMR and 63% by CT. In cases in which both studies were abnormal, NMR usually demonstrated many more lesions and more extensive involvement than CT. The appearance and locations of lesions identified by NMR were similar to those of autopsy studies of MS and may be relatively specific for this disease. Some lesions identified by CT disappeared during serial examinations, but lesions identified by NMR did not resolve over time. Seventy-five percent of the lesions were clinically "silent"; only 5% were definitely related to the clinical symptoms and signs. All of those lesions were located in the brainstem or cerebellar peduncles and were identified by NMR, but missed by CT.

The maturation of 5-hydroxytryptamine and 5-hydroxyindole acetic acid in the gerbil (Meriones unguiculatus) brain

5-Hydroxytryptamine (5-HT) and 5-hydroxyindole acetic acid (5-HIAA) stores have been estimated in gerbil cerebral hemispheres and brainstem between one day postpartum and adulthood. Although patterns of 5-HT and 5-HIAA maturation were similar in part to those of the rat and mouse, there was significant difference in the pattern of postnatal 5-HIAA.

Subcortical arteriosclerotic encephalopathy (Binswanger's disease). Computed tomographic, nuclear magnetic resonance, and clinical correlations

Twenty-three elderly patients were found to have a consistent pattern of leukoencephalopathy by computed tomography and nuclear magnetic resonance imaging. Eight patients presented with vague, nonspecific symptoms and had no neurologic deficits. The other 15 patients had neurologic deficits that presented in one of three ways: stroke, seven patients; slowly progressive dementia and gait disturbance, five patients; or slowly progressive dementia alone, three patients. Risk factors for arteriosclerosis (hypertension, diabetes) were present in 18 patients (78%). The necropsy of one patient revealed arteriosclerotic vasculopathy characteristic of subcortical arteriosclerotic encephalopathy (SAE) or Binswanger's disease. Subcortical arteriosclerotic encephalopathy may be a relatively common affliction of elderly patients, most of whom have risk factors for arteriosclerosis. The modes of presentation and associated clinical signs are variable, and more than one third may have no neurologic deficit. In some cases SAE overlaps with normal pressure hydrocephalus by clinical and neuroimaging criteria. Some patients with normal pressure hydrocephalus who do not respond to ventricular shunting may actually have SAE.

Intrathecal interferon in the treatment of multiple sclerosis. Patient follow-up

Follow-up observations on patients with multiple sclerosis who were treated with human fibroblast interferon (interferon beta) administered intrathecally for six months revealed a persisting beneficial effect in terms of a reduction in exacerbation rates. At the time of our last report in 1982, ten interferon beta recipients had shown a reduction in their mean exacerbation rate from 1.8/yr before the study to 0.2/yr during the study while ten control patients with multiple sclerosis showed no change in their rates during the study (0.69/yr) compared with before it (0.68/yr). That report was based on observations made for means of 1.9 years in the recipients and 1.6 years in the controls. The recipient patients have now been followed up for 4.4 years (mean) and their exacerbation rates have continued to decrease to a current mean level of 0.16/yr. The control patients were "crossed over" and began receiving interferon beta intrathecally after they had been in the study for two years without showing any change in their rate. During the 2.0 years since crossover they also have shown a reduction in exacerbation rate to a mean of 0.30/yr. The toxic side effects of interferon beta administered intrathecally were acceptable in view of the benefit achieved. Interferon was identified in the cerebrospinal fluid (but not the serum) of two patients prior to treatment, which is probably a manifestation of de novo production of interferon by the central nervous system in response to the multiple sclerosis disease process.

Selective paralysis of downward gaze caused by bilateral lesions of the mesencephalic periaqueductal gray matter

A patient who had selective paralysis of downward gaze caused by bilateral lesions of the dorsolateral mesencephalic periaqueductal gray (PAG) matter is reported. Her necropsy findings differed from all previous reports of the syndrome, in that regions of the mesencephalon that have been considered as critical for executing downward gaze (dorsomedial to red nuclei, rostral interstitial nuclei of the medial longitudinal fasciculus [ri MLF]) were normal. These lesions may have produced the syndrome by involving the caudal portions of the nuclei of the posterior commissure (subcommissural), from which one of the commissural systems used by the ri MLF originates. It is also possible that the syndrome was produced by selective destruction of PAG neurons that generate downward impulses or by interruption of posterior commissure fibers containing downward impulses that travel through the dorsolateral PAG before terminating in the more ventral mesencephalon.

Factor analysis of the aftereffects of drinking in alcoholics

Research that deals with the causes of alcoholism has been hampered by the absence of factor analyses that deal specifically with ethanol's aftereffects. We factor analyzed 100 alcoholics' reports of the effects that they experience after alcohol consumption. Five factors emerged--Hangover, Euphoria, Flushing, Seizures, and Sleepiness. They are described and discussed. Future investigators may find them helpful in assessing theories on the etiology of alcoholism and in studies of ethanol's effects on subsets of alcohol abusers.

Megakaryoblastic transformation in myeloproliferative disorders

Megakaryoblastic transformation, with cells showing characteristic morphology and ultrastructural cytochemistry, developed in two patients with agnogenic myeloid metaplasia or myelofibrosis, and in one with chronic granulocytic leukemia. From the onset of the leukemic phase, all three have followed a relatively benign clinical course, surviving for 48, 29, and 24 months, respectively; only hydroxyurea has been necessary to control thrombocytosis. This experience emphasizes that it is possible for a patient to have an improved quality of life with minimum chemotherapy. In contrast, megakaryoblastic leukemia or acute myelofibrosis, where splenomegaly and a leukoerythroblastic blood picture are typically absent, responds poorly to any form of chemotherapy, and survival is short.

Do alcoholics give valid self-reports?

Self-reports on drinking among alcoholics (100 men inpatients) were compared with descriptions of their consumption given by collaterals (one friend or relative each) at 10 points during an 18-month follow-up study. The correlations between the two were only moderate; barely one-half of the variance in the alcoholics' self-reports corresponded to the collaterals' assessments. Patients underestimated collaterals' descriptions about three times as often as they overestimated them, but their over- and underestimations appeared to be of roughly equal size. The relationships between alcoholics' and collaterals' reports tended to be curvilinear. Among subjects whom the collaterals had described as abstinent or controlled drinkers, patients' and collaterals' assessments were similar but patients' descriptions grossly underestimated collaterals' reports when uncontrolled consumption was reported by the latter. The results support a moratorium on the use of patients' self-reports in follow-up studies on alcohol consumption.

The birth seasonality effect in nonschizophrenic psychiatric patients

Several studies have suggested that patients with affective, neurotic, and personality disorders are particularly likely to have been born during the early months of the year. They suggest that seasonal factors may play a role in the etiologies of these disorders. However, Lewis and Griffin (1981) have suggested that the reported seasonal exaggerations in psychiatric patients' birthrates simply may reflect artifacts. We searched for seasonal trends in the birth patterns of neurotics (N = 989), alcoholics (N = 2,870), affective disorders (N = 320) and personality disorders (N = 713), both before and after controlling for these artifacts. No significant effect appeared.

Altitudinal hemianopia caused by occipital infarctions. Clinical and computerized tomographic correlations

Two patients with altitudinal homonymous hemianopia caused by bilateral occipital infarctions were studied. Their clinical-computerized tomographic correlations showed the anatomic representation of the superior and inferior visual fields in the lower and upper banks of the calcarine fissure, respectively. The patient with the superior-field defect was unusual because he retained normal color vision and facial recognition abilities, despite having bilateral lesions that have classically produced central achromatopsia and prosopagnosia.

The relationship of beliefs about controlled drinking to recidivism in alcoholic men

A total of 100 men were studied to determine the relationship between belief in the abstinence theory and outcome after treatment of alcoholism. Twenty-seven subjects reported believing that at least some alcoholics can tolerate a single drink without losing control or can learn to drink in moderation and the remaining 73 rejected both contentions. The mean alcohol-consumption ratings of the two groups over 10 evaluations covering the first 18 months after treatment did not differ. The Groups X Time interaction effect, which would have indicated a difference in the rates at which recidivism developed in the two groups, was also nonsignificant. Finally, the percentages of the two groups who were rated as abstinent, in complete control of their drinking or in control most of the time were compared at each of 10 follow-up points. Only a chance number of these differences were significant. The results suggest that there is little relationship between belief in or rejection of the abstinence theory and recidivism.

Clinical and computed tomography findings in intracranial sarcoidosis involving the juxtasellar region

Two patients with endocrine and visual disturbances had CT evidence of an intra- and suprasellar enhancing mass. Both patients showed clinical improvement following treatment with systemic corticosteroids. In one case, there was no evidence of systemic sarcoidosis; and the exact nature of the juxtasellar lesion was established by surgical biopsy.

Schizophrenic birth seasonality in relation to the incidence of infectious diseases and temperature extremes

Previous research has indicated that schizophrenics are particularly likely to have been born during the winter months. In the present investigation, we studied the relationships of this birth-seasonality effect to year-to-year variations in the incidences of eight seasonal diseases and climatological temperature extremes in 3,246 schizophrenics. The winter birth-seasonality effect was greater in the years directly following those marked by high levels of infectious disorders than in years directly following those with low incidences of these diseases. Winter diseases (particularly diphtheria, pneumonia, and influenza) appeared to be more involved than others. These effects appeared among unmarried (presumably severe) schizophrenics but not among married patients, suggesting that the relationship is specific to process schizophrenia. The fact that most of the significant and near-significant relationships paired strength of birth seasonality to previous-year disease incidences suggested a prenatal rather than postnatal effect. Birth seasonality did not vary with winter or summer temperature extremes.