External noninvasive cardiac pacing in out-of-hospital cardiac arrest

External noninvasive cardiac pacing was applied outside the hospital to 19 patients who had experienced cardiopulmonary arrest and 1 patient with life-threatening bradycardia. Seven patients developed electrocardiographic evidence of pacemaker capture, although only 2 had palpable pulses. The patient with bradycardia was successfully paced. This study demonstrates the feasibility of cardiac pacing in out-of-hospital cardiac arrest but confirms the poor prognosis of asystolic cardiac arrest even with the application of pacing.

Antigenic differences between endozoites and cystozoites of Toxoplasma gondii

Antigenic differences between the cystozoite and endozoite of Toxoplasma gondii were found using fluorescent antibody staining. Antisera against the cystozoite reacted against only the cystozoite, whereas antisera against the endozoite reacted against both endozoite and cystozoite. Absorption of sera with endozoites removed only positive reactions with endozoites. These findings are the first to suggest antigenic differences between these two forms of Toxoplasma.

Optimal phenotypic expression times for HPRT mutants induced in foreskin-, skin-, and lung-derived human diploid fibroblasts

A series of paired lung- and skin-derived fibroblast cultures has been established from human embryonic tissues under carefully controlled, identical conditions, providing the unique opportunity to study differences between normal diploid fibroblast populations from skin and lung without the confusion of genetic differences between donors. To reliably assess differences in the induced mutation frequencies observed among different cell populations, optimal phenotypic expression times in the HPRT mutagenesis system were determined for neonatal foreskin, fetal skin, and fetal lung cultures. Cell populations were mutagenized with several doses of N-methyl-N'-nitro-N-nitrosoguanidine and were replated in 6-thioguanine selective medium at intervals over 14 days. Survivals following MNNG exposure ranged from 1.6% to 45.5%. For all doses and survivals tested a 7-day expression period was the optimal value for cultures from the three different tissue sources in six independent experiments. Mutant frequency data derived from untreated control populations confirmed that spontaneous mutations during the expression period contributed negligibly to the final mutant frequency. Differences between the mutation frequencies obtained using an in situ and a replating protocol were approximately twofold for lung-, skin-, and foreskin-derived cultures.

Haematology Grand Rounds. Hairy cell leukaemia masquerading as malignant lymphoma

Pancytopenia with massive splenomegaly, minimal lymphadenopathy and circulating atypical lymphoid cells with cytoplasmic projections characterize the lymphoproliferative disorder known as hairy cell leukemia, or leukaemic reticulo-endotheliosis. Many of the features of hairy cell leukaemia are shared with a malignant lymphoma of the B-cell type, from which it can be distinguished on a number of criteria, including histological examination of bone marrow, lymph nodes, liver and spleen. Recognition that this syndrome is not homogeneous is important, since in the B-cell tumour the clinical course is progressive, requiring chemotherapy which is usually effective; the disease is indolent in leukaemic reticulo-endotheliosis and drug treatment may actually shorten survival. The patient presented illustrates the ease with which this diagnostic error can arise, and the features separating these two unusual entities are reviewed.

Intrathecal interferon in multiple sclerosis

Human fibroblast interferon (IFN-beta) was administered by serial lumbar puncture to ten patients with multiple sclerosis (MS). Their clinical courses were compared with those of ten MS control patients who did not receive IFN-beta. As of this writing, the recipients have been followed up for 1.8 to 2.0 years (mean, 1.9 years), and the controls for 1.5 to 1.7 years (mean, 1.6 years). During the study, two recipients suffered four exacerbations, and six controls suffered 11 exacerbations. The recipients' rates of exacerbation during the study were significantly less than their rates both for the entire prestudy duration of the disease and for the 1.8 to 2.0 years immediately preceding entry into the study. The controls' rates of exacerbation before the study and during the study period did not differ significantly. Clinically, the conditions of five recipients and two controls improved, those of three recipients and four controls were unchanged, and those of two recipients and four controls worsened. Headaches, sometimes accompanied by fever and rarely by nausea and vomiting, occurred after injections of IFN-beta. Toxic symptoms usually disappeared within 24, hours; rarely, they persisted for seven to ten days. Each recipient had transient CSF pleocytosis and elevated levels to total protein (the latter remaining elevated in seven). These findings show that intrathecal administration of IFN-beta is feasible in patients with MS, warrant cautious optimism that intrathecal IFN-beta may be effective in altering the course of the disease, and support concepts of a viral or dysimmune cause of MS.

Simultaneous contrast imaging of the left ventricle by two-dimensional echocardiography and standard ventriculography

Simultaneous contrast two-dimensional echocardiograms and contrast ventriculograms were analyzed for 19 cardiac cycles in 6 patients. Ventriculographic volume was underestimated by 10 +/- 4.5% (p less than .001) by the contrast echocardiograms, despite good correlation (r = 0.88). Discrepancies could not be assigned to changes in volume between studies nor to a lack of precise endocardial definition. Simultaneous imaging demonstrated that the ultrasonic transducer was located 33 degrees cephalad to the cardiac apex. Although angiographic volume was severely underestimated, ejection fraction (r = 0.93) and stroke volume (r = 0.90) could be calculated from two-dimensional echocardiograms using regression equations.

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.

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.