[Diagnostic differentiation of dementia diseases by modern imaging procedures]

We present a review on recent neuroimaging techniques, like x-ray computed tomography (XCT), magnetic resonance imaging (MRI), positron emission tomography (PET) and single photon emission tomography (SPECT) in dementia and related diseases. Significant new findings have been obtained using techniques reflecting proton density, regional brain perfusion and brain metabolism. In dementia of the Alzheimer type, for example, temporoparietal and sometimes also frontal reductions in cerebral blood flow and metabolism are characteristic. The infarctions found in multi-infarct dementia are especially well visualized on T2-weighted MRI images. Pick's disease is characterized by brain atrophy and decrease of radiotracer activity in the frontal lobes. In huntington's chorea the metabolic rate on PET scan in the area of the caudate nuclei may be reduced even before signs and symptoms become apparent. Furthermore, neuroimaging provides us with fairly typical finding in Creutzfeld-Jakob's disease, alcoholic dementia, Wilson's disease, hydrocephalus, Parkinson's disease, progressive supranuclear ophthalmoplegia, Fahr's disease, and the olivopontocerebellar ataxias. Neuroimaging techniques, however, have always to be interpreted in conjunction with clinical findings, thus disclosing their full range of information.

The leucine zipper domain of avian cMyc is required for transformation and autoregulation

Small deletions of 7 to 48 amino acids have been generated in the leucine zipper domain of the avian cMyc protein and the mutant cMyc proteins expressed using an avian retroviral vector. Retrovirally encoded cMyc protein transforms primary chick embryo fibroblasts and leads to abnormal regulation of the endogenous c-myc gene. Deletion of the most C-terminal leucine of the zipper motif confers a partial phenotype affecting some but not all parameters of transformation. Complete loss of transforming activity results from deletion of further leucine residues, including one which is not part of the heptad repeat. In cMyc transformed cells endogenous c-myc mRNA is expressed at a low level and is abnormally refractory to induction by serum stimulation. In contrast, a non-transforming cMyc protein which lacks the zipper does not affect normal c-myc expression. These results demonstrate that the leucine zipper domain of avian cMyc is required for both transformation and autoregulation, and suggests that essential leucine residues within the motif may be spaced differently from those in the zippers of Fos and Jun.

Neuropsychological findings in treated Wilson's disease

Seventeen patients, treated for Wilson's disease (WD), underwent a set of neuropsychological tests and were compared with a closely matched control group. There were clear differences between the groups (chi 2-test, p less than 0.0001). Wilson patients with only hepatic involvement, however, did not at all differ from their controls. Wilson patients with neuropsychiatric signs differed from controls on a reasoning test (p = 0.0016), and the entire WD group differed on a perceptual speed task (p = 0.0025). Compared to normal test values, however, the patients' group means were all within plus or minus one standard deviation from the normal mean. Special testing procedures and construction of the test battery excluded a factor of motor deficits as a major cause for the differences. The neuropsychological findings are viewed in relation to other findings in patients with motor disorders and predominantly subcortical lesion sites. Wilson's disease may be a dementing condition, but not when treated adequately.

Is Wilson's disease a dementing condition?

A case presentation in this journal by Rosselli, Lorenzana, Lasselli and Vergara (1981) has raised the issue of intellectual deterioration in Wilson's Disease. Relevant findings in the recent literature are discussed.

The interaction of human papillary and reticular fibroblasts and human keratinocytes in the contraction of three-dimensional floating collagen lattices

Fibroblasts derived from the papillary and reticular dermis of human skin and human keratinocytes show differences in their abilities to contract floating three-dimensional gels constructed from type I collagen. Reticular fibroblasts produce greater gel contraction than papillary fibroblasts. When equal numbers of papillary and reticular fibroblasts are mixed in the gels, papillary fibroblasts consistently inhibit gel contraction by reticular fibroblasts indicating interaction between these cell types in the contraction process. Surprisingly, keratinocytes alone produce greater gel contraction than that produced by either fibroblast type. Cooperativity in the gel contraction process is observed when fibroblasts are incorporated into the collagen matrix and keratinocytes are seeded onto the gel surface. Keratinocytes and dermal fibroblasts adhere to the collagen fibril to induce gel contraction by different mechanisms. Fibroblast contraction of collagen gels does not require fibronectin but is a serum-dependent reaction. In contrast, keratinocyte contraction of collagen gels occurs in a serum-free environment. Polyclonal, affinity-purified antibodies to human plasma fibronectin at high concentrations do not inhibit gel contraction by keratinocytes, making unlikely the possibility that fibronectin synthesized by the keratinocyte is a significant factor in the gel contraction process. We are currently examining the possibilities either that keratinocytes are synthesizing other adhesion proteins or that receptors on the cell surface can interact directly with the collagen fiber.

Foix-Chavany-Marie-syndrome--neurological, neuropsychological, CT, MRI, and SPECT findings in a case progressive for more than 10 years

In a 66-year-old woman signs and symptoms of bilateral opercular syndrome (Foix-Chavany-Marie-syndrome) developed progressively over a period of more than 10 years. Facio-linguo-velopharyngeo-masticatory diplegia with automatic-voluntary dissociation was accompanied by motor aphasia and oral apraxia leading to a state of almost complete anarthria. Although it initially resembled the anterior biopercular syndrome there are also features indicating involvement of the posterior opercula. Although the aetiology remains obscure without pathological data, a bilateral focal brain atrophy is assumed. This is probably the first case documented by MRI and SPECT.

Comparison of extensive brain calcification in postoperative hypoparathyroidism on CT and NMR scan

A case of postoperative hypoparathyroidism is presented in which calcifications seen on CT scan were differently visualized on T2 weighted NMR images. High and low signal intensities may reflect different stages of the calcifying process thus confirming neuropathological findings.

[Continuous pattern recognition in the assessment of memory disorders in dementia]

A simple and short method for assessing visual short term memory is presented, based on continuous picture recognition, which is not explicitly dependent on input or output language abilities. The material was gathered from Kimura's Recurring Figures Test (RFT) and Erzigkeit's SKT. Two of three parallel series which are characterized by different levels of "nameability" and familiarity are apt to distinguish between demented patients and patients without memory problems. Objectivity is assured by a simle scoring system which allows rapid transformation into d'-values according to signal detection theory. It is expected that by this procedure not only screening for memory problems in the demented will be facilitated, but also the impact of language disorders will be minimized.

Attenuation of burn-induced changes in hemodynamics and glucose metabolism by the PAF antagonist SRI 63-675

The importance of platelet-activating factor (PAF) in producing hypotension, hemoconcentration and alterations in carbohydrate metabolism following thermal injury was investigated in chronically catheterized rats. Animals were fasted overnight, anesthetized with pentobarbital, and then injected with saline or the PAF antagonist SRI 63-675 prior to a 25% body surface area scald injury. Burned animals showed a sustained 20-30% fall in mean arterial pressure that was attenuated by the PAF antagonist. Burn also produced a prolonged increase in hematocrit. Animals pretreated with SRI 63-675 showed a similar degree of polycythemia after 1 h, but thereafter hematocrit fell and was not different from sham-burned animals. Burn increased the plasma glucose (45-52%) and lactate (5-6 fold) concentrations, and tended to produce an early increase and a later decrease in the rate of glucose appearance (Ra). These metabolic changes were associated with elevated plasma levels of glucagon and catecholamines. The PAF antagonist prevented the hyperglycemia, reduced the hyperlactacidemia, and prevented the late fall of glucose Ra. Treated animals still showed increased levels of glucagon, while catecholamine concentrations were reduced by 50%. Short-term survival (4 h) was markedly improved (86 vs. 43%). These results suggest that PAF produced following thermal injury is responsible, at least in part, for the early hemodynamic changes and hemoconcentration. However, the role of PAF as a mediator of burn-induced glucose dyshomeostasis appears secondary to its hemodynamic effects.

[Suprascapular nerve entrapment syndrome]

Nineteen patients with isolated suprascapular entrapment neuropathy were seen between 1980 and 1986. A neurogenic cause and absence of other deficits were confirmed by electromyography. Electroneurographic tests were performed in 13 and demonstrated delayed conduction time and (or) reduction in stimulus response amplitude. In 16 patients there was an acute or chronic mechanical cause (direct pressure on the suprascapular nerve, forced dislocation of the shoulder blade). Two types of paralysis could be distinguished, an upper one affecting both the infra- and the supraspinatus muscles (12 patients), and a lower one involving only the infraspinatus muscle (4 patients). In two patients an inflammatory cause was considered likely, while in one the cause remained unclear. Restricting movement brought about an improvement in most patients, while in one the neurophysiological parameters improved after neurosurgical intervention, without complete clinical restoration.

[Crohn's disease-- 10 years' experience at a city hospital]

Between 1977 and 1986, 92 patients with Crohn's disease (53 females and 39 males, average age 32 years at diagnosis) were admitted for a total of 158 hospital stays at the St. Claraspital, Basel. In 71 cases the diagnosis was based on one or more of radiologic and endoscopic evaluation and/or operative findings. In 4 cases diagnosis was based solely on clinical findings and in the remaining 17 the original diagnostic workup could not be evaluated retrospectively. 65% of cases were histologically proven, while the rest of the patients were either not biopsied or biopsy yielded inconclusive results. Crohn's disease was located simultaneously in the small and large bowels in 41 patients, in the small bowel only in 23 (25%) and in the large bowel only in 20 (22%). The remaining localizations were either proximal GI tract or anal region only. Surgery was performed a total of 65 times in 44 of the 92 patients (48%), the most frequent procedures being ileocecal resection and surgical treatment of perianal fistulas and abscesses. Accordingly, the main indications for surgery were perianal complications (37%) and stenotic bowel lesions (29%). The resection rate was higher in ileal (35%) than in colorectal (25%) involvement. The 3 rectal amputations eventually necessary were all in patients with anorectal involvement.

Gordon's reflex phenomenon in Huntington's disease

The patellar tendon jerk was examined quantitatively in 8 cases of Huntington's disease and in 27 controls using surface electrodes over the quadriceps femoris and biceps femoris muscles. The purpose was to investigate whether Gordon's patellar phenomenon was caused by a lack of antagonistic innervation or by late agonistic tonic reflex activity in Huntington's disease. Specific results could indicate that the patellar tendon jerk could be used as a diagnostic aid, as is the long loop reflex of hand muscles. A late tonic stretch response was found, appearing between 160 and 260 ms after the tendon tap. This response appeared in 6 out of the 8 Huntington's cases, even when Gordon's phenomenon was not observed. Therefore, it could be assumed that the tonic quadriceps activation gives rise to the clinically observed Gordon's phenomenon.

[Current status of aphasia therapy]

Aphasia therapy in adults has been established to a larger extent relatively lately in the history of aphasiology, i.e. after its social medical importance had been realized and one of the cardinal problems of neurology solved more satisfactorily--lesion localization by imaging techniques. In order to evaluate the efficiency of aphasia therapy--which is still not quite uncontradicted--it was necessary to acquire sufficient knowledge of the spontaneous recovery process. It takes place--e.g. after stroke--mainly during the first 3 months, coming, as a rule, to a halt during the first year. Longer recovery periods, however, have been described. Next to etiology neurological status, overall health condition, type and severity of aphasia, and time delay between onset of the disease and start of therapy have been ascertained, whereas age and handedness seem to be of minor relevance. If syndrome change occurs the boundary between Broca's and Wernicke's aphasia is not surpassed; this taken apart almost any change from a more severe to a milder form of aphasia is possible. To isolate the therapeutic effect from spontaneous recovery in larger groups is difficult. There are, however, more recent investigations which suggest, that a correctly indicated therapy, which is sufficiently intensive and lasts long enough, will be effective. One of the corner-stones of any therapeutic effort ist adequate stimulation, oriented toward the patients needs and his aphasic syndrome, and taking into account the systemic nature of language and its most important linguistic structural components. Furthermore, a phase-specific and interdisciplinary approach and integration of closely related persons play an important role. We divide the numerous therapeutic techniques into 3 groups: direct or stimulation approach, indirect or circumventory approach, compensatory or alternative strategies approach. Representatives of all 3 groups are presented briefly, e.g. auditory stimulation, divergent semantic intervention, promoting aphasics communicative effectiveness, language enrichment therapy, programmed instruction; then the deblocking method, melodic intonation therapy, imagery, a sample of linguistically oriented methods for the reeducation of syntax, semantics, and phonemics along with special methods for the treatment of alexia and agraphia; finally compensatory techniques like visual communication, visual action therapy, and bliss symbolics. Some particular problems encountered in working with aphasics are addressed. A point is made about the feasibility and profit of lay therapy.(ABSTRACT TRUNCATED AT 400 WORDS)

[Relation between long loop reflex findings and the topography of cerebral infarcts]

27 patients with demarcated cerebral infarctions were examined in the computed tomograms. The long loop-reflexes were elicited by electrical stimulation of the median nerves. The localization of substance defects was clearly related to the loss of the late M2-potentials. This result points out a transcortical reflex loop through medial lemniscus, ventral posterolateral nucleus of the thalamus, dorsal limb of the internal capsule, corona radiata and somatosensory cortex.

Is direct CT caudatometry superior to indirect parameters in confirming Huntington's disease?

The largest diameter and area of the head of the caudate nucleus in the CT slice closest to the foramina of Monro were compared to other conventional parameters used in confirming Huntington's disease and contrasted with two groups of non-Huntington patients. A maximum diameter under 6.5 mm and an area under 92.5 mm2 were indicative of, but not specific for, Huntington's chorea. Without taking additional parameters into account, mainly occlusive hydrocephalus may be confused with genuine caudate atrophy. With advancing technology--especially Nuclear Magnetic Resonance imaging--it is to be hoped that direct measurement of the caudate nucleus may be easier and more reliable and emerge as a valuable adjunct to conventional measures.

Palinoptic phenomena as an error mechanism in resolving alexia without agraphia. A case report

Palinoptic, visual perseverative, or prolonged positive after-image phenomena have most often been met in right-sided occipital pathology. Less frequent with left-sided lesions they can be associated with the alexia without agraphia syndrome (with or without color naming deficit or hemifield loss). This is illustrated by our case in which rapidly fading visual reduplicative sensations--rather than linguistic incompetence--were apparently responsible for most of his paralexic errors.

[Simultaneous combined radio-/chemotherapy of locally recurring breast cancer]

Combined simultaneous radiochemotherapy is our treatment conception for the locoregionally recurrent mammary carcinoma. With this therapy, complete or partial remissions are achieved in 92%. In only 25%, another recurrence appears within the irradiated region. The median survival time is 23 months. The results of the chemotherapy combination CMFV are better than the results of other combinations. Due to the good local effect, the quality of life without tumor of the thoracic wall is improved.

Value of serum PABA as a pancreatic function test

In a total of 71 subjects (19 controls, 24 patients with non-pancreatic gastrointestinal disease, and 27 patients with pancreatic disease) an oral pancreatic function test using N-benzoyl-L-tyrosyl-PABA (BT-PABA) was performed with simultaneous determination of the serum para-aminobenzoic acid (PABA). Urinary excretion of PABA was significantly less (p less than 0.001) in patients with chronic pancreatitis (n = 12) and pancreatic carcinoma (n = 10) than in controls and in patients with non-pancreatic disease. The serum concentration curve in patients with chronic pancreatitis was significantly flattened (p less than 0.001) compared with that of the control group and the patients with non-pancreatic gastrointestinal disease. The discrimination between the controls and the patients with chronic pancreatitis was best at 120 minutes after administration of BT-PABA (lower limit of normal: 2.8 micrograms/ml). The results of our study show that determination of PABA serum concentration two hours after administration of BT-PABA is as valuable an index of pancreatic function as the urinary excretion of PABA.

[Normal values of spirometry for the 15- to 20-year-old age group]

In 130 healthy young men and women aged 15 to 20 years, all non-smokers, volume flow curves were recorded during forced expiratory vital capacity measurements. The forced vital capacity (FVC), the forced expiratory volume of 1 sec (FEV1) and the mid-expiratory flow rate (MEF50) were evaluated in order to establish new standard values for normal people in this particular age group. FVC is strongly height and sex dependent. Our new normal values are in good agreement with those of the literature. Our FVC values, however, are in general slightly higher than those of previous authors. MEF50 turns out to be sex independent but height dependent, but not as much as FVC. Our new normal values for MEF50 are in good agreement with those of Knudson et al., though slightly lower. The FEV1/FVC quotient was found to decrease significantly with height from 0.9 to 0.8. This decrease may be due to the increase in lung volume with growth. It could also be due to lung damage caused by atmospheric air pollution in young adults who are still growing.

Nifedipine in hypertensive emergencies

The effects and safety of using oral nifedipine 10-20 mg as acute antihypertensive treatment were studied in a single-blind placebo-controlled study of 25 consecutive patients with very high blood pressure requiring emergency reduction. In addition the effect of this treatment on cerebral blood flow was investigated using xenon-133 in 10 patients randomly allocated to receive oral nifedipine or intravenous clonidine. Whereas placebo did not alter the blood pressure, oral nifedipine significantly reduced the systolic and diastolic blood pressures in all 25 patients (from 221 +/- 22/126 +/- 14 mm Hg to 152 +/- 20/89 +/- 12 mm Hg after 30 minutes, p less than 0.001). Heart rate increased from 74 +/- 11 to 84 +/- 11 beats/minute (p less than 0.01); this effect was inversely related to age (r = -0.65, p less than 0.01). The falls in systolic and diastolic blood pressures were closely related to the blood pressures before treatment ) r = 0.67, p less than 0.001 for systolic, and r = -0.58, p less than 0.01 for diastolic values). No serious unwanted effects were observed. Measurement of cerebral blood flow after nifedipine showed an increase in flow in four out of five patients. Clonidine, by contrast, reduced cerebral blood flow in all patients by up to 28%. Nifedipine is a simple, effective, and safe alternative drug for managing hypertensive emergencies, especially when continuous monitoring of the patient cannot be guaranteed.

Efficacy and side effects of haloperidol in psychotic patients: oral versus intravenous administration

It is a commonly held view among clinicians that intravenously administered haloperidol has a greater antipsychotic effect than oral haloperidol. To test this hypothesis, the authors carried out a double-blind study on patients with acute schizophrenia and patients with schizophreniform or schizoaffective (with manic features) psychoses. Using biologically equivalent doses, they found that intravenously administered haloperidol was slightly more effective during the first 3 hours; thereafter the route of administration did not make a difference in effectiveness.

Assessment of exocrine pancreatic function by oral administration of N-benzoyl-L-tyrosyl-p-aminobenzoic acid (Bentiromide): 5 years' clinical experience

Exocrine pancreatic function was assessed in 588 subjects by oral administration of 1 g of the chymotrypsin-labile peptide N-benzoyl-L-tyrosyl-p-aminobenzoic acid (Bentiromide) from 1974 to 1979. The pancreatic function test (PFT) was performed in 126 controls, 217 patients with pancreatic diseases, 196 patients with various non-pancreatic gastrointestinal disease, 18 patients with renal disease and 31 patients with various other diagnoses. In 62 of 72 patients (86 per cent) with chronic pancreatitis and in 19 of 25 (76 per cent) with pancreatic carcinoma, the excretion of p-aminobenzoic acid (PABA) in the urine was significantly less than in the controls. In contrast, 328 of 353 controls and patients with non-pancreatic diseases (93 per cent) had PABA excretion within normal limits. The sensitivity and specificity of the Bentiromide-test observed in this study is sufficient to detect moderate to severe disturbances of pancreatic exocrine function. The PFT has proved to be an easy and reliable screening test for pancreatic exocrine function in ambulatory as well as in hospitalized patients.

A case of bilateral temporal lobe agenesis

A 76-year-old man with bilateral temporal lobe agenesis producing clinical features resembling the Robinson syndrome is described. The malformation was discovered during a routine CT examination after the appearance of a homonymous visual field defect. The patient was examined by (neuro) psychological testing. The findings are compared with other reported cases and discussed with regard to cerebral localisation.

[Testing aphasia by psychometric methods (author's transl)]

In a survey of psychometric tests in world-wide use for the examination of aphasia stress is laid on methodological points. Separately for individual tests and tests and test batteries the development and clinical application are delineated, statistical criteria mentioned and diagnostic usefulness evaluated.

The oral pancreatic function test with N-benzoyl-L-tyrosyl-p-aminobenzoic acid: acute toxicity and effects of renal function on this test

The oral pancreatic function test with N-benzoyl-L-tyrosyl-p-aminobenzoic acid was performed on 24 healthy test subjects, and its toxicity was examined. Eight patients with restricted renal function and known renal disease were also investigated. The pancreatic function test and the same procedure using free p-amino-benzoic acid were performed at 2-3-day intervals. During all the investigations with the pancreatic function test, no clinical side effects were observed. All parameters investigated at all the test times fell within the normal range. No toxicity of N-benzoyl-L-tyrosyl-p-amino-benzoic acid could be found. The excretion of p-aminobenzoic acid after administration of N-benzoyl-L-tyrosyl-p-aminobenzoic acid ws greatly reduced in all patients with restricted renal function. Four of eight patients also showed essentially no increase in excretion rate when free p-aminobenzoic acid was given instead of the peptide. It is therefore not possible to correct the pancreatic function test results in patients with renal insufficiency by calculating the ratio of p-aminobenzoic acid excretion after peptide intake to that after free p-aminobenzoic acid ingestion. Adequate renal function is therefore a prerequisite for the pancreatic function test.

[The study of exocrine pancreas function by means of orally administered N-benzoyl-L-tyrosyl-praaminobenzoic acid (BT-PABA-test). Evaluation after 5 years clinical experience]

Exocrine pancreatic function was assessed in 588 persons by oral administration of 1 g of the chymotrypsin-labile peptide N-benzoyl-L-tyrosyl-paraaminobenzoic acid (BT-PABA) from 1974 to 1979. The BT-PABA-test was performed in 126 controls, 217 patients with pancreatic diseases, 196 patients with various non-pancreatic gastrointestinal diseases, 18 patients with renal diseases, and 31 patients with various other diagnoses. In 62 of 72 patients (86.1%) with chronic pancreatitis and in 19 of 25 patients with pancreatic carcinoma the excretion of paraaminobenzoic acid (PABA) in the urine was significantly less than in the controls. In contrast, 328 of 353 controls and patients with non-pancreatic diseases (92.9%) had a PABA excretion within normal limits. The sensitivity and specificity of the BT-PABA observed in this study is sufficient to detect moderate to severe disturbances of exocrine pancreatic function. The replacement of the liquid test-meal by a standard breakfast and additional meals taken during the collection period 4 or 5 hours after peptide intake did not influence the results of the BT-PABA-test, thus considerably simplifying the BT-PABA-test.

Immunofluorescent antibodies in patients with bird-fancier's lung

To assess its value as a screen for avian antibodies, indirect immunofluorescence against avian intestinal tissue has been to test sera from thirty-nine patients with documented bird-fancier's lung disease, thirty-eight asymptomatic bird-fanciers and 257 controls without known avian contact. Immunofluorescent antibodies occurred more frequently than precipitins among patients with BFL and asymptomatic bird-fanicers. Globular fluorescence within the mucus occurred only in patients with avian contact, although other fluorescent antibodies were seen with control patients. No particular pattern was confined to patients with the lung disease. When included in an autoantibody profile, indirect immunofluorescence provides a sensitive and convenient alternative to precipitin methods in screening for avian antibodies.

IgA and IgG reticulin antibodies in coeliac and non-coeliac patients

Using indirect immunofluorescence, comparisons were made of patterns of staining of five tissue substrates with 28 RI reticulin antibody-positive coeliac sera, and 23 RI reticulin antibody-positive non-coeliac sera. IgA and IgG fluorescein conjugates were used separately. IgA antibodies were seen in 22 coeliac patients (78%) compared with three non-coeliacs (13%). Concomitant sinusoidal fluorescence (RS pattern) was seen more frequently with the non-coeliac (60.9%) than with the coeliac sera (10.7%). Such differences may help to distinguish those patients who should have a jejunal biopsy when using the reticulin antibody as a screening test for coeliac disease.

The metabolism of choline by a sympathetic ganglion

Cat's superior cervical ganglia were perfused with Locke's solution containing choline (Ch) at physiological concentration but labelled (methyl-3H), and the radioactive products in extracts of such ganglia were identified by a combination of selective precipitation and chromatographic tests. Ch was incorporated into acetylcholine (ACh), into phosphorylcholine (PCh), and into phospholipid. The rate of formation of PCh and phospholipid from Ch was measured to be about 2 ng/min of each, and this rate was unaffected by activity or by hemicholinium. Free Ch liberated by PCh or phospholipid turnover is unlikely to be an important source of Ch for ACh synthesis under physiological conditions.