Consecutive Gas Chromatographic Determination of Phenytoin, Phenobarbital, Primidone, Phenylethylmalondiamide, Carbamazepine, Trimethadione, Dimethadione, Ethosuximide, and Valproate from the Same Serum Specimen

A quantitative gas-liquid chromatographic procedure is described for the consecutive determination of phenytoin, phenobarbital, primidone, phenylethylmalondiamide, carbamazepine, trimethadione, dimethadione, ethosuximide and valproate from a single serum specimen of 1.2 ml. After extraction from serum by two different procedures, the anticonvulsants are chromatographed without further purification on a 3% OV 17 column either with or without derivative formation by means of "on-column" methylation. Multiple internal standards are employed in order to enhance the reproducibility of drug-concentration measurement.     

Prevalence, knowledge, attitude, and practice of epilepsy in Kerala, South India

PURPOSE: To ascertain the prevalence and pattern of epilepsy and to characterize and quantify knowledge, attitude, and practice (KAP) toward epilepsy among the people of the state of Kerala, which is distinguished from the rest of India by a high level of literacy and health awareness of its population. METHODS: We conducted a door-to-door survey covering the entire population of 238,102 people residing in 43,681 households in a semiurban area of central Kerala. The screening questionnaire administered by medical social workers had a sensitivity of 100% for identifying persons with epilepsy. Neurologists examined all the individuals suspected of having epilepsy. We evaluated KAP toward epilepsy among 1,118 subjects (439 males and 679 females; mean age, 33.3 years; age range, 15-85 years) from households without epilepsy in the study area. RESULTS: Through a three-phased survey, we ascertained 1,175 cases (616 males and 559 females) with active epilepsy, providing a crude point prevalence ratio of 4.9 cases per 1,000 people and an age-adjusted prevalence ratio of 4.7 cases per 1,000 population. The highest age-specific prevalence rate of 6.5 per 1,000 occurred in the 10- to 19-year-old age group. Sex-specific prevalence rates did not significantly differ. The proportion of generalized and localization-related epilepsies was 58.8% and 30.6%, respectively. Ninety-nine percent of the KAP respondents had read or heard about epilepsy. Thirty-one percent and 27% thought epilepsy was a hereditary disorder and a form of insanity, respectively. About 40% of the respondents felt that individuals with epilepsy could not be properly educated or employed. Eleven percent would object to their children having contact with epileptic children. CONCLUSIONS: The prevalence and pattern of epilepsy in central Kerala, South India, do not differ from that of developed countries. Although the awareness of epilepsy among the people of Kerala was comparable to that of developed countries, the attitudes were much more negative. The need for educating the people of Kerala on epilepsy and for incorporating an adequate knowledge of epilepsy in the school curricula cannot be overemphasized.     

Tools, works of art, psychoanalysis

The roots of psychoanalysis lie deep within the evolutionary history of human life and intelligence. In this article I will explore a set of evolving relationships between human beings and the artifacts they have created. The psychoanalytic treatment method is one such artifact, despite the apparent reluctance of many psychoanalysts to describe what they do in terms that might be interpreted to minimize the personal element in their work with their patients. But the personal element can be effectively understood only through the study of individual human beings interacting with their surroundings. Psychoanalysis is a lineal descendent of simpler and earlier interactions with a special group of artifacts, those that incorporate human meanings in a way that provides a continuous source of feedback information.     

Tetrabenazine therapy of dystonia, chorea, tics, and other dyskinesias

Dopamine receptor blocking drugs, commonly used in the treatment of involuntary movements, may cause potentially serious adverse effects, including tardive dyskinesia. Tardive dyskinesia has not been reported with tetrabenazine, a dopamine-depleting drug. We report a follow-up in 217 patients treated with tetrabenazine for about 18 months (range, 1 to 80). The response was rated on a scale of 0 to 5 (1 = marked improvement, 4 = no response, 5 = worsening). The mean effect from tetrabenazine was rated as follows: 2.3 in 44 patients with tardive dyskinesia, 2.6 in 15 with tardive dystonia, 2.6 in 10 with Huntington's disease, 2.7 in 17 with Gilles de la Tourette's syndrome, 2.8 in 19 with generalized dystonia, 2.8 in 57 with Meige's syndrome, and 3.4 in 25 with other focal dystonias. Twenty-two patients with a variety of unusual movement disorders had a mean effect of 2.9. Parkinsonism occurred as a side effect in 53 patients, sedation in 28, depression in 23, anxiety in 16, insomnia in 11, and akathisia in 10. The choreatic movement disorders are most amenable to tetrabenazine therapy, but tardive and idiopathic dystonia may also be responsive. Tetrabenazine is an effective and relatively safe drug for a variety of hyperkinetic movement disorders.     

Injuries to the major branches of peripheral nerves of the forearm: By Morton Spinner,x + 141 pages, 63 illustrations,Saunders, Philadelphia,London, Toronto, 1972, £ 5.35

We report the case of a patient who suffered from RSSE, and about 13 years later, developed slowly progressive impairment of mental, visual and auditory function, oculomotor involvement, dysphagia, pyramidal and cerebellar signs.Increases of γ-globulin, IgG and IgA were noted in the cerebrospinal fluid. A diffuse atrophy of the cerebrum and cerebellum was observed on pneumoencephalography.Serological tests indicated unusually high antibody titres (HI) against RSSE virus and the Negishi strain of RSSE virus both in the serum and in the cerebrospinal fluid.Histological studies of a brain biopsy specimen indicated active chronic inflammation of the meninges, cortex and white matter. From these findings, we consider that this case demonstrates a chronic progressive encephalitis due to a slow, latent infection by RSSE virus.     

Nasal encephaloceles: a review of etiology, pathophysiology, clinical presentations, diagnosis, treatment, and complications

Introduction

Encephaloceles are considered by most to be a type of neural tube defect characterized by a herniation of the brain and meninges through structural weaknesses in the bony structures of the skull.

Discussion

Many different types of encephaloceles have been classified according to the location of the bony defect. Basal and frontoethmoidal encephaloceles constitute a nasal subclass of encephaloceles, which are herniations from the skull base and ethmoid bone, respectively. Basal encephaloceles are usually occult and can herniate into nasal structures causing obstruction. Frontoethmoidal encephaloceles usually present as a protrusion that is visible at birth and enlarges during crying. Both of these entities are rare with an incidence ranging from 1 in 5,000 to 1 in 40,000 live births around the world with the majority of cases localized in Southeast Asia.

Conclusion

Although cases have been recorded since the sixteenth century, there is still a scarcity of knowledge on the exact causes and factors associated with the development of the disease. Many studies have determined these to be caused by a combination of genetic and environmental factors. Most cases are nonlife threatening and the preferred method of treatment is surgical removal after diagnosis is confirmed with computerized tomography or magnetic resonance imaging. Prognosis is generally positive, especially in the subset of patients with frontoethmoidal encephaloceles.     

Impact of IQ,age, SES,gender, and race on autistic symptoms

The purpose of our study was to determine differences in autism severity and symptoms as a function of IQ, age, SES, gender, and race while simultaneously controlling these variables in 777 children with autism using a comprehensive measure evaluating 30 core and associated symptoms of autism. The children were 1–17 years of age with IQs from 9 to 146. Results showed that autism severity (total score on the Checklist for Autism Spectrum Disorder) and the 30 CASD item scores were not related to gender or race. However, the two CASD items reflecting mood and behavior problems were significantly more common in the lower than higher SES group. Our findings revealed significant, though modest, IQ and age effects. Autism severity increased with decreasing IQ and age, as did the frequency of 14 of the 30 CASD symptoms. The direction of IQ and age effects was the opposite for five symptoms and was nonsignificant for 11. Though IQ was associated with autistic symptoms, the majority of children with both high functioning and low functioning autism had most CASD symptoms and their symptom profiles were overwhelmingly similar. This supports the DSM-V Work Group's position that autism is a single spectrum disorder.     

Public awareness of, attitudes toward, and understanding of epilepsy in Isparta, Turkey

The social stigma attached to epilepsy very often constitutes a considerable problem and much private grief for patients and their relatives. This study was aimed at investigating "perceivers"' awareness of, attitudes toward, and understanding of epilepsy in Isparta, Turkey. Using a questionnaire survey, we interviewed, face-to-face, a random sample of 582 persons older than 18, excluding persons with epilepsy or those with relatives who had epilepsy. Eighty-one percent of respondents had heard of epilepsy, 47% knew a person with epilepsy, and 54% had seen an epileptic seizure. Somewhat less knowledgable were the elderly and less educated individuals. Attitudes toward social acceptance and employment of persons with epilepsy were generally negative, especially to children's associations and marriage. Twelve percent considered epilepsy as a form of insanity. Although understanding of epilepsy was favorable, the results indicate that there exists significant discrimination against persons with epilepsy, and there is a need to implement public education campaigns.     

实验性脑梗死IL-8动态观察

目的:探讨IL-8与缺血性脑水肿的关系;方法:采用健康的Wistar大鼠,建立线栓法脑梗死(MCAO)模 型。测定不同时点的脑组织水含量、IL-8水平的变化。结果:脑梗死后血清中IL-8水平迅速升高,在48小时达到高峰。 IL-8升高趋势与脑组织水含量升高趋势一致。结论:脑梗死后血清中IL-8水平升高,其升高趋势与脑组织水含量升高 趋势一致,说明IL-8参与了缺血性脑水肿的形成,IL-8的测定可以间接反映脑水肿的程度。     

The definition,taxonomy, epidemiology,and ecology of self-injurious behavior

The paper is a theoretical analysis of the evolution of the concepts related primarily to the definition and to the antecedents of self-injurious behavior (SIB). It was found that the definition of SIB as currently used contains surplus meanings unrelated to its scientific utility. At present, a restricted definition of SIB is not warranted because its basic parameters have not been studied adequately. Analysis of SIB taxonomies suggests two subclasses of SIB: social and nonsocial. Epidemiological studies of SIB suggest chronic and acute subsamples that differ in organicity, chronicity, and length of institutionalization. Ecological analysis suggests that a variety of antecedent conditions affect rates and topographies of SIB, e.g., ambient environmental conditions, background settings, situational demands, self-restraint, and type of daily routine activity. Implications were drawn for the organization of therapeutic environments, the study of covariation among collateral topographies, the dynamics of SIB responding, and sequential dependencies among SIB and related topographies. This research was supported by USPHS Grant Number HD-03110, MCH Project 916, NICHD Grant Number HD-10570, and NIEHS Grant Number ES-01104. We especially acknowledge DDSA H.I.P. Grant Number 51P2052 entitled, “Modifying Retardates' Self-Injurious Behavior” to Murdoch Center from 1974 to 1977, Stephen R. Schroeder, project director. Now at the University of Marburg, Germany.     

Laterality of hand, foot, eye, and ear in twins

Information on handedness, footedness, eyedness, and earedness was collected from 33 monozygotic (MZ) twin pairs and 67 dizygotic (DZ) twin pairs. The incidence of nonright-sidedness in the twins is not higher than that reported in the literature for singletons. Similar results are found for the other lateralities. The results of assessing handedness with preference tests do not differ from those carried out with performance tests. There are no differences in incidence of nonright-sidedness between MZ and DZ twins. The concordance of lateralities is similar in MZ and DZ twins. The proportions of Right-Right, Right-Nonright, and Nonright-Nonright pairs in both groups of twins show a binomial distribution. The present results do not confirm a genetic hypothesis of determination of sidedness in humans and are comparable with the results obtained by other twin studies.     

Overview on the structure, composition, function, development, and plasticity of hippocampal dendritic spines

There has been an explosion of new information on the neurobiology of dendritic spines in synaptic signaling, integration, and plasticity. Novel imaging and analytical techniques have provided important new insights into dendritic spine structure and function. Results are accumulating across many disciplines, and a step toward consolidating some of this work has resulted in Dendritic Spines of the Hippocampus. Leaders in the field provide a discussion at the level of advanced under-graduates, with sufficient detail to be a contemporary resource for research scientists. Critical reviews are presented on topics ranging from spine structure, formation, and maintenance, to molecular composition, plasticity, and the role of spines in learning and memory. Dendritic Spines of the Hippocampus provides a timely discussion of our current understanding of form and function at these excitatory synapses. We asked authors to include areas of controversy in their papers so as to distinguish results that are generally agreed upon from those where multiple interpretations are possible. We thank the contributors for their insights and thoughtful discussions. In this paper we provide background on the structure, composition, function, development, plasticity, and pathology of hippocampal dendritic spines. In addition, we highlight where each of these subjects will be elaborated upon in subsequent papers of this special issue of Hippocampus.     

Activities of arginase, transamidinase, and ornithine aminotransferase in glia, neurons, and synaptosomes

The regional, cellular, and subcellular distribution of some enzymes of the urea cycle in brain is not clearly known. Glia, neurons, and synaptosomes have been prepared from rat cerebral cortex and arginase (EC 3.5.3.1), transamidinase (EC 2.1.4.1), and ornithine aminotransferase (EC 2.6.1.13) have been estimated in order to understand the metabolic and functional role of these enzymes. It has been observed that arginase is predominantly localized in synaptosomes and neurons. The ornithine aminotransferase was found to be high in glial cells and very high in synaptosomes (higher than arginase). Transamidinase was mostly localized in glial cells. The implication of these results has been discussed in relation to a possible role of ornithine acting as a precursor of glutamate in glutametargic nerve endings and its possible participation in the glutamate-glutamine cycle.     

Efficacy of a fixed combination of indomethacin, prochlorperazine, and caffeine in the treatment of episodic tension-type headache: a double-blind, randomized, nimesulide-controlled, parallel group, multicentre trial

In this double-blind, randomized, parallel group, multicentre study the efficacy of a fixed combination of indomethacin, prochlorperazine, and caffeine (IndoProCaf) and nimesulide were compared over an 8-h period in the treatment of two consecutive episodes of tension-type headache (TTH). Both drugs were administered orally. Of 54 randomized patients, 40 were compliant to the protocol. More patients on IndoProCaf than on nimesulide were pain-free at 2 h post-dose (45% vs. 10%; P<0.05), reached a pain reduction of at least 50% at 2 (75% vs. 30%; P<0.05) and 4 h post-dose (90% vs. 58%; P<0.05), and had a statistically significant lower mean time to a 50 and 100% pain reduction in the second TTH episode. A higher percentage of patients reached a 50 or 100% pain reduction at 2 h post-dose with IndoProCaf compared with nimesulide, in two of two treated TTH episodes. A clinically and statistically significant change within each treatment group over time was found for the severity of pain, the headache intensity difference (HID), the sum of headache intensity difference (SHID), the maximum headache intensity difference (MAXHID), the headache relief (HER), the sum of total headache relief (TOTHER) and the maximum headache relief (MAXHER). In conclusion, IndoProCaf showed to be superior, but globally not statistically different from nimesulide in the treatment of episodic TTH. Both drugs were very effective and well tolerated.     

Mass spectrometric identification of Cu, Zn, Fe, Co, Mn, Mg, and Pb in mammalian brain.

Combining the techniques of thin-layer chromatography (TLC) and mass spectrometry, we unambiguously identified the trace metals Cu, Zn, Fe, Pb, Mn, Co, and Mg in the brain of a female human who had no evidence of any pathologic disease in the central nervous system, and in brains from mouse, rat, guinea pig, and rabbit. These trace metals were also found in anatomic regions of human brain: cortex (gray), cortex (white), caudate nucleus, putamen, hippocampus, and thalamus, and in anatomic regions of rat brain: hypothalamus, cerebellum, stem striatum, and "the rest." The metals were characterized from the color and Rf values of their tetraphenylporphyrin chelates on TLC and from the mass and pattern of molecule ion cluster of the mass spectrum. The unexpected presence of lead in the brain is discussed.     

Long-Term Side Effects of Newer-Generation Antidepressants: SSRIS, Venlafaxine, Nefazodone, Bupropion, and Mirtazapine

Anecdotal reports have suggested that the long-term use of selective serotonin reuptake inhibitors (SSRIs) may be associated with significant weight gain, sexual dysfunction, drug interactions, and discontinuation symptoms. Are these effects inevitable or can they be managed effectively with the appropriate interventions? In reviewing published, controlled clinical trials, it has been noted that many depressed patients experience weight gain during remission with or without treatment. Most antidepressants appear to produce a 3- to 4-kg weight gain after 6–12 months of therapy, which may be managed with nutritional counseling and exercise. The exception is mirtazapine, which appears to be associated with significant weight gain early in therapy. Antidepressant-induced sexual dysfunction is also common but may be managed with the addition of an antidote or substitution. Drug interactions are most common with fluvoxamine, nefazodone, and fluoxetine because these agents are more likely to affect the metabolism of commonly prescribed medications. It may be possible to prevent discontinuation symptoms with a cross taper to another antidepressant or by slowly tapering the antidepressant.     

Neuroendocrinological investigations during sleep deprivation in depression. I. Early morning levels of thyrotropin, TH, cortisol, prolactin, LH, FSH, estradiol, and testosterone

Measurements of 12 hormones were conducted in patients with major depressive disorder at 8 AM on the morning before and at 8 AM on the morning after total sleep deprivation (SD). Thyrotropin (TSH), thyroxine (T4), triiodothyronine (T3), and free T3 (fT3) were measured in 50 patients, free T4 in 39 patients, reverse T3, cortisol, prolactin, luteinizing hormone, and follicle-stimulating hormone in 21, estradiol in 20 (women), and testosterone in 14 (men). After SD, there was a significant rise in TSH, T4, T3, and fT3 concentrations and a significant fall in testosterone levels. The increases in TSH levels were significantly correlated to clinical response. Responders to SD had higher T4, fT4, rT3, and testosterone concentrations before SD. Neither age, gender, polarity, nor antidepressant medication had a clearly significant effect on the response to SD.     

Histopathology,classification, and grading of gliomas

Neoplastic transformation occurs in all glial cell types of the human nervous system, producing a wide variety of clinico-pathological entities and morphological variants. Astrocytomas are most common and span an unusually wide spectrum, ranging from the slowly growing juvenile pilocytic astrocytoma to the highly malignant glioblastoma multiforme. Diffusely infiltrating astrocytomas of the cerebral hemispheres show an inherent tendency for progression towards a more malignant phenotype. This change is morphologically categorized in histologic grading schemes (e.g., WHO Grade II to IV) and is associated with the sequential acquisition of genetic alteration, including mutation in the p53 and homozygous deletion of the p16 tumor suppressor genes. Loss of heterozygosity on chromosomes 10 and 19q as well as amplification of the EGF receptor are largely restricted to malignant gliomas and thus considered late events in astrocytoma progression. Gliomas often show phenotypic expresson of different glial cell lineages (e.g., oligoastrocytoma). Recent studies sugeest that the occurrence of mixed glomas is not indicative of a polyclonal orgin but rather reflects altered gene exprssion leading to a charge in the balance of growth factors influencing glioma defferentiation. © 1995 Wiley-Liss, Inc.