Apolipoprotein E co-localizes with newly formed amyloid β-protein (Aβ) deposits lacking immunoreactivity against N-terminal epitopes of Aβ in a genotype-dependent manner

Different types of amyloid -protein (A)-containing plaques occur in brains of Alzheimers disease (AD) patients. Diffuse plaques seen during early stages of AD differ from neuritic plaques in later stages both with respect to the length of the A peptides and the presence of other proteins, e.g., apolipoprotein-E (apoE). Since apoE is involved in A transport and clearance, and the 4-allele of the apolipoprotein-E gene (APOE) is a major risk factor for sporadic AD, it is plausible to speculate that apoE plays a pathophysiological role in the initiation of A deposition. To address the issue of whether binding of apoE to A is involved in initial A deposition, we studied the human medial temporal lobe of 60 autopsy cases encompassing the full spectrum of AD-related pathology. In temporal lobe regions, which become involved for the first time at a given stage of -amyloidosis, all plaques represent newly formed plaques, and these were studied with immunohistochemical methods. ApoE was present in 36 cases, and was frequently co-localized with newly formed A deposits detectable with anti-A₄₂ but not with antibodies raised against N-terminal epitopes of A. In 10 additional cases, immunoreactivity against apoE was completely lacking in newly formed plaques, which, at the same time, displayed immunoreactivity against N-terminal epitopes of A. The failure of N-terminal epitopes of A to co-localize with apoE in newly formed plaques indicates that these deposits presumably contain apoE-A complexes, in which the N-terminal epitopes of A are often concealed after complexing with apoE, thus preventing subsequent binding of antibodies. Moreover, apoE-positive newly formed plaques were seen more frequently in APOE 4/4 cases than in non-APOE 4/4 individuals, thereby underlining the potentially crucial role of apoE for the development of A deposits.     

Electroconvulsive therapy in Parkinson's syndrome with “on-off” phenomenon

Summary During long-term treatment with L-dopa in Parkinson's syndrome on-off phenomenon develops in many cases, often entailing considerable therapeutic problems. Decreased sensitivity in postsynaptic striatal dopamine (DA) receptors has been shown to occur in parkinsonian patients during long-term treatment with L-dopa. This has been suggested as one possible mechanism for development of the on-off phenomenon. In contrast to L-dopa treatment electroconvulsions have been shown to increase sensitivity in the DA receptors, when administered to animals.The antiparkinsonian effect of electroconvulsive therapy (ECT) was investigated in five parkinsonian patients with on-off phenomenon, with or without concomitant signs of mental depression. ECT was administered according to praxis in treatment of mental depression. Drug therapy, including L-dopa, was maintained on previously adjusted doses during and after ECT.A marked improvement in the parkinsonian symptoms as well as in the on-off phenomenon occurred in three of the patients, persisting for several months. The other two patients showed only slight and transient improvement.It thus seems that ECT may be useful as a supplementary treatment in parkinsonian patients with on-off phenomenon. The antiparkinsonian effect of ECT is probably mediated by increased sensitivity in postsynaptic DA structures.     

Zum Problem der sogenannten Simultanagnosie

Zusammenfassung Bei einem Patienten mit einem vorzugsweise lobär verlaufenden hirnatrophischen Prozeß wurden die Störungen der Gesamtauffassung bildlich dargestellter Situationen (Simultanagnosie), die er neben Wortfindungsschwierigkeiten, Paraphasien, Dysgraphie, Dyskalkulie und Merkschwäche bot, einer Analyse unterzogen. Die gestörte Intellektualität der Wahrnehmung zeigte sich als ein Darniederliegen ihrer sinngerichteten Aktivität. Der Patient war nicht in der Lage, Strukturen in eine Wahrnehmungsgegebenheit zu bringen, war unfähig, eine Gestalt aufzubauen. Durch Störungen des Übersehens hatte die Überschaubarkeit des Wahrnehmungsfeldes gelitten. Bei schneller Absättigung des Sinnfindungsbedürfnisses kam es zum sinngemäßen Illusionieren innerhalb kurzschlüssig hergestellter Sinneinheiten. Die durch das Zurücktreten der Gestalt gegenüber der Physiognomie des Gegenstandes gekennzeichneten Zeichnungen des Patienten wurden den raumagnastischen Gestaltungsstörungen zugeordnet. Die Bedeutung der Störungen für das Leben des Patienten erhellen sein Verzicht auf Wahrnehmung und seine Unsicherheit gegenüber einer eindringlicher gewordenen, nicht mehr dahingestellten Welt.     

Kritische Anmerkungen über die Gedankeneingebung

Zusammenfassung Gedankeneingebung ist eines der Symptome ersten Ranges im Sinne von Kurt Schneider. Schon früher hatte Karl Jaspers eine feinere Trennung vollzogen: Er unterschied zwischen der Gedankeneingebung in einem engeren Sinne und gemachten Gedanken. Indessen haben die meisten deutschen und englischen Autoren die Jasperschen Kriterien dieser Unterscheidung verschmolzen und dadurch den Gebrauch des Terminus ausgeweitet. Auch Kurt Schneider und Weitbrecht sprachen von Gedankeneingebung, gemachten Gedanken und Gedankenbeeinflussung, als ob diese Phänomene identisch seien. Demgegenüber bietet die Jaspersche Differenzierung eine Trennschärfe bei der Erfassung psychopathologischer Symptome, auf die nicht verzichtet werden sollte. Logischerweise und aus praktischen Gründen läßt sich diese Differenzierung auf alle gemachten oder Beeinflussungserlebnisse ausdehnen, so daß man vier Aspekte solcher Phänomene unterscheiden kann. Einige differential-diagnostische Überlegungen hinsichtlich der Gedankeneingebung werden abschließend kurz besprochen.Professor H. -H. Meyer zum 65. Geburtstag herzlich zugeeignet.     

Enlarging skull fractures in children

Large skull fractures are conventionally followed radiographically until healing occurs. Fractures which enlarge or remain unhealed are commonly termed leptomeningeal cysts or growing skull fractures. This study of ten children with this injury and a review of the literature shows that a true leptomeningeal cyst is seldom present and that skull fractures do not grow. Moreover, careful history-taking and physical examination will correctly identify all enlarging or unhealed skull fractures of childhood without the need for plain radiographs or computed tomography of the skull.     

AMP-rated psychopathology in chronic alcoholics

Summary In a group of 39 alcoholics within a withdrawal process, the psychical situation was rated using AMP scales (Angst et al. 1969). Cluster analysis of the items rendered the following five-cluster solution: (1) aggressive-depressive patients, (2) less impaired persons, (3) slowed persons with diminished contact, (4) emotionally inadequate persons, (5) appealing depressive persons. These results are discussed with respect to other data from clinical history and diagnostic findings.Supported by Deutsche Forschungsgemeinschaft, Sonderforschungsbereich 115, Teilprojekt C21     

Formation of “neo-cortex” in a congenital human teratoma

Summary A congenital human teratoma contained a neuroectodermal mass with architectonic features similar to those of the normal developing neo-cortex. Surrounding a central cavity, a germinal, an intermediate and a cortical zone were clearly distinguishable from innermost to outermost. Glial fibers coursed radially through the intermediate and cortical zones. In the cortical plate neuronal elements were oriented radially with an inside out gradient of differentiation. Mesothelial tissue covered the outer surfaces of the cortex. Over limited sectors a gap in the integrity of the meso-glial barrier were associated with neuroglial ectopias.The following points are of neurobiologic importance: the formation of the miniature cerebral cortex occurred in the absence of any influence of afferent subcortical fibers. The radial alignment of glial fibers between the germinal pseudostratified epithelium and the outer surface occurred only in sectors of the neuro-ectodermal mass where a neo-cortex was present, and may therefore have been a critical determinant in the formation of the cortical plate. The integrity of the outer glial mesenchymal barrier may be necessary for the normal arrangement of cortical neurons.     

Types of authority and two problems of psychiatric wards

This paper concerns the relationship between authority structures and two problems reported in the literature as common to milieu or therapeutic community wards. Psychiatric wards with rational-legal and charismatic authority structures are found more likely to experience mood and morale swings on the part of patients and staff and to spend excessive time and energy changing ward rules.     

Die Hamburger Schätzskala für Psychische Störungen nach Herzoperationen (HRPD)

Zusammenfassung An einer Stichprobe von 99 herzoperierten Patienten wurde zur Erfassung, Beschreibung und Klassifikation früh-postoperativer psychischer Störungen aus dem psychopathologischen Befundbogen des AMP/AMDP-Systems eine Kurzform (HRPD) entwickelt. Weitgehend mit Hilfe einer klassischen Itemanalyse wurde eine Auswahl von 36 Symptomen vorgenommen.Eine Faktorenanalyse dieser Kurzform ergab 8 Merkmalsfaktoren bzw. Syndromskalen: Desorientierung, Konzentrations-/Denkstörungen, paranoid-halluzinatorische Symptomatik, Angstsymptomatik, gehemmt-depressive Symptomatik, Hostilität, Kontrollverlust sowie Selbstaufgabe.Clusteranalytisch wurden 6 psychopathologisch verschiedene Patientengruppen gefunden: unauffällig, fast unauffällig, leichte psychoorganische Symptomatik mit Affektstörungen, schwere psychoorganische Symptomatik mit Kontrollverlust, Hostilität mit paranoid-halluzinatorischer und psychoorganischer Symptomatik, sowie delirante Symptomatik.Ein Vergleich der Ergebnisse der HRPD mit Syndrombeschreibungen anderer AMP/AMDP-Untersucher ergab zum Teil gute Übereinstimmungen, zum Ted aber auch deutliche Unterschiede, die am ehesten durch die besondere Situation herzoperierter Patienten bedingt sein dürfte.Vorform in englischer Sprache: HRPD = Hamburg Rating Scale for Psychic Disturbances     

An immunohistochemical study of glial and neuronal markers in primary neoplasms of the central nervous system

Summary Paraffin-embedded tissues from 56 primary neoplasms of the central nervous system and seven cases of non-neoplastic reactive astrocytosis were examined by immunoperoxidase techniques on serial sections using monoclonal antibodies to glial fibrillary acidic protein (GFAP) and the 68 kDa neurofilament subunit and monospecific polyclonal antibodies to -and -enolase. -Enolase was present in all neoplasms of neuronal origin, but was also present in anaplastic gliomas (particularly in giant cells), in some well-differentiated astrocytomas and reactive astrocytes. The cells containing -enolase in these cases appeared morphologically identical to those containing -enolase and GFAP in adjacent serial sections. No relationship was found between -enolase immunoreactivity and cellular anaplasia in the gliomas studied. Subependymal neoplasms from patients with tuberose sclerosis exhibited evidence of both astrocytic and neuronal differentiation, sometimes in morphologically distinct cell populations, consistent with their suggested origin from a primitive cell line.Supported by Wellcome Trust Grant No. 11353/1.5     

Meningiomas with a non-meningotheliomatous component

Summary Seven cases of meningiomas with pseudopsammoma bodies have previously been described in the literature. Two additional cases are presented. Electron microscopy of the cells surrounding the pseudopsammoma bodies reveals an ultrastructure different from that of the meningotheliomatous cells. It is concluded that meningotheliomatous meningiomas with pseudopsammoma bodies are mixed tumours, including a non-meningotheliomatous component, the origin and significance of which is uncertain.     

Golgi-like demonstration of “dark” neurons with an argyrophil III method for experimental neuropathology

Summary A silver method is proposed for the selective, well-contrasted and reproducible demonstration of dark neurons in frozen, vibratome and paraffin sections cut at a thickness of 5 to 200 m from aldehyde-fixed brains. The Golgi-like staining of the dendrites enables asorting of dark neurons according to characteristic neuron classifications. The staining procedure includes an esterification with 1-propanol, a treatment with diluted acetic acid and development. The esterification strongly increases the argyrophilia of both dark neurons and mitochondria. Unwanted co-staining of mitochondria is suppressed by the acetic acid treatment, while a special developer is used to render the staining controllable. The applicability of the method to experimental neuropathology is demonstrated by Golgi-like staining of dark neurons in rat brains exposed, before transcardial perfusion-fixation and delayed autopsy, to various pathological conditions including ischemia, hypoglycemia, trauma, status epilepticus, deafferentation and poisoning with kainic acid, colchicine and sodium azide, respectively.     

“Dorm D:” A form of group psychotherapy with children in residential treatment

In this paper, Dorm D, a form of group psychotherapy for severely emotionally disturbed children, is described, along with the inpatient setting in which this specific form of treatment evolved. Three paradigms of Dorm D are presented as prototypes for conceptualizing groups in the inpatient residential setting, followed by a discussion of the technical demands evoked by all three paradigms, including limit setting. The paper is intended as an illustration of how classical group therapy techniques can be expanded and modified to provide a viable treatment alternative in a great variety of settings in which children are placed into groups.     

The selling of community mental health

The author criticizes what he considers to be the golden rhetoric, questionable statistics, and even more questionable practices of The Movement.Although the article leans heavily toward pessimism and will therefore irritate many readers, Dr. Steinhart's warning deserves serious consideration. Certain it is that rampant over-optimism can lead to big trouble, as David Halberstam has documented with regard to the evaluations of our Saigon experts in the early 60s.     

Colocalization of growth hormone (GH) and glycoprotein subunit α in GH-producing pituitary adenomas in acromegalic patients

Thirty-one consecutive cases of pituitary adenoma in acromegalic patients were studied by immunohistochemistry. All adenomas contained cells immunoreactive with the anti--subunit of gonadotropic hormones (; 0.6–53% of tumor cells) as well as with anti-growth hormone (GH; 4–74% of tumor cells). In serial section study, most cells immunoreactive with anti- were identical to cells immunoreactive with anti-GH. There was a positive correlation between the percentages of cells immunoreactive for in GH cells [(%)/GH(%)] and those for prolactin (PRL) in immunoreactive tumor cells {PRL(%)/[PRL(%)+GH(%)]} in mixed GH cell-PRL cell adenomas, suggesting that the -subunit may play a role in emergence of PRL cells.     

Neuropsychiatrische Aspekte des sogenannten Pseudohypoparathyreoidismus

Zusammenfassung Es wird über einen Fall von Pseudohypoparathyreoidismus berichtet und an Hand dieses Kranken speziell der neuropsychiatrische Aspekt dieses scheinbar seltenen Krankheitsbildes erörtert. Eine Reihe neuer Daten, für die im Schrifttum bislang keine vergleichbaren Mitteilungen gefunden werden konnten, wurden referiert.

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Neuropsychiatric aspects of the socalled pseudohypoparathyroidism

Summary A case of pseudohypoparathyroidism is reported and the neuropsychiatric aspect of this seemingly rare disease entity is discussed in particular. A number of data not hitherto described in the literature is presented.

     

Initiation of visual-guided random saccades and remembered saccades in parkinsonian patients with severe motor-fluctuations

Summary We studied the initiation of saccades to visual-guided random time and remembered targets in a group of nine Parkinsonian patients with severe motor fluctuations and in 9 age matched control subjects. In contrast to a marked skeletomotor improvement during the on condition, saccadic latencies for both visual-guided random saccades and remembered saccades were increased in the patients during the on condition compared to the off condition. This result of dissociation between skeletomotor and oculomotor function indicates that common concepts of saccadic initiation in parkinsonian patients do not hold true in patients with severe fluctuations since dopaminergic stimulation seems to increase saccadic latencies in these patients.     

Peripheral chromatolysis after transection of mouse facial nerve

Summary Adult male mice, after transection of the facial nerve near the stylomastoid foramen, were sacrificed at predetermined intervals by the two-step perfusion fixation with a modified Heidenhain's Susa solution and subsequently autopsied after a delay of at least four hours.The normal population of neurons consists of one small form with small basophil granules and one large with numerous coarse granules.The initial change demonstrable in the large neuron 12 hours post-operatively is the loosening of cytoplasmic basophil material which proceeds to a disappearance peripherally at the 24-hour stage; simultaneously an increased staining of the non-particulate cytoplasm takes place. The disintegration of basophil material reaches a maximum 9 days post-operatively and from 12 through 49 days post-operatively occurs an increasingly prominent restoration of basophil material near the nuclear membrane. At the 49-day stage the number of recovered large neurons is small and many are lost. At the 9-and 12-days post-operative stages appears a dark abnormal neuron of questionable origin. Histiocyte reaction is apparent by an increasing number of mitotic figures along vascular walls from the 2nd day to the 9th day; the invasion of microglia cells occurs from the 3rd day and clusters of microglia from the 9th day.The sequential changes in the small neuron are somewhat similar to those in the large type. In its recovered forms, it exceeds the large in number, but is abnormal in color and poorly supplied with basophil material.A concurrent study of the rabbit facial nucleus discloses two types of neurons which after axotomy react differently but mimic at a slower rate the sequence in mice.The cardinal feature of acute retrograde cell changes is the inability of the cytoplasm to store properly its basophil material, as first manifested by a loosening of texture with an early disappearance along the cell periphery and then by haphazard deposition of granular material.With 2 Figures in the Text     

Light and electron microscopic examination of amyloid-rich primitive plaques: comparison with diffuse plaques

Summary In Alzheimer-type dementia brains, numerous amyloid-rich primitive plaques (PPs) were observed with -protein immunostaining and periodicacid methenamine (PAM) staining. These amyloid-rich primitive plaques were accompanied by various degrees of small argyrophilic rod-like, granular or filamentous structures. Routine and modified-PAM electron microscopy revealed many bundles and flecks consisting of amyloid fibrils scattered widely throughout the plaques. Degenerate neurites, astrocytic processes and bundles of glial fibres also participated in the formation of the plaques. The similarities and differences between these amyloid-rich primitive plaques and diffuse plaques are described.     

Long-term observation of chronic subsutaneous administration of lisuride in the treatment of motor fluctuations in parkinson's disease

Summary Twenty-nine patients with advanced Parkinson's disease were treated with subcutaneous lisuride infusion in addition to a basic therapy consisting of levodopa + PDI in all, and deprenyl in some patients. At the time of the report, 13 patients are still receiving lisuride infusion after 5–36 months, while 16 have dropped out after 0.5–30 months one because of psychosis, three because of insufficient efficacy, three due to death unrelated to treatment, three because of difficulties in handling the pump as outpatients, and six for other reasons. Off-periods and parkinsonian disability in off and in on were reduced significantly. These improvements remained constant throughout the observation period. Once the optimal dose regimen is established, only minor adjustments of the doses of lisuride and levodopa are required in the individual case.