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.     

γ-Enolase and glial fibrillary acidic protein in nervous system tumors

Summary A large series of central and peripheral nervous system tumors was studied for the presence of glial fibrillary acidic protein (GFAP) and -enolase (neuron-specific enolase, NSE), using specific monoclonal antibodies (mAbs). Occurrence in and specificity of GFAP to glial and mixed tumors was confirmed and depended on the malignancy grade and features such as meningeal invasion. Using a well-characterized mAb, -enolase was demonstrated in neuronal, as well as in a whole range of non-neuronal tumors. This lack of specificity of -enolase prohibits its use as an exclusive neuronal marker. Nevertheless quantization or comparison with other types of enolases could still prove to be useful in well-defined situations. The advantages inherent to mAbs and a highly sensitive detection system turn GFAP stainings into a specific and readily reproducible technique.Supported in part by FGWO (grant no. 3.0019.86) and by the Geconcerteerde Actie (grant no. 84/89-68, Brain specific proteins)     

Die Bedeutung der diskontinuierlichen Zonierung des Immunglobulinbereiches für die Diagnose neurologischer Erkrankungen

Zusammenfassung 1. 340 Patienten, welche bei der agarelektrophoretischen Auftrennung der Liquorproteine eine diskontinuierliche Zonierung im Bereiche der -Globuline zeigten, wurden bezüglich Verteilung dieser clonalen -Zonen auf die verschiedenen neurologischen Erkrankungen untersucht.2. Bei der MS und den anderen entzündlichen neurologischen Erkrankungen findet sich eine Häufung der schnell wandernden Zone ₂ und der mittelschnell wandernden Zonen ₃ und ₄.3. Bei den Discushernien und den zentralnervös-nichtentzündlichen Erkrankungen ist die Zonenverteilung ziemlich flach und undifferenziert, wobei hier wie auch bei Tumoren und Polyneuritiden der relativ hohe ₀-Anteil auffällt als ein Phänomen, das bei zentralnervös-entzündlichen Prozessen nur selten anzutreffen ist. In den wenigen Tumorfällen mit -Zonierung scheint die ₄-Position deutlich zu überwiegen.4. In der Hälfte aller MS-Liquoren mit -Zonierung ist das Totalprotein, in einem Sechstel das Total--Globulin (rel%) normal, und nur bei zwei Dritteln finden sich Plasmazellen. Die elektrophoretische Feststellung von -Zonierung ist in der neurologischen Labordiagnostik folglich ein wichtiges Hilfskriterium.5. Mit zunehmendem Anstieg des -Globulin-Gehaltes im Liquor läßt sich bei MS-Patienten, nicht aber bei allen Krankheitsgruppen, eine Zunahme der Häufigkeit der -Zonierung nachweisen.6. Das Auftreten von -Zonierung ist bei den zentralnervös-entzündlichen Krankheiten und der MS sechsmal häufiger als bei den zentralnervös-nichtentzündlichen Krankheiten.7. -Zonierung scheint beim Gesunden, bei psychiatrischen Erkrankungen, Myopathien, bei gewissen Tumoren (Neurinomen) und metabolisch bedingten Polyneuritiden nicht vorzukommen.

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The significance of discontinuous zonation of electrophoretically separated globulins for the diagnosis of neurological diseases

Summary 1. 340 patients in whom discontinuous zonation of the globulin region was observed after electrophoretic separation of the CSF proteins were examined to see how the distribution of these clonal zones is correlated with different neurological diseases.2. In multiple sclerosis (MS) and other inflammatory diseases of the CNS, zones are most frequently found in the medium positions: ₂, ₃ and ₄.3. In disk hernias and the noninflammatory diseases of the CNS, the dispersion of zone frequency is rather undifferentiated. In these conditions and in tumors of the CNS and polyneuritis, the relatively high proportion of ₀ zones is a conspicuous feature; it is scarcely encountered in inflammatory processes of the CNS. The rare cases of tumors with zonation show a preponderance of the ₄ zone.4. The total protein content is normal in half of all MS fluids with zonation; in one sixth the relative amount of total globulin is also normal, whereas plasma cells are demonstrable in only two thirds. The electrophoretic evaluation of zonation is, therefore, an important tool in neurological laboratory work.5. Increased amounts of globulin in CSF are accompanied by an increased frequency of zonation in some diseases, such as MS, but not in tumors or vascular processes.6. The incidence of zonation is about 6 times higher in MS than in noninflammatory diseases of the CNS.7. zonation seems not to be present in healthy persons, in psychiatric diseases, myopathies, some tumors (neurinoma) and polyneuritis of metabolic-toxic etiology.

     

“Sporadic” prealbumin-related amyloid polyneuropathy: report of two cases

Summary Two sporadic cases of amyloid polyneuropathy are reported. There was no family history or plasma cell dyscrasia. Both showed sensorimotor and autonomic polyneuropathy with onset in the seventh decade. Amyloid deposits in both cases reacted with anti-human prealbumin sera but not with antisera to human AA and anti-human immunoglobulin light-chain amyloids, including A and A. One patient had the abnormal serum prealbumin and abnormal DNA sequence found in type I familial amyloid polyneuropathy (FAP) (Japanese type). Investigations in sporadic amyloid polyneuropathy should include immunohistochemistry, using antisera to the different amyloid proteins, and the radioimmunoassay and recombinant DNA techniques for diagnosis of FAP.     

A new low-dose formulation of selegiline: clinical efficacy,patient preference and selectivity for MAO-B inhibition

Summary. Three studies were performed using a fast dissolving formulation of selegiline hydrochloride designed for buccal absorption Zydis Selegiline. The aim of the first study was to compare the therapeutic efficacy of Zydis Selegiline (1.25mg or 10mg) with conventional selegiline hydrochloride tablets conventional selegiline tablets (10mg) in patients with Parkinsons disease (PD) who were previously treated with conventional selegiline tablets as an adjunct to levodopa/dopamine agonist therapy. Patients were observed for 4 weeks to ensure that they were stable. Stable patients (n=197) were then randomised to continue with conventional selegiline tablets 10mg (n=68), or to treatment with Zydis Selegiline 1.25mg (n=64) or Zydis Selegiline 10mg (n=62) for 12 weeks in this randomised, parallel group study. A further aim was to establish the acceptability of Zydis Selegiline compared with conventional selegiline tablets. Patient preference for Zydis Selegiline was also evaluated in a second study, a single-dose, randomised, two-way crossover study conducted in patients with PD (n=148). Patients were stratified by the presence or absence of swallowing and salivation problems and were randomised to either Zydis Selegiline 5mg or a placebo fast-dissolving formulation. In a third study, the degree of potentiation of the tyramine pressor effect following Zydis Selegiline was compared with that following conventional selegiline tablets in healthy volunteers. A total of 24 healthy volunteers were randomised to receive Zydis Selegiline 1.25mg or conventional selegiline tablets 10mg for 14–16 days in an open-label, randomised parallel group study.Both Zydis Selegiline (1.25mg and 10mg) treatments were shown to be therapeutically equivalent to conventional selegiline tablets 10mg based on comparison of mean total Unified Parkinsons Disease Rating Scale (UPDRS) scores. Therapeutic equivalence was defined a priori as the 90% confidence interval (CI) for the difference in total UPDRS scores between groups to lie entirely within the range ±5. The difference (90% CI) in mean adjusted total UPDRS between Zydis Selegiline 1.25mg and conventional selegiline tablets 10mg was –2.50 (–4.84, –0.17), and for Zydis Selegiline 10mg and conventional selegiline tablets 10mg, 0.04 (–2.30, 2.38). For the motor subscores of the UPDRS, differences between adjusted means (90% CI) compared with the conventional selegiline tablets group were: Zydis Selegiline 1.25mg, –2.14 (–3.94, –0.33) and Zydis Selegiline 10mg, –0.90 (–2.70, +0.91). Patients who switched from conventional selegiline tablets to Zydis Selegiline 1.25mg showed a slight improvement in UPDRS scores following 12 weeks of treatment (standard error of difference 1.039; p=0.01).In the single-dose crossover study, most (61%) patients liked Zydis Selegiline 5mg; a significantly greater proportion than the null hypothesis of 50% (p<0.002). However, only 62 patients (46%) indicated that they liked the taste of Zydis Selegiline. Nevertheless, the proportion of patients who preferred Zydis Selegiline (65%) to their usual medication was significantly greater than the null hypothesis of 50% (p<0.001).Similar findings were demonstrated in the 12-week study where a higher proportion of patients who received up to 3 months of treatment indicated a preference for either Zydis Selegiline 1.25mg (90%) or Zydis Selegiline 10mg (86%) over conventional selegiline tablets 10mg. More than 90% of patients found Zydis Selegiline easy to take, with 61% rating it as extremely easy. Most (81%) patients taking Zydis Selegiline 1.25mg liked the taste compared with 45% taking Zydis Selegiline 5mg (in the previous study).Zydis Selegiline did not potentiate the tyramine effect: a pressor effect was elicited after 400mg tyramine both before and after 14 days of treatment with Zydis Selegiline 1.25mg. In contrast, after 14 days treatment with conventional selegiline tablets 10mg, the threshold dose required to elicit the tyramine pressor response was significantly (p<0.0001) reduced from 400mg to 200mg.In summary, Zydis Selegiline at doses of 1.25mg and 10mg was therapeutically equivalent to conventional selegiline tablets 10mg. The Zydis Selegiline formulation was well-liked by all patients, with most preferring Zydis Selegiline 1.25mg to their usual selegiline tablet. Furthermore, Zydis Selegiline was well tolerated and, unlike conventional selegiline tablets, appeared to retain specificity for inhibition of monoamine oxidase type B (MAO-B), since it did not potentiate the pressor response to tyramine.Present address: Cephalon UK Ltd., Surrey Research Park, Guildford, United KingdomPresent address: Safetymednet, Ruscombe, United KingdomPresent address: Oxford Glycosciences (UK) Ltd., Abingdon, United KingdomReceived December 3, 2002; accepted July 23, 2003     

Über die sogenannte „zentrale Tonusdifferenz“ mit Nystagmusbereitschaft nach einer Seite

Zusammenfassung An Hand von 71 sowohl otologisch als auch neurologisch-psychiatrisch untersuchten Fällen wird zur Frage der sog. zentralen Tonusdifferenz Stellung genommen.1. In 40% der Beobachtungen waren als Ursache des einseitigen Nystagmusüberwiegens Schäden im Labyrinth bzw. im Bereich des 1. vestibulären Neurons anzunehmen.2. Bei 35% der Untersuchten war sowohl eine periphere als auch zentrale Verursachung möglich. Überwiegend handelt es sich um Patienten mit einem klinischen Halswirbelsäulensyndrom. Der funktionelle Charakter der Störung wird diskutiert.3. In 25% unserer Fälle lagen sicher zentrale Schäden vor, jedoch fand sich mit 2 Ausnahmen kein Anhalt für die Annahme einer Hirnstammläsion als Ursache der Nystagmusbereitschaft nach einer Seite.Therapieversuche werden erwähnt.Der Begriff zentrale Tonusdifferenz wird als mißverständlich abgelehnt und betont, daß dem einseitigen Nystagmusüberwiegen keineswegs ein Hinweischarakter auf eine Hirnstammcontusion zukommt. Die Nystagmusbereitschaft nach einer Seite kann von jedem Abschnitt des vestibulären Systems ausgelöst werden.Teilergebnis eines Forschungsauftrages des Bundesministeriums für Arbeit.     

“Echoing approval”: A new speech disorder

We report the cases of two patients presenting a peculiar speech disorder, which we have named echoing approval, in which the patients echo, in replying to questions in a dialogue with short phrases, the positive or negative syntactical construction of a question, or its positive or negative intonation, but without any repetition of whole or part of sentences. When asked about their symptoms, the patients replied 80% of the time with yes, yes, that's right, or exactly to positive questions and no, no or absolutely not to negative questions, regardless of their actual symptoms and oblivious to self-contradiction. In addition, when the examining doctor was speaking to a medical colleague in the patient's presence and using medical terminology that the patient did not understand, he/she agreed or disagreed with any sentence and technical word uttered in a way entirely dependent on the syntax or intonation used. To distinguish this speech disorder from echolalia or verbal perseverations, with which it may be superficially confused, we suggest that it be called echoing approval, as it may be part one of the manifestations of the environment-dependency syndrome. This clinical picture was found to be associated with features of transcortical motor aphasia and frontal lobe signs. One patient had a bilateral callosofrontal malignant glioma and the other a probable multiple system atrophy with global deterioration, pre-eminent frontal release signs, diffuse leukoencephalopathy and multiple lacunes. On the basis of these clinical deficits and neuroimaging features, we are unable to delineate the common, or minimal, lesioned network required for this symptomatology to occur, especially in the absence of a series of patients, and with such a difference in both the location and causes of the lesions. However, bilateral frontosubcortical dysfunction was pre-eminent in the clinical picture in both patients, even though more diffuse brain pathology was seen in one, and it might be speculated that dysfunction of the bilateral orbitofrontal and frontomesial motor frontosubcortical circuits might be involved in the aetiology of this peculiar speech disorder.     

Gestalt- und erkenntnispsychologischer Beitrag zum melancholischen Wahn

Zusammenfassung Gestalt- und erkenntnispsychologische Zusammenhänge ergeben, daß dem melancholischen Wahn ein ametrisches Verhältnis der das menschliche Weltbild mitkonstituierenden Strukturtendenzen der Prägnanztendenz sowie des antiprägnanten Gestaltreizes der Welt zugrunde liegt. Dabei verstehen wir unter Weltbild die Erkenntnisgestalt der Welt, die vorweg (a priori) bestimmt, was je—individuell wirklich erkannt und verstanden wird. In der Melancholie kommt es nun durch eine Reduktion der Prägnanztendenz zu einem extrem einseitigen Bestimmtsein des Weltbildes durch den antiprägnanten Gestaltreiz der Welt. Die Folge dieser ametrischen Strukturiertheit des Weltbildes ist eine pathologische Wirklichkeitsgewißheit (Wahngewißheit) in allen Erkenntnisfunktionen also auch in der Vorstellung, in der Phantasie und in der Einbildung. Die Inhalte der melancholischen Wahnerlebnisse aber gehen auf den antiprägnanten Gestaltreiz der Welt zurück, der im Verlauf der normalen aktualgenetischen Entwicklung des Weltbildes zunehmend auf den Abbau und Zerfall der von der Prägnanztendenz intendierten Erkenntnisinhalte z. B. der immer intakten und integren Leib-, Ich- und Kommunikationsgestalt des Menschen aus ist, damit vom Erwachsenen auch Nichtintegres und Nichtintaktes sowie Zerfall in jeder Form verstanden und bewältigt werden kann. Die Gerichtetheit des antiprägnanten Gestaltreizes der Welt erkennt man in den melancholischen Wahnerlebnissen des Zerfalls des Leibes bis zur Verwesung bei lebendigem Leibe oder des Zerfalls der Ichgestalt bis zum nihuil unmittelbar wieder.Keine eindeutigen Aussagen jedoch erlauben unsere Beobachtungen über einen Wandel im Strukturverhältnis der Tendenz nach Wesenseigenschaften zur rein sachlichen Sinngehaltlichkeit der Individualgestalten in der Melancholie, während nach Matussek (1963) Wesenseigenschaften in der schizophrenen Wahrnehmungswelt einen Vorrang haben.     

Cytoplasmic and axoplasmic density variations in relation to hyperactivity

Summary The density of the cytoplasm and axoplasm of the anterior horn cell in rats was determined by X-ray microradiography. The average density of the cytoplasm of more than 400 cells from control rats was 0.31 g/³, while that of over 600 cells from rats fed IDPN (- iminodipropionitrile) was 0.43 g/³.Hyperactivity developed during the first 5 weeks and was associated with a gradual increase in cytoplasmic density to 0.51 g/³.At 6 weeks there was a drop in density to 0.36 g/³ which coincided with the appearance of axonal balloons having a density of 0.17 g/³.During the 7–12th week on the diet, the cytoplasmic density showed a gradual increase to 0.59 g/³ and the balloons to 0.29 g/³.The volume of the nerve cells remained fairly constant. The density increases were discussed in relation to hypertrophy, dystrophy, and hyperactivity.

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Zusammenfassung Die Dichte des Cytoplasmas und Axoplasmas der Vorderhornzellen von Ratten wurde durch Röntgenmikroradiographie bestimmt. Die mittlere Dichte des Cytoplasmas von mehr als 400 Zellen der Kontrollratten war 0,31 g/³, während die mittlere Dichte von mehr als 600 Zellen der Ratten, die mit IDPN (- iminodipropionitrile) gefüttert waren, 0,43 g/³ war.Hyperaktivität entwickelte sich während der ersten 5 Wochen und war mit einer progressiven Zunahme der Cytoplasmadichte bis auf 0,51 g/³ verbunden.Nach 6 Wochen sank die Dichte auf 0,36 g/³. Diese Tatsache traf mit dem Auftreten der Axonauftreibungen zusammen, die eine Dichte von 0,17 g/³ hatten.Nach 7–12 Wochen zeigte die Cytoplasmadichte eine progressive Zunahme auf 0,59 g/³ und die der Auftreibungen eine Zunahme auf 0,29 g/³.Das Volumen der Nervenzellen blieb ziemlich konstant.Die möglichen Zusammenhänge zwischen Zunahme der Dichte, Hypertrophie, Dystrophie und Hyperaktivität werden dargestellt.

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Supported by U. S. Public Health Grant NB 1305.     

Obsessive-Compulsive Disorder in Popular Magazines

To examine what the general public is learning about Obsessive-Compulsive Disorder (OCD) through popular magazines, all articles listed in the Reader's Guide to Periodical Literature under the topic headings of obsessive-compulsive behavior or obsessive-compulsive disorder between 1983 and 1997 were read and rated. Only 31 of the 107 articles under these headings dealt explicitly with OCD, and these were found to be reasonably accurate in their presentations of symptoms, causes, and treatments. Many of the other articles under the target headings, however, focused on incidents of stalking of famous people by obsessed fans. The implications of the content patterns of these articles for understanding and misunderstanding of OCD are discussed.     

Über angeborene Mischgeschwülste des Kleinhirns

Zusammenfassung Es wird über neun umschriebene Geschwülste der hinteren Schädelgrube berichtet, die feingeweblich aus zwei verschiedenen, in Feldern und Zügen angeordneten Gewebsanteilen bestehen. Die Zellen der Felder sind kleine, körnerzellähnliche Elemente mit runden, stark chromatinreichen Kernen. Die Zellen der Züge sind größere Elemente mit rund-ovalen, kommaartigen, chromatinarmen Kernen. In den Zügen läßt sich regelmäßig ein ausgedehntes Reticulinfasernetz nachweisen. Die Felder sind dagegen reticulinfrei, sie bestehen aus einer feinfaserigen neuroectodermalen Grundsubstanz. Charakteristikum dieser Tumoren ist, daß das Mengenverhältnis der zwei Gewebsanteile von Fall zu Fall und sogar innerhalb des gleichen Falles stark variieren kann, so daß die Beobachtung von nur einzelnen Geschwulstpartien oft nicht erlaubt, die gesamte Struktur des Tumors zu erfassen und zu falschen Diagnosen führt.Diese als angeborene Mischtumoren des Kleinhirns bezeichneten Geschwülste sind feingeweblich von den Mischgewächsen des Unterwurmes Ostertags zu trennen. Sie zeigen hingegen gewisse Ähnlichkeiten mit dem sogenannten umschriebenen Arachnoidealsarkom des Kleinhirns (Foerster u. Gagel), von dem sie aber ebenfalls zu trennen sind.Die formale Genese dieser Geschwülste wird unter Berücksichtigung histogenetischer, feingeweblicher und lokalisatorischer Aspekte diskutiert. Sie werden als Kombinationstumoren angesehen mit einer mesodermalen Züge- und einer neuroectodermalen Felder-Gewebskomponente. Ihre dysembryogenetische Natur bzw. ihr früher Entstehungszeitpunkt wird durch das Vorkommen von Kleinhirnmißbildungen bestätigt. Schließlich werden ihre Beziehungen zu den Geschwülsten der sogenannten Medulloblastomgruppen erörtert.

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Summary Nine circumscribed tumors of the posterior cerebral fossa are described; histologically, they were characterized by two different types of tissue components arranged in strands and fields. The parvicellular fields are of neuroectodermal origin, the mesodermal strands consist of large cells and are rich in reticulin containing fibers. One of the two components may considerably outgrow the other one and become responsible for quantitative alterations.These tumors show some resemblance with the so-called circumscribed arachnoidal sarcoma of Foerster-Gagel, but should not be confused with it. They are morphologically also different from Ostertag's mixed tumors of the posterior vermis.This group of tumors is generally combined with cerebellar malformations which underline their dysontogenetic nature or at least the early onset of their development. As to their formal genesis they may be compared with the congenital mixed tumors of other organs (kidney, liver), and therefore be classified as combination tumors according to Meyer.Finally, their relation to so-called medulloblastomas is discussed.

     

Intelligence and temperament as protective factors for mental health. A cross-sectional and prospective epidemiological study

The Sjöbring system of personality dimensions measuring intellectual capacity, activity, impulsivity and sociability was used to study possible salutogenic (i.e. causes of health) effects. The study comprised 590 subjects investigated in 1947, 1957, 1972 and 1988–1989 in the Lundby project, an epidemiological study in Sweden. Psychiatric diagnoses were made in 1947, 1957 and 1972. Mental health was estimated in 1988–1989 using the concept love well, work well, play well and expect well. The Sjöbring dimensions were clinically assessed in 1972. Both in the concurrent study in 1972 and in the prospective study in 1988–1989 super capacity (high intellectual function), super validity (high activity level) and super solidity (low impulsivity) were statistically associated with lower frequencies of certain psychiatric diagnoses and a higher frequency of positive mental health. These variables are proposed to increase coping capacity, and therefore increase stress resilience.     

Clonidine and a β-agonists induce hyperthermia in rats at high ambient temperature

Summary The effects of the-agonist clonidine and the-agonist clenbuterol on body temperature of rats kept at high ambient temperature (28°C) were studied. Both drugs induced a dose-dependent significant increase in temperature. The clonidine-induced hyperthermia was blocked by various a2-antagonists, yohimbine, rauwolscine and RX 781094 and the ₁-antagonists, prazosin and corynanthine but not by l-propranolol, spiperone, metergoline. The hyperthermic effect of clonidine was potentiated in rats after a lesion of the central noradrenergic terminals by DSP-4. The clenbuterol-induced hyperthermia was counteracted by 1-propranolol, yohimbine and rauwolscine but not by atenolol, prazosin, spiperone, metergoline. These observations indicate that clonidine and clenbuterol-induced hyperthermia is mediated by ₂-(postsynaptic) and-adrenoceptors, respectively. Moreover, in the latter effect ₂-adrenoceptors are involved. The simple temperature measurement can thus be used as a preliminary indicator of central ₂ or-agonistic properties of the screened drug.     

Refraktärperioden und frequente Impulsfortleitung im gemischten N. ulnaris des Menschen bei Polyneuropathien

Zusammenfassung Bei 30 Patienten mit Neuropathien unterschiedlichen Schweregrades (subklinisch, leicht, mittelschwer und schwer) wurden am N. ulnaris neben den üblichen neurophysiologischen Parametern [distale Latenz, maximale motorische und gemischte Nervenleitgeschwindigkeit (Nlg.)] die Refraktärperioden (Rp.) (absolute Rp. und relative Rp.-Amplitude und -Latenz) und die unteren Grenzfrequenzen (u. F.) (u. F.-Amplitude und -Latenz) bestimmt.Beim Vergleich mit einem Normalkollektiv (n=31, s. Lowitzsch u. Hopf, (1972a)) war die Nlg. nur in 37% der Fälle pathologisch verlangsamt, während die relative Rp.-Latenz in ca. 80% und die u. F.-Latenz in ca. 60% pathologisch verändert waren.In zwei Stichproben (13 Normalfälle und 13 Polyneuropathien) mit einer normalen gemischten Nlg. von 51,0–63,5 m/sec unterschieden sich die Mittelwerte für die distale Latenz sowie die motorische und gemischte Nlg. statistisch nur auf dem 1%-Niveau, für die relative Rp.-Latenz und die u. F.-Latenz hingegen auf dem 0,5-Niveau.Die Bestimmung der Refraktärperioden, insbesondere der rel. Rp. L., sowie der unteren Grenzfrequenz (u. F. L.), stellt eine im Vergleich mit den üblichen neurophysiologischen Verfahren (Nlg.-Bestimmung) wesentlich empfindlichere Untersuchungsmethode zur Erfassung auch geringer (subklinischer) Funktionsstörungen des peripheren Nervensystems dar.Die unterschiedliche Beeinflussung der Refraktärperioden und der Grenzfrequenzen durch die Art des zugrundeliegenden pathologischen Prozesses (axonale Degeneration — segmentale Demyelinisierung — Mischtyp) wird an Hand der in 9 Fällen nervenbioptisch (N. suralis) gewonnenen Befunde diskutiert.

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Refractory periods and frequent impulse conduction in mixed N. ulnaris of man in polyneuropathies

Summary Some electrophysiological parameters were studied in the ulnar nerve of 30 patients suffering from neuropathy of various origin and severity.Absolute and relative refractory periods and lower limiting frequencies were measured and compared to the usual parameters (distal motor latency, conduction velocity of motor fibres, and the mixed nerve action potential).The conduction velocity was indicative of the diseased function in 37% whereas the relative refractory period (latency) was abnormal in nearly 80% and the lower limiting frequency (latency) in about 60%.Two samples taken at random, each of them consisting of 13 patients with normal conduction velocities between 51.0 and 63.5 m/sec showed differences only at the 1% level (p<0.01) as far as the mean values of the distal latency and the maximum conduction velocity were concerned. The difference between the mean values of the relative refractory period (latency) and of the lower limiting frequency (latency), however, was highly significant (p<0.0005). Thus, in our experience, the relative refractory period (latency) and the lower limiting frequency (latency) are more sensitive indicators of mild functional disturbances of peripheral nerves than the maximum conduction velocity.

Die Untersuchungen wurden in dankenswerter Weise von der Deutschen Forschungsgemeinschaft unterstützt.     

Neuroectodermal tumors of the peripheral and the central nervous system share neuroendocrine N-CAM-related antigens with small cell lung carcinomas

Summary The current study describes the presence of neuroendocrine antigens of peripheral and central neural tumors using eight monoclonal antibodies raised to small cell lung carcinoma (SCLC), which recognize neural/neuroendocrine or neural antigens, as defined by their reaction pattern in normal tissues and tumors. At least five of them recognize different epitopes of the neural cell adhesion molecule (N-CAM). It was found that all of 12 neuroblastomas, 2 ganglioneuroblastomas and 4 ganglioneuromas as well as 23 central primitive neuroectodermal tumors, 13 astrocytomas and 4 ependymomas share neural/neuroendocrine antigens (as defined by the anti-N-CAM antibodies Moc-1,-21,-32,-52 and-191) with SCLC. The neural/neuroendocrine antigen defined by Moc-171 was also found in all peripheral tumors, but only in further differentiated central tumors. Non-N-CAM related neural antigens (as defined by Moc-51 and-172) were found only in better-differentiated peripheral and central tumors, but they could be demonstrated in all three medulloblastoma cell lines studied. In addition, the antigen defined by Moc-51 was demonstrated in an immunoblot of a neuroblastoma cell line. Antibodies recognizing epithelia antigens of SCLC and other epithelia and their tumors (Moc-31 and-181) were non-reactive. It was concluded that these findings give further support for a relation between neural and neuroendocrine tumors and that some of the antibodies may be useful for the detection of differentiation in neural tumors. Antibodies with an epithelia recognition pattern may serve to distinguish neural from neuroendocrine tumors.Supported by NIH grant CA 36245 W.M.M. was a Fullbright scholar     

Gerstmann-Sträussler-Scheinker disease showing β-protein type cerebellar and cerebral amyloid angiopathy

Cerebral amyloid angiopathy is observed in several brain degenerative disorders, but this pathological condition has received little attention in Gerstmann-Sträussler-Scheinker disease (GSS). We report a 69-year-old man who showed the cardinal features of GSS together with typical and extensive congophilic angiopathy. Immunohistochemical studies revealed that the vast majority of the amyloid plaques present in the brain of this patient were consistently labeled by anti-prion protein (PrP) antibody. Double immunostaining disclosed many additional -protein immunoreactive plaque-like lesions, including a special type of hybrid plaque with colocalization of PrP and -protein (-PrP). The vascular amyloid deposits seen in both the cerebellum and cerebrum were immunoreactive only to anti--protein antibody. It seems likely that the extensive deposition of -protein amyloid (including brain vascular amyloidosis) seen in this and other similar cases is part of pathology of GSS, although the possibility that this finding is due to ageing or concomitant Alzheimer's disease cannot be completely ruled out.Supported by a research grant from the Intractable Disease Division, Ministry of Health and Welfare, Primary Amyloidosis Research Committee, Japan     

Attitudes toward mental health professionals in a hospital-based community mental health center

This study examined the attitudes of several diverse subject groups in a large medical center toward various mental health professionals. The groups consisted of: 1) general hospital staff; 2) professional mental health workers; and 3) psychiatric in-patients. Subjects evaluated a selection of 11 professional health related role titles (clinical psychologist, physician, psychiatrist, etc.) and the categories me and mental patient by marking a series of 19 seven-step rating scales, each composed of bipolar anchoring adjectives. Additionally, a familiarity rating for each of the role titles was obtained. An understanding and a value cluster were derived from the 19 adjectives along with an overall favorability-unfavorability score for each role title. It was expected that subjects would value mental health professional roles more strongly than they would indicate an understanding of these same roles. Secondly, it was expected that the hospital setting itself, the subject's role within that setting, and the degree of familiarity with the role being rated would have a significant impact on the subject's attitude. Results generally supported the above expectations. Overall ratings of the professional groups were consistently high, with less difference between the health designations (physician, nurse) and the psych designations than has been previously reported in the literature.     

The Diverse Roles of Anticonvulsants in Bipolar Disorders

Anticonvulsant drugs (ACs) have diverse antiseizure, psychotropic, and biochemical effects. Carbamazepine and valproate have mood-stabilizing actions, benzodiazepines and gabapentin have anxiolytic actions, lamotrigine is useful in rapid cycling and acute treatment and prophylaxis of bipolar depression, and topiramate and zonisamide can yield weight loss. Limited controlled data suggest the carbamazepine keto derivative oxcarbazepine has antimanic effects. A categorical approach to the diverse roles of ACs in bipolar disorders is proposed, using broad categories of ACs, on the basis of their predominant psychotropic profiles. Thus, some ACs have sedating profiles that may include sedation, cognitive difficulties, fatigue, weight gain, and possibly antimanic and/or anxiolytic effects. In contrast, some newer ACs have activating profiles that may include improved energy, weight loss, and possibly antidepressant and even anxiogenic effects. Still other newer ACs have novel mixed profiles, combining sedation and weight loss. A categorical–mechanistic extension of this approach is also presented, with hypotheses that sedating profiles might be related to prominent potentiation of gamma-aminobutyric acid (GABA) inhibitory neurotransmission, activating profiles could be related to prominent attenuation of glutamate excitatory neurotransmission, and for mixed profiles, sedation and weight loss might be related to concurrent GABAergic and antiglutamatergic actions, respectively. The categorical approach may have utility as an aid to clinicians in reinforcing the heterogeneity ACs, and recalling psychotropic profiles of individual ACs, but is limited as it fails to address the etiology of the heterogeneity of AC psychotropic effects. The categorical–mechanistic extension strives to address this issue, but requires systematic clinical investigation of more precise relationships between psychotropic profiles and discrete mechanisms of action to assess its merits.     

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.     

Präsenile leukencephalopathische Hydrocephalie

Zusammenfassung Es wird von einem 59jährigen Patienten berichtet, der 16 Monate vor dem Tode an Antriebsnachlaß, Vergeßlichkeit, Konzentrationsminderung und Schlafstörungen erkrankte. Die neurologische Symptomatik war durch Gangstörungen, Brady- und Dysdiadochokinase, Hypomimie, Mikrographie und positive Pyramidenzeichen, Inkontinenz sowie Sprechverlangsamung bis zu völligem Mutismus gekennzeichnet. Im EEG fand sich eine anterior bradyrhythmia. Neuropathologisch wurde ein bereits angiographisch erkannter Hydrocephalus internus non occlusus festgestellt, der mit streifenförmigen periventrikulären, gliösfaserig substituierten Demyelinisationen einherging. Die Beobachtung ähnelt klinisch und hinsichtlich des Hydrocephalus den von Adams i. Mitarb. beschriebenen ebenfalls präsenilen Verläufen, die Messert u. Baker als idiopathic nonobstructive atrophic white matter degeneration with ventricular dilatation beschrieben. Der von uns hierbei erhobene neuropathologische Befund wird als präsenile leukencephalopathische Hydrocephalie bezeichnet. Pathogenetische Möglichkeiten werden kurz erörtert.

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Hydrocephalus in presenile leukoencephalopathyDifferential diagnosis of the brain-organic syndrome associated with hydrocephalic neurologic symptoms at older age

Summary The clinical and neuropathologic features of the symptomatic occult hydrocephalus with normal cerebrospinal fluid pressure (Adams-Hakim) occurring in a 59-year-old male are described. The illness lasted 16 months. The main psychopathologic symptoms included increasing loss of mental abilities, characterized by forgetfullness, loss of psychomotor reactions, and psychomotor retardation (Antriebsnachlaß), respectively, as well as disorders of concentration, unconcern, insomnia, and — in advanced stages — mutism. The neurologic syndrome consisted of unsteady and atactic gait, vertigo, cephalgia, defective sphincter control, brady- and dysdiadochokinesia, pyramidal and extrapyramidal signs (hypomimia, micrographia). The EEG displayed typical anterior bradyrthmia. The essential neuropathologic findings in this case of idiopathic nonobstructive atrophic white matter degeneration with ventricular dilatation (Messert-Baker) consisted of diffuse periventricular demyelination with isomorphic fibrous gliosis.

Herrn Prof. Dr. med. van Bogaert in bewährter Verbundenheit.