NYSTAGMUS AND EYE DEVIATIONS AFTER ELIMINATION OF VISUAL FIXATION BY CORNEAL CONTACT CAPS

A method is presented for direct studies of oculostatic and oculomotor disturbances appearing after reduction of visual stimuli. Some clinical illustrations are given showing the appearance of marked ocular deviations and complex nystagmus patterns after the application of black contact caps. The method offers a possibility to provoke a whole series of phenomena of interest in neurological work. Several of these features can evidently not be recorded with the aid of electronystagmography.     

IMMUNOHISTOLOGICAL STUDIES OF EXPERIMENTAL MYOSITIS IN RELATION TO HUMAN POLYMYOSITIS WITH SPECIAL REFERENCE TO PASSIVE TRANSFER AND FLUORESCENT ANTIBODY TECHNIQUE

Immunohistological investigation of experimental myositis was performed. This was produced in guinea-pigs given 10 or 20 injections of 20% homologous muscle homogenate mixed with Freund's complete adjuvant at weekly intervals. Ouchterlony's agglutination test showed a negative reaction between the muscle homogenate and the animal serum. On the other hand strong fluorescence was observed in some muscle fibers. Intraperitoneal injection of spleen and lymph-gland cells, removed from six donor guinea-pigs with experimental myositis, produced muscle changes 2–7 days after the transfer similar to those of donor animals. This occurred all six recipient guinea-pigs, which had been previously treated with 400r. whole body irradiation. The number of cells transferred ranged from 1.1 × 10⁸ to 1.3 × 10⁹. Capability of passive transfer and delayed type skin reaction in experimental myositis as compared with polymyositis as autoimmune disease were discussed. Clinical findings of polymyositis as well as similarity to experimental myositis led to considering an autoimmune disease. However, there remain many problems to be solved from the immunological point of view.     

SUCCESSIVE MEASUREMENTS OF URINARY 5-HIAA IN MENTAL ILLNESS WITH SPECIAL REFERENCE TO DIURNAL CHANGES AND LOADING TEST WITH TETRABENAZINE

• 1) Successive measurement of 5-HIAA excretion in relation to changes in the clinical condition revealed a tendency to a relative increase during the state of impaired consciousness, emotional disturbance or psychomotor restlessness.
• 2) Diurnal variations of 5-HIAA levels in 3 hour urine fractions were the greatest in acute psychotics followed by organic psychotics, chronic schizophrenics and controls. Acute psychotics tended to stabilize with clinical improvement, but still were relatively unstable even in states of near remission. In the chronic schizophrenic group, variation was relatively small, about the same as in the control group.
• 3) No significant difference was demonstrated between the chronic schizophrenic and control groups in terms of the increase response of the 5-HIAA level after L-tryptophan loading.
• 4) Loading of tetrabenazine resulted in maximum release of 5-HIAA within 9 hours and recovery to the initial level in 18 hours in the control group, while abnormal responses were seen in the three groups of psychotics, as follows;

• a) In the chronic schizophrenic group, the maximum level of 5-HIAA was reached more slowly and the recovery time prolonged (“delayed and probnged response”).
• b) In the acute psychotic group, 5-HIAA level was very high and recovered very rapidly (“excessive response”).
• c) In the organic psychotic group, increase of 5-HIAA level was more or less similar to that of the contro? group, but recovery tended to be delayed (“prolonged response”).

     

SPONTANEOUS AND PHA STIMULATED LYMPHOCYTE TRANSFORMATION IN MULTIPLE SCLEROSIS PATIENTS DURING AND AFTER ACUTE EXACERBATIONS WITH SPECIAL REFERENCE TO STEROID THERAPY

Spontaneous (SLT) and phytohemagglutinin (PHA) stimulated lymphocyte transformation was studied in multiple sclerosis (MS) patients suffering from acute exacerbations or from the chronic progressive type of MS. The changes in cell-mediated immunity were also observed before, during and after immunosuppressive (prednisone) treatment. A total of 85 venous blood samples from 23 MS patients (11 males, 12 females) were included in the material. The controls consisted of 25 measurements from 17 healthy volunteers who served as normal controls. The pathological controls consisted of 13 patients with neurological diseases other than MS. All these and MS patients were hospitalized. The IUFdR uptake of the cells of MS patients was more rapid than that of the controls at 1-hr incorporation time in SLT. The difference decreased and was eliminated by longer incubation times (2–4 hrs). MS patients also differed from pathological controls in this sense. The reaction to PHA stimulation was lower both in the MS groups (64 per cent from the normal controls) and in the pathological controls. Within the different MS groups, significantly lower values were seen only in the samples of the patients receiving immunosuppressive therapy. Under prednisone (80–100 mg initial dosis) PHA stimulation values rapidly dropped within the first week and slowly returned within 2–4 weeks after the stopping of the corticosteroid treatment. In some cases, however, PHA values remained at a low level for several months. The significance of this finding for the understanding of the underlying pathogenetic mechanisms has to be studied in more detail.     

STATISTICAL CORRELATIONS OF DIFFUSE CEREBRAL ATROPHY, WITH SPECIAL REFERENCE TO DIAGNOSTIC AND AETIOLOGIAL CLUES

To evaluate diagnostic and aetiological clues for diffuse cerebral atrophy, the statistical correlations between 35 pneumoencephalographic and 97 clinical variables in 268 patients were analysed. Each case of diffuse cerebral atrophy was originally of unknown cause, and all had pneumoencephalography. Ventricular diffuse atrophy correlated positively with psychic and co-ordinative impairment and dysarthria, and cortical diffuse cerebral atrophy with psychic impairment (P < 0.01 to 0.001). There was a close correlation (P < 0.001) of cortical diffuse cerebral atrophy with use of vibrating tools at work. Psychic impairment combined with co-ordinative dysfunction and dysarthria is an unspecific syndrome, but should make one think of diffuse cerebral atrophy. Arteriosclerosis, abuse of alcohol, and vibrating tools at work appear to have aetiological significance for some types of diffuse cerebral atrophy. Thus the number of patients with idiopathic diffuse cerebral atrophy may rapidly decline.     

ELECTRON MICROSCOPIC STUDY OF INTRANUCLEAR SPHERES OF BOUTEILLE TYPE-III IN ASTROCYTES WITH SPECIAL REFERENCE TO LIVER CARCINOMA

Astrocytic intranuclear spheres of Bouteille type-III were studied with the electron microscope in the neocortex of 29 patients dying from various causes. The numbers of laminate whorls in these spheres in patients with carcinoma involving the liver were found statistically to be significantly more numerous than the whorls in the spheres of patients who did not have carcinoma of the liver. This second group included patients who were suffering from carcinoma of other organs or from cirrhosis of the liver. The frequency of cases with the spheres increased with age. The numbers of spheres found in people with liver carcinoma, carcinoma of other organs and cirrhosis were the same as the numbers found in people dying from other diseases. The possibility that the increase in numbers of whorls found in people with liver carcinoma was related to a raised metabolic activity of the astrocytes resulting from reduced catabolism of hormones or metabolites by the liver is briefly discussed.     

APPRAISAL OF LONG-TERM LEVODOPA TREATMENT OF PARKINSONISM WITH SPECIAL REFERENCE TO THERAPY LIMITING FACTORS

The efficacy of levodopa in long-term treatment has still not been sufficiently demonstrated. In this study 126 parkinsonians have been treated for a minimum of 12 and a maximum of 36 months. The patients were evaluated clinically at regular intervals according to a protocol. The maximal therapeutic effect was achieved after 6 months of treatment. The patients with a slight to moderate degree of disease showed the best response to treatment. 13.6 per cent of the patients continued to improve after 1 year of treatment, and all these patients had a short history of the disease. Patients treated with thalamotomy prior to levodopa treatment showed a less favourable late prognosis. Based on information from the patients' relatives satisfactory treatment was achieved in ? of the patients. 10 patients reported subjective improvement although no definite therapeutic effect was observed. 92 per cent of all patients who had been treated a minimum of 12 months showed a beneficial response further on in the course of the treatment. Nausea and vomiting declined, whereas involuntary movements increased with the length of the treatment and were observed in 80 per cent of the patients at the last registration. Serious mental disturbances occurred in 26 per cent of the patients. 12 per cent of the patients developed akinesia paradoxica during the treatment. The major problem yet to be solved is the alleviation of the adverse effects of mental disturbance and hyperkinesia.     

INHIBITORY EFFECT OF UNSATURATED FATTY ACIDS ON LYMPHOCYTE-ANTIGEN INTERACTION WITH SPECIAL REFERENCE TO MULTIPLE SCLEROSIS

Using the macrophage electrophoretic mobility (MEM) test, the in vitro effects of oleic, linoleic and arachidonic acid, as well as Naudicell oil and methyl gamma-linolenate, on lymphocyte response to various antigens (PPD, thyroid antigen and EF) were studied in patients with mutiple sclerosis, patients with other neurological diseases, and in normal subjects. In all three groups, linoleic and arachidonic acid showed a significant inhibition; the latter was greater than the former, when tested at physiological concentrations, suggesting that unsaturated fatty acids may exert an immunoregulatory effect in vivo. The methylester of gamma-linolenate is the most powerful suppressing agent yet tested. The inhibitory activity of linoleic and arachidonic acids was consistently greater in MS than in other subjects and forms the basis of an in vitro test for the disease. The possible relationship of these findings to widespread alterations in the fatty acid composition of the tissues and to the pathogenesis of MS is discussed.