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.     

DL-lysine-H3 uptake in “light” and “dark” neurons of the inferior olivary nucleus of euthyroid and dysthyroidal rats

Summary Uptake of DL-Lysine-H³ into light and dark cells of the rat inferior olivary nucleus was studied by radioautographiy. Uptake in light cells was higher than in dark cells and appears to be possibly related to the greater frequency of relationship with glial satellites. Dysthyroidal states were also observed to increase uptake of radioactivity which was prominently observed in hypothyroid rats. Since dark cells appear to take up less lysine than normal cells and are less frequently closely associated with glial satellites it is suggested these cells may represent a less physiologically active unit than the light cells rather than being simply artifactually produced by the procedures employed.

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Zusammenfassung Die Aufnahme von DL-Lysin-H³ in hellen und dunklen Zellen im unteren Olivenkern der Ratte wurde mit Autoradiographie beobachtet. Die Aufnahme war höher in den hellen Zellen als in den dunklen, was möglicherweise mit einer größeren Häufigkeit von Glia-Satellit-Verbindungen in Zusammenhang gebracht werden könnte. Veränderungen im hormonalen Zustand der Schilddrüse konnten auch dazu beitragen, die Aufnahme von Radioaktivität zu erhöhen, was besonders bei Ratten mit niedriger Schilddrüsenaktivität hervortrat. Da dunkle Zellen offenbar weniger Lysin aufnehmen als normale Zellen, und sie seltener mit Glia-Satelliten verbunden sind, wird angenommen, daß diese Zellen möglicherweise eine weniger aktive physiologische Einheit darstellen als die hellen Zellen und daß es sich nicht einfach um ein Kunstprodukt handelt.

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This investigation was supported in part by a PHS research grant (NB-456802) from the division of Neurological Disease and Blindness and in part by Contract NONR 4018(01), (NR 101-592), between the Office of Naval Research, Department of the Navy, and the Research Foundation of the State University of New York.     

Microglial cells and amyloid β protein (Aβ) deposition: association with Aβ40-plaques

Two distinct species of amyloid protein (A) with different carboxyl termini, A₄₀ and A₄₂₍₄₃₎, are deposited in plaques in the brains of patients with Alzheimer's disease and Down's syndrome. The relationship between these two forms of A and microglial cells was investigated in 16 subjects with Down's syndrome ranging in age from 31 to 64 years. The amount of A₄₀ in plaques was low in persons under 50 years of age, even though high amounts of A₄₂₍₄₃₎ were present, but this former species increased after this age. Microglia were observed most commonly in plaques containing both A₄₀ and A₄₂₍₄₃₎ but less commonly in those with A₄₂₍₄₃₎ alone. The presence of microglial cells in plaques may be associated with the accumulation of A₄₀ and these cells may have a role in the production or processing of this particular molecular species.     

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.     

Extraocular muscles light microscopy and ultrastructural features

Summary Thirty extraocular muscles (EOM) from 20 patients were evaluated by light microscopy (LM), electron microscopy (EM), and enzyme histochemistry (EZH). Twenty-one EOM were obtained from 13 patients with strabismus, 9 EOM from 4 patients undergoing eye surgery for other reasons and from 3 autopsy cases. One m thick sections revealed marked variation in muscle fibre shape and size and in myofibrillar structure; also noted were small, hypertrophied, whorled, and ringbinden fibres. Dense and granular material in the central portion of some fibres and sarcomere disruption in 2–3 m sections was observed. EZH revealed the absence of the classical mosaic pattern usually found in skeletal muscles. ATPase studies were inconsistent and did not correlate with the expected reciprocal activity of NAD-H diaphorase, particularly on the large fibres.Ultrastructural features consisted of vacuoles within myofilament bundles, smearing of Z bands, and nemaline rods. Occasional myelin figures and lipid-like droplets were observed in subsarcolemmal spaces, associated with scattered clusters of glycogen granules. Abnormal mitochondria and subsarcolemmal inclusions of dense and granular material were conspicuous. Leptomeric profiles, Zebra bodies, or striated bodies were noted in 8 EOM's, and an Hirano body was found in 1. The intramuscular nerves contained structures resembling Luse bodies in 7 cases.These observations suggest that EOM from individuals with and without strabismus possess unique structural characteristics suggestive of developmental and morphological disarrangement of contractile elements. Some of these changes might play a role in the pathogenesis of strabismus and in the development of clinical symptoms.These features are significantly different from striated skeletal muscle. Therefore the criteria used in the pathological evaluation and diagnosis of skeletal muscle disorders cannot be unequivocally applied to EOM investigations. These data establish the necessity to determine histological norms, ultrastructural patterns, and develop new enzyme histochemistry criteria for the evaluation of EOM. Only then can an acceptable comparison of EOM and skeletal muscle be made.     

Immunohistochemical study on the distribution of α and β subunits of S-100 protein in brain tumors

Summary The immunohistochemical distribution of and subunits of S-100 protein (S-100, S-100, respectively) in 138 cases of human brain tumors was investigated by the avidin-biotin immunoperoxidase method. Brain tumors can be divided into four groups: group 1 [S-100 (+) and/or S-100 (+)]; astrocytoma, glioblastoma, ependymoma, subependymoma, oligodendroglioma, choroid plexus papilloma, gangliocytoma, meningioma, chordoma, malignant melanoma. Group 2 [S-100 (+) and S-100 (-)]; pineoblastoma, pituitary adenoma, craniopharyngioma, rhabdomyosarcoma. Group 3 [S-100 (-) and S-100 (+)]; acoustic Schwannoma. Group 4 [S-100 (-) and S-100 (-)]; medulloblastoma, malignant lymphoma, germinoma. The S-100 immunoreactivity pattern in brain tumors was similar to those obtained using conventional anti-S-100 protein sera. In the first group of brain tumors both the number of positively stained tumor cells and the staining intensity were generally greater for S-100 than for S-100 with a few exceptions including one gemistocytic astrocytoma, one subependymoma, one malignant melanoma, and some cases of glioblastomas. As to the relationship between malignancy and S-100 protein in glioma, S-100 immunoreactivity decreased according to degree of malignancy, while that of S-100 varied, suggesting a heterogeneity of tumor cells in glioblastomas. Immunostaining for S-100 and S-100 might become a useful diagnostic procedure in brain tumors and may give us more detailed and precise data of S-100 protein in brain tumors.     

Zur Frage des Off-On-Effektes bei Levodopa-Behandlung des Parkinsonismus

Zusammenfassung Tagesschwankungen der Leistungsfähigkeit bei Parkinsonkranken unter langdauernder Levodopabehandlung sind als sogenanntes Off-On-Phänomen bekannt. Reduzierter Proteingehalt in der Nahrung soll diesen Effekt bei Kranken, die nur mit L-Dopa allein behandelt werden, beheben können, nicht aber bei denjenigen, die eine Behandlung mit L-Dopa Dekarboxylasehemmer erhalten (Cotzias et al.). Die Hypothese von Cotzias beruht auf der Annahme, daß eine Transportkonkurrenz zwischen L-Dopa und Aminosäuren zu den Hirnganglien besteht.Um diese Ergebnisse zu prüfen, wurde bei 23 Parkinsonkranken mit Off-On-Phänomen der Einfluß einer proteinarmen Nahrung untersucht.Alle Patienten waren 5–8 Jahre mit L-Dopa vorbehandelt und erhielten zumindest in den letzten 3 Jahren eine Kombinationsbehandlung mit Dopa/Dekarboxylasehemmer. Der Eiweißgehalt der Nahrung wurde auf 25 g pro Tag beschränkt (weniger als 0,5 g pro kg Gewicht) und dies für eine Zeit von 1–4 Monaten.In 6 Fällen konnte eine deutliche Besserung mit Verminderung des Off-On festgestellt werden, in 1 Fall kam es zum völligen Verschwinden des Phänomens. Eine auffallende Besserung der allgemeinen Leistungsfähigkeit konnte in weiteren 5 Fällen beobachtet werden und eine objektive Besserung der Symptome, aber nur während der Off-Periode, festgestellt werden. Die restlichen 12 Fälle haben nicht angesprochen. Bei allen Patienten mit Hyperkinesie wurde eine Steigerung des Symptoms während der Diätperiode beobachtet. Eine Abhängigkeit von Diät zum Alter, Schwere, Dauer der Krankheit und der Dopabehandlung konnte nicht festgestellt werden. Der mögliche Mechanismus des Off-On-Phänomens sowie einige Vorschläge es zu beeinflussen werden dargestellt.

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The off-on phenomenon during treatment of Parkinson's disease with Levodopa

Summary The fluctuation in daily performance of Parkinson patients on long-term L-dopa therapy is known as the so called off-on phenomenon. Cotzias et al. found that a low protein diet is able to control this phenomenon in patients taking L-dopa alone but not in those receiving a combination of L-dopa and decarboxylase inhibitor. The author's hypothesis was based on the competition between the alimentary aminoacids and L-dopa for transport to the brain ganglia.In our attempt to prove the findings of Cotzias group we tested the influence of a low protein diet on 23 Parkinson patients manifesting the off-on phenomenon. All had been pretreated with L-dopa for 5–8 years and taking dopa DI for a minimum of 3 years. The protein intake was limited to 25 g/day (which is less than 0.5 g/kg body weight) for 1–4 months.In 6 cases there was a marked improvment with reduction of the off-on effect, and in one it disappeared completely.A distinct improvement of general capability was seen in the other 5 cases, and an objective improvement of the symptoms was noted, exept during the off period. No response could be observed in the remaining 12 cases. All cases with hyperkinesia showed an augmentation of this symptom during the use of the diet. The diet restriction was not found to be correlated with age, stage, duration of illness or duration of dopa treatment. The possible mechanism of the off-on phenomenon and some suggestions to influence it, are presented.

     

Somatosensory evoked potentials in patients with thalamic lesions

Summary Somatosensory evoked potentials (SEPs) were recorded in 20 patients with thalamic lesions confirmed by CT (10 with infarction, 10 with haemorrhage). The changes in SEP configuration are discussed in their relationship to clinical symptoms. Four types of SEP abnormality produced by thalamic lesion are distinguished: (1) FF type, (2) N20/P23 dissociation type, (3) N18/N20 false shift type, and (4) reduced early component type. It was shown that clinically similar lesions might produce different SEP patterns.     

Chronic progressive and relapsing neuromyopathy with massive dilatations of endoplasmic reticulum in muscle fibers

Summary Large intracytoplasmic inclusions arising from the endoplasmic reticulum and nuclear envelope were found in the muscle fibers of a 32-year-old individual with a life-long, chronic and progressive sensory-motor neuropathy. The morphological features of the inclusions were similar to that occasionally reported in the striated muscles in several unrelated conditions as well as to hyaline or colloid inclusions commonly seen in motor neurons of the brain stem and spinal cord. The chemical nature of the inclusions is not known. Their occurrence in the muscle fibers is probably secondary to chronic denervation.     

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     

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.     

Quantitative analysis of “synaptic” ribbon profiles in the pineal complex of male and female Pirbright-White guinea pigs

Summary Previous studies have pointed in the direction of sex differences as well as regional differences in the pineal gland of guinea pigs. In the present investigation these aspects were studied at the electron-microscopic level by quantitating different types of synaptic bodies, intrinsic to pinealocytes. The two major types of synaptic organelles, ribbons and spherules, did not exhibit regional or sex differences. Synaptic structures intermediate in appearance to ribbons and spherules were significantly larger in number in males in the distal region of the pineal gland, compared to females. As previous studies have shown that ribbon and spherule numbers undergo characteristic changes depending on the functional state of the pineal gland, it is concluded that, as far as the synaptic organelles are concerned, no clear-cut sex or regional differences appear to exist in the guinea pig pineal gland.     

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.     

Zur Morphologie und Pathogenese spinaler Läsionen bei Verletzungen der Halswirbelsäule

Zusammenfassung An einer Serie von verifizierten Rückenmarksschäden nach Gewalteinwirkung auf die Halswirbelsäule werden die wichtigsten morphologischen Befunde und ihre formale Pathogenese erörtert. Neben lokalen Kompressions- und Quetschungsnekrosen sowie spinalen Contusionen am Ort der Gewalteinwirkung sind die Nebenläsionen in den Nachbarsegmenten sowie die cranial und caudal vom Lokalherd auftretenden multisegmentalen stiftförmigen Zentralläsionen von Bedeutung, die auch als Fernschäden ohne direkte räumliche Beziehung zur Lokalverletzung sowie ohne manifeste Wirbelaffektion entstehen können. Bei den erst nach mehrtägiger Überlebensdauer nachweisbaren zentromedullären Läsionen, welche den bekannten Cysten mit nekrotischem Inhalt entsprechen, handelt es sich um eigenartige Partialnekrosen ohne Abbau- und Organisationstendenz, die einer reaktionslosen Verflüssigung anheimfallen und am ehesten atypischen Ödemnekrosen vergleichbar sind. Pathogenetisch stehen neben den mechanischen Faktoren vor allem primäre und sekundäre spinale Zirkulations-störungen zur Diskussion, wobei auf die aus den mitgeteilten Befunden morphologisch abzuleitende Bedeutung venöser Durchblutungs- und Abflußstörungen für die Entstehung der spinalen Nebenläsionen und Fernschäden nach Halswirbeltrauma hingewiesen wird.

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Summary In a series of verified spinal cord lesions caused by cervical spine injuries, the most important morphological findings as well as their formal pathogenesis are discussed. Beside local compression and crushing necroses as well as spinal contusions immediately at the side of the impact also Nebenläsionen in the neighbouring segments as well as multisegmental pencil-like central lesions several segments above and below the site of injury are of great importance. These may also occur as remote lesions without direct spatial relation to the local injury and without significant vertebral affection. The centro-medullar lesions to be disclosed only after a survival of several days corresponding to the well known cysts with necrotic content are particular partial necroses having no tendency to reduction and organisation. They undergo a non-reactive liquefaction and can be best compared with atypical edema necroses. As to their pathogenesis beside mechanical factors above all primary and secondary disturbances of spinal cord circulation are to be discussed. The importance of disturbances of venous circulation and drainage is emphasized for the pathogenesis of the spinal neighbouring and remote lesions after cervical spine injuries.

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Mit 7 Textabbildungen

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Auszugsweise vorgetragen auf dem 9. Kongreß der Internationalen Gesellschaft für Orthopädische Chirurgie und Traumatologie, am 1.–7. 9. 1963 in Wien.     

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     

Cerebral hemodynamics and “re-build-up” phenomenon on electroencephalogram in children with moyamoya disease

Re-build-up phenomenon, induced by hyperventilation, is a characteristic finding on electroencephalogram (EEG) in children with moyamoya disease, and suggests close correlation with cerebral ischemic attack. Its mechanism, however, remains obscure. In this study, we examined the relationship between the cerebral hemodynamics and this phenomenon before and after vascular reconstructive surgery. Regional cerebral blood flow and its reactivity to acetazolamide were analyzed using the xenon-133 inhalation method and single photon emission computed tomography in six children with moyamoya disease. These results were compared with the EEG. Regional vasoreactivity to acetazolamide was significantly lower in re-build-up-positive regions than in re-build-up-negative regions. Postoperative studies revealed a significant improvement of reactivity in the regions where the re-build-up phenomenon disappeared after surgery. These results suggest that the re-build-up phenomenon represents a focal reduction of the cerebral perfusion reserve in moyamoya disease.     

Some factors relating to success and failure of male chronic schizophrenics on their first foster home placement

The relationship between 9 demographic variables and the success or failure of 102 male chronic schizophrenic patients on their first foster home placement were investigated. Failure was defined as staying out of the hospital less than 11 months. Three significant findings all independent of each other showed that compared to the 25 failures the 77 successes had been older at their first hospitalization, had a shorter period between first hospitalization and placement in a foster home, and had fewer admissions to this hospital. Some factors relating to differences in patients, communities, and the use of tranquilizers are suggested as possible reasons underlying the discrepancies in results between this study and others.This paper was presented at the annual meeting of the Midwestern Psychology Association, Chicago, Illinois, May, 1966.     

Contents of day and night dreams of emotionally disturbed adolescents

Summary Content analysis of night, day, and repetitive day dreams of three groups of adolescents has been attempted for the purpose of (a) empirical data collection, (b) classification, (c) achievement of quantitative measures useful for dream studies, and (d) correlation studies. There seem to be significant differences between the contents of day and night dreams in the patient and control population groups, although various degrees of positive correlation of the contents of daily preoccupations, emotions, and happenings with night dream contents in each subject and/or group of subjects do exist. The schizophrenic patients show striking differences in their dream reporting and contents compared to other clinical groups. Positive correlation between the themes of repetitive day dreams and night dreams in each subject is much greater in the inpatient group than in the other two groups.This paper was prepared in collaboration with S. Blaesing, R.N., V. Hanses, R.N., M. Schrader, R.N., J. Brockhaus, R.N., M. Hofius, R.N., and S. Albright, M.A. Ed.     

The effect of oxidative stress on amyloid precursor protein processing in cells engaged in β-amyloidosis is related to apolipoprotein E genotype

The reduced antioxidative defense in allele 4 carriers is suggested to contribute to -amyloidosis in Alzheimers disease and Downs syndrome. We studied the effect of oxidative stress on accumulation of amyloid- peptide (A) in vascular smooth muscle cells (SMCs) that are engaged in production of amyloid- in vivo. Previously, we found that oxidative stress caused by ferrous ions induced accumulation of A-apolipoprotein E deposits in lysosomes and was associated with a greater oxidative protein damage in 4 carriers. Here, we demonstrate that ferrous ions induce formation of A deposits also in vascular tunica media in organotypic cultures of whole brain vessels, suggesting the role of oxidative stress in development of vascular -amyloidosis. Cellular accumulation of A in SMCs treated with ferrous ions was associated with a greater accumulation of C-terminal amyloid precursor protein (APP) fragments in 4/4 than in 3/3 myocytes and reduced the amount of soluble APP in 3/3, but not 4/4, cultures. Antioxidant vitamin E prevented these effects, and, when applied alone, diminished the amount of APP C-terminal fragments and increased the amount of secreted APP in 3/3, but not 4/4, cells. C-terminal APP-immunoreactive material was accumulated in lysosomes partly with A- and N-terminal APP immunoreactivities. These results suggest that the increased accumulation of APP and its fragments in lysosomes may yield additional amounts of cellular A, particularly in 4 carriers. We hypothesize that the altered processing of APP in SMCs locally exposed to oxidative stress facilitates cellular deposition of A and contribute to the increased risk of development of -amyloidosis in 4/4 carriers.     

Experience and philosophy with regard to case registers in health and welfare

A well designed and executed case register for mental illness or other conditions can provide information not readily obtainable by any other method. This includes unduplicated counts of diagnosed cases of the disease and longitudinal information such as changes in diagnosis, outcome, and survival information. Registers often are the only way in which new cases can be identified with any certainty. Also, the register can serve as a sampling frame for more intensive studies of services and of prevalence of the disease in the community, genetic studies, studies of the cost of treating various types of patients, before and after comparisons, and many other sociological and epidemiologic investigations. At the same time, there are many problems and pitfalls to case registers. This paper outlines some of these difficulties and suggests that registers be established only after careful planning and preparation.This paper is based on a presentation for a Workshop on Case Registers, American Orthopsychiatric Association Meeting, Chicago, Illinois, March 20, 1964. An extended bibliography on case registers is available from the author.