A clinical and polysomnographic comparison of neuroleptic-induced akathisia and the idiopathic restless legs syndrome.

Neuroleptic-induced akathisia (NIA) is motor restlessness caused by dopamine receptor blocking antipsychotic agents. Nine patients with NIA and 11 patients with idiopathic restless legs syndrome (RLS) were studied polysomnographically. The sleep disturbances were milder in NIA than idiopathic RLS but increased numbers of awakenings and decreased sleep efficiencies were common to both groups. In addition, RLS patients demonstrated prolonged sleep latencies. Periodic movements in sleep (PMS) were present in only 5 of 9 patients with NIA but in all 11 patients with idiopathic RLS. In no NIA patient did we see the multiple, large amplitude, violent, resting myoclonic jerks of the legs that we saw during wakefulness in some of our more severe cases of idiopathic RLS. NIA patients tended to experience inner restlessness and idiopathic RLS patients tended to experience leg paresthesias as an antecedent to motor restlessness. Idiopathic RLS patients had symptoms that were worse at night and in repose far more frequently than patients with NIA. NIA and idiopathic RLS have similarities and differences. Because both NIA and idiopathic RLS are characterized by motor restlessness and sleep disturbances, the pharmacodynamics of antipsychotic medications may give clues as to both the cause and treatment of idiopathic RLS.     

Variation in microdeletions of the cyclic AMP-responsive element-binding protein gene at chromosome band 16p13.3 in the Rubinstein-Taybi syndrome

Most reported microdeletions of the CREB-binding protein (CBP) gene in the Rubinstein-Taybi syndrome (RTS) were detected by fluorescence in situ hybridization (FISH) with a single cosmid probe specific to the 3' region of the gene. In order to test the hypothesis that the rate of microdeletion-positive cases would be greater if the entire gene was evaluated, we performed FISH on 66 patients with an established diagnosis of RTS, using a panel of five cosmids that span the CBP gene. Five of 66 patients had deletions by FISH (9%), consistent with those rates reported in various series that ranged between 3-25%. Among our cases, different deletions were observed; one was deleted for the 5' but not the 3' region of the CBP gene (case 055). Other deletions included a total CBP deletion extending from the 5' through the 3' region (case 017), a deletion of all but the 5' region (cases 006 and 060), and an interstitial deletion in the 3' region (case 028). Fine breakpoint mapping with additional cosmid and yeast artificial chromosome (YAC) constructs was performed on these patients. The findings of a partial 5' deletion and of interstitial deletions of the CBP gene add to the known spectrum of mutations of this gene in RTS and demonstrate the need for evaluation of the entire CBP gene region for deletions rather than only the 3' region in RTS patients. These results further suggest that the true rate of microdeletion across the CBP gene detectable by FISH has yet to be established firmly. No phenotypic differences between partial deletion, complete deletion, and nondeletion patients were observed, supporting a haploinsufficiency model for RSTS.     

Immunohistochemical differences between intracranial germinomas and their gonadal equivalents. An immunoperoxidase study of germ cell tumors with epithelial membrane antigen, cytokeratin, and vimentin

Twenty-six intracranial germ cell tumours (11 germinomas, 10 teratomas, 2 endodermal sinus tumours, 1 teratocarcinoma, and 2 undifferentiated embryonal carcinomas) and 26 gonadal germ cell tumours (13 testicular seminomas, 2 ovarian dysgerminomas, 9 ovarian teratomas, and 2 myometrial choriocarcinomas) were studied by immunoperoxidase with monoclonal antibodies (MAbs) against epithelial membrane antigen (EMA), cytokeratin, and vimentin. Typical tumour cells in three of the 11 germinomas (two of the latter being situated in the posterior fossa) expressed both EMA and cytokeratin, whereas those in the seminomas and dysgerminomas did not. In one seminoma, a few multinucleated giant cells expressed cytokeratin. In three of seven germinomas, vimentin-positive tumour cells were found, but all seminomas and dysgerminomas were negative. In the other forms of intracranial and gonadal germ cell tumours, epithelial and mesenchymal elements displayed the expected patterns of immunoreactivity to the respective determinants. The immunoperoxidase differences between the intracranial germinomas and their gonadal equivalents indicate that, in the former, early epithelial or mesenchymal differentiation of the primordial germ cells may be present. The findings draw attention to the heterogeneous cellular composition of these otherwise morphologically homogeneous-appearing tumours and, especially in the posterior fossa, to their transitional links to the immature teratomas.     

Immunohistochemistry of a spontaneous murine ovarian teratoma with neuroepithelial differentiation. Neuron-associated beta-tubulin as a marker for primitive neuroepithelium

Spontaneous ovarian teratomas develop in a large proportion of female LT strain mice. These tumors display a large neuroectodermal component with morphologic differentiation ranging from primitive neuroepithelium (medulloepithelial and ependymoblastic rosettes) to mature neurons, and provide a useful system for the study of various asynchronous stages of neuroepithelial differentiation. The aim of this study was to assess the expression of various cytoskeletal proteins in conjunction with other differentiation-related antigens in these tumors. We found that the medulloepithelial rosettes reacted with only two anti-beta-tubulin monoclonal antibodies. One of these (TU27) recognizes an epitope common to all of the mammalian beta-tubulin isotypes. The other monoclonal antibody (TUJ1) recognizes an epitope unique to class III beta-tubulin isotypes (neuronal-associated). Whereas immunoreactivity in the ependymoblastic rosettes was limited to TU27, differentiating polar neuroblasts reacted with both TU27 and TUJ1 and expressed neuron-specific enolase, synaptophysin, and the 68 kilodalton subunit of neurofilament protein. In well-differentiated foci, mature neurons were positive for all three neurofilament protein subunits (68, 168 and 200 kilodaltons), microtubule-associated-protein 2, synaptophysin, and neuron-specific-enolase, and reacted with both TU27 and TUJ1. By contrast, glial elements expressed glial fibrillary acidic and S-100 proteins, Leu-7 and TU27 but not TUJ1. Myelin basic protein and myelin-associated glycoprotein reactivity was found in the neuropile of these mature areas. The neuroepithelial components were negative for retinal S-antigen and cytokeratin. The expression of the class III beta-tubulin isotype by medulloepithelial rosettes suggests that this isotype may be one of the earliest markers to signal neuronal commitment in primitive neuroepithelium.     

Reproducible alteration of cytoplasmic polyhedrosis virus double-stranded RNA genome patterns on laboratory passage.

A change in the polyacrylamide gel electrophoretic pattern of the double-stranded RNA genome segments of a cytoplasmic polyhedrosis virus was observed following only one or two passages through laboratory-reared larvae of Heliothis armigera. This change consisted of the loss of a high molecular weight segment concomitant with the appearance of a low molecular weight segment and was a reproducible feature observed with several separate isolates from the field.     

Childless elderly: Theoretical perspectives and practical concerns

Almost nothing is concretely known about childless elderly in cross-cultural perspective. Few published papers have appeared on this social category in the West, although childless elders make up (at least) 20% of the population of elderly in many Western nations. Little is known about childless elderly in the Third World. This paper provides some theoretical background to the study of childless elderly and articulates some social policy concerns about them. It suggests that there are five important questions to examine concerning the lives of childless elderly. These include, how childless aged are or are not provided for in societies in which a great deal of the care of the aged is undertaken by children; how kinship functions as a matrix for care; how the increasingly common phenomenon of voluntary childless may give meaning to childlessness in late life; how childlessness fits with such social science models such as the developmental cycle; and, the relationship of this phenomenon to changing opportunities for women. The paper further examines how factors such as fertility, systems of caregiving, the social meaning of childlessness, alternatives to childlessness such as adoption, and educational and economic opportunities may affect the lives of childless elders.     

The construction of a day by elderly widowers

The way in which some elderly widowers living alone experientially organize time can be viewed as on a continuum structured around the notion of a "day" as a central organizing focus. Related to this is the role of a "daily highlight" in organizing daily activities. The continuing role of bereavement, effects of living alone, and other factors may help structure this experiential continuum.