The dissociation of visuospatial neglect and neglect dyslexia.

A right-handed man with a left hemisphere lesion extending into the right hemisphere, with evidence of both a left-sided neglect dyslexia and right-sided visuospatial neglect is reported. When copying simple geometric designs he omitted to copy figures on the right-hand side of the page, when bisecting lines he tended to bisect the line to the left of the line's actual centre. He had a neglect dyslexia which was characterised by paralexic errors affecting the beginning (that is, left) of words. The occurrence of these two phenomena provides evidence of a dissociation of these forms of neglect. The findings are discussed in relation to the possible mechanisms of unilateral neglect.     

Participation of angiotensin II in learning and memory. III. Interactions of angiotensin II with GABAergic drugs

The experiments were carried out on male albino rats trained and tested for retention (24 hr later) in a shuttle-box. Angiotensin II (AT II) 0.10 micrograms intracerebroventricularly (i.c.v.), gamma-aminobutyric acid (GABA) 100 micrograms i.c.v., bicuculline 0.5 and 1.0 mg/kg intraperitoneally (i.p.), and picrotoxin 0.5 and 1.0 mg/kg i.p. administered independently or in combinations immediately after training. AT II was found to improve retention. GABA also facilitated retention. Combination of AT II + GABA potentiated the memory-improving effect of AT II. Bicuculline and picrotoxin at a dose of 0.5 mg/kg did not affect retention, while at a dose of 1.0 mg/kg they improved it. Combinations of AT II + bicuculline (0.5 mg/kg) and AT II + picrotoxin (0.5 mg/kg) abolished the retention-improving effect of AT II. Bicuculline (0.5 mg/kg) or picrotoxin (0.5 mg/kg) abolished the retention-facilitating effect of the combination of AT II + GABA as well as the potentiating action of GABA on the memory effect of AT II. These results suggest the participation of GABAergic transmission in the CNS in the mechanisms of the long-term memory-improving effect of AT II.     

Experience with the 'skew flap' below-knee amputation

A review of 353 lower limb amputations over the last 7 years has been performed to assess the results of the skew flap myoplastic below-knee amputation which was introduced in April 1983 because of reported advantages in terms of wound healing and earlier ambulation. Comparing the first 3 1/2 year period with the second, the total number of amputations decreased by 31 per cent. The number of above-knee amputations remained similar in the two periods (82,62), whilst the number of Gritti-Stokes amputations fell from 79 to 21 (0.001 greater than P greater than 0.01). The proportion of below-knee (BK) amputations increased from 50 (23.7 per cent) to 59 (41.5 per cent) (0.01 greater than P greater than 0.025). The groups were comparable in terms of previous vascular surgery and co-existing medical conditions. The time to full stump healing was significantly shorter in the skew flap group compared with the earlier Burgess type BK amputation (P = 0.001), and there was a trend to fewer stump failures in the skew flap group. We therefore feel that the skew flap amputation gives superior results to the Burgess BK amputation in terms of healing and a lower complication rate, allowing a higher proportion of BK amputations to be performed. A prospective randomized trial of the two techniques is in hand to determine the accuracy of this hypothesis.     

Dorsal dislocation of the ulnar styloid and extensor carpi ulnaris tendon into the distal radioulnar joint: the empty sulcus sign

Two cases of distal radioulnar joint (DRUJ) disruption and diastasis secondary to distal radial fractures were associated with displacement of the ulnar styloid and extensor carpi ulnaris (ECU) into the DRUJ. Both cases had a palpable empty ECU tendon sulcus. In one case surgical exploration revealed that the ulnar styloid, triangular fibrocartilage, and extensor carpi ulnaris tendon had dislocated into the DRUJ as a unit. The end result was good. In the second case lack of recognition and reduction of the ECU tendon and ulnar styloid led to persistent subluxation and diastasis. The end result was poor. Early recognition of the dislocation of the ulnar and ECU into the DRUJ and their significance may avoid poor results.     

Clinical and hormonal effects of chronic gonadotropin-releasing hormone agonist treatment in polycystic ovarian disease

Previously, we reported that short term administration of a highly potent GnRH agonist (GnRHa) for 1 month to patients with polycystic ovarian disease (PCO) resulted in complete suppression of ovarian steroidogenesis without measurable effects on adrenal steroid production. This new study was designed to evaluate the effects of long term GnRHa administration in PCO patients with respect to their hormone secretion patterns and clinical responses. Eight PCO patients and 10 ovulatory women with endometriosis were treated daily with sc injections of [D-His6-(imBzl]),Pro9-NEt]GnRH (GnRHa; 100 micrograms) for 6 months. Their results were compared to hormone values in 8 women who had undergone bilateral oophorectomies. In response to GnRHa, PCO and ovulatory women had rises of serum LH at 1 month, after which it gradually declined to baseline. In both groups FSH secretion was suppressed throughout treatment. Serum estradiol, estrone, progesterone, 17-hydroxyprogesterone, androstenedione, and testosterone levels markedly decreased to values found in oophorectomized women by 1 month and remained low thereafter. In contrast, serum pregnenolone and 17-hydroxypregnenolone were partially suppressed, and dehydroepiandrosterone, dehydroepiandrosterone sulfate, and cortisol levels did not change. Clinically, hyperplastic endometrial histology in three PCO patients reverted to an inactive pattern, and proliferative endometrium in two other PCO patients became inactive in one and did not change in the other. Regression of proliferative endometrial histology occurred in all ovulatory women. Vaginal bleeding occurred in all women studied during the first month of GnRHa administration, after which all but one PCO patient became amenorrheic. Hot flashes were noted by all ovulatory women and by four of eight PCO patients. All PCO patients noted subjective reduction of skin oiliness, and five had decreased hair growth. We conclude that in premenopausal women: 1) chronic GnRHa administration results in apparently complete persistent suppression of ovarian steroid secretion; 2) adrenal steroid secretion is not influenced directly or indirectly; and 3) its use may be helpful in the treatment of endometrial hyperplasia and ovarian androgen excess in women with PCO.     

Comparison of PET, MRI, and CT with pathology in a proven case of Alzheimer's disease

Positron emission tomography (PET) with fluorodeoxyglucose (FDG), magnetic resonance imaging (MRI), and CT were carried out in a patient with Alzheimer's disease 16 months before he died. At autopsy, the gross appearance of the brain correlated with MRI and CT, which showed some regional atrophy. These were much less revealing than PET, which correlated with microscopic findings of neuronal loss and proliferation of glia. In areas of moderately impaired local cerebral metabolic rate of glucose, as revealed by reduced FDG uptake, there was some gliosis, primarily around the numerous senile plaques. In areas of severe metabolic impairment, there was a profound loss of neurons, extensive gliosis, and a diminished appearance of plaques. PET-FDG is a better measure of the severity of Alzheimer's disease than MRI or CT, because it reflects the degree of neuronal pathology.