bluuebunny/crossref_metadata_2025 huggingface dataset:
Characteristics of adults who wish to enter a trial of growth hormone replacement
Authors: Holmes Sarah J. , Shalet Stephen M.
Published: March 2008

OBJECTIVE It Is possible that the degree of perceived well‐being may Influence the decision of an adult with GH deficiency to receive GH replacement. We have therefore sought factors which Influenced whether or not such a patient wished to enter a study of GH replacement.

DESIGN Biochemical, anthropometric and demographic characteristics, and well‐being, of patients who chose to enter a 12‐month study of GH replacement at Christie Hospital NHS Trust were compared with those of patients who declined to enter the study.

PATIENTS Sixty‐five adults with GH deficiency who entered a study of GH replacement and 33 adults with GH deficiency who were approached but who declined to enter the study.

MEASUREMENTS The two groups of patients were compared according to sex, age, height, weight, body mass Index, peak serum GH response to provocative testing, estimated duration of GH deficiency, whether GH deficiency was of childhood or adult onset, presence or absence of additional pituitary hormone deficiencies, aetiology of GH deficiency, previous therapeutic Interventions, employment status, marital status and living arrangement (65 entered vs 33 declined to enter). Well‐being or distress was measured using the Nottingham Health Profile (NHP) (65 entered vs 20 declined to enter) and the Psychological General Well‐being Schedule (PGWBS) (33 entered vs 19 declined to enter).

RESULTS Those who entered the study had significantly higher scores on the energy (P= 0.03) and emotional reaction (P= 0.02) subsections and on the total score (P= 0.04) of the NHP, indicating greater distress, and had a significantly lower score (P= 0.009) on the vitality subsection of the PGWBS, again indicating greater distress. Those who entered the study had a significantly lower prevalence of non‐functioning pituitary adenoma (P= 0.02) but there was no other difference in biochemical, anthropometric or demographic characteristics between the two groups.

CONCLUSION Adults who enter a study of GH replacement exhibit greater distress on questionnaire assessment than those who decline to enter such a study. This bias must be considered when Interpreting studies of the effect of GH replacement on well‐being in adults.
Utility of 99mTc‐sestamibi scintigraphy as a first‐line imaging procedure in the preoperative evaluation of hyperparathyroidism
Authors: Caixàs Assumpta , Bernà Lluis , Piera Joan , Rigla Mercedes , Matías‐Guiu Xavier , Farrerons Jordi , Puig‐Domingo Manel
Published: March 2008

OBJECTIVE The use of preoperative imaging in patients with hyperparathyroidism remains controversial. Many of the available techniques are insufficiently sensitive and specific to justify their routine use. We have evaluated the Sensitivity and specificity of 99mTc‐sestamibi scintigraphy in the management of patients with different forms of hyperparathyroidism.

DESIGN Preoperative imaging evaluation was carried out by sclntigraphic detection of pathological parathyroid glands using 99mTc‐sestamibi as a radiotracer; confirmation of scan findings was obtained surgically.

PATIENTS A group of 25 patients with primary (n= 21) or secondary (n=4) hyperparathyroidism were studied. All were considered for surgical treatment.

MEASUREMENTS In all cases parathyroid imaging was carried out by 99mTc‐sestamibi scintigraphy together with at least one other imaging technique which included CT‐scan, ultrasonography, MRI or 201TI/99mTc subtraction scintigraphy. Blood tests included measurements of total calcium and PTH.

RESULTS 99mTc‐sestamibi scintigraphy correctly localized 20 out of 21 adenomas, giving a sensitivity of 95.2%, markedly higher than that obtained with the other imaging techniques (ultrasonography 75%, 201TI/99mTc subtraction scintigraphy 57.1%, CT‐scan 41.7% and MRI 33%). Of a total of 17 glands identified surgically as hyperplastic and confirmed by pathological examination, 99mTc‐sestamibi scintigraphy showed a positive image in 10, corresponding always to the larger abnormal glands (sensitivity 58.8%, higher than that observed with the other techniques). No false positive images were obtained with 99mTc‐sestamibi. All the ectopic adenomas (n= 3) were identified preoperatively, which contributed significantly to the surgical approach.

CONCLUSION In patients with hyperparathyroidism, 99mTc‐sestamibi scintigraphy may be used as the single imaging technique as it shows a very high sensitivity and specificity in the preoperative localization of pathological parathyroid glands; the benefit of localizing parathyroid tissue prior to surgery in cases of ectopic adenomas clearly indicates that when an imaging procedure is required, this technique may be of great help in the management of hyperparathyroidism.
Diagnostic and clinical features in azoospermia
Authors: Foresta C. , Ferlin A. , Bettella A. , Rossato M. , Varotto A.
Published: March 2008

BACKGROUND AND OBJECTIVE The recent advances In assisted fertilization and gamete micromanipulation techniques have enabled fertilization in some forms of azoospermia; for example, epididymal sperm aspiration in obstructive azoospermia. Therefore knowledge of the specific degree of testicular damage is of primary importance, since other clinical parameters, such as FSH plasma levels and testicular volume, do not discriminate between the different testiculopathies. in order to further Characterize the specific testicular conditions present in azoospermia, we have examined a large group of azoospermic subjects on the basts of testicular cytological analysis obtained by fine needle aspiration. DESIGN AND PATIENTS One hundred and twenty‐two infertile, azoospermic men were studied by physical examination, FSH radioimmunoassay, testicular ultrasound examination and fine needle aspiration of the testes. Thirty‐five infertile normozoospermic subjects were studied as controls.

RESULTS The cytological analysis Identified five different sub‐types in azoospermic subjects: I, Sertoli cell‐only syndrome; II, hypospermatogenesis; III, spermatogonial and/or spermatocytic arrest; IV, spermatidic arrest; and V, normal germ line. The testicular volume was reduced in groups I and II, while the FSH plasma levels were Increased in groups I, II and III, suggesting a primary role of spermatids In the control of FSH secretion.

CONCLUSIONS in azoospermic subjects, testicular cytological analysis permits the Identification of different sub‐types and this classification may be very important in determining therapy, particularly the choice between surgical treatment and the hypothetical use of assisted fertilization techniques by retrieval of epididymal or Intratesticular spermatozoa or spermatids.
Clinical efficacy and safety of low‐dose flutamide alone and combined with an oral contraceptive for the treatment of idiopathic hirsutism
Authors: Dodin Sylvie , Faure Nacia , Cédrin Isabelle , Mechain Catherine , Turcot‐Lemay Luclle , Guy Jocelyne , Lemay André
Published: March 2008

BACKGROUND AND OBJECTIVE High doses of flutamide, which is the only antiandrogen that specifically blocks the androgen receptor, have recently been used with good clinical results in women with hirsutism. Since regression of hair growth requires long‐term therapy, clinical and economic considerations are important. The use of the lowest efficacious dosage could reduce costs. This study was undertaken to compare safety and efficacy of a low dose of flutamide (125 mg twice daily) alone and in combination with a triphasic oral contraceptive (OC) in women with idiopathic hirsutism.

PATIENTS Flutamide was administered orally in a low dose of 125mg twice daily for 12 months alone in women with no risk of pregnancy or during the use of an oral contraceptive.

MEASUREMENTS Women were seen every 3 months and were evaluated for hirsutism score, hormone and lipid measurements.

DESIGN The study, which was conducted as a prospective open trial, was proposed to patients with idiopathic hirsutism, that is, with serum androgen levels in normal range and LH/FSH ratio less than 2.

RESULTS A statistically significant decrease in hirsutism score as compared to baseline was observed after only 3 months with either treatment, flutamlde alone (16.9 ± 1.6 vs 14.2 ± 1.7, P < 0.0001) or the combination of flutamide with OC (15.6 ± 0.8 vs 11.9 ± 0.8, P < 0.001). Three months after cessation of treatment a statistically significant decrease from baseline was observed in the two groups. Nevertheless, at 6 months post‐treatment this decrease was still Significant only in the group who took flutamlde in Combination with an oral Contraceptive. Flutamide alone does not appear to modify the levels of lipoproteins. The association of flutamide with a triphasic formulation significantly Increased the HDL‐C levels. CONCLUSIONS This study shows beneficial effects of a low dose of flutamide in women with idiopathic hirsutism. The addition of an oral contraceptive is judicious to prevent pregnancy and reduce recurrence of hirsutism after cessation of flutamide. Peripheral androgenic blockage does not modify lipid profiles and it might reduce the negative effect of oral contraceptive on HDL‐C levels. The addition of electrolysis delays the recurrence of hirsutism after cessation of flutamide.
Extra‐adrenal effects of metyrapone include inhibition of the 11‐oxoreductase activity of 11β‐hydroxysteroid dehydrogenase: a model for 11‐HSD I deficiency
Authors: Raven P. W. , Checkley S. A. , Taylor N. F.
Published: March 2008

BACKGROUND AND OBJECTIVE Previous studies suggesting effects of metyrapone on extra‐adrenal cortico‐steroid metabolism have involved significant alterations in plasma cortisol. We have therefore studied effects of metyrapone on urinary excretion of steroids in a group of patients treated concurrently with hydrocortisone so that changes in plasma cortisol were minimized.

DESIGN Replacement doses of hydrocortisone (30 mg/ day) were given concurrently with metyrapone (2–4 g/ day) for 2 weeks. Blood samples were taken and 24‐hour urinary steroid collections were made at baseline and after 1 and 2 weeks of treatment.

PATIENTS Subjects were 6 female patients with major depression from a trial of metyrapone as an antidepressant.

MEASUREMENTS Urinary steroid profiles were measured by gas chromatography; plasma cortisol and urinary free cortisol were measured by fluorescence immunoassay.

RESULTS Plasma cortisol levels were not significantly decreased by treatment, while excretion of 11‐deoxycortisol metabolites increased eightfold after 2 weeks indicating that concurrent hydrocortisone administration had not suppressed the adrenal. Ratios reflecting 11β‐hydroxyl 11‐oxo metabolites of cortisol were significantly decreased, consistent with inhibition of the 11‐oxoreductase activity of 11β‐hydroxysteroid dehydrogenase (11‐HSD). Other changes included significant decreases in the rates of 5αvs 5β and of 20αvs 20β reduction of corticosteroids.

CONCLUSIONS Metyrapone has multiple effects on extra‐adrenal corticosteroid metabolism and is the only agent we know of which selectively inhibits 11‐oxoreductase. Metyrapone thus provides a model for 11‐HSD I deficiency and a tool for in‐vitro studies of cortisol‐cortisone Interconversion. The results also suggest mechanisms whereby corticosteroid effects can be regulated separately from corticosteroid synthesis.
EPILEPTOID PSYCHOSIS: A GROUP OF ATYPICAL ENDOGENOUS PSYCHOSES
Authors: Sawa Masaichi
Published: March 2008

Clinical and EEG studies were performed on 60 cases of a group of atypical endogenous psychoses. The onset of psychic symptoms was sudden after a short period of melancholia, displeasure and insomnia.

In a catatonic type, the patients showed a violent catatonic excitement. Their illusion and hallucination were fantastic and fluctuating. They had the delusions of persecution and other delusive ideas. Their thinking was incoherent and fragmental, their affect excitable and explosive. A catatonic stupor followed such a catatonic excitement, whereby patients were apathetic and abulic. However, sometimes abnormally impulsive and fitful behaviors were also observed.

In hebephrenic type, the patients had various sorts of hallucinations, delusive ideas of reference, and the delusion of persecution. Their affect showed the loss of ireshness, apathy and indifference. Their thinking was dull and retarded, their psychomotility was lowered even to akinesia.

In a manic type, the patients were very hyperkinetic. Their affect was exalted and easily led to anger. On the contrary, the patients of a depressive type showed a colorless, unfresh emotional state. Their psychomotility was hypokinetic and even akinetic. There were some cases of manic‐depressive type and the transitional type to schizophrenic type.

To all these types, the cloudiness of consciousness, though varied in degree, was common.

In a considerable number of the patients, certain singular tendencies that is called “epileptic personality” were observed. There were also some patients whose relatives had epileptic seizures.

The EEGs of all these patients showed epileptic abnormalities either in a rest state or due to Metrazol activation. The activation threshold values of Metrazol were evidently lower than those of schizophrenics, manic‐depressive psychotics and also normal control cases. There were some, among the patient's close relatives, who showed abnormal EEGs by Metrazol activation.
ELECTROPHYSIOLOGICAL STUDY ON THE PERFUSED CAT BRAIN BASED ON ELECTROENCEPHALOGRAPHY
Authors: Yamada Takaharu , Ikeda Hisao
Published: March 2008

We studied electroencephalographically on the perfused cat brains both under glucose‐containing condition and glucose‐free condition, and discussed the relation between the electrical activity and metabolism of the brain. The results were as follows:

1. In case of brain perfusion in which an anesthetic agent is used for premedication.

a) EEG of both glucose‐containing cases and glucose‐free cases reveal high voltage spindle bursts that appear regularly, speak for that there exists a specific effect of the anesthetic agent used in premedication. From this result we would like to assume that by this perfusion method we stood in position to observe the brain function and metabolism under the influence of anesthetic agent.

b) In the two cases of the brain perfusion there could not be recognized any essential differences in their EEG patterns. Shortly, EEG must have come in accord with the changes of brain metabolism.

2. The brain perfusion under premedication with d‐tubocurarine, that is, under unanesthetized state.

a) In the case of glucose‐containing perfusion it can be divided into three stages according to the changes of EEG of neocortex, and EEG pattern shifts from low voltage fast waves of 25–30c/s, 20–30pV to spindle bursts and then to irregular slow waves. Throughout this period the amygdala reveals low voltage fast waves, indicating dissociation of electrical activity between the amygdala and neocortex. At the hippocampus there appear first regular hippocampal slow waves but in response to the appearance of slow waves in neocortex its regularity is lost by increased fast wave components.

b) In the case of glucose‐free perfusion there appear irregular low voltage spindle bursts in the neocortex, low voltage fast waves in amygdala, and likewise there appear in the hippocampus for a certain period of time regular hippocampal slow waves, proving dissociation of the electrical activity between the neocortex and the limbic system.

c) In two modes of brain perfusion there can be recognized differences in EEG patterns as well as in the time of EEG appearance, whereby in the glucose‐free perfusion the EEG of neocortex disappears within 10 odd minutes or around 30 minutes after the commencement of the perfusion. In other words, by this method the presence or the absence of glucose in the perfused blood constitutes an important factor in the fluctuations of the neocortex EEG.

d) By this method of the brain perfusion, seizure discharge occurs frequently at the site centered around the limbic system when the excitatory level of the brain is low and, as for the brain metabolism, there can be recognized an increase in the oxygen consumption and glucose uptake of the brain after the onset of seizure disharge.
ELECTROGRAPHIC AND EVOKED POTENTIAL STUDIES DURING SLEEP IN THE CAT (THE STUDY ON SLEEP, I)
Authors: Okuma Teruo , Fujimori Masamoto
Published: March 2008

In order to study the neural mechanism underlying the physiological sleep of the cat, especially of the stage of sleep characterized by an electrographic pattern similar to those of the arousal stage and also by disappearance of the postural muscle tone, the spontaneous electrograms of the brain as well as the evoked potentials induced by stimulation of peripheral and central nervous structures were studied in different stages of sleep by using chronically implanted cats.

(1) Physiological sleep of the cat was divided into 4 stages: A (arousal), S1 (sleep with 6 to 14 c/sec. spindle burst in the neocortical electrogram), S2 (sleep with spindle burst and high voltage slow activity in the neocortical electrogram) and Sa (sleep with electrographic features similar to those of the arousal stage) stages.

(2) It was difficult to differentiate between the low voltage fast activity in the neocortical electrograms during the Sa stage and those during the arousal stage.

(3) The hippocampal rhythmic activity was of higher frequency during the Sa stage than in the arousal stage. The frequency became particularly high during the period of the rapid eye movements in the Sa stage.

(4) During the Sa stage, spindle burst of 10 to 14 c/sec. activity was frequently observed in the caudal pontine and bulbar reticular formation with or without concomitant spindle burst in the neocortical electrogram. Spindles of 6 to 10 c/sec. were seen less frequently.

(5) Evoked potentials in the specific systems induced by direct electric stimulation of the brain decreased amplitude during the S1 and S2 stages with slow background activity and showed the amplitude equal to or higher than the arousal level during the Sa stage. The enhancement of the evoked potential appeared more remarkably when low frequency repetitive stimulation was used. The amplitude of the evoked potential was particularly large during the period of the rapid eye movements in the Sa stage.

(6) Evoked potentials in the non‐specific thalamocortical system such as the recruiting response were enhanced in the S1 and S2 stages and suppressed during the Sa stage of sleep.

(7) Some components of the evoked potential in the mesencephalic reticular formation showed diminution of amplitude in the S1 and S2 stages and enhancement in the Sa stage, while those in the caudal pontine and bulbar level showed marked suppression during the Sa stage.

(8) It was suggested that the Sa stage of sleep might be due to the inhibitory process in the lower brain stem. The hypothesis was presented that during the Sa stage, the structures lying above the mesencephalon was in the state of overactivation due to release from the ascending inhibitory (EEG synchronizing) mechanism of the lower brain stem.
PERFORMANCE OF CONDITIONED AVOIDANCE RESPONSE UPON HYPOTHALAMIC STIMULATION IN CATS
Authors: Ikeda Terutika
Published: March 2008

Resumé

With the use of 7 adult cats as the subjects of experiment, the performance of conditioned avoidance behavior was observed by implanting electrodes in the hypothalamus, midbrain reticular formation, hippocampus, amygdala, and caudate nucleus under application of electric stimuli. The result reads as follows:

A. Facilitation of the learning behavior was observed under relatively weak stimulation from all the electrodes implanted in the hypothalamus.

B. When the stimulation was intensfied through the electrodes implanted in the hypothalamus, 1) the action latency was markedly reduced under the stimulation given to the medial part of anterior hypothalamus, but spontaneous avoidance response occurred and the performance of the learning behavior was disorganized. 2) Under the stimulation on the ventromedial, posterolateral part of the hypothalamus, the learning behavior once facilitated was inhibited.

C. The stimulation given to the midbrain reticular formation caused facilitation of the learning behavior.

D. Inhibition was the common outcome of stimulation given to all other structures (hippocampus, amygdala, and caudate nucleus.)

On the basis of the above facts, the facilitation and inhibition of learning behavior was discussed with reference to its formation of motivation.
AN EXPERIMENTAL STUDY OF THE COURSE AND TERMINATION OF THE PROJECTION FIBERS FROM CORTICAL AREAS 4 AND 6 IN THE CAT
Authors: Niimi Kahee , Kishi Seiichiro , Miki Michihiro , Fujita Shiroyuki
Published: March 2008

The axon degeneration following cortical ablation of areas 4 and 6 of the cat has been traced in serial sections impregnated by the Nauta‐Gygax method.

The results obtained are as follows:

1. The motor cortex projects ipsilaterally to the caudate nucleus, the putamen, the claustrum, the amygdaloid complex, the thalamic nuclei, the subthalamic nucleus, the zona incerta, the field of Forel, the substantia nigra, the red nucleus, the central gray, and to the superior and inferior colliculi. In addition to ipsilateral projections, the motor cortex has a few projections to the contralateral subcortical centers, that is the caudate nucleus, the putamen, the claustrum, the ventral thalamic nucleus, the red nucleus, the central gray and the suparior colliculus.

2. Practically no fibers from the motor cortex reach the motor nuclei of the cranial nerves except for the nucleus ambiguus and the nucleus of the accessory nerve, both of which appear to receive only a very few fibers. On the contrary, the motor cortex projects to some sensory nuclei of the cranial nerves such as the main sensory and spinal nuclei of the trigeminal nerve, the lateral and inferior vestibular nuclei and the nucleus of the solitary tract.

3. The motor cortex sends fibers profusely to the reticular formation and the nuclei pontis, and to a lesser degree to the gracile and cuneate nuclei.

4. The corticospinal tract is composed of the crossed and uncrossed lateral pyramidal tracts, and the crossed and uncrossed ventral pyramidal tracts. The crossed lateral pyramidal tract can be traced as far as the caudal end of the spinal cord, while the uncrossed terminates at the level of the third lumbar segment. The uncrossed anterior pyramidal tract reaches the levels from the third cervical to the second thoracic segment, but the crossed ends at the level of the third cervical segment.

5. The corticospinal tract sends fibers to the dorsal horn, the nucleus dorsalis, the intermediate zone and the lateral horn, but sends scarcely any fibers to the ventral horn and the substantia gelatinosa.

6. The corticobulbar and corticospinal tracts contain more numerous ipsilateral fibers than is generally thought. Moreover, it should be mentioned that very few crossed fibers appear to recross the midline and end in the dorsal column nuclei and the dorsal horn of the operated side.

7. The projection fibers from the motor cortex are generally classified into the pyramidal and the cortical extrapyramidal tracts. However, it is regarded as impossible to distinguish morphologically between these tracts.

This work was aided by grants from the Ministry of Education for Scientific Rcsearch, for which the authors wish here to express their deepest thanks.
THE ANACLITIC DRUG‐PSYCHOTHERAPY —A synthesis of psychoanalysis and high dose drugtherapy—*
Authors: Nishizono Masahisa
Published: March 2008

Summary

Psychopathological states are said to be rooted in frustrated personality development through distorted childhood experiences, which is psychoanalytically designated as fixation. I assume that the nature of the fixation is essentially psychophysiological, and thus a purely psychological maneuver such as psychotherapy alone is not effective in some cases. An integrative approach on the basis of psychophysiological standpoint, however, can easily induce therapeutic regression and assist the movement in treatment. According to this thesis, I instituted “Anaclitic Drug‐psychotherapy” by administrating high doses of Levomepromazine and psychoanalytically oriented psychotherapy as well as anaclitic nursing. Many of the patients who had not responded to various psycho‐ and drug‐therapies in the past were helped by this therapy, even though this did not happen in the same fashion. Those who had a high tolerance for Levomepromazine, which is a strong neuroleptic, did not respond so readily. This phenomenon also indicates the psychophysiological nature of fixation.
AN AUTOPSY CASE OF CHRONIC DISSEMINATED ENCEPHALOMYELITIS COMPLICATED BY BEHCET'S SYNDROME, WITH SPECIAL REFERENCE TO THE DEMYELINATING DISEASES
Authors: Totsuka Shiro , Matsumoto Yutaka , Tanikawa Kyuichi
Published: March 2008

Summary

An autopsy case of chronic disseminated encephalomyelitis has been examined. The relevant history extended over a period of six years, and was characterized by recurrent exacerbations and remissions, primarily of the brain stem symptoms. The clinical picture resembled that of multiple sclerosis, but was accompanied by Behqet's syndrome during the later course of the illness. The differential diagnosis of this case has been discussed with special reference to the demyelinating diseases and the central nervous system complications of Behqet's syndrome.

A man of 26 years of age experienced onset of his illness with intermittent twitchings of both legs, and four years later he developed double vision, dysarthria, nystagmus, blurred vision, constipation, urinary retention, and disturbed gait. Mentally, he was euphoric with occasional pathological laughing and weeping. These symptoms and signs fluctuated frequently and were accompanied by intermittent high fever of unknown origin, purulent erythematous papules, and both labial and scrotal ulcers. Terminally, he became dyspneic and expired in a comatose state.

Neuropathologically, the main lesions were confined to the brain stem, but were also widespread from the diencephalon to the spinal cord, and to the optic nerve. They corresponded well with the clinical picture mentioned above. Histologically there were poorly defined perivascular foci of demyelination, especially those in the white matter being confluentially disseminated. Perivenous spaces in the lesions were remarkably dilated and laden with numerous fat granule cells, and glial fibers proliferated in varying degrees. Except for certain circumscribed areas, inflammatory cell infiltrations in demyelinated foci of long‐standing were absent. Both nerve cells and neuroaxons in the foci, on the other hand, were comparatively well‐preserved. In the severely damaged ireas swelling and fragmentation of the axons were observed. In the spinal cord, the lateral pyramidal tracts showed a marked secondary degeneration bilaterally with corresponding gliosis. In Goll's tracts, symmetrical demyelination was found, which might indicate a systemic degenerative process.

The above‐mentioned pathoanatomical findings suggest that the present case may belong to the category of demyelinating encephalomyelitides in a broad sense. The central nervous system involvement in the fatal cases of Behset's syndrome have not often been reported in the literature. To the best of our knowledge the present case demonstrates some unusual clinico‐pathological features.
TWO CASES OF ATYPICAL SPINAL PROGRESSIVE MUSCULAR ATROPHY (Lumbosacral Leg‐Thigh Type) A Clinicopathological Study with the Survey Of the Relevant Literature
Authors: Okumura Nikichi , Terao Akira
Published: March 2008

Summary

The case histories and anatomic alterations of two patients with the lumbosacral leg‐thigh type of spinal progressive muscular atrophy are presented. The course of the diseese was very rapid, and the patients died of bulbar palsy in 7 months (first case) and 18 months (second case), respectively.

Cutaneous sensation was normal and pyramidal signs were not elicited in both cases. Electromyogram and biopsy specimens showed characteristic changes of lower motor neuron damage. Pathological examination revealed degeneration of the anterior horn cells with marked decrease in their numbers and demyelination of anterior roots. The giant pyramydal cells of Betz and pyramydal pathways were, nevertheless, intact. The second case generally demonstrated myasthenic syndrome clinically, and dystrophic changes of muscle fibers on pathological studies.

There have been three clinical pictures simulating the lumbosacral leg‐thigh type of spinal progressive muscular atrophy. They are all atypical amyotrophic lateral sclerosis; the leg‐thigh form without spastic phenomena (Kahler, 1884), the pseudo‐polyneuritic form (Marie et Patrikios, 1918), and the peroneal form (Hemmer, 1951). Their characteristic findings were compared clinicopathologically with our two cases.
A NEW METHOD OF EEG ANALYSIS AND ITS APPLICATION TO THE STUDY OF SLEEP
Authors: Koga Einosuke , Arai) N. , Asahina) K.
Published: March 2008

a) In the course of our polygraphic study of sleep, a new method of EEG analysis was developed. As the result of a simple modification of the ordinary Walter type frequency analyser. we succeeded in obtaining a compact and easily observable record showing the long time variation of the integrated values of each band respectively.

b) The application of this method to the study of sleep EEG opened a new aspect.

1. The most remarkable feature of this analysis is the undulatory fluctuation of relatively long time in the low frequency component (long undulatory fluctuation), especially in 1–2 cps band. In general, one sleep cycle is composed of a few of these undulatory fluctuations repeatedly appearing and the state of slight fluctuation mainly corresponding to the paradoxical phase. This long undulatory fluctuation corresponds to successive sleep phases in certain rule. The gradual change appearing at the time of a shift from the moderate phase to the deep phase is characteristic.

2. Generally the crest of the highest of these undulatory fluctuations during successive sleep cycles is highest at the first cycle and tends to decrease toward morning. The increasing slope is steepest at the first cycle and gentler toward morning.

3. During the ascending stage of this undulatory fluctuation the gross body movements are very few and in the other periods are relatively many. Most of the abrupt decreases of the integrated values of the low frequency band are accompanid by gross body movement.

This report is dedicated to Professor Haruo Akimoto, Director of the Department of Neuropsychiatry, Faculty of Medicine, University of Tokyo, in commemoration of his sixtieth birthday.

This study was carried out with the earnest cooperation of C. Sasaki, B.A. and N. Nagamura, M.A. We are much indebted to Mr. K. Akagi of San'ei Instrument Ltd. for the technical support.
THE AGE OF ONSET OF CHILDHOOD SCHIZOPHRENIA
Authors: Makita Kiyoshi
Published: March 2008

Summary

The aim of this article based on a pilot study of 50 schizophrenic children under the age of 15 is to point out that the onset of schizophrenic disorders tends not to occur in late childhood between ages 5 and 10. This gap of incidence pertinent to the age of onset may serve to raise two important questions, namely (1) whether or not we are dealing with the same entity and (2) why schizophrenic disorder does not manifest itself in this particular period if we assume that we are dealing with schizophrenia. Although the present knowledge does not answer those questions, it was shown that the periods of vulnerability for schizophrenic disorder are those in which massive qualitative changes occur in biological as well as in psychological and sociological equilibriums.

In addition, it was suggested that the term “childhood schizophrenia” should be used to denote earlier schizophrenic manifestation with regression other than such specific types described by Kanner or Mahler, since it is likely that there is no childhood schizophrenia with an onset in late childhood that could be correctly called “schizophrenia in older children”. Prepubescent and pubescent schizophrenia may not deserve to be called “childhood schizophrenia” for it does not have any unique features and could be understood merely as an antecedant appearance of adult schizophrenia.
NARCOLEPTIC SYNDROME AND PARADOXICAL SLEEP
Authors: Suzuki Jirô
Published: March 2008

Summary

In order to elucidate the mechanism of the narcoleptic syndrome, the course of all‐night sleep was investigated by means of poly graphic methods or by using inducing stimuli. Further study on each symptom was performed in relation to the sleep mechanism using similar methods. Thirty‐three cases of typical narcolepsy were examined. The results from these studies are summarized as follows.

1. The paradoxical phase of sleep occurs immediately after sleep onset in the natural nocturnal sleep of narcoleptics. The proportion of sleep time spent in the paradoxical phase (30%) in narcoleptics is higher than in normals, whereas that of the deep sleep stage is lower.

2. In narcolepsy, hypnagogic hallucination and sleep paralysis appear mostly during the paradoxical phase. During these episodes the level of cerebral vigilance ascends temporarily but slight differences are found between these two episodes. The responses to the stimuli (auditory evoked response, the H reflex and the knee jerk) are similar to those in normals in each stage of sleep.

3. Chlorpromazine, being effective against hypnagogic hallucination and sleep disturbance, stabilizes a night's sleep and prolongs the duration of deep sleep and the paradoxical phase. Imipramine with a suppressing action on cataplectic attack, inhibits the occurrence of the paradoxical phase at sleep onset and diminishes the following paradoxical phases, accompanied by a decrease of hypnagogic hallucination.

4. The level of wakefulness tends to descend easily in narcoleptics. In sleep attacks, the subjects fall rapidly into the paradoxical phase from alert or drowsy state. Both sleep attacks and a tendency to fall asleep are apt to occur periodically in the daytime with lucid intervals.

5. A cataplectic attack closely relates to the paradoxical phase. During the episode, a great discrepancy is found between hypofunction of the arousal system and function of the motor and autonomic systems. Cataplectic occur frequently concomitant with the sleeping‐waking rhythm.

6. Fundamental disorders of narcolepsy are considered as follows: the abnormal occurrence of the paradoxical phase of sleep, the tendency to fall asleep easily, the sleep cycle through night and day and the remarkable dissociation of the arousal system from the motor or autonomic systems. Accordingly, disorders in the sleep‐wakefulness regulating mechanisms are found. Dysfunction of the brain stem reticular formation, especially in the pons, and disturbances of the interrelationship among them are discussed.
A PROPOS DE LA PHARMACOLOGIE DES ANTIDEPRESSEURS (PHARMACOLOGIE COMPAREE DU MEFEXAMIDE ET DE L'IMIPRAMINE)
Authors: Kurihara Masanao , Nakajima Hiroshi
Published: March 2008

Summary

A battery of laboratory tests was proposed for the purpose of examining antidepres‐sive properties of various psychotropic drugs. In this paper, the pharmacodynamic action of imipramine and mefexamide, a new antidepressive derivative of aryloxyacetic acid, was studied in reference to the biogenic amines, on the following items:

1. Antagonism to blephaloptosis due to reserpine (rabbit) and tetrabenazine (rat).

2. Potentiation of hyperthermia evoked by LSD‐25 and noradrenaline.

3. Effect on the convulsion threshold due to demegride under the influence of reserpine.

4. Modification of EEG.

5. Potentiation of narcosis.

Pharmacodynamics of imipramine are fairly complex, and have some pharmacological similarities to the precursors of biogenic amines, such as DOPA and 5‐HTP in one aspect, and to various psychotropic drugs, such as amphetamine, cocaine, anti‐cholinergic drugs and phenothiazine derivatives, in other aspect. Although imipramine is one of the most effective antidepressive drugs, it causes some inconvenience as anxiety manic change of mood, neurological symptoms and so on.

The pharmacological actions and clinical effects of mefexamide are limited compared with imipramine, but it was suggested that mefexamide can be used as an effective antidepressive drug in mild depressive patients, because of the lack of anxiety symptoms.
FOURTEEN AND SIX PER SECOND POSITIVE SPIKES —A Further Consideration of the Clinical Significance of This Pattern and Some Comments for Recording and Interpretation—
Authors: Takahashi Takeo
Published: March 2008

Summary

From the analysis of 230 cases with 14 and 6 per second positive spikes, the following was found:

1) Fourteen per second positive spikes were commonly found in young individuals, whereas 6 per second positive spikes were commonly found in aged individuals. Unusually fast frequency components of positive spikes (18–28 per second) were seen in 9 cases, all less than 17 years of age.

2) The appearance of positive spikes was more common over the right hemisphere (84 cases) than over the left hemisphere (46 cases). Focal EEG abnormalities other than positive spikes tended to appear in the hemisphere where positive spikes were not seen. Two out of 10 cases which showed consistent lateralized positive spikes in serial records had hemiparesis and showed voltage suppression over the hemisphere where positive spikes were not seen.

3) Epilepsy (93 cases), particularly autonomic epilepsy (51 cases) was most frequently found.

4) The frequent occurrence of a history of head trauma (95 cases) was presumed to be the most common etiology of positive spikes.

5) Mecholyl tests done in the 24 cases showed 15 S‐type, 8 N‐type and 1 P‐type. The above results were discussed. In addition, some techniques for recording positive spikes were also presented and the interpretation of positive spikes was described.
SOME OBSERVATIONS ON THE BASIC EEG RHYTHM OF EPILEPTIC PATIENTS IN TERMS OF AUTOCOR‐RELOGRAMS, FREQUENCY SPECTRA AND FREQUENCY RESPONSES
Authors: Mochizuki Junji
Published: March 2008

Summary

A study was done on autocorrelograms of EEGs obtained numerically by a simplified method (Sato et al. 1962), their frequency spectra and frequency response activities of two petit mal and ten grand mal patients.

Autocorrelograms of the EEGs of petit mal patient in the occipital, parietal and temporal regions showed relatively regular oscillation of about 10 cps, not distinctly different from those of normal adults demonstrated by Yuzuriha (1960) and Sata (1963, 1965). The situation, of course, was the same in their frequency spectra. On the contrary, irregular fluctuations were observed in the autocorrelograms of grand mal patients and the predominant peaks were observed in their frequency spectra in the frequency range slower than 10 cps, whereas peaks at about 10 cps were not so dominant. In some instances, peaks also appeared at frequencies higher than 10 cps.

Multimodal frequency response activities were induced by rhythmic flash stimulation of 1–20 or ‐30 cps in the petit and grand mal patients. These peaks were not located at the same frequency as the peak in the frequency spectra of the EEG from the same region of the same patient, but, rather, the predominant activity was enhanced in many instances at a frequency lower than that of the dominant peak in the frequency spectrum.

It was verified in the grand mal patients that slow wave activity was driven in the frequency response in the occipital region and a similar tendency was also shown in the parietal and frontal regions. In addition, fast activity was also driven slightly.
FLUCTUATION OF OPTIC: EVOKED POTENTIALS DURING CONDITIONED AVOIDANCE BEHAVIOR IN CATS: EFFECTS OF ATTENTION AND DISTRACTION ON PRIMARY EVOKED POTENTIALS
Authors: Ikeda Terutika
Published: March 2008

Summary

Seven cats with chronically implanted electrodes were trained to learn conditioned avoidance behavior, and changes of the cortical evoked potentials to repetitive optic nerve stimulation during that behavior were observed in two experimental situations; (1) CS was buzzer and (2) CS was the optic nerve stimulation itself. And the changes were compared in the same animals.

(1) Repetitive stimulation of the optic nerve was capable of becoming the conditioning signal which induces the cat to perform the avoidance movement. Even with 1 c/sec. stimulation, the cat was able to respond to it within 5 seconds.

(2) Grouped facilitations of the evoked potentials intermittently appeared during conditioned behavior. Except for the initial augmentation of the potentials following the onset of CS, there was no distinct difference between the two experimental situations. The initial augmentations were associated with the startle or orientation reflex of the animal and, when buzzer was used as a CS, their latencies were shorter than in the case in which optic nerve stimulation was used as a CS. Whether buzzer or optic nerve stimulation was used as a CS, augmentations of the evoked potentials were highly associated with the animal's aroused behaviors; startle, looking around, intention to move, etc.

(3) A comparison was made of the evoked potentials during successful and failed avoidance behaviors with optic nerve stimulation as CS. Mean amplitude of the responses in avoidance group was greater and the variability of the responses was smaller than in non‐avoidance group.

On the basis of the above data, it is considered that the fluctuation of the primary cortical evoked potentials to optic nerve simulation might be related with nonspecific arousal level of the animal rather than sense‐modality‐specific attention effect.
A COMBINED TECHNIQUE OF HISTOCHEMISTRY, MICRO‐DISSECTION AND THIN‐LAYER CHROMATOGRAPHY APPLICABLE TO LIPID STORAGE DISEASES
Authors: Austin James H. , Yokoi Susum
Published: March 2008

Summary

A procedure is noted in which histochemical and microdissection techniques arc combined with thin‐layer chromatography. Representative results are illustrated for distended ganglion cells in a controlled study of human cerebral cortex. Diseases chosen as examples are Tay‐Sachs' disease, gargoylism and metachromatic leukodystrophy.

Factors are discussed which aid or interfere with the application of this kind of approach to the study of cerebral cortex in some lipid deposition diseases.
SECRETION OF HUMAN GROWTH HORMONE DURING INSULIN COMA AND ELECTROSHOCK THERAPIES
Authors: Takahashi Kiyohisa , Takahashi Saburo , Honda Yutaka , Shizume Kazuo , Irie Minoru , Sakuma Maki , Tsushima Toshio
Published: March 2008

Summary

The responses of plasma HGH during psychiatric shock therapies were investigated, and the mechanisms of HGH secretion and of shock therapies were discussed.

1. The response following a sinall dose of i.v. insulin administrotion.

a) The plasma HGH following 0.1 U/kg of i.v. insulin in schizophrenic patients showed marked elevation in six out of seven cases. It reached to the peak value of 30.4±9.2 mμg/ml between 60 and 90 minutes after i.v. insulin.

b) This type of response was not affected by the various psychotropic drugs that were administered orally in controlling the mental symptoms of the patients.

c) Intramuscular injection of chlorpromazine (30–50 mg) did not alter the pattern of the plasma HGH response.

2. Insulin coma therapy

a) A marked elevation of plasma HGH level was observed in all cases of schizophrenia during insulin coma therapy. The peak value was 9–32 mμg/ml (average 22.6±8.1 mμg/ml).

b) A tendency of delay in reaching the peak value was observed in the determination performed in the second week of coma days as compared to the initial determination in the early days of insulin coma. A tendency was observed that better therapeutic results were correlated with the absence of or decrease in the delay in reaching the peak value in the course of insulin coma therapy.

c) The protracted insulin coma was associated with the marked decrease in the magnitude of the peak value of plasma HGH as compared to the initial determination, suggesting the presence of a fatigued state of the central mechanism regulating the secretion of HGH.

3. Electroshock therapy

a) Elevation of the plasma HGH level was observed after electroshock therapy in five of six cases of schizophrenia. A non‐responsive case was found to be moderately obese. A case of depression and a case of atypical psychosis lacked HGH response after EST in the absence of obesity.

b) The peak value after the electroshock therapy was lower than the one during insulin coma therapy or after administration of a small dose of i.v. insulin. The average peak value after EST was 8.1±6.8 mμg/ml.

c) The responsivity of plasma HGH was found to be unrelated to the various prernedications, such as i.v. thiopental and succinylcholine chloride. It was also concluded that the presence or absence of generalized convulsion was not related to the responses of HGH following EST.

d) No correlation was found between the changes of blood sugar level and the type of plasma HGH responses following the EST.

It was suggested that the elevation of HGH at the time of electroshock therapy was induced by the direct electric stimulation of the hypothalamic center, but the effect of stimulating the HGH secretion was much lower than that induced by the insulin coma or i.v. insulin administration.
SWITCH‐OFF BEHAVIOR AND ELECTRICAL STIMULATION OF THE PONS IN CATS
Authors: AOKI Isao , NAKAO Hiroyuki
Published: March 2008

Electrical stimulation of certain areas in the brain stem and limbic system induces an averting drive in animals. These areas lie in the midbrain2,6,7,8), hypothalamus1,5,9,10), thalamus8,11), and hippocampus3). Yet the pons has not been studied from a motivational standpoint.

The aim of the present experiments is to investigate whether electrical stimulation of the pons induces reinforcement of the switch‐off behavior5,6), an escape learning, in cats.
ELECTRON MICROSCOPIC OBSERVATIONS OF EARLY CHANGES IN THE VENTROMEDIAL HYPOTHALAMUS OF THE MOUSE FOLLOWING GOLDTHIOGLUCOSE*,†,‡
Authors: MORI Atsuyoshi , PERRY John H.
Published: March 2008

The lesion of the ventromedial region of the mouse hypothalamus which results from a single parenteral injection of goldthioglucose, has been studied at both light3,7,12,15.,18,27) and electron microscope levels13). There is evidence from distribution studies following injection of labeled goldthioglucose23), and neutron activation of sections of the hypothalamus of mice treated with the unlabeled compound4,5) which indicates that the drug enters the neural compartment rapidly. Existing studies13) with the electron microscope following goldthioglucose administration are limited to 12‐and 96‐hour post‐injection intervals. The present experiments were undertaken to ascertain the ultrastrctural changes evident in the ventromedial nucleus of the hypothalamus at closely spaced time intervals during the first 24 hours after treatment with the compound.