Optic nerve sheath meningiomas. Role of MR imaging

Optic nerve meningiomas usually are seen in middle-aged and elderly women, and present as a slowly progressing axial proptosis and loss of vision. CT and MR imaging are the most valuable diagnostic tools to evaluate these tumors. This article reviews the MR imaging and CT characteristics of optic nerve sheath meningiomas and discusses features that may distinguish optic nerve sheath meningiomas from simulating lesions.

Age-related changes in the level of urinary myelin basic protein-like material during childhood

OBJECTIVE

To examine the developmental profile of myelin basic protein-like material (MBPLM) in urine. If urinary MBPLM exhibits a developmental profile corresponding to that of forebrain myelination, certain inferences should follow deviations from normal. Thus, MBPLM might provide a marker for monitoring the neurodevelopmental status in infants at risk for adverse outcomes.

BACKGROUND

MBPLM in different immunochemical forms is detectable in human CSF and urine, presumably a result of myelin basic protein (MBP) catabolism. Urinary MBPLM has been used successfully as a marker of disease status in adults with MS. Urinary MBPLM increases in MS patients changing from a relapsing-remitting to a progressive course, possibly reflecting attempted or failed remyelination. Scant information exists concerning the presence or specific levels of urinary MBPLM during infancy and childhood when myelination is most active.

METHODS

MBPLM was assayed in 402 urine specimens from 398 infants and children ranging in age from birth to 17 years according to previously described methods.

RESULTS

MBPLM is detectable in urine from newborns, although at substantially lower levels than in adults (157.3 +/- 83.9 ng/mg creatinine). Whether expressed as nanograms per milliliter urine or nanograms per milligram creatinine, MBPLM levels are lower (p < 0.05) from birth through 12 months and greater (p < 0.05) between ages 2 to 8 years than in adults.

CONCLUSION

Human urinary MBPLM exhibits a developmental profile that parallels the onset of normal myelination and exceeds normal adult values through early childhood. Thus, urinary MBPLM could serve as a useful marker of myelination in the developing child.

Correlates of prescription and over-the-counter medication usage among older Mexican Americans: the Hispanic EPESE study. Established Population for the Epidemiologic Study of the Elderly

OBJECTIVES

To determine the prevalence rates of prescription and over-the-counter (OTC) medication usage among community-dwelling older Mexican Americans.

DESIGN

Cross-sectional survey of a regional probability sample of older Mexican Americans.

SETTING

The 1992-1997 Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE), a probability sample of noninstitutionalized Mexican Americans, age 65 and over, living in the five Southwestern states of Texas, New Mexico, Colorado, Arizona, and California.

PARTICIPANTS

2899 persons, age 65 and over, considered Mexican American, using appropriate weighting procedures to produce regional estimates.

OUTCOME MEASURES

Use of prescription and OTC medication within the last 2 weeks before the survey confirmed by in-home review of medication containers.

RESULTS

Medication users consumed a mean of 2.9 prescription and 1.3 OTC medications. Over half (58.9%, n = 1,798) of the participants used at least one prescribed medication, and 31.3% (n = 847) used at least one OTC medication within the 2 weeks before their participation in the study. Factors associated with both prescription and OTC medication usage were self-perceived health and number of co-morbid conditions. Factors associated only with prescription medication usage included female gender, alcohol usage, ADL dependency, and presence of additional insurance. Structural assimilation was associated only with OTC medication usage.

CONCLUSIONS

These data show lower prevalence rates of prescription medication usage among Mexican American older men and lower rates of OTC medication usage in older Mexican Americans of both genders than previously reported in other ethnic groups. This may reflect differences in time and geographic location of the Hispanic EPESE relative to other EPESE studies, ethnic differences in access to care as reflected by insurance in addition to Medicare, ethnic differences in survival, especially among males, or ethnic differences in medication preferences.

Impact of psychosocial factors on health outcomes in the elderly. A prospective study

One hundred and thirty-five initially healthy men and women older than 65 years of age were studied prospectively to identify factors associated with health outcomes. At study onset, measures of personality, social interaction, and health locus of control were obtained while participants were still healthy. A reliable health outcome measure was developed, based on the annual objective coding of morbidity. Correlations between variables showed significant associations between age, a less independent personality trait, and poor health outcomes. Anxiety and low levels of social interaction were associated with poor health after 8 years. Gender and health locus of control were not significantly related to health outcomes. A path analysis showed significant direct paths between age and trait anxiety and 8-year health outcomes, and indirect paths between anxiety and extroversion and 8-year health, by way of social interaction. There was no evidence that social interaction mediated the effects of either anxiety or extroversion on health. The structure of psychosocial characteristics of the healthy elderly sample was revealed in the pattern of correlations between personality, social interaction, and locus of control.

Fat and carbohydrate metabolism during exercise in elderly and young subjects

We evaluated the effect of aging on fat and carbohydrate metabolism during moderate intensity exercise. Glycerol, free fatty acid (FFA), and glucose rate of appearance (Ra) in plasma and substrate oxidation were determined during 60 min of cycle ergometer exercise in six elderly (73 +/- 2 yr) and six young adults (26 +/- 2 yr) matched by gender and lean body mass. The elderly group was studied during exercise performed at 56 +/- 3% of maximum oxygen uptake, whereas the young adults were studied during exercise performed at the same absolute and at a similar relative intensity as the elderly subjects. Mean fat oxidation during exercise was 25-35% lower in the elderly subjects than in the young adults exercising at either the same absolute or similar relative intensities (P < 0.05). Mean carbohydrate oxidation in the elderly group was 35% higher than the young adults exercising at the same absolute intensity (P < 0.001) but 40% lower than the young adults exercising at the same relative intensity (P < 0.001). Average FFA Ra in the elderly subjects was 85% higher than in the young adults exercising at the same absolute intensity (P < 0.05) but 35% lower than the young adults exercising at a similar relative intensity (P < 0.05). We conclude that fat oxidation is decreased while carbohydrate oxidation is increased during moderate intensity exercise in elderly men and women. The shift in substrate oxidation was caused by age-related changes in skeletal muscle respiratory capacity because lipolytic rates and FFA availability were not rate limiting in the older subjects.

Genetic and biochemical dissection of transgenic RNA-mediated virus resistance

RNA-mediated virus resistance has been observed in transgenic plants at varying frequencies, suggesting that a nuclear requirement or other pre-condition must be met. This study was undertaken to characterize genetically transgenes that confer a highly resistant state to infection by tobacco etch virus (TEV). Transgenic tobacco line 2RC-6.13, expressing an untranslatable mRNA containing the TEV coat protein open reading frame, had three distinct transgene integration events that segregated as two linkage groups. A genetic series of plants that contained zero, one, two, or all three transgene inserts in both homozygous and heterozygous conditions was produced and examined. Genetic and biochemical data suggested that RNA-mediated virus resistance is a multigenic trait in line 2RC-6.13; three or more transgenes were necessary to establish the highly resistant state. One or two transgene copies resulted in an inducible form of resistance (i.e., recovery). Transcription rates and steady state RNA levels of the transgene-derived transcript present in different members of the genetic series supported a post-transcriptional RNA degradation process as the underlying mechanism for transgene transcript reduction and virus resistance. This degradation process appeared to initiate via cleavage of specific sites within the target RNA sequence, as determined by RNA get blot and primer extension analyses of transgene-derived mRNA from various transgenic plant lines.

Lightning and electrical injuries: neuro-ophthalmologic aspects

Lightning and electrical injuries have widespread manifestations involving almost all organ systems of the body, including the central nervous system (CNS) and the eye. This article considers the neuro-ophthalmologic effects of lightning and electrical injury.

RNA-mediated resistance with nonstructural genes from the tobacco etch virus genome

Sense RNA-mediated virus resistance has been described for transgenic plants expressing potyviral capsid protein sequences. This study was undertaken to determine if expression of other viral sequences could induce this type of virus resistance. Plants showing highly resistant or 'recovery' phenotypes were generated by expressing the tobacco etch virus (TEV) 6 kDa/21 kDa reading frames. Expression of translatable or untranslatable versions of this TEV sequence produced resistant lines. Highly resistant and recovery phenotype plants expressing TEV coat protein sequences. High transcription rates with low steady-state levels of the transgene transcript generally correlated with resistance. During recovery and induction of the resistance, RNA and protein steady-state levels decreased 5- to 20-fold, while transcription of the transgene continued at a similar level. A posttranscriptional, cellular system eliminating sequences contained in the transgene transcript and viral genome would be consistent with the results.

Circadian body temperatures and the effects of a cold stress in elderly and young subjects

To determine whether there is a decrement in normal resting body temperature with age, 11 healthy elderly and 11 young adults were studied together for 48 h in warm (21 degrees C) ambient conditions. The resting levels and daytime rhythms of urine and oral temperature were similar, but night-time body temperature fell to a lower value in the young. There were time-of-day effects of increasing skin temperature and metabolic rate in both groups with resting levels higher in the young. After 6 h in cold (6 degrees C) conditions, core (urine) temperature fell by 0.4 degrees C in the elderly subjects but was maintained in the young, and the rise in blood pressure in the elderly exceeded that in the young. Self-reported arousal, however, increased equally in both groups in the cold.

Mathematical modeling of dendritic growth in vitro

The dendritic branching pattern of cultured hippocampal neurons was analyzed to obtain mathematical parameters that fit the time-dependent growth of dendrites under limited extrinsic influence. Cultured neurons were stained with a non-toxic carbocyanine dye (diO) and pyramidal-shaped neurons that were physically separated from one another were analyzed at post-plating days 1, 2, 3, 4, 6 and 7. The geometric branching pattern of the dendrites was analyzed using a mathematical model that incorporates random effects in the form of a Galton-Watson branching process where splitting of one branch is statistically independent of the splitting of all other branches, and deterministic effects in the form of a parameter that measures the extent to which dense patterns (clusters) or sparse patterns (elongated trees) are formed. The geometric branching pattern of the dendrites was analyzed using a mathematical model that incorporates random and deterministic effects. The model parameters were estimated via the method of maximum likelihood. The data suggest that in vitro basal dendrites grow according to a purely random branching process without pronounced dense or sparse patterns, while apical dendrites tend to form elongated trees with fewer secondary bifurcations. This trend is quantified, and it depends on the culture conditions in which the neurons are grown. The quantitative assessment of various influences on dendritic growth patterns are discussed.

Physician sexual exploitation: Wisconsin in the 1980s

Several factors make 1980s Wisconsin a useful window on the social changes now shaping the response by psychiatry and other medical specialties to patients who accuse physicians of sexual misconduct. The state medical board disciplined 19 such physicians in the 1980s, in contrast to 1 each in the two prior decades, as the state weathered several highly publicized cases in which multiple complainants accused prominent psychiatrists. Wisconsin was one of the first states to enact criminalization (1984) and mandatory reporting (1988) laws. Also, the relatively high number of physicians (3% of the state's psychiatrists) disciplined in the 1980s allows a beginning look at the epidemiology of this problem. Several patterns emerged: 1) Lone complainants who are psychiatric patients face many pressures. Fewer than 25% of successful cases against psychiatrists involved a lone complainant, while all the nonpsychiatrists were disciplined on the basis of a single patient's complaint. 2) More than half of disciplined psychiatrists had regained licensure by decade's end. Neither multiple sexual complainants nor multiple types of complaints seemed to deter relicensure. However, no physician with a criminal conviction has been relicensed. 3) Surprisingly, several connections were noted among offenders, including mentorships, friendships, and therapy relationships. Three disciplined psychiatrists were past presidents of local psychiatric societies. Psychiatrists who had been disciplined were significantly more likely to have been trained under one of the eminent sexual abusers than were other male psychiatrists in the state.

Accutracker II (version 30/23) ambulatory blood pressure monitor: clinical validation using the British Hypertension Society and Association for the Advancement of Medical Instrumentation standards

OBJECTIVE

To assess the Accutracker II (version 30/23) ambulatory blood pressure monitor by nationally agreed protocols in order to resolve previous conflicting assessments, and to examine the feasibility of combining these protocols into one study.

DESIGN

The protocols of the Association for the Advancement of Medical Instrumentation (AAMI) and the British Hypertension Society (BHS) were used simultaneously.

SUBJECTS

Five normotensive subjects were used to assess interobserver variation; 30 subjects took part in the field evaluation and 85 in the laboratory evaluation. The latter subjects were selected to cover a wide range of blood pressures and differences in arm circumference.

OUTCOME MEASUREMENTS

Classification of device accuracy according to the criteria of the BHS and AAMI protocols.

RESULTS

Among 255 observations the mean +/- SD difference between blood pressure measurements by the Accutracker II and the observers was -2.2 +/- 0.8/-3.5 +/- 0.9 mmHg. There was a small but statistically significant difference between one device and the other two, but all three fulfilled the BHS criteria of 95% of measurements falling within 3 mmHg before and after use. In 30 24-h recordings > 80% of the programmed inflations produced valid recordings. Editing criteria accounted for the majority (55%) of invalid readings; weak Korotkoff sounds, imperfect electrocardiogram signals or movement artefact accounted for the remainder.

CONCLUSIONS

Version 30/23 of the Accutracker II fulfilled the AAMI criteria; using the BHS system, it was graded A for systolic and C for diastolic blood pressure. Although both protocols were readily combined into one study, they do not assess exactly the same aspects of blood pressure measurement. Previous conflicting evaluations could be due to differences in applying the protocols or may result from modifications in production models. Posture may affect the rating given by the BHS protocol. Until there is general international agreement on the method used to validate ambulatory blood pressure monitors, simultaneous use of both the BHS and AAMI protocols is recommended. In future assessments or investigational use of any similar instruments the model used should be described precisely.

Cerebrospinal fluid diversion procedures in pseudotumor cerebri

We reviewed the efficacy of CSF diversion for pseudotumor cerebri (PTC) in patients from six different institutions. Thirty-seven patients underwent a total of 73 lumboperitoneal shunts and nine ventricular shunts. Only 14 patients remained "cured" after a single surgical procedure. The average time between shunt insertion and shunt replacement was 9 months, although 64% of shunts lasted less than 6 months. Shunt failure (55%) and low-pressure headaches (21%) were the most common causes for reoperation. The vision of most patients improved (13) or stabilized (13) postoperatively. However, three who had initially improved subsequently lost vision. Six had a postoperative decrease in vision. Two patients improved in one eye but worsened postoperatively in the other. Four lost vision despite apparently adequate shunt function. Shunt failure with relapse of PTC occurred as late as 7 years after insertion. CSF diversion procedures have a significant failure rate as well as a high frequency of side effects.

Pattern visual evoked potentials in cases of ambiguous acuity loss

Thirty patients were referred to our visual evoked potential laboratory with complaints of profound acuity loss in one or both eyes. However, the objective ophthalmologic findings were normal, including pupillary reaction, and anterior segment and fundus examinations. Transient visual evoked potentials to a 2.3-c/deg sinusoidal grating pattern were found to be present in 26 of these 30 patients. Visual evoked potentials may be used as a measure of afferent pathway integrity.

Clinical methods of goniometry: a comparative study

This investigation compared the reliability and interchangeable use of three currently available goniometers--a universal goniometer, a fluid goniometer, and an electrogoniometer. Three consecutive readings of the active range of movement of the right elbow joint were taken from each of 23 healthy female volunteers; three experienced observers each used each type of goniometer on two occasions. A balanced experimental design was used to eliminate order effects with respect to subject, tester, or goniometer, and a rigid protocol was employed to reduce error due to diurnal or methodological variations. The results show that there are significant differences between the goniometers used, the testers, and the replications. Significant interaction effects also exist between the goniometers and the occasion, the goniometers and the testers, and the testers and replications. The data suggest that the interchangeable use of different types of goniometer in a clinical setting is inadvisable.

The epidemiology of skin tears in the institutionalized elderly

While skin tears are a common occurrence in the institutionalized elderly population, nothing has been written about this problem. We retrospectively studied all incident reports during a 1-year period at a large, urban, long-term-care facility to identify residents with skin tears. The overall incidence of skin tears was 0.92 per patient per year. The incidence rate for females, but not for males, increased significantly with age (P = 0.012). The mean length of the skin tear was 1.9 cm +/- 1.4 (mean +/- SD). Eighty percent occurred in the upper extremities, with the most frequent location being the forearm. Almost half of the skin tears reported had an unknown cause. Wheelchairs and accidentally bumping into an object each accounted for a quarter of the skin tears where the cause was known. Transfers and falls contributed to a lesser extent. Impaired mental status was no more likely to be present in residents experiencing a skin tear than in all nursing home residents. Twenty-four of the 147 residents with skin tears had four or more tears, accounting for 40% of all skin tears reported. Ninety-seven percent of the episodes resulted in no attending physicians' orders other than the standing orders. Future studies should be designed to determine if there are adverse consequences of skin tears and to suggest programs to reduce their occurrence.

A novel EMG/video system for the analysis of movement

A simple movement-analysis system is described which provides a video display of the moving image and an easily-observable EMG signal in the form of a time-synchronized light-emitting-diode (LED) display. Its salient feature is the economic and meaningful way in which both data are displayed simultaneously. Its applications in the field of clinical education and training, in diagnosis, and in rehabilitation are discussed.

Cephalic blood flow correlates of induced headaches

The purpose of this study was to examine the cephalic blood flow patterns of subjects with frequent headaches during a headache induction procedure. Thirty-six subjects with muscle-contraction, migraine, or mixed headache symptoms were exposed to a 1-hr stressor designed to induce a headache while multiple cephalic blood volume pulse amplitude (BVPA) was measured. Thirty subjects reported a headache during the procedure, and the procedure was associated with significant changes in several cephalic BVPA measures. Between-group differences were found for several cephalic BVPA sites and there were significant correlations between induced headache activity and cephalic BVPA measures for most subjects. The results support causal roles for psychosocial stressors and cephalic blood flow in muscle-contraction and migraine headache.

Multiple electrodes for detecting spikes in partial complex seizures

The contribution of various electroencephalographic electrodes in detecting spikes from patients with seizures of suspected anterior temporal origin was prospectively studied with a standard protocol. The following electrodes were studied: International Standard 10-20 positions F7-8 and A1-2, sphenoidal (SP), nasopharyngeal (NP), anterior temporal (T1-2), mandibular notch surface (MNS), and mandibular notch subdermal (MNSD). Twenty patients were recorded of whom 16 demonstrated anterior temporal spikes. There was no difference in the number of spikes detected by SP, MNS, MNSD, or T1-2 electrodes (p less than 0.05); however these electrodes detected significantly more spikes than NP, F7-8, or A1-2. The SP electrode recorded spikes of highest amplitude (p less than 0.05). We conclude that for patients suspected of having seizures of anterior temporal origin, (1) a substantial number of spikes will be missed if only the International Standard electrode system is employed; (2) in comparison to SP electrodes the non-invasive and easily applied MNS or T1-2 electrodes will detect almost all spikes and should be used in outpatient EEG recordings; (3) NP electrodes provide no information that cannot be obtained by more reliable and better tolerated electrodes.

New laws about sexual misconduct by therapists: knowledge and attitudes among Wisconsin psychiatrists

As many as 7% of psychiatrists admit to having sexual intercourse with patients, despite ethical prohibitions going back to the Hippocratic Oath. Emotional damage, reported by 85% to 90% of involved patients, forms part of the justification for this prohibition. Since 1986, therapist sexual misconduct has been a felony in Wisconsin. Under this law, definitions of sexual exploitation include sexual contact as well as sexual intercourse, and non-psychiatric physicians may be defined as "therapists." In May 1988, Wisconsin legislation became effective requiring therapists to report sexual exploitation revealed in treatment. A 1987 survey of 175 members of the Wisconsin Psychiatric Association showed that a majority favored passage of such a law. More than 40% of surveyed psychiatrists have had experience with such cases, and more than half were willing to provide consultation in this area.

Visual evoked potentials to multiple temporal frequencies. Use in the differential diagnosis of optic neuropathy

The usefulness of the visual evoked potential (VEP) in differential diagnosis increases when stimulus parameters such as check size and grating orientation are varied. In this study we varied the stimulation frequency. Temporal frequency-specific abnormalities were compared in three patient categories, including retrobulbar optic neuritis (eight patients), pseudotumor cerebri (11 patients), and thyroid eye disease (seven patients). All patients had minimal clinical evidence of optic nerve damage when tested. A 2.3 cycle-per-degree sinusoidal grating of 55% contrast was phase reversed at either 1 or 4 Hz. The P1 latency of the 1-Hz data and the phase at 8 Hz, the second harmonic of the 4-Hz input frequency, were measured. In retrobulbar neuritis, latency (phase) was severely abnormal at both temporal frequencies. In thyroid eye disease, VEP phase was abnormal at 8 Hz while the P1 latency was normal at 1 Hz. The P1 latency and phase were normal in most cases of pseudotumor cerebri. The results suggest differing mechanisms for damage in compressive vs primary demyelinating neuropathies.

Steady-state visual evoked potentials to asymmetrical contrast

The temporal frequency components in the steady-state visual evoked response (VEP) depend on the method of stimulus presentation; a first harmonic is generated to "on-off" patterns while a second harmonic occurs to both "on-off" and counterphase patterns. This study examined the VEP response in humans to patterns between these two extremes. In the main experiment, a 1 c/d sinusoidal grating was phase reversed sinusoidally at 8 Hz. The DC offset, however, was adjusted such that two different levels of peak contrast occurred during a temporal cycle. Within this context, a counterphase pattern would represent complete contrast symmetry and an "on-off" pattern would represent maximum contrast asymmetry during a temporal cycle. With this manipulation, the a) integrated luminance change; b) local luminance change; and c) total contrast remained constant. Only mean contrast varied. The amplitude of the first harmonic strongly depended on mean contrast. The amplitude and phase of the second harmonic, however, changed little across experimental conditions suggesting a dependence on one or more of the above three listed stimulus attributes which remained constant. In a supplementary experiment, this phase constancy was confirmed using other temporal frequencies.

Correlates of menopausal hot flashes

The purpose of the present study was to examine the relationships of frequency, duration, and intensity of hot flashes with daily stress, ambient temperature, and caffeine, alcohol, and nicotine intake in menopausal women. Ten menopausal women suffering from hot flashes monitored these variables daily for 6 weeks. Intrasubject correlational analyses revealed significant relationships between hot-flash activity and stress for half of the sample; few women exhibited significant relationships between hot-flash activity and other variables. The results are discussed with respect to theoretical implications and treatment strategies.

Alterations in neutrophil superoxide production following piroxicam therapy in patients with rheumatoid arthritis

Twenty patients with classical rheumatoid arthritis were enrolled in a study to determine the effects of piroxicam therapy on neutrophil function as defined by chemotaxis and superoxide anion (O2-) production. T-lymphocyte chemotaxis was also evaluated in these patients. Leukocytes were obtained from these subjects initially, after two weeks of placebo treatment, and subsequently after four and 10 weeks of piroxicam therapy (20 mg, once daily). Responses were compared to simultaneously tested normal controls and to the patient's own cells obtained at the different time points. Studies showed that four and 10 weeks of piroxicam therapy resulted in significantly suppressed neutrophil O2- production in response to phorbol myristate acetate (PMA) and formyl methionyl leucyl phenylalanine (FMLP). O2- production in response to opsonized zymosan was not significantly affected after four weeks of therapy, but was significantly reduced after 10 weeks of therapy when compared to the patient's own cell response after two weeks of placebo treatment. Unlike O2- production, PMN random migration and chemotaxis in response to C5a or FMLP did not differ significantly from normal or untreated patient controls. Analysis of T-lymphocyte migration showed that T-cell random migration or migration to the chemokinetic agent, casein, was not significantly altered by piroxicam therapy. However, when T lymphocytes were tested for chemotaxis in response to lymphocyte-derived chemotactic factor for T cells (LCF), T cell migration was significantly suppressed after 10 weeks of therapy. Furthermore, when T cells from these subjects were cultured for 24 h, random migration was significantly reduced after four and 10 weeks of piroxicam therapy when compared to the patient prior to therapy, and migration in response to LCF was suppressed after four weeks of therapy when compared to normal controls. These data indicate that in patients with rheumatoid arthritis, treatment with piroxicam will significantly suppress PMN O2- production and may also alter the locomotor capacity of T lymphocytes. These actions may contribute to the antiinflammatory effects of piroxicam.

Motion aftereffects associated with pursuit eye movements

Contrary to an earlier report [Anstis and Gregory, Q. Jl exp. Psychol. 17, 173-174 (1965)], we find that the sustained retinal motion caused by tracking a moving target over a stationary grating does not result in a motion aftereffect (MAE) which is equivalent to that resulting from comparable retinal motion caused by actual motion of a grating. The MAE associated with tracking generally occurs in elements falling on areas not previously exposed to retinal motion. It is in the same direction as the previous retinal motion in the display and is apparently an induced MAE caused by a weak, below threshold MAE in the elements stimulating areas that were previously exposed to retinal motion. Based on an analysis of eye movement records, we do not believe that the weakness of the tracking MAE is primarily a function of the poor quality of the tracking eye movements. Other possible reasons for the weakness of the MAE are suggested.

Inherited levator-medial rectus synkinesis

We examined two sisters with lid retraction on adduction, the classic sign of levator-oculomotor synkinesis. In both women, the left eye was involved. No history of trauma or ocular surgery or complaints of diplopia were elicited, and both had good visual acuity and full ocular motility. Each exhibited 2 mm of left upper lid elevation on adduction and 4 to 6 mm of lid elevation on adduction with depression. In one of the sisters, 1 mm of ptosis was present in straight ahead gaze in the involved eye, which increased to almost 2 mm on abduction, but full levator function was observed. Four other family members in three consecutive generations were similarly affected, suggesting an autosomal-dominant mode of inheritance. To our knowledge, this type of isolated levator-oculomotor synkinesis has not been reported previously on a congenital and inherited basis.

Anterior choroidal artery-territory infarction. Report of cases and review

Occlusion of the anterior choroidal artery (AChA) can cause infarction in the posterior limb of the internal capsule. Infarction is less frequent in the thalamus, midbrain, temporal lobe, and lateral geniculate body territories of the AChA. The most common clinical sign is hemiparesis. Hemisensory loss is usually transient but may be severe at onset. Homonymous upper-quadrant anopia, hemianopia, or upper- and lower-quadrant sector anopsia can be present. A homonymous defect in the upper and lower visual fields sparing the horizontal meridian is probably diagnostic of a lesion in the lateral geniculate body in the territory of the AChA. The most common stroke mechanism is small-vessel occlusive disease, predominantly found in hypertensive and diabetic patients, but cardiac-origin embolism also can affect the AChA territory. Two of our patients had infarction after temporal lobe resection for epilepsy. Occasionally patients have associated disabilities of higher cortical function that are usually transient. The lesion should be recognizable by computed tomography.

Use of alternate therapist during pregnancy leave

Women therapists involved in the long-term treatment of severely disturbed patients can be faced with interruptions due to childbearing. In the following cases, use of an alternate therapist during pregnancy-related leaves of absence was helpful in bridging the therapeutic pause and allowed the patients to make significant gains.

Family violence: principles of intervention and prevention

The dispersal of clinical and research information on family violence among many subspecialties has obscured the multidimensional nature of the problem and the need for clinicians in all settings to develop a coherent approach to family violence. Through an interpretive review, the author discusses specific mental health contacts that necessitate the exploration of family violence. Failure to do so may lead to underdiagnosis of dissociative disorders and overdiagnosis of depressive disorders in victims. The author also discusses three types of interventions--verbalization, violence-prevention strategies, and advocacy and support--that are useful with victims, abusers, and other family members as well as with "battered professionals" who handle these cases, and describes a comprehensive intervention program.

Norfloxacin: activity against urinary tract pathogens and factors influencing the emergence of resistance

The activity of norfloxacin was investigated in vitro in conventional minimum inhibitory concentration tests, by continuous turbidimetry and in a mechanical model simulating the hydrokinetic conditions that exist in the treatment of bacterial cystitis. The high activity of norfloxacin against virtually all bacterial pathogens isolated from infected urine was confirmed. However, in urine agar (pH 6 X 5) and in DST agar adjusted to pH 5 X 5, the activity was substantially reduced. Turbidimetric experiments indicated that increases in resistance to norfloxacin could be induced easily by sequential subculture, but results obtained in the bladder model, where conditions of exposure more closely resemble those that exist during the treatment of infection, suggest that such resistance is unlikely to arise commonly during treatment.

Neuro-ophthalmologic signs in the angiitic form of neurosarcoidosis

We studied eight patients with CNS sarcoidosis, including two patients with postmortem evidence of sarcoid granulomatous angiitis. Neuro-ophthalmologic findings included perivenular sheathing of retinal veins resembling the dripping of candle wax, vitreous cells, anterior uveitis, optic disk edema or granulomas, and conjunctival granulomas. Perivenous sheathing in the retina and the perivascular meningeal lesions in sarcoid angiitis were identical.

Identification of trout and salmon bloods by simple immunological technique and by electrofocusing patterns of red cell enzyme superoxide dismutase

Species identification of animal bloods is readily achieved by immunological tests. Differentiation among fish species on this basis is more difficult although considerable success has been achieved on the basis of both inter- and intra-specific differences in their serum proteins. This report describes a method for the identification of the different species of fish within the Salmonidae family and some coarse fish families on the basis of an immunological test and electrofocusing patterns of the enzyme superoxide dismutase from the red cell. The immunological technique relies on the development of a specific anti-trout (Salmonidae) serum which is used initially to differentiate the blood of a Salmonidae from other freshwater fish. Further discrimination, within the Salmonidae, is made on the basis of the different polymorphic forms of the enzyme superoxide dismutase separated in a pH 2.5 to 8 gradient. Using this technique, it is possible to differentiate among salmon, sea/brown trout, char, cheetah trout, and a number of varieties of rainbow trout.

Grandfather - granddaughter incest: a trigenerational view

Grandfather-granddaughter incest accounts for about 10% of all reported cases of intrafamilial childhood sexual abuse. In a sample of 10 such cases, all referrals came from mothers of the child victims; six of these mothers had themselves been abused in childhood by the perpetrator. For eight of the 10 perpetrators, multiple child sexual victims were identified in a pattern that suggests facultative pedophilia. Only two of the 18 grandchildren sexually abused by the 10 grandfathers were asymptomatic at the time of report. Grandchild victims from chaotic families showed educational and behavioral symptoms; those from stable families exhibited fears and phobias. Eight of the 18 grandchildren were victimized by multiple perpetrators. The results cast doubt on the assumption that grandparent incest is a benign form of abuse and indicate that there is some justification for the fears expressed by adult incest victims about visitation between their children and the father-perpetrator.

Self-efficacy expectancies, response-outcome expectancies, emotionally based expectancies, and their relationship to avoidant behavior and its reduction through therapy

Investigated the relationship of four types of expectancy to snake avoidant behavior and its reduction through modeling. Response-outcome expectancies are beliefs about the consequences of a behavior; self-efficacy expectancies are beliefs about one's ability to perform the behavior. Intellectually based expectancies are views of oneself or the world that are perceived to be accurate representations of reality; emotionally based expectancies are views of oneself or the world that may be perceived as inaccurate or irrational by the person who holds them. Experiments I and II investigated the relationship of intellectually and emotionally based versions of both response-outcome expectancies and self-efficacy expectancies to snake avoidant behavior. It was found that all four expectancy variables correlate significantly with behavior on a snake avoidance task. Self-efficacy expectancies are not clearly better predictors of behavior than are response-outcome expectancies. Experiment III found that all four variables are changed as a consequence of modeling. It was concluded that a four-variable expectancy model is necessary to explain avoidant behavior.