The PPARα agonists fenofibrate and CP-778875 cause increased β-oxidation, leading to oxidative injury in skeletal and cardiac muscle in the rat

Weak peroxisome proliferator-activated receptor (PPAR) α agonists (fibrates) are used to treat dyslipidemia. This study compared the effects of the potent and selective PPARα agonist CP-778875 on peroxisomal β-oxidation and cardiac and/or skeletal muscle injury with those of the weak PPARα agonist fenofibrate. We hypothesized that these muscle effects are mediated through the PPARα receptor, leading to increased β-oxidation and consequent oxidative stress. CP-778875 (5 or 500 mg/kg) and fenofibrate (600 or 2,000→1,200 mg/kg, dose lowered because of intolerance) were administered to rats for six weeks. Standard end points, serum troponin I, heart and skeletal muscle β-oxidation of palmitoyl-CoA, and acyl co-oxidase (AOX) mRNA were assessed. Both compounds dose-dependently increased the incidence and/or severity of cardiomyocyte degeneration and necrosis, heart weight, troponin I, and skeletal muscle degeneration. Mean heart β-oxidation (3.4- to 5.1-fold control) and AOX mRNA (2.4- to 3.2-fold control) were increased with CP-778875 500 mg/kg and both doses of fenofibrate. β-Oxidation of skeletal muscle was not affected by either compound; however, a significant increase in AOX mRNA (1.6- to 2.1-fold control) was observed with CP-778875 500 mg/kg and both doses of fenofibrate. Taken together, these findings were consistent with PPARα agonism and support the link between increased cardiac and skeletal muscle β-oxidation and resultant muscle injury in the rat.

SAR and species/stereo-selective metabolism of the sorbitol dehydrogenase inhibitor, CP-470,711

SAR studies on the stereoisomers of CP-470,711 suggested that in vivo epimerization was taking place in rats. Further metabolism studies revealed that no epimerization was occurring in dogs, and that no epimerization was expected in humans. A mechanism for the in vivo epimerization is proposed involving an oxidation-reduction pathway of the secondary benzylic alcohol, in contrast to an acid/base-promoted epimerization of the same center during chemical synthesis.

Orally-effective, long-acting sorbitol dehydrogenase inhibitors: synthesis, structure-activity relationships, and in vivo evaluations of novel heterocycle-substituted piperazino-pyrimidines

Optimization of a previously disclosed sorbitol dehydrogenase inhibitor (SDI, II) for potency and duration of action was achieved by replacing the metabolically labile N,N-dimethylsulfamoyl group with a variety of heterocycles. Specifically, this effort led to a series of novel, in vitro potent SDIs with longer serum half-lives and acceptable in vivo activity in acutely diabetic rats (e.g., 62, 67, and 69). However, the desired in vivo potency in chronically diabetic rats, ED(90) < or = 5 mg/kg/day, was achieved only through further modification of the piperazine linker. Several members of this family, including 86, showed better than the targeted potency with ED(90) values of 1-2 mg/kg/day. Compound 86 was further profiled and found to be a selective inhibitor of sorbitol dehydrogenase, with excellent pharmacodynamic/pharmacokinetic properties, demonstrating normalization of sciatic nerve fructose in a chronically diabetic rat model for approximately 17 h, when administered orally at a single dose of 2 mg/kg/day.

The incredible shrinking brain

A 65-year-old white woman developed progressive visuospatial abnormalities over an eight-year course, secondary to Alzheimer's disease with amyloid angiopathy. Imaging studies demonstrated focal atrophy of the parietal and occipital lobes without hemorrhage. This patient manifested simultagnosia without ocular dysmetria or optic ataxia; hence, a true Balint's syndrome was not present. Her visual acuities and fields have remained stable status post-occipital lobe biopsy.

Apraxia due to a pathologically documented thalamic infarction

We report a pathologically documented case of infarction of the dominant thalamus with extensive involvement of the ventral lateral, ventral posterolateral, and lateral posterior nuclei and some involvement of the pulvinar. This patient exhibited linguistic impairment with features fairly typical for thalamic lesions. He also demonstrated a severe ideomotor apraxia. The preservation of repetition, syntax, and implicit memory despite severe naming deficits in patients with thalamic lesions suggests the possibility that thalamic involvement in cognitive function involves processes underlying declarative as opposed to nondeclarative (eg, implicit or procedural) memory. The occurrence of apraxia with thalamic lesions may be consistent with this hypothesis if it is accepted that only actual tool use approaches a pure skill that involves only nondeclarative memory, while other aspects of praxis implicate declarative memories.

Absence of cortical white matter changes in three patients undergoing long-term vigabatrin therapy

Chronic administration of the experimental antiepileptic drug vigabatrin (gamma-vinyl GABA) to animals has been shown to cause dose-dependent neuropathological changes characterized by a microvacuolation in specific white matter tracts. This finding has led to some concern as to whether similar pathologic changes might occur in patients taking this medication. Here we report on analysis of tissue specimens taken during neurosurgery from three patients undergoing chronic vigabatrin therapy (4 g/day). The first patient, a 34-year-old woman, had taken vigabatrin for 2 years prior to surgery, the second, a 50-year-old man, had taken the drug for 1 year, and a 34-year-old man had taken the drug for 5.3 years. For comparison, similar specimens were taken from three other patients not taking vigabatrin who were undergoing surgery for intractable epilepsy. Specimens from each subject were prepared in an identical manner and examined with light and electron microscopy. All specimens were examined in a blinded fashion. There was some minor nonspecific myelinic splitting seen in both controls and vigabatrin-treated patients but there was no evidence for any drug-induced lesions similar to that seen in experimental animals.

Aluminium intoxication in undialysed adults with chronic renal failure

The dialysis encephalopathy syndrome (DES) consists of altered mental status, communication difficulty, seizures and myoclonus. It has been attributed to elevated serum aluminium (A1) levels. Two undialysed patients with chronic renal failure who presented with the characteristic syndrome are reported. The first, a 48 year old female, had used A1 containing phosphate binders for two years. Her serum A1 level was 25.34 mumol/L. Despite treatment with desferoximine and dialysis, she died. Necropsy revealed elevated A1 levels in the cerebral cortex (19 mcg/gm) and spongioform change in the outer three cortical layers. The second patient, a 46 year old woman, had a serum A1 of 8.70 mumol/L. She had never taken A1 containing phosphate binders but had taken several grams/day of citrate for at least six months. Treatment with haemodialysis and discontinuation of the citrate produced a resolution of symptoms and return of the A1 level to normal. During two years of haemodialysis there has been no recurrence.

Alzheimer's disease and alcoholism: possible interactions

The purpose of this investigation was to test the hypothesis that chronic exposure to alcohol may accelerate Alzheimer's disease (AD), either by independently adding receptor losses or by accelerating the AD disease process itself. Muscarinic [3H]quinuclidinyl benzilate and benzodiazepine [3H]-flunitrazepam receptor binding in homogenates of human autopsy brains were determined in four nonalcoholic and seven alcoholic AD brains and in histologically normal brains from 20 alcoholics and 20 nonalcoholics. Muscarinic binding was decreased in alcoholic AD compared with nonalcoholic AD in the parahippocampal region of frontal cortex, premotor temporal cortex, and amygdala, but not in the hippocampus. Benzodiazepine receptors were lost from the temporal cortex and amygdala, but the difference in the amygdala was not statistically significant. Plaque counts considered a marker of the severity of AD were not increased in the brains of alcoholics compared with nonalcoholics. Larger receptor losses in some alcoholic AD were associated with low plaque counts. Since all of these patients were severely demented, it is tentatively suggested that the receptor losses resulting from alcoholism may have contributed to the dementia in these AD patients.

Insulin-like growth factor I receptor binding in brains of Alzheimer's and alcoholic patients

Patients with chronic alcoholism and/or Alzheimer's disease show degenerative changes in the cerebral cortex and hippocampus. To investigate possible changes in insulin-like growth factor I receptor binding sites in brain tissue of patients with these pathological conditions, the number of 125I-insulin-like growth factor I binding sites was determined in tissues obtained from control patients and those with Alzheimer's and/or with a history of alcoholism. The four experimental groups examined consisted of patients from similar age groups. Postmortem histology and a clinical history were used for the diagnosis of Alzheimer's disease and alcoholism, respectively. Careful clinical records were kept concerning other variables such as immediate cause of death and medications administered before death. Specific binding of 125I-insulin-like growth factor I to homogenates prepared from cerebral cortex of Alzheimer's, alcoholic, alcoholic Alzheimer's, and age-matched control patients was similar, although Alzheimer's patients tended to have slightly higher binding values. No significant differences in insulin-like growth factor I binding in cerebral cortex were found with regard to age of patients, the interval between death and autopsy, and CNS-active medications. No statistical differences in 125I-insulin-like growth factor I binding were noted in hippocampal tissue from the four patient groups. Thus, human insulin-like growth factor I binding sites in cerebral cortex and hippocampus appear unaffected by several variables.

Long-term follow-up of radiotherapy for pituitary adenoma: the absence of late recurrence after greater than or equal to 4500 cGy

Recent literature has suggested that late recurrence of pituitary adenoma after radiotherapy is common. We hypothesized that late failures might be a result of inadequate dose (less than 4500 cGy). To investigate, we analyzed 105 patients treated at our institution between 1965 and 1986 (analysis, 2/89). The minimum observation time was greater than or equal to 5 years in 58% and greater than or equal to 10 years in 30% of the patients. All patients received megavoltage radiotherapy (range, 4200-5500 cGy; mean, 4821 cGy) at a mean dose per fraction of 172 cGy; 100 patients received greater than or equal to 4500 cGy tumor dose. Twenty-nine patients received radiotherapy alone, and 76 had postoperative radiotherapy after frontal craniotomy (20 patients) or transsphenoidal hypophysectomy (56 patients). At presentation, 71% of patients had extrasellar disease, 57% had visual field deficits, and 50% had endocrinopathy. Of patients treated postoperatively, 74% had gross residual disease. Four local failures occurred at 13, 16, 57, and 64 months after postoperative radiotherapy, all within the irradiated volume (tumor doses of 4700, 4715, 5000, and 5100 cGy). All four patients had presented with moderate to extensive extrasellar disease with visual field defects. Two of the four remain free of second recurrence at 7 and 13 years after salvage transsphenoidal hypophysectomy. The local control rate with radiotherapy (product-limit method) at 10 years was 100% in the radiotherapy-alone group and 92% in the postoperative radiotherapy group (95% for all patients). To prevent bias, seven patients who received bromocriptine, none of whom demonstrated a recurrence, were censored from the local control analysis at the initiation of the drug. No patient in this study suffered recurrence greater than 64 months after radiotherapy, with 31 patients (none with bromocriptine) observed 10 to 21 years. We conclude that treatment of pituitary adenoma with greater than or equal to 4500 cGy in 25 fractions can result in a high (greater than or equal to 90%) probability of stable long-term control.

Anatomic examination of a case of open trigeminal nucleotomy (nucleus caudalis dorsal root entry zone lesions) for facial pain

Nucleus caudalis dorsal root entry zone lesions (open trigeminal nucleotomy) are a surgical procedure which can achieve pain control without major complications in the difficult clinical setting of deafferentation-type facial pain. Two patients are reported, who had relief of pain, but also experienced neurological complications. One patient succumbed to pulmonary complications, which provided the opportunity for anatomic analysis of the lesioned area, which is discussed in detail. Potential modifications of the surgical technique are suggested.

Binding of [125I]-insulin-like growth factor-1 (IGF-1) in brains of Alzheimer's and alcoholic patients

Patients with chronic alcoholism and/or Alzheimer's disease suffer from degenerative changes in the cerebral cortex and hippocampus. To investigate possible changes in IGF-1 receptor binding sites in brain tissue of patients with these pathological conditions, the binding of [125I]-IGF-1 was determined in tissues obtained from control, Alzheimer's and/or patients with a history of alcoholism. The four experimental groups examined consisted of patients from similar age groups. Specific binding of [125I]-IGF-1 to cerebral cortical membranes from Alzheimer's patients had significantly more binding sites than age-matched controls, alcoholic patients and alcoholic patients with Alzheimer's disease. Regression analyses indicated that there were no significant differences in [125I]-IGF-1 binding in cerebral cortex with regard to age of patients (1.1% of total variance with a range of 52 to 92 years). Likewise, the time interval between death and autopsy contributed only 1.4% to the total variance in IGF-1 binding. No statistical differences in [125I]-IGF-1 binding were noted in hippocampal tissue from the various patient groups. Thus, human IGF-1 binding sites in cerebral cortex and hippocampus appear to be relatively stable for a number of variables. The increase in cerebral cortical [125I]-IGF-1 binding sites could be due to upregulation of IGF-1 receptors resulting from a decrease in IGF-1 levels in Alzheimer's patients.

The Incidence of Unexpected Pathological Findings in an Image-Guided Biopsy Series: A Review of 100 Consecutive Cases

Despite the widespread availability of image-guided stereotactic biopsy, the need for such procedures in patients with “clear-cut” clinical and radiographic diagnoses is still frequently discussed. In an attempt to ascertain the incidence of unexpected pathological findings, 100 consecutive stereotactic biopsies have been reviewed. Twelve patients were found to have diagnoses of pathological conditions that preoperatively were considered unlikely, or not considered at all. The details of these “diagnostically discordant” cases are discussed.

The incidence of unexpected pathological findings in an image-guided biopsy series: a review of 100 consecutive cases

Despite the widespread availability of image-guided stereotactic biopsy, the need for such procedures in patients with "clear-cut" clinical and radiographic diagnoses is still frequently discussed. In an attempt to ascertain the incidence of unexpected pathological findings, 100 consecutive stereotactic biopsies have been reviewed. Twelve patients were found to have diagnoses of pathological conditions that preoperatively were considered unlikely, or not considered at all. The details of these "diagnostically discordant" cases are discussed.

Loss of muscarinic cholinergic receptors from the temporal cortex of alcohol abusers

It is currently controversial whether all the brain damage in alcohol abusers in the result of thiamine deficiency (Wernicke-Korsakoff's disease) or whether, in addition, alcohol abuse may affect the brain by other mechanisms as well. The purpose of this study was to determine if alcohol abuse affects muscarinic cholinergic and benzodiazepine receptors in histologically normal brains obtained at autopsy in a general hospital population. Patients were excluded from this study if they had clinical brain diseases (including Wernicke's disease), died in coma, or had liver disease, significant brain atrophy, or dementia severe enough to require institutionalization. We found that muscarinic cholinergic synaptic receptor density determined with [3H] quinuclidinly benzilate was decreased by 40% in homogenates of the tempeoral cortex of 26 alcohol abusers compared with 26 matched nonalcoholic controls. The affinities of the muscarinic receptors were not significantly different between the two groups. In contrast, receptor densities and affinities of benzodiazepine receptors determined with [3H]flunitrazepam were not significantly different in the two groups. Age and death-autopsy time interval had no significant effects on either wet tissue protein concentrations, yields of protein after centrifugation, or receptor binding. The contributions of age and time interval were each less than 2% of the total variance of protein concentrations and receptor binding. When patients were excluded or included who had received cholinergic, anticholinergic, or benzodiazepine medications before death, no significant effects on the final results were observed. Pneumonia, known to be associated with acute hypoxia, and chronic obstructive pulmonary disease, known to be associated with chronic hypoxia, where approximately equally distributed between the two groups and had no significant effects on the results reported here. The loss of muscarinic and the sparing of benzodiazepine receptors occurs in the temporal cortex of histologically normal brains in the absence of significant atrophy and of gross dementia. This means that these changes are early in the development of an alcohol encephalopathy. We have previously reported a decrease in both muscarinic and benzodiazepine receptor binding in the frontal cortex and a decreasing muscarinic but not benzodiazepine receptors in the temporal cortex of alcohol abusers. Taken together, these findings suggest that alcohol neurotoxicity does not simply result in a random loss of neurons and or their associated synapses with their receptors. Instead, different types of receptors, depending upon their location in different brain regions, are specifically affected or spared. This suggests the involvement of region- and receptor-specific mechanisms in chronic alcohol toxicity.(ABSTRACT TRUNCATED AT 400 WORDS)

Neuroreceptor changes in the putamen of alcohol abusers

The purpose of this study was to determine if alcohol abuse affects muscarinic cholinergic and benzodiazepine receptors in histologically normal brains obtained at autopsy in a general hospital population. Patients were excluded from this study if they had clinical brain (including Wernicke's) disease, died in coma, had liver disease, significant brain atrophy, or dementia severe enough to require institutionalization. We found that muscarinic cholinergic synaptic receptor density determined with [3H]quinuclidinyl benzilate was decreased by 40% in homogenates of the putamen of 27 alcohol abusers compared with 37 matched nonalcoholic controls. In contrast, receptor densities and affinities of benzodiazepine receptors determined with [3H]flunitrazepam were not significantly different in the two groups. Age and death-autopsy time interval had no significant effects on either wet tissue protein concentrations, yields of protein after centrifugation, or receptor binding. The contributions of age and time interval were each less than 3% of the total variance of protein concentrations and receptor binding. When patients who had received cholinergic, anticholinergic, or benzodiazepine medications before death were excluded or included we observed no significant effects on the final results. Pneumonia, known to be associated with acute hypoxia, and chronic obstructive pulmonary disease, known to be associated with chronic hypoxia, were approximately equally distributed between the two groups and had no significant effects on the results reported here. It is significant that the loss of muscarinic and the sparing of benzodiazepine receptors in the putamen occurs in histologically normal brains in the absence of significant atrophy and gross dementia. It implies that these changes are early in the development of alcoholic encephalopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Loss of muscarinic and benzodiazepine neuroreceptors from hippocampus of alcohol abusers

Thiamine deficiency (Wernicke-Korsakoff's disease) may not be the only mechanism whereby chronic alcohol abuse affects the brain and not all alcohol-related changes may be evident morphologically. The purpose of this study was to determine if alcohol abuse affects muscarinic cholinergic and benzodiazepine receptors in the hippocampus of histologically normal brains obtained at autopsy in a general hospital population. Because patients were excluded who had significant brain atrophy and/or dementia severe enough to require institutionalization, the reported findings are presumed to be early changes in the development of an alcohol encephalopathy. In addition, patients were excluded from this study if they had clinical brain diseases (including Wernicke's disease), died in coma, had liver disease, or received medications that could potentially alter receptor binding. The reported changes in receptor binding were therefore presumed to be related to alcohol abuse per se and not an alcohol-associated condition. We found that muscarinic cholinergic synaptic receptor density determined with 3[H] quinuclidinyl benzilate was decreased by 30% in homogenates of the hippocampus of 25 alcohol abusers compared with 25 matched nonalcoholic controls. Similarly, densities of benzodiazepine receptors determined with 3[H] flunitrazepam were also decreased by approximately 30% in alcohol abusers. The affinities of both receptor types were not affected by alcohol abuse. Age and death-autopsy time interval had no significant effects on either wet tissue protein concentrations, yields of protein after centrifugation, or receptor binding. The contributions of age and time interval were each less than 2% of the total variance of protein concentrations and receptor binding.(ABSTRACT TRUNCATED AT 250 WORDS)

Loss of cholinergic muscarinic receptors in the frontal cortex of alcohol abusers

Alcohol abuse causes impairment of cognitive function ranging from mild forms to end-stage dementia. Alcohol-related dementia accounts for nearly 20% of all admissions to state mental hospitals and may result from head trauma, thiamine deficiency, Alzheimer's, and other brain diseases that can be diagnosed conclusively only at autopsy. However, we postulate that after all these conditions have been excluded, an "alcohol encephalopathy" remains. This is characterized by impaired synaptic function, which underlies the continuum of impaired intellectual function. We found in 79 histologically normal brains of a nondemented general hospital population a 40% decrease in the density of cholinergic muscarinic receptors in the frontal cortex of alcoholics when compared with matched controls of the same age. Only alcohol abuse and not aging, postmortem changes, medications, clinical (including liver) diseases, or differences in causes of death could account for this loss.

The meningioma controversy: postoperative radiation therapy

Total surgical excision is the main goal of therapy for intracranial meningiomas. The controversy today involves the efficacy of postoperative radiation therapy. To evaluate this question, 132 patients with benign intracranial meningiomas, treated between October 1964 and April 1985, were evaluated. All patients had a minimum 2-year follow-up. The actuarial local control rates at 10 years for the three treatment groups were as follows: subtotal excision alone, 18%; subtotal excision plus postoperative radiation therapy, 82%; and total excision alone, 77%. The actuarial determinate survival rates at 10 years were 49%, 81%, and 93%, respectively. Postoperative radiation therapy was also effective for patients treated at the time of the first recurrence, with an actuarial local control rate at 10 years after salvage treatment of 30% for patients treated with surgery alone and 89% for patients receiving postoperative radiation therapy at the time of salvage. This analysis suggests that radiation therapy has a significant role in the treatment of subtotally excised and recurrent intracranial meningiomas.

Decrease of benzodiazepine receptors in frontal cortex of alcoholics

We hypothesize that chronic alcohol abuse results in a loss of neurons and their associated synaptic receptors. This encephalopathy may be a precursor of brain atrophy and end-stage dementia. Autopsies were performed on normal brains of 27 alcoholics (mean age 62.5) and 30 nonalcoholic matched controls (mean age 64.4) free of other brain and liver diseases. None had recently received benzodiazepine medications. Gross brain atrophy was slight and equal in both groups. Benzodiazepine receptor densities and affinities in homogenates of frontal cortex were determined using [3H]flunitrazepam. Bmax specific binding was reduced by 20% in alcoholics compared with nonalcoholic controls of comparable age and with similar death-autopsy time intervals. The affinity was slightly less in the alcoholics. Wet tissue brain protein concentrations and their yields of 50,000-g pellet proteins were similar. Aging, death-autopsy time intervals, pneumonia and chronic obstructive pulmonary disease (diseases usually associated with hypoxia) had no significant effect on brain proteins, receptor densities, or affinities. We conclude that chronic alcoholism is associated with a loss of benzodiazepine receptor densities. Alcohol abuse may affect the results of post-mortem neurochemical investigations of other diseases.

Intramedullary spinal tuberculoma

A case report of intramedullary spinal tuberculomas presenting as cervical myelopathy is described. The rarity of these lesions in North America make this case unique. The use of modern neurodiagnostic and microsurgical techniques as well as the use of postoperative antituberculous drugs resulted in a good outcome. The first known description of magnetic resonance imaging of intramedullary spinal tuberculomas is presented. The gross and microscopic appearances of the lesion are given.

Effects of aging and alcohol on the biochemical composition of histologically normal human brain

Human brains were removed at autopsy and examined grossly and histologically for any abnormality or evidence of disease. Sixty-two brains appearing normal by these criteria were examined further. First, a detailed record of alcohol consumption was obtained. Second, frozen punches of gray and white matter were used to determine the compositional change associated with age and drinking patterns. Increased age was associated with an increase in the water content, particularly in the white matter, a decline in RNA content in gray matter, a decline in total protein in white matter, and a decline in both myelin and the myelin-like subfraction. The loss of myelin membrane in white matter corresponded to a similar increase in water content, although there was an additional loss of some nonmyelin protein. There was no significant shift in the density between the myelin and the myelin-like membranes, and the protein composition of myelin was not significantly altered by age. A history of heavy alcohol consumption was associated with a relative increase in total protein in white matter even though heavy drinking accelerated the age-related loss of myelin. Presumably, alcohol produced a lag in the rate at which nonmyelin proteins are lost or accelerated the accumulation of abnormal protein. Alcohol consumption did not influence the myelin composition or the ratio of myelin and myelin-like membranes. The interval between patient death and autopsy was shown to have little or no effect on the samples used in this study. These data show that normal aging, uncomplicated by other disease processes, can have a significant effect on the composition of brain tissue, particularly the white matter, and that heavy alcohol consumption accelerates degenerative change, even in tissue appearing normal by histology.

Brain heterotopia and anencephaly

This report describes the finding of nodular collections of heterotopic brain tissue in the lungs of a stillborn anencephalic infant. Immunoperoxidase staining was performed on the nodules and on the neural tissue found at the infant's cranial defect, for neuron-specific enolase, glial-fibrillary acidic protein, carcinoembryonic antigen, and epithelial membrane antigen. The nodules were shown to consist of neurons and neuroglia. Epithelium-lined channels within the nodules were shown to have the same staining characteristics as bronchi and bronchioles in the lung, and to be different from ependyma. To our knowledge, ours is the first report of immunoperoxidase techniques being used to objectively characterize the makeup of the lesions in a case of brain heterotopia.

Multiple sclerosis mimicking primary brain tumor

Surgical biopsy specimens of multiple sclerosis plaques have been only infrequently reported, and the scanty descriptions of these specimens have generally emphasized the inflammatory nature of the lesion. We present surgical specimens from four patients with multiple sclerosis on whom biopsies were performed because of clinical features mimicking brain tumor. Both general pathologists and neuropathologists involved with these cases experienced difficulty in arriving at the correct diagnosis. In all four cases, the lesions were remarkably uniform in microscopic appearance, consisting of monotonous sheets of gemistocytic astroglia interspersed by numerous foamy macrophages. In sections stained with hematoxylin-eosin, the most helpful diagnostic features were the even distribution of the foamy macrophages and the absence of associated necrosis. In each case, the diagnosis was confirmed with special stains that disclosed total destruction of myelin sheaths with relative preservation of axons. Significant inflammatory infiltration was present in only one of five biopsy specimens.

Subcortical arteriosclerotic encephalopathy: CT spectrum and pathologic correlation

Because of recent papers suggesting that subcortical arteriosclerotic encephalopathy (SAE) (Binswanger's disease) is more common than historically assumed, this investigation was initiated to assess the frequency of SAE, to gauge the reliability of CT in making this diagnosis, and to assess the strength of the correlation between SAE and arterial hypertension. Of 202 autopsied patients in a 17-month period, 82 had undergone antemortem CT. Of these, 20 had CT findings thought to represent varying degrees of the disease spectrum of SAE. Microscopy confirmed this diagnosis in 18 cases. The pattern of diminished attenuation in the white matter was periventricular in 16 patients (marked asymmetry in one) and limited to an isolated focus somewhat removed from the ependyma in two. Among the 16 with periventricular disease, the extent of the process by CT appeared mild in nine, moderate in five, and severe only in two. There were two false positive CT diagnoses of SAE. Among a control group of 10 patients with normal white matter by CT, seven had some microscopic evidence of SAE, although it was generally less severe than in those with positive CT scans. Subcortical arteriosclerotic encephalopathy is common and can be identified in its various forms by CT with a high degree of reliability.

Anatomical, cellular and molecular analysis of 8,000-yr-old human brain tissue from the Windover archaeological site

Recovery and analysis of ancient tissue and bone of human origin has long been extensively investigated. Only recently, however, has it been technically possible to recover genetic material from ancient human and animal samples. As both previous studies involved dried tissue, it is important to determine whether other conditions may also preserve ancient tissue and genetic material. We describe here an analysis of preserved human bone and soft matter discovered in 1984-85 buried in a small swampy pond in central Florida. The recovered skeletal material represented a minimum of 40 individuals of both sexes and various ages. Corrected radiocarbon dates directly from bone and from peat matrix gave consistent ages in the range of 7,790 to 8,290 yr before present (BP). Nine individuals with intracranial soft matter were recovered and, in five of these, material recognizable as preserved or replaced brain tissue was present. Further analysis demonstrated gross anatomical features, remnant cellular structure and human DNA. As this find appears to be the oldest-known example of preserved human cell structure and DNA, it represents a significant resource for both anthropological and genetic studies.

Primary leptomeningeal glioma mimicking an acoustic neuroma: case report with review of the literature

Primary leptomeningeal gliomas are rare. Historically, they have been found in the spinal canal more frequently; however, in the recent literature nearly all have been found within the cranium. In the only cadaveric study of leptomeningeal glial nests, the most frequent site was the medulla and pons. Until now, no leptomeningeal glioma has been found at this site. We report what we believe to be the first such case mimicking an acoustic neuroma.

Lead encephalopathy: symptoms of a cerebellar mass lesion and obstructive hydrocephalus

The neurologic signs and symptoms of lead intoxication are quite varied. We review a case of lead poisoning in a 9-month-old child who presented clinically and radiographically with a posterior fossa mass effect and obstructive hydrocephalus. The predominance of edema of the cerebellum sufficient to achieve obstruction of the ventricular system represents a particularly unusual presentation of this disease process. Review of the literature for similar cases of lead encephalopathy is included.

Resolution of gumma with steroid therapy

Antibiotic usage has rendered neurosyphilis uncommon, and cerebral gummas are rare. Reduced awareness of cerebral gummas and abolition of serologic screening can delay diagnosis of this treatable disease. Diagnostic confusion between syphilitic and nonsyphilitic cerebral mass lesions can be increased by apparent resolution of a gumma during steroid therapy. Such an occurrence in a young woman emphasizes the need for serologic testing for syphilis in diagnosing cerebral mass lesions. A trial of conservative therapy using penicillin (with or without prednisone) should be considered for patients with intracerebral mass lesions and positive serologic findings.

Cavernous angioma: a review of 126 collected and 12 new clinical cases

The histopathological, clinical, and radiological features of the intracranial cavernous angioma are reviewed, based on an analysis of 138 symptomatic, histologically verified cases. Twelve of the cases are from our own series and 126 were collected from appropriately documented reports in the modern literature. The analysis indicated that, at the time of diagnosis, one-third of the patients (49 cases) were being evaluated for seizures, one-third (40 cases) for clinical evidence of hemorrhage, and one-third (49 cases) for mass lesions. Unlike the other two groups, the group presenting with clinical evidence of hemorrhage was distinguished by a dominant age at the time of diagnosis (41% were diagnosed during the 4th decade of life), by a high incidence of prior neurological evaluation (43%), by a higher rate of diagnosis at autopsy (28%) than at operation, and by the absence of microscopic calcification within the lesion.

Regeneration in peripheral nerve grafts to the cat spinal cord

Peripheral nervous system grafts have long been known to promote CNS axonal elongation in the rodent. To investigate whether these principles also apply to a higher order animal, more suitable for physiologic studies, we performed autogenous sciatic nerve grafts to the adult cat spinal cord. This report is a brief, initial study of these grafts. In an effort to study both descending and ascending fibers as separately as possible, laminectomies were performed at both thoracic (T2-T9) and lumbar (L2-L4) levels. Aspiration lesions were made in the left side of the cord and the sciatic grafts were introduced. Three cats were studied with standard histological techniques, confirming previous reports of glial scar formation, collagen deposition, and cyst formation at the graft-CNS junction. In 7 other animals, at 146-179 days after the initial operation, the axonal origins were traced retrogradely using horseradish peroxidase and the tetramethyl benzidine technique. Reinnervation of the graft was found by intrinsic spinal cord neurons and dorsal root ganglia neurons. The number of reinnervating neurons was found to be greater than previously reported in the rodent. There was, however, no evidence of regeneration from brainstem nuclei when the grafts were placed at spinal levels where this has been seen in the rat. This may support an absolute maximum for regenerative distances vs a relative one. Although the amount of data was limited, it did support previous reports that peripheral axotomy enhances the regenerative response seen in primary sensory neurons.

Upgaze paralysis caused by lesion of the periaqueductal gray matter

A 61-year-old man with upgaze paralysis was found on postmortem examination to have had a single lesion of the brain stem confined to the periaqueductal gray matter between the levels of the superior and inferior colliculi. Most previous neuropathologic cases reported in human beings have consisted of much larger lesions with common involvement of the posterior commissure and pretectum. We suggest that the lesion in this case caused upgaze paralysis either by interrupting descending fibers from the interstitial nucleus of Cajal or by destroying neurons located within the periaqueductal gray matter.

Septic cavernous sinus thrombosis associated with gingivitis and parapharyngeal abscess

A 29-year-old previously healthy man died of spread of infection from gingivitis to both parapharyngeal (pharyngomaxillary) spaces and to the cavernous sinus. The diagnosis was delayed because gingival and parapharyngeal sources of cavernous sinus thrombosis were not initially considered, and the ophthalmic congestion was believed at first to represent orbital cellulitis rather than cavernous sinus thrombosis.

Primary lymphoma of the central nervous system. Computerized tomography scan characteristics and treatment results for 12 cases

A retrospective analysis of 12 patients with primary central nervous system non-Hodgkin's lymphoma seen from 1958 to 1980 was carried out with emphasis on diagnostic evaluation and treatment results. Computerized tomography (CT) scans were found to be the most valuable diagnostic tool both for initial evaluation as well as follow-up. Characteristic CT scan features were identified and are discussed. Three patients had a history of previous immunosuppression; two had preceding and concurrent uveitis. Nine of the 12 patients were treated primarily with radiation therapy. Three patients were diagnosed at autopsy and had not received definitive therapy. Size of lesion proved to be the most important prognostic factor and appeared to be related to location. Gross total excision of tumor did not appear to improve survival. Two patients were alive with no evidence of disease at 38 and 48 months, respectively. Recurrences were noted from 1 to 33 months after diagnosis (median, 14 months), suggesting the advisability of long-term follow-up prior to presumption of cure. From these results and a review of the literature, possible treatment approaches are presented.

Superficial siderosis: a cause of leptomeningeal enhancement on computed tomography

A case of superficial siderosis of the central nervous system proven by brain biopsy is described. The diagnosis was made antemortem, the first such case reported in the English language literature. Postcontrast material cerebral CT demonstrated widespread meningeal enhancement. The differential diagnosis is discussed.

Electrophysiologic recordings in a patient with a discrete unilateral thalamic infarction

The electroencephalogram, and somatosensory and auditory evoked potentials were recorded from a patient, who, at necropsy, showed a restricted unilateral thalmic infarct involving predominantly the anterior and lateral thalamus. The electroencephalogram showed distinct monomorphic delta activity and a suppression of the alpha rhythm over the side of the lesion. Short latency somatosensory evoked potentials were present bilaterally; mid-latency somatosensory evoked potentials were absent ipsilateral to the lesion. Both mid-latency and long latency auditory evoked potentials were normal.

Dendritic alterations in rat isocortex within an iron-induced chronic epileptic focus

Ferrous chloride was injected into the rat isocortex in 5-microliters volumes as an aqueous solution with a concentration of 100 mM. Bursts of epileptiform discharges were sustained throughout the 6 weeks of observation. Nissl and Golgi-Cox stains showed gliosis and neuronal loss within the injection site. Neurons adjacent to the cavitory lesion showed deformity of dendrites, dendritic nodularity, loss of spines, and string-of-beads deformity. These changes are identical to those found in human epileptogenic foci.

An experimental model for cerebral metastasis: preliminary light and ultrastructural studies

An experimental model for hematogenously spread cerebral metastases by injection of a suspension of M3 fibrosarcoma cells into the carotid artery of C57 BL/6 mice was developed. Intracerebral metastatic tumor nodules were consistently produced by this method with subsequent death of the animals. Development of extracerebral metastatic disease was minimal. Light and electron microscopic studies were carried out at various time intervals postintracarotid injection of tumor cells to observe the morphologic events during the development of the brain metastases. Tumor cells were observed arrested in the cerebral capillaries from 15 minutes to 4 days post-injection. From 1 day to 4 days post-injection, individual tumor cells were also observed in the pericapillary spaces in the brains of the injected animals. From 5 days post-injection on, tumor cells were seen to be proliferating in peri-capillary spaces displacing the brain parenchyma and eventually formed tumor nodules with resulting death of the animals. Morphological changes were observed in the endothelial cells of the blood vessels which were surrounded by the growing metastatic tumors. This model, and modifications thereof, should prove to be valuable in the study of cerebral metastatic disease.

So-called extraskeletal Ewing's sarcoma. Report of a case with ultrastructural analysis

The light and the electron microscopic features of an extraskeletal round-cell tumor resembling Ewing's sarcoma are described. Ultrastructural observation revealed features similar to Ewing's sarcoma of bone. Variable agrees of nuclear complexity are described. These soft tissue tumors are probably composed of undifferentiated mesenchymal cells; there is no ultrastructural evidence to indicate the cell of origin.

Nondestructive Quality Evaluation From a Horticulturist's Point of View

Application of nondestructive sorting of fruits can be direct or indirect. Direct applications involve mainly objective means of establishing grades and quality of fruits and vegetables, as well as use of light-sorting and other nondestructive means for determining when a crop should be harvested or whether it should be marketed fresh or processed immediately. Indirect applications might be termed "research" usage of nondestructive sorting. Plant breeders would find nondestructive techniques useful for rapidly evaluating quality characteristics during the development of high quality cultivars. Physiologists could utilize it to rapidly determine the effects of treatments upon the quality of the commodity. Examples of development of techniques of light-sorting of blueberries and grapes for ripeness are discussed.

Melanotic schwannoma

Reports of melanotic nerve sheath tumors of Schwann cell origin are rare, only three having been found in the literature. Two new cases of spinal intradural melanotic nerve sheath tumors are reported and the literature is reviewed. Controversy has arisen in regard to the origin of melanin within these tumors. Electron microscopic study of one of our cases indicates that the Schwann cell is capable of producing melanin. The available evidence suggests that ultrastructural identification of the cell type in these pigmented tumors is essential in plotting the therapy and prognosis of patients with melanotic nerve sheath tumors.