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A review of the literature discloses 56 cases of bronchial adenoma in children under the age of 16 years; we now report two additional cases. The diagnosis of bronchial adenoma in children is often delayed due to erroneous interpretation of the secondary manifestations of pneumonitis, fever, or wheezing. These tumors should be considered potentially malignant, since local invasion and metastasis have been reported in this age group. Treatment is by thoracotomy with total excision of the lesion.

Single-unit recordings were made from lateral hypothalamic area (LHA) neurons of infant (8 through 21 days of age) male and female albino rats. Basal (or spontaneous) firing rates of LHA neurons were recorded for 20 min from rats 8 through 21 days of age, and mean basal firing rates did not differ across ages. Basal firing rates of LHA neurons in infant rats ranged from less than 1 spike/sec up to 27 spikes/sec, with 56% of the basal rates less than 1 spike/sec. Infant rats also received hypertonic saline injections (and control injections) to determine osmosensitivity characteristics of LHA neurons. Across ages, 56%--88% of LHA neurons were osmosensitive, with the highest percentages of osmosensitive units found in rats 14--21 days of age. Infant rats showed LHA unit electrophysiological characteristics that were quite similar to those obtained from LHA neurons in adult rats with respect to basal firing rates and osmosensitivity, however, LHA neuron activity in infants was not modulated by sensory stimuli as is frequently reported for adults. The results are discussed in terms of functional development of the LHA.

In neurons of the substantia nigra (SN) of Macaca fascicularis the administration of parkinsongenic doses of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) caused morphological changes of the neuromelanic granules. Under light microscopy, the granules appeared more dispersed and larger. Electron microscopy revealed coalescence of granules in large masses with loss of the electrodense component. Phagocytosis of neuromelanin by glial cells was also observed. In several neurons the neuromelanic changes were evident in the presence of morphologically intact mitochondria. These data suggest an interaction between MPTP and neuromelanin that may have relevance to the nigrotropic toxicity of MPTP and are in agreement with observations on neuromelanin in parkinsonian patients.

The time course and severity of the excitotoxic syndrome induced in rats by s.c. injection of 10 mg/kg kainic acid (KA) was modified by pretreatment with MK801, a non-competitive inhibitor of the NMDA receptor, at doses of 0.1, 1 and 10 mg/kg. A dose-dependent increase in the severity of the KA-induced electrographic (EEG) manifestations of epilepsy was seen after MK801. This consisted of an earlier appearance and higher number of EEG seizures, longer time spent in seizures, and an earlier onset of status epilepticus. In contrast, behavioral seizures were increased only in the 0.1 mg/kg MK801 group, but abolished by higher doses. On the contrary, wet dog shakes were progressively reduced with increasing doses of MK801. Four of the 9 animals receiving KA-only group and 3 of the 10 animals in the 1 and 10 mg MK801 groups were sacrificed 5 days after KA. The brain of the KA-only rats presented diffuse gross and microscopic evidence of hemorrhagic necrosis and neuronal damage; the MK801 rats showed only minimal neuronal loss in the CA3 hippocampal sector. This study demonstrates that neuronal damage and epileptiform activity can be dissociated. Furthermore, it confirms the protective effect of MK801 against neuronal damage caused by multiple factors. Lastly, it emphasizes the need for EEG monitoring in order to accurately assess any epileptic/antiepileptic effect.

Histopathologic examination of the prepiriform cortex (PPC) in four documented cases of dementia of the Alzheimer type revealed increased numbers of neurofibrillary tangles and neuritic plaques. These findings indicate that some early- and late-onset cases of Alzheimer's disease may be associated with significant damage to the PPC, a relay center of the mammalian olfactory system that has extensive connections with structures concerned with cognitive and behavioral functions. Involvement of the PPC may be related to the complex neuropsychiatric manifestations observed in this disorder.

An analysis of twenty-six cases of epidermoid carcinoma of the anus from the University of Virginia Medical Center and 1,060 cases from the surgical literature has been presented. We believe this review justifies the following conclusions. (1) Considerable delay in diagnosis frequently occurs, adversely affecting the prognosis of patients with this disease. (2) Abdominoperineal resection remains the treatment of choice. Wide local excision is inadequate for most lesions, and should be reserved for lesions of the anal verge less than 2 cm in diameter with favorable histology, that is, low grade of malignancy. (3) Large lesions and those with a high grade of malignancy are associated with a poor prognosis, but even these patients may sometimes be cured with aggressive surgical excision. (4) Synchronous inguinal node metastases are associated with a poor prognosis, but an occasional patient may be cured by iliofemoral node dissection. (5) Iliofemoral node dissection is indicated for metachronous inguinal node metastases in the absence of distant spread. (6) Iliofemoral node dissection should not be performed if these nodes are not clinically involved with metastases. Approximately 70 per cent of these patients will not need this procedure and would therefore have this resection and its attendant morbidity unnecessarily.

Intraperitoneal administration of 5-10 mg/kg of THIP (4,5,6,7 tetrahydroxyisoxazolo (4,5,c) pyridine 3-ol) induced a transient, reliable model of bilaterally synchronous spikes and waves in rats. The paroxysmal bursts elicited by THIP had similar topographical distribution to the spontaneously-occurring spike and wave discharges often observed in naive rats. The responsiveness to electrical stimulation of subcortical nuclei was different in the two models. Systemic administration of THIP provided a simple, reliable model of bilaterally synchronous spike and wave discharges that may involve the same cerebral structures as those involved in the generation of the spontaneous paroxysms. The administration of the drug increased the yield of paroxysmal responses and provided a stable and predictable 4 hr test situation that may easily be quantified.

The pectoralis major muscle has overcome many of the complications of augmentation mammoplasty after subcutaneous mastectomy. It places the implant deep to prevent skin slough and irregularities in skin surface contour. The flap eliminates abnormal implant posture when the pectoralis major is contracted. The short (5 to 7 days) staging of the procedure allows sealing of the pocket from external innoculation of bacteria while preventing unretrievable skin and nipple shrinkage.

An ultrasensitive triple-column ion-exchange/fluorometric method was utilized to measure the levels of over 30 amino acids and related primary amino compounds in Long-Evans rat superior colliculus (SC), visual cortex (VC) and inferior colliculus (IC). Comparison of levels of amino compounds revealed distinctly different profiles for each region. Major constituents were the neurotransmitters and related compounds glutamate, glutamine, GABA, taurine, aspartate and glycine. Glutathione levels were also relatively high in all three regions. SC exhibited a significantly higher level of GABA and beta-alanine compared to both VC and IC. VC had significantly higher levels of glutamate and taurine. VC exhibited the lowest level of glycine and IC the highest. A time-course experiment using SC documented that levels of eleven of thirty-four compounds, including GABA, were subject to significant postmortem alteration in vitro. SC GABA stability experiments indicated that significant in vitro increases of free GABA levels between 1 and 4 min postmortem were associated with equimolar decreases of conjugated GABA levels.

Nonoperative management of fingertip pulp amputations has been employed in eighteen adults. After wound cleansing and debridement, the wound was covered by an occlusive dressing. Healing of the amputated fingertip occurred within four weeks. The healed fingertip had an excellent sensory perception, normal range of motion and an acceptable cosmetic appearance. This satisfactory outcome was realized with less than ten days lost from work.

Generalized corticoreticular epilepsy was established in adult cats by parenteral penicillin, and electroencephalographic monitoring was carried out. Ketamine HCl was injected intravenously in doses of 2.5 to 20 mg per kilogram. If doses of penicillin were inadequate to establish typical spike-wave activity, ketamine induced the spike-wave pattern typical of much higher doses of penicillin. At doses of penicillin that established the spike-wave pattern, ketamine potentiated the spike-wave activity and sometimes induced spike-and-wave status. These findings suggest caution in the clinical use of ketamine in patients with corticoreticular epilepsy. Because analogous effects have been observed upon administration of GABA-mimetic agents, GABA systems may play a role in ketamine anesthesia and corticoreticular epilepsy. Precollicular brain transections failed to modify ketamine effects, excluding a possible influence of mesencephalic centers on the observed potentiation.

Discharges of single cells in the thalamic mediodorsal nucleus (MD) of the opossum were recorded during electrical stimulation of the lateral olfactory tract. Responsive sites were histologically localized throughout the entire mediolateral extent of MD. In both rabbit and squirrel monkey responses are confined to the medial half of MD. Thus the lateral non-olfactory nuclear subdivision, common to both rabbit and squirrel monkey, was not found in the opossum. Firing patterns of cells were similar to those observed in rabbit and squirrel monkey. They commonly consisted of an early spike or burst of spikes, followed by a period of inactivity and then, in many cells, by a later period of response or of resumed spontaneous activity. The results indicate that olfactory input is characteristic of MD in a diverse sample of mammals but that topographic organization of the input is distinctly different in the opossum.

Administration of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) (30 mg/kg s.c. for 5 days) to mice resulted in complete abolishment of strychnine seizure and of the tonic phase of the maximal electroshock response. Bicuculline and picrotoxin convulsions were not significantly affected by MPTP treatment. The severity of the pentylenetetrazole seizures was mildly, but significantly affected in the protective way. MPTP depleted neostriatal dopamine and its metabolites, together with hippocampal norepinephrine. No nigral neuronal loss was detected histologically. Strychnine seizures and the tonic phase of the maximal electroshock response are thought to depend mostly on hindbrain (bulbo-spinal) structures. Thus, these experiments suggest that a caudally projecting system originates from the substantia nigra, pars compacta, and/or locus coeruleus, controlling seizures that involve bulbo-spinal centers. While neostriatal dopamine depletion offers a good index of seizure resistance, its role in the protection from seizures remains to be established.

Direct GABA agonists that suppress spikes induced by penicillin in cats failed to do so in rats. Phenytoin and large doses of THIP increased the rate of spiking activity of the penicillin focus. Only progabide caused marked, initial, short-lasting suppression and a modest reduction of frequency of spikes for 1 hr. Homotaurine (3APS) reduced the amplitude and changed the morphology of the contralateral "mirror" spike. Antagonism of penicillin-induced spikes in rats is considered to be an unsuitable parameter for the screening of anticonvulsant agents.

Donor tectal tissue from fetal rats was transplanted to the tectal region of intact host newborn rats. Histological and ultrastructural characteristics of mature tectal grafts were examined with special emphasis placed on glial elements and the interface between transplant and host brain. Most transplants survived, proliferated, and differentiated to mature neurons and glial cells. Mature transplants were found to contain small and medium sized neurons which formed clusters along the transplant border. Neurites traversed the interface between transplant and host brain. There was an absence of phagocytosis, inflammatory reactions and chromatolytic neurons throughout the transplant. Classical staining techniques and GFAP immunoreactive stains revealed only mild focal astrogliosis confined mostly to the subpial and perivascular regions of the transplant-host interface. Ultrastructural examination of the transplant revealed numerous axodendritic synapses with aggregates of synaptic vesicles and well formed postsynaptic membranes. The absence of a leptomeningeal membrane at several points along the transplant-host interface may allow neurites from both sides to establish functional synaptic contacts. Single unit recording combined with anterograde WGA-HRP neuronal tract tracing was used to determine the presence and extent of host retinal innervation of tectal transplants.

The effects of cortical superfusion of various chemical agents on the inhibition of the discharge of cortical neurons evoked by caudate nucleus stimulation were studied in urethane anesthetized rats. The post-stimulus inhibition (PSI) was unaffected by cortical superfusion with bicuculline, 6-amino-methyl 3-methyl-4H, 1, 2, 6-benzothiadiazine-1, 1-diazidehydrochloride (TAG) and atropine. The PSI was readily and reversibly blocked by cortical superfusion or i.v. injection of strychnine independently of both strychnine capability of eliciting epileptiform activity, and of the degree of excitation produced by the drug. Two animals with poor or absent PSI showed appearance of PSI after glycine topical application. These data suggest that in the rat neocortex, glycine may mediate the inhibitory effect resulting from caudate stimulation.

There is ample evidence from this retrospective comparison to indicate that emphysematous cholecystitis does merit clinical distinction apart from acute cholecystitis. It is an acute infection of the gallbladder caused by a specific group of bacteria that may be aided by some aspect of local ischemia. Cholelithiasis does not seem to be a major factor in the pathogenesis of emphysematous cholecystitis, and this, in association with some dependence upon ischemia, may account for the predominance of this disease in males rather than females. Gangrene is a common feature of the pathologic process, and thus it is not surprising that the diagnosis of emphysematous cholecystitis implies a risk of gallbladder perforation that is five times that expected from ordinary acute cholecystitis. The key to identifying this disease is the plain abdominal roentgenogram which in most instances will make the diagnosis and provide an impetus for early operative intervention.

Prefrontal cortex is commonly defined as cortex which receives afferents from the thalamic mediodorsal nucleus (MD). The extent of opossum prefrontal cortex was mapped with anterograde and retrograde axonal transport methods. The prefrontal field was found to include not only cortex on the lateral convexity of the frontal lobe as reported in earlier studies, but, in addition, cortex within the rhinal fissure and cortex on the rostral medial wall of the hemisphere. The organization of the thalamic input to the medial wall was analyzed in some detail and compared with that of the rat. The reason for this emphasis stemmed from earlier observations which suggested that a lateral, nonolfactory segment of MD, prominent in the rat and other species, may not be present in opossum MD. In the rat, the lateral segment, which constitutes approximately one-third of MD, projects to a relatively large expanse of rostral medial cortex which is also projected upon by the anteromedial nucleus. The main projection field of the lateral one-third of opossum MD is to cortex on the lateral convexity of the frontal lobe which has no input from the anteromedial nucleus and has no counterpart in the rat. Only the most lateral edge of opossum MD projects to medial cortex, to a very small field, which is also projected upon by the anteromedial nucleus. In other respects, the organization of the rostral medial cortex is similar in rat and opossum. These results suggest that, rather than being absent, an equivalent of a nonolfactory segment may be present in opossum MD but is markedly reduced in size, compared to that in rat and other species.

Fetal tectal tissue was transplanted adjacent to the superior colliculus of neonatal rats. In mature recipient animals, ultrastructural studies provided evidence of host cortical synapses on cells within the transplants. To determine whether these synapses were functionally effective in driving transplant cells, tungsten in glass microelectrodes were used to record from single units in the transplants and the host cerebral cortex was electrically stimulated. Of the 214 tested units which were shown histologically to be within the transplants, 25 (11.7%) were orthodromically excited from host cortex at latencies of 15 ms or less (mean 7.3 ms). A further four transplant units were activated at relatively long latencies (40-300 ms). The presence of a functional host retinal input was also tested by electrically stimulating the host optic nerves. No transplant units were activated from these sites, apparently because very few electrode penetrations passed through the localized zones of optic axon distribution. The possible functional interrelationships between transplant and host are discussed.

Misleading pneumoperitoneum takes one of two forms: true pneymoperitoneum without peritonitis or pneumoperitoneum simulated by adventitious x-ray shadows. In both instances, the roentgenographic appearance of free intraperitoneal air proves to be a specious indication for laparotomy. Twenty-eight per cent of 29 patients with misleading pneumoperitoneum were subjected to operations that, retrospectively, might not seem absolutely necessary. The decisions to operate on patients with pneumoperitoneum without peritonitis were based on the amount of pneumoperitoneum roentgenographically visualized. The instances of pseudopneumoperitoneum had several common features. The diagnosis often was based only on x-ray films of the chest. Compatibility with clinical features was marginal; the radiolucency was often not truly at the apex of the diaphragm. Finally, the x-ray films, interpretation and working conditions frequently were suboptimal.

Infection within the peritoneal cavity without an identifiable source of contamination is rare. The diagnosis is one of exclusion, and can be made with certainty only after a thorough laparotomy. The response to antibiotic therapy is usually prompt and gratifying.

Treatment of mice with the proximate neurotoxin MPTP depletes striatal dopamine levels. Depletion of striatal dopamine and metabolites in MPTP-treated mice is accompanied by depletion of glutathione (GSH) in the substantia nigra (SN). Striatal GSH and nigral amino acid levels were not significantly affected by MPTP. Results suggest that GSH depletion in SN may represent an index of regional vulnerability to metabolic oxidative stress and also of selective susceptibility to the toxic effects of MPTP.

Intracerebral injection of L-acetylcarnitine in rats induced interictal and ictal epileptic phenomena with immediate onset, lasting up to 4 h. Pretreatment with systemic atropine prevents all epileptiform phenomena. Local injection of muscimol and THIP abolish ictal events, but not single spikes. L-carnitine induced only ictal discharges with a latency of 40-90 min. Acetylcarnitine epileptogenic properties are probably related to muscarinic agonism. The transition from interictal to ictal events may involve failure of GABAergic mechanisms.

Amino acid and reduced glutathione (GSH) levels in substantia nigra (SN) as well as striatal monoamine levels were measured in acetyl-L-carnitine (ALCar) treated and control Swiss-Webster mice. ALCar, L carnitine, or saline were administered i.p. to mice for 5 days and mice were decapitated 24 hours following the last injection. Substantia nigra and striata were isolated within 2.5 and 3 min., respectively, and frozen immediately on dry ice. A significant dose-dependent increase of nigral GABA was observed following ALCar treatment; GABA levels were also increased by administration of carnitine. Nigral GSH levels were also increased. Striatal levels of dopamine and metabolites were not significantly affected by ALCar or carnitine. These results, suggest that ALCar may be useful in treating symptoms of neuronal dysfunction related to accumulation of metabolic waste.

Pretreatment of rats with homotaurine (3 aminopropanesulfonic acid; 3APS), a synthetic gamma-aminobutyric acid (GABA) analog, protected from the convulsant and cytotoxic action of systemically injected kainic acid (KA). Wet dog shaking (WDS) behavior was significantly reduced. Taurine, an inhibitory non-GABA-mimetic amino acid, and muscimol (another direct GABA-agonist) reduced the number of seizures and lesions in the brain but were less effective than homotaurine. Progabide (a GABA-agonist) did not modify kainic acid effects. The neurotoxicity of kainic acid could have been due to repetitive convulsive activity. Activation of GABA-mediated inhibition is an effective, but not the determinant means of preventing KA-induced abnormalities.

Male (N = 9) and female (N = 7) infant albino rats sustained bilateral lateral preoptic area (LPO) destruction on the tenth day of life. During development and as adults, these brain-damaged rats were subjected to repeated testing of drinking behaviors in response to cellular and extracellular dehydration. Immediately following LPO destruction the pups ceased suckling and most rats required tube-feeding to maintain life; however, all pups were maintaining body weight through voluntary suckling and/or feeding-drinking by 20-21 days of age. Daily water intakes were elevated from 30-42 days of age, following which intakes decreased to control vonse to water deprivation, polyethylene glycol injection and food deprivation treatments. These results are consistent with the suggestion that the LPO contains osmoreceptors for drinking behavior, and the present results suggest that such osmoreceptors, may be functional by the tenth day of life for rats.