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Patients with alcoholic cirrhosis have subnormal liver zinc concentrations, and excessive urinary zinc excretion. It has been suggested that diversion of dietary zinc into the systemic circulation through porta-systemic shunts may be a major factor influencing the organ distribution of zinc in these patients. To test this hypothesis, we randomized Sprague-Dawley rats into a sham-operated group, and a group subjected to partial portal-vein occlusion (PPVO), which induces the formation of extensive porta-systemic collaterals. Three months after the operation, liver, brain and kidney zinc concentrations were measured in 8 sham-operated and 8 PPVO rats. Mean liver zinc concentrations were significantly higher in the PPVO group when compared to sham-operated controls (P less than 0.05). Brain and kidney zinc concentrations were similar in the 2 groups. This short-term study indicates that liver zinc concentrations are maintained and even increased in rats with porta-systemic shunting, and that diversion of portal blood into the systemic circulation is not a major cause of the low liver zinc concentration observed in alcoholic cirrhosis.

Eighty-three cases of dermatitis caused by wood or sawdust have been seen at St John's Hospital for Dieases of the Skin, London, in the last 20 years. The clinical details and results of patch tests are reported. The literature on dermatitis, mucosal irritation, asthma and other toxic effects of woods of some 300 botanical species is reviewed at length, with an index of scientific, trade and vernacular names, chemical formulae of the known sensitizing substances, and a table of the 28 toxic woods most often encountered. Pathogenesis, diagnosis and prophylaxis are discussed.

In patients with coronary artery disease, left ventricular (LV) regional wall akinesia can develop during the Mueller maneuver. The present study determines if the presence of myocardial ischemic disease with no infarction is a sufficient condition for this to occur, or if the presence of prior acute myocardial infarction (MI) is necessary. In men, first-pass radionuclide ventriculography was performed in the 30 degree left anterior oblique supine position to measure LV ejection fraction, end-diastolic and end-systolic volumes and heart rate, and to obtain an image of the LV cavitary perimeter. This procedure was performed in 4 subject groups: 13 normal volunteers, 25 patients with coronary artery disease but no prior MI, 13 patients with coronary artery disease and prior nontransmural MI, and 36 patients with coronary artery disease and prior transmural MI. All patients had angina and underwent routine contrast coronary angiography; 60 also underwent contrast coronary angiography; 60 also underwent contrast LV angiography. Ejection fraction decreased during the Mueller maneuver in each of all the coronary artery disease groups (p less than 0.01), but not in the normal subjects. Heart rate increased in groups 1, 2 and 4 (p less than 0.01), and end-diastolic volume decreased in all 4 groups (p less than 0.01), whereas end-systolic volume did not change. Only in group 4 did regional wall akinesia develop (17 patients) during the Mueller maneuver. Among patients who had akinesia during the Mueller maneuver and also underwent routine contrast ventriculography, half of the akinetic segments were not seen on routine contrast study, but were seen only on radionuclide ventriculography during the Mueller maneuver.(ABSTRACT TRUNCATED AT 250 WORDS)

Neurologic abnormalities in 21 nonschizophrenic siblings and parents of schizophrenics, 24 DSM-III schizophrenics, and 24 normal "control" subjects were assessed by experienced neurologists blind to the subjects' psychiatric status. Medication artifacts and other neurologic signs likely to be etiologically irrelevant to psychiatric illness were excluded. Psychiatric diagnostic assessments of subjects were made blind to neurologic results. The prevalence of neurologic abnormalities in relatives was significantly greater than in controls, but similar to that among the schizophrenics. Relatives and controls differed even more markedly on signs involving motor system abnormalities of localizing significance. Finally, the relatives showed a suggestive dissociation of psychopathology and neurologic signs. The results appear most consistent with the hypothesis that overt schizophrenia may often result from the combined operation of two independent familial factors--one "psychopathologic," the other "neurologic".

Acquired aphasia in children has been generally characterized as nonfluent, transient, and frequently due to right hemisphere lesions. We studied 65 children with unilateral hemispheric brain lesions occurring after speech acquisition any time from the second through the fourteenth year. Of 34 patients with a left hemisphere lesion, 25 had an initial aphasic speech disturbance, while of 31 patients with a right hemisphere lesion, only 4 (including 2 left-handers) showed any initial aphasia. All those who became aphasic before the age of 8 years eventually regained speech, but recovery time required ranged from less than a month to more than two years. One 5-year-old boy who recovered had initial jargon aphasia. Our review of the literature indicated that the conflict between our results and the traditional claim of frequent aphasia with right hemisphere lesions only apparent; the great majority of crossed aphasias are concentrated in reports written before antibiotics were used, and many cases were assoicated with systemic bacterial infections.

PLATELET aggregation is now recognised as an important early event in thrombosis. Problems associated with the measurement of the degree of platelet aggregation in plasma are outlined.An approach to the determination of the degree of platelet aggregation in whole blood using a new apparatus is described. When whole blood is placed in a circular transparent rotor chamber and subjected to rotational centrifugation at appropriate gravity forces the red cells are spun outwards leaving an inner zone of plasma containing single platelets. Since platelet aggregation does not occur in the absence of blood movement, the blood in the rotor is first agitated by discontinuous rotation using a suitable rotor drive system. Any platelet clumps which form are larger than single platelets and they may be later centrifuged out of the light path with the red cells. The clumps of platelets which have been removed from the plasma zone can be determined, by inference, by monitoring the plasma zone with a light beam. The precision in detecting platelet numbers may be improved by attention to factors such as the light path and wavelength.Because platelet concentrations, and perhaps plasma absorbance, vary in different individuals the light attenuation for blood plasma with and without platelets should be determined prior to estimating the degree of platelet aggregation under test conditions.

In this report, data are presented on pre- and postdexamethasone cortisol levels, neuropsychological testing, and computed tomography (CT) scan findings in 30 depressed patients (15 psychotic and 15 nonpsychotic). Particularly significant findings were observed when data from the unipolar subgroup (n = 22) were analyzed separately. Unipolar psychotic depressed patients had significantly larger (p less than 0.05) anterior pole and cella media ventricle-to-brain ratios (VBRs) and significantly greater (p less than 0.05) left and right inferior parietal brain "atrophy" than nonpsychotic depressed patients. Higher rates of Dexamethasone Suppression Test (DST) nonsuppression were observed in psychotic depressed patients and in patients with larger cella VBRs. Inferior parietal brain atrophy and large VBRs were also associated with greater cognitive impairment on psychometric testing. Implications of these findings are discussed.

The presence of mirror movements was assessed as part of the overall neurological examination of 170 inpatients in a child psychiatric unit. It was found that when patients were divided by presence or absence of problems of repetitive aggressiveness, the aggressive patients, particularly the subgroup of aggressive male patients, had significantly more mirror movements than nonaggressive patients. The results persisted after the exclusion of patients with focal neurological or electroencephalographic abnormalities. It is hypothesized that mirror movements and repetitive aggressive behavior may both result from a delay in the development of normal inhibitory mechanisms.

A 57-year-old woman developed severe generalised amnesia following an embolic stroke. The amnesia persisted until her death nine months later. The left hemisphere had a large infarction of the medial temporal-occipital region, while the right showed only a small infarct limited to the posterior two-thirds of the hippocampus. If bilateral lesions are necessary for the production of permanent amnesia, the findings support the view that the hippocampus is itself a critical structure in the medial temporal diencephalic memory circuit.

Twenty-seven children with childhood injury to the left hemisphere were tested for language function and compared with appropriate controls. Eleven children had incurred their lesions before the age of 1 year, 16 afterward. The group with perinatal injury to the left hemisphere did not show a specific aphasic deficit even though they were mildly cognitively impaired. The group of children with later injury to the left hemisphere showed aphasic deficits if the original injury had caused a language defect; otherwise the left hemisphere injury was not associated with specific disturbances in language function. The average age at time of lesion in those children who had recovered from aphasia was 4.7 years. We conclude that even when childhood aphasia results from a unilateral nonprogressive lesion, recovery of language is less complete than has been generally supposed.

Mirror movements are normal in childhood and may persist to a later age following early brain lesions. We studied these movements in patients with childhood hemiparesis at different ages. The earlier the lesions, the more the mirror movements persisted. More mirror movement persisted in the nonparetic hand than in the paretic one. Complete paralysis of either hand tended to abolish all mirror movements in both hands. The task eliciting the most mirror movement was one that may come under ipsilateral control following contralateral damage. The greater persistence of mirror movements after earlier lesions appears to be an indicator of more extensive compensatory motor system reorganization that takes place after damage to a less mature nervous system.

Eleven McLean Hospital (Belmont, Mass) depressed patients who experienced seizures while receiving maprotiline hydrochloride are presented, as are data on 87 cases reported to the manufacturer (Ciba-Geigy). Most seizures occurred at high dosages, sometimes after many weeks at a stable dose, but neither rapid dosage escalation nor high drug plasma levels seemed related to seizure occurrence. Our experience suggests that a long-acting metabolite might be responsible for seizures. Ten of the 11 McLean Hospital seizures occurred in patients receiving dosages outside of the since-revised current dosage guidelines, as did 60% of the seizures reported to the company. Data in this study suggest that reductions in maximum dosage of maprotiline prescribed after the initial six weeks of treatment could result in a further decrease in risk of seizures beyond that obtained from previous alterations in regimens.

As newer surgical techniques and concepts have emerged, including revascularization of the totally occluded renal artery and alternatives to aortorenal bypass (hepatic, splenic, or iliac artery to renal artery grafts), our patient population has changed. Patients with diffuse atherosclerotic disease, bilateral renal artery stenosis, totally occluded renal arteries, and azotemia are being referred for renal revascularization, thereby changing the indications for operation and the results that can be anticipated. Although our results in patients operated on solely for uncontrollable hypertension or renal failure have been successful, much work needs to be done to improve the results obtained when patients have a combination of uncontrollable hypertension and renal failure.

A case of choriocarcinoma metastatic to the lung following a previous hydatidiform mole is presented. It was possible to make definitive identification of trophoblastic elements on a needle aspiration biopsy using an immunoperoxidase staining technique, thus avoiding diagnostic thoracotomy prior to therapeutic intervention. A method of immunoperoxidase staining of previously fixed and Papanicolaou-stained needle aspiration biopsy specimens is also described, and other uses of the immunoperoxidase technique on needle biopsy specimens are discussed.