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In pulmonary hernia or pneumocele the lung protrudes through a defect in the chest wall. In this report of a case of spontaneous intercostal lung hernia, we describe the pathogenesis and classification of such hernias, including signs, symptoms, radiological findings and treatment methods. Our patient presented with severe chest pain at the base of the left hemithorax. A chest film and computed tomography of the region showed an left intercostal hernia. Surgical treatment was successful.

The effects of divided attention (DA) on episodic memory encoding and retrieval were investigated in 12 normal young subjects by positron emission tomography (PET). Cerebral blood flow was measured while subjects were concurrently performing a memory task (encoding and retrieval of visually presented word pairs) and an auditory tone-discrimination task. The PET data were analyzed using multivariate Partial Least Squares (PLS), and the results revealed three sets of neural correlates related to specific task contrasts. Brain activity, relatively greater under conditions of full attention (FA) than DA, was identified in the occipital-temporal, medial, and ventral-frontal areas, whereas areas showing relatively more activity under DA than FA were found in the cerebellum, temporo-parietal, left anterior-cingulate gyrus, and bilateral dorsolateral-prefrontal areas. Regions more active during encoding than during retrieval were located in the hippocampus, temporal and the prefrontal cortex of the left hemisphere, and regions more active during retrieval than during encoding included areas in the medial and right-prefrontal cortex, basal ganglia, thalamus, and cuneus. DA at encoding was associated with specific decreases in rCBF in the left-prefrontal areas, whereas DA at retrieval was associated with decreased rCBF in a relatively small region in the right-prefrontal cortex. These different patterns of activity are related to the behavioral results, which showed a substantial decrease in memory performance when the DA task was performed at encoding, but no change in memory levels when the DA task was performed at retrieval.

The eyes can come to be the sole tool of communication for highly disabled patients. With the appropriate technology it is possible to successfully interpret eye movements, increasing the possibilities of patient communication with the use of speech synthesisers. A system of these characteristics will have to include a speech synthesiser, an interface for the user to construct the text and a method of gaze interpretation. In this way a situation will be achieved in which the user will manage the system solely with his eyes. This review sets out the state of the art of the three modules that make up a system of this type, and finally it introduces the speech synthesis system (Síntesis Visual del Habla [SiVHa]), which is being developed in the Public University of Navarra.

Large-scale networks of brain regions are believed to mediate cognitive processes, including episodic memory. Analyses of regional differences in brain activity, measured by functional neuroimaging, have begun to identify putative components of these networks. To more fully characterize neurocognitive networks, however, it is necessary to use analytical methods that quantify neural network interactions. Here, we used positron emission tomography (PET) to measure brain activity during initial encoding and subsequent recognition of sentences and pictures. For each type of material, three recognition conditions were included which varied with respect to target density (0%, 50%, 100%). Analysis of large-scale activity patterns identified a collection of foci whose activity distinguished the processing of sentences vs. pictures. A second pattern, which showed strong prefrontal cortex involvement, distinguished the type of cognitive process (encoding or retrieval). For both pictures and sentences, the manipulation of target density was associated with minor activation changes. Instead, it was found to relate to systematic changes of functional connections between material-specific regions and several other brain regions, including medial temporal, right prefrontal and parietal regions. These findings provide evidence for large-scale neural interactions between material-specific and process-specific neural substrates of episodic encoding and retrieval.

Positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) have been extensively used to explore the functional neuroanatomy of cognitive functions. Here we review 275 PET and fMRI studies of attention (sustained, selective, Stroop, orientation, divided), perception (object, face, space/motion, smell), imagery (object, space/motion), language (written/spoken word recognition, spoken/no spoken response), working memory (verbal/numeric, object, spatial, problem solving), semantic memory retrieval (categorization, generation), episodic memory encoding (verbal, object, spatial), episodic memory retrieval (verbal, nonverbal, success, effort, mode, context), priming (perceptual, conceptual), and procedural memory (conditioning, motor, and nonmotor skill learning). To identify consistent activation patterns associated with these cognitive operations, data from 412 contrasts were summarized at the level of cortical Brodmann's areas, insula, thalamus, medial-temporal lobe (including hippocampus), basal ganglia, and cerebellum. For perception and imagery, activation patterns included primary and secondary regions in the dorsal and ventral pathways. For attention and working memory, activations were usually found in prefrontal and parietal regions. For language and semantic memory retrieval, typical regions included left prefrontal and temporal regions. For episodic memory encoding, consistently activated regions included left prefrontal and medial temporal regions. For episodic memory retrieval, activation patterns included prefrontal, medial temporal, and posterior midline regions. For priming, deactivations in prefrontal (conceptual) or extrastriate (perceptual) regions were consistently seen. For procedural memory, activations were found in motor as well as in non-motor brain areas. Analysis of regional activations across cognitive domains suggested that several brain regions, including the cerebellum, are engaged by a variety of cognitive challenges. These observations are discussed in relation to functional specialization as well as functional integration.

Positron emission tomography (PET) was used to investigate the hypothesis that older adults' difficulties with temporal-order memory are related to deficits in frontal function. Young (mean 24.7 years) and old (mean 68.6 years) participants studied a list of words, and were then scanned while retrieving information about what words were in the list (item retrieval) or when they occurred within the list (temporal-order retrieval). There were three main results. First, whereas the younger adults engaged right prefrontal regions more during temporal-order retrieval than during item retrieval, the older adults did not. This result is consistent with the hypothesis that context memory deficits in older adults are due to frontal dysfunction. Second, ventromedial temporal activity during item memory was relatively unaffected by aging. This finding concurs with evidence that item memory is relatively preserved in old adults and with the notion that medial temporal regions are involved in automatic retrieval operations. Finally, replicating the result of a previous study (Cabeza, R., Grady, C. L., Nyberg, L., McIntosh, A. R. , Tulving, E., Kapur, S., Jennings, J. M., Houle, S., and Craik, F. I. M., 1997), the old adults showed weaker activations than the young adults in the right prefrontal cortex but stronger activations in the left prefrontal cortex. The age-related increase in left prefrontal activity may be interpreted as compensatory. Taken together, the results suggest that age-related changes in brain activity are rather process- and region-specific, and that they involve increases as well as decreases in neural activity.

A description of semantic lexicon arrangement is a central goal in examinations of language processing. There are a number of ways in which this description has been cast and a host of different mechanisms in place for providing operational descriptions (e.g., feature sharing, category membership, associations, and co-occurrences). We first review two views of the structure of semantic space and then describe an experiment that attempts to adjudicate between these two views. The use of a false memory paradigm provides us with evidence that supports the notion that the semantic lexicon is arranged more by association than by categories or features., (Copyright 1999 Academic Press.)

Background: Several options are available for treating patients with a first episode of primary spontaneous pneumothorax (ISP). The aim of this study was to compare the efficacy of two treatment alternatives: puncture-aspiration (PA) using a small caliber catheter, and pleural drainage through a chest tube (DCT)., Patients and Methods: We compared a current series of 91 patients treated with PA with a retrospective series of 216 patients treated with DCT. PA was performed by emergency room physicians and DCT was performed by chest surgeons. Patients were followed for a period of 24 months., Results: The immediate efficacy of PA was superior to DCT (86.7% versus 76%, p < 0.05). The proportion of recurrences after each treatment was similar (23% and 17%, respectively, NS). Duration of hospital stay was shorter for PA-treated patients (24 h) than for DCT-treated patients (138 h) (p < 0.05). The efficacy of the two procedures 24 months later was similar (63.7% and 62.9%, respectively, NS), and the cost of PA was three times less than that of DCT., Conclusions: PA is as effective a treatment procedure as DCT. PA is simple enough for emergency room physicians to perform correctly. Inconvenience to the patient, cost to the health care system, and time of hospital stay are all significantly less with PA.

In all cognitive tasks, general task-related processes operate throughout a given task on all items, whereas specific item-related processes operate differentially on individual items. In typical functional neuroimaging experiments, these two sets of processes have usually been confounded. Herein we report a combined positron emission tomography and event-related potential (ERP) experiment that was designed to distinguish between neural correlates of task-related and item-related processes of memory retrieval. Two retrieval tasks, episodic and semantic, were crossed with episodic (old/new) and semantic (living/nonliving) properties of individual items to yield evidence of regional brain activity associated with task-related processes, item-related processes, and their interaction. The results showed that episodic retrieval task was associated with increased blood flow in right prefrontal and posterior cingulate cortex, as well as with a sustained right-frontopolar-positive ERP, but that the semantic retrieval task was associated with left frontal and temporal lobe activity. Retrieval of old items was associated with increased blood flow in the left medial temporal lobe and with a brief late positive ERP component. The results provide converging hemodynamic and electrophysiological evidence for the distinction of task- and item-related processes, show that they map onto spatially and temporally distinct patterns of brain activity, and clarify the hemispheric encoding/retrieval asymmetry (HERA) model of prefrontal encoding and retrieval asymmetry.

The prototype effect in face recognition refers to a tendency to recognize the face corresponding to the central value of a series of seen faces, even when this central value or prototype has not been seen. Five experiments investigated the extension and limits of this phenomenon. In all the experiments, participants saw a series of faces, each one in two or more different versions or exemplars, and then performed a recognition test, including seen and unseen exemplars and the unseen prototype face. In Experiment 1, a strong prototype effect for variations in feature location was demonstrated in oldness ratings and in a standard old/new recognition test. Experiments 2A and 2B compared the prototype effect for variations in feature location and variations in head angle and showed that, for the latter, the prototype effect was weaker and more dependent on similarity than for the former. These results suggest that recognition across feature variations is based on an averaging mechanism, whereas recognition across viewpoint variations is based on an approximation mechanism. Experiments 3A and 3B examined the limits of the prototype effect using a face morphing technique that allows a systematic manipulation of face similarity. The results indicated that, as the similarity between face exemplars decreases to the level of similarity between the faces of different individuals, the prototype effect starts to disappear. At the same time, the prototype effect may originate false memories of faces that were never seen.

Synaptosomes incorporated mixed brain gangliosides at a rapid initial rate followed by a slower phase of net movement from the protein-associated fraction into the membrane core. The pattern of incorporated gangliosides reflected the pattern available for incorporation. Intact synaptosomes incorporated approximately 100 pmol GM1/mg protein. Synaptosomes preincubated with proteolytic enzymes (trypsin, chymotrypsin, and papain) at different pH values (6.2, 7.4, 7.8) incorporated more exogenous gangliosides than synaptosomes preincubated in buffer alone. This effect was maximal at pH 7.8, though analysis of variance revealed that the proteolytic treatment and pH effects were probably independent processes. Overall uptake of exogenous gangliosides correlated significantly with amount of membrane protein loss, indicating that initial access of exogenous gangliosides to synaptosomal membranes is retarded by cell-surface proteins. These results suggest synaptosomes as a useful alternative to cultured cells for investigating the interaction of gangliosides with other cell surface constituents.

Isolated retrograde amnesia is defined as impaired recollection of experiences pre-dating brain injury with relatively preserved anterograde learning and memory. We present findings from a patient (M.L.) with isolated retrograde amnesia following severe traumatic brain injury (TBI) that address hypotheses of the interrelationships of focal neuropathology, episodic memory and the self. M.L. is densely amnesic for experiences predating his injury, but shows normal anterograde memory performance on a variety of standard tests of recall and recognition. The cognitive processes underlying this performance were examined with the remember/know technique, which permits separation of episodic from non-episodic contributions to memory tests by quantifying subjects' reports of re-experiencing aspects of the encoding episode. The results demonstrated that M.L. does not episodically re-experience post-injury events to the same extent as control subjects, although he can use familiarity or other non-episodic processes to distinguish events he has experienced from those he has not experienced. M.L.'s MRI showed damage to the right ventral frontal cortex and underlying white matter, including the uncinate fasciculus, a frontotemporal band of fibres previously hypothesized to mediate retrieval of specific events from one's personal past. Recent functional neuroimaging evidence of an association between right frontal lobe functioning and episodic retrieval demands suggest that M.L.'s memory deficits are related to this focal injury. This hypothesis was supported by right frontal polar hypoactivation in M.L. in response to episodic retrieval demands when he was examined with a cognitive activation H2(15)O PET paradigm that reliably activated this frontal region in both healthy controls and patients with TBI carefully matched to M.L. (but without isolated retrograde amnesia). He also showed increased left inferomedial temporal activation relative to control subjects, suggesting that his spared anterograde memory is mediated through increased reliance on medial temporal lobe structures. Re-experiencing events as part of one's past is based on autonoetic awareness, i.e. awareness of oneself as a continuous entity across time. This form of awareness also supports the formulation of future goals and the implementation of a behavioural guidance system to achieve them. The findings from this study converge to suggest that M.L. has impaired autonoetic awareness attributable to right ventral frontal lobe injury, including right frontal-temporal disconnection. Reorganized brain systems mediate certain preserved cognitive operations in M.L., but without the normal complement of information concerning the self with respect to both past and future events.

A sensory-sensory learning paradigm was used to measure neural changes in humans during acquisition of an association between an auditory and visual stimulus. Three multivariate partial least-squares (PLS) analyses of positron emission tomography data identified distributed neural systems related to (i) processing the significance of the auditory stimulus, (ii) mediating the acquisition of the behavioral response, and (iii) the spatial overlap between these two systems. The system that processed the significance of the tone engaged primarily right hemisphere regions and included dorsolateral prefrontal cortex, putamen, and inferior parietal and temporal cortices. Activity changes in left occipital cortex were also identified, most likely reflecting the learned expectancy of the upcoming visual event. The system related to behavior was similar to that which coded the significance of the tone, including dorsal occipital cortex. The PLS analysis of the concordance between these two systems showed substantial regional overlap, and included occipital, dorsolateral prefrontal, and limbic cortices. However, activity in dorsomedial prefrontal cortex was strictly related to processing the auditory stimulus and not to behavior. Taken together, the PLS analyses identified a system that contained a sensory-motor component (comprised of occipital, temporal association and sensorimotor cortices) and a medial prefrontallimbic component, that as a group simultaneously embodied the learning-related response to the stimuli and the subsequent change in behavior.

Age-related differences in brain activity may reflect local neural changes in the regions involved or they may reflect a more global transformation of brain function. To investigate this issue, we applied structural equation modeling to the results of a positron emission tomography (PET) study in which young and old adults encoded and recalled word pairs. In the young group there was a shift from positive interactions involving the left prefrontal cortex during encoding to positive interactions involving the right prefrontal cortex during recall, whereas in the old group frontal interactions were mixed during encoding and bilaterally positive during recall. The present results suggest that age-related changes in neural activation are partly due to age-related changes in effective connectivity in the neural network underlying the task.

Recollecting a past episode involves remembering not only what happened but also when it happened. We used positron emission tomography (PET) to directly contrast the neural correlates of item and temporalorder memory. Subjects studied a list of words and were then scanned while retrieving information about what words were in the list or when they occurred within the list. Item retrieval was related to increased neural activity in medial temporal and basal forebrain regions, whereas temporal-order retrieval was associated with activations in dorsal prefrontal, cuneus/precuneus, and right posterior parietal regions. The dissociation between temporal and frontal lobe regions confirms and extends previous lesion data. The results show that temporal-order retrieval involves a network of frontal and posterior brain regions.

The relation between imagery and perception was investigated in face priming. Two experiments are reported in which subjects either saw or imagined the faces of celebrities. They were later given a speeded perceptual test (familiarity judgement to pictures of celebrities) or a speeded imagery test (in which they were told the names of celebrities and asked to make a decision about their appearance). Seeing faces primed the perceptual test, and imaging faces primed the imagery test; however, there was no priming between seeing and imaging faces. These results show that perception and imagery can be dissociated in normal subjects. In two further experiments, we examined the effects of imaging faces on a subsequent face-naming task and on a task requiring familiarity judgements to partial faces. Both these tasks were facilitated by prior imaging of faces. These results are discussed in relation to those of McDermott & Roediger (1994), who found that imagery promoted object priming in a perceptual test involving naming partial line drawings. The implications for models of face recognition are also discussed.

The purpose of this study was to directly compare the brain regions involved in episodic-memory recall and recognition. Changes in regional cerebral blood flow were measured by positron emission tomography while young healthy test persons were either recognizing or recalling previously studied word pairs. Reading of previously nonstudied pairs served as a reference task for subtractive comparisons. Compared to reading, both recall and recognition were associated with higher blood flow (activation) at identical sites in the right prefrontal cortex (areas 47, 45, and 10) and the anterior cingulate. Compared to recognition, recall was associated with higher activation in the anterior cingulate, globus pallidus, thalamus, and cerebellum, suggesting that these components of the cerebello-frontal pathway play a role in recall processes that they do not in recognition. Compared to recall, recognition was associated with higher activation in the right inferior parietal cortex (areas 39, 40, and 19), suggesting a larger perceptual component in recognition than in recall. Contrary to the expectations based on lesion data, the activations of the frontal regions were indistinguishable in recall and recognition. This finding is consistent with the notion that frontal activations in explicit memory tasks are related to the general episodic retrieval mode or retrieval attempt, rather than to specific mechanisms of ecphory (recovery of stored information).

The bronchogenic cyst is a tracheobronchial tree congenital malformation, normally intrathoracic. Usually presenting as an acute respiratory insufficiency (especially during infancy) or as recurrent respiratory infections or may be an accidental finding in asymptomatic patients. We present a rare case of cervical localization which began as an acute respiratory distress following a tonsilar infection.

Four cases of costal chondrosarcoma were observed in the Thoracic Surgery Department of Nostra Señora de Aránzazu Hospital in San Sebastián. This tumour rarely occurs in the ribs and no papers concerning more than one personal case, over such a brief interval, have been reported. The diagnosis was established on the basis of clinical and radiological data in three cases and after biopsy in the fourth case. Large surgical resection allowed complete histological examination, which confirmed the diagnosis of chondrosarcoma. The tumours were classified into grade I and II according to the degree of differentiation of the tumour cells. All 4 patients were treated exclusively by surgical resection. Marlex mesh was necessary to repair the chest wall defect in 3 cases. The functional result was satisfactory. One of these patients was lost to follow-up and no signs of recurrence have been observed in the other 3 patients, although the follow-up remains relatively short (9, 8 and 7 months, respectively).

We review PET studies of higher-order cognitive processes, including attention (sustained and selective), perception (of objects, faces, and locations), language (word listening, reading, and production), working memory (phonological and visuo-spatial), semantic memory retrieval (intentional and incidental), episodic memory retrieval (verbal and nonverbal), priming, and procedural memory (conditioning and skill learning). For each process, we identify activation patterns including the most consistently involved regions. These regions constitute important components of the network of brain regions that underlie each function.

Positron emission tomography (PET) was used to compare regional cerebral blood flow (rCBF) in young (mean 26 years) and old (mean 70 years) subjects while they were encoding, recognizing, and recalling word pairs. A multivariate partial-least-squares (PLS) analysis of the data was used to identify age-related neural changes associated with (1) encoding versus retrieval and (2) recognition versus recall. Young subjects showed higher activation than old subjects (1) in left prefrontal and occipito-temporal regions during encoding and (2) in right prefrontal and parietal regions during retrieval. Old subjects showed relatively higher activation than young subjects in several regions, including insular regions during encoding, cuneus/precuneus regions during recognition, and left prefrontal regions during recall. Frontal activity in young subjects was left-lateralized during encoding and right-lateralized during recall [hemispheric encoding/retrieval asymmetry (HERA)], whereas old adults showed little frontal activity during encoding and a more bilateral pattern of frontal activation during retrieval. In young subjects, activation in recall was higher than that in recognition in cerebellar and cingulate regions, whereas recognition showed higher activity in right temporal and parietal regions. In old subjects, the differences in blood flow between recall and recognition were smaller in these regions, yet more pronounced in other regions. Taken together, the results indicate that advanced age is associated with neural changes in the brain systems underlying encoding, recognition, and recall. These changes take two forms: (1) age-related decreases in local regional activity, which may signal less efficient processing by the old, and (2) age-related increases in activity, which may signal functional compensation.

The purpose of this study was to identify the brain regions invoked when subjects attempt to learn verbal materials for a subsequent memory test. Twelve healthy subjects undertook two different tasks: reading and encoding of word pairs, while they were being scanned using [15O]H2O positron emission tomography (PET). As expected, the encoding pairs were remembered much better (recall 39% vs. 8%; P < 0.001) than reading pairs in a subsequent memory test. The encoding scans, as compared to reading scans, showed activation of the left prefrontal cortex, the anterior cingulate cortex and the left medial temporal cortex. The left prefrontal activations were in two discrete regions: (i) a left anterior and inferior left prefrontal (Brodmann's areas 45, 46) which we attribute to semantic processing; and (ii) a left posterior mid-frontal region (BA 6, 44) which may reflect rote rehearsal. We interpret the data to suggest that when subjects use cognitive strategies of semantic processing and rote-rehearsal to learn words, they invoke discrete regions of the left prefrontal cortex. And this activation of the left prefrontal cortex along with the medial temporal region leads to a neurophysiological memory trace which can be used to guide subsequent memory retrieval.

Remembering an event involves not only what happened, but also where and when it occurred. We measured regional cerebral blood flow by positron emission tomography during initial encoding and subsequent retrieval of item, location, and time information. Multivariate image analysis showed that left frontal brain regions were always activated during encoding, and right superior frontal regions were always activated at retrieval. Pairwise image subtraction analyses revealed information-specific activations at (i) encoding, item information in left hippocampal, location information in right parietal, and time information in left fusiform regions; and (ii) retrieval, item in right inferior frontal and temporal, location in left frontal, and time in anterior cingulate cortices. These results point to the existence of general encoding and retrieval networks of episodic memory whose operations are augmented by unique brain areas recruited for processing specific aspects of remembered events.

Two important objectives in the neuroscience of memory are (1) identification of neural pathways involved in memory processes; and (2) characterization of the pattern of interactions between these pathways. Functional neuroimaging can contribute to both of these goals. Using image subtraction analysis of regional cerebral blood flow data measured with positron emission tomography, we identified brain regions that changed activity during episodic memory retrieval (visual work recognition). Relative to a baseline reading task, decreased activity was observed in bilateral prefrontal, bilateral anterior and posterior temporal, and posterior cingulate cortices. Brain regions showing increased activity were the right prefrontal (different from deactivated regions), left anterior cingulate, and left occipital cortices, and vermis of cerebellum. We then performed a network analysis with structural equation modeling to test the hypothesis that regional decreases came about through active inhibition by regions showing increased activity during retrieval. This analysis demonstrated that the influence of activated regions on deactivated regions was more negative during retrieval than during reading, confirming the inhibition hypothesis. Such confirmation could not have been made from the subtraction analysis alone because decreases can come about, at the very least, through reduction of functional influences as well as by active inhibition. The concepts of ensemble excitation and inhibition, as defined through network analysis, are introduced. We argue that is is critical to examine the combined pattern of excitatory and inhibitory influences to fully appreciate the neural basis of episodic memory.

We review positron emission tomography (PET) studies whose results converge on the hemispheric encoding/retrieval asymmetry (HERA) model of the involvement of prefrontal cortical regions in the processes of human memory. The model holds that the left prefrontal cortex is differentially more involved in retrieval of information from semantic memory, and in simultaneously encoding novel aspects of the retrieved information into episodic memory, than is the right prefrontal cortex. The right prefrontal cortex, on the other hand, is differentially more involved in episodic memory retrieval than is the left prefrontal cortex. This general pattern holds for different kinds of information (e.g., verbal materials, pictures, faces) and a variety of conditions of encoding and retrieval.

Positron emission tomography (PET) was used to identify brain regions associated with two component processes of episodic retrieval; those related to thinking back in subjective time (retrieval mode) and those related to actual recovery of stored information (ecphory). Healthy young subjects recognized words that had been encoded with respect to meaning or the speaker's voice. Regardless of how the information had been encoded, recognition was associated with increased activation in regions in right prefrontal cortex, left anterior cingulate, and cerebellum. These activations reflect retrieval mode. Recognition following meaning encoding was specifically associated with increased activation in left temporal cortex, and recognition following voice encoding involved regions in right orbital frontal and parahippocampal cortex. These activations reflect ecphory of differentially encoded information.

Subjects studied words in a classification task (to what categories does it belong?) or in a production task (producing associates to the word) and then completed one of two implicit memory tests-category association or free association. The classification study task and the category-association test emphasize categorical relations between concepts, and the production study task and the free-association test draw on associative relations. As predicted by the transfer-appropriate processing principle, priming in the category-association test was larger for words studied under the classification task than for those studied under the production task, whereas the opposite was true in the free-association test. This crossover dissociation is the first obtained between two implicit conceptual tests, and it provides support for the claim that it is necessary to distinguish between different types of conceptual processing.

The present experiments measured the release of acetylcholine (ACh) by the cat superior cervical ganglia in the presence of, and after exposure to, 2-(4-phenylpiperidino)cyclohexanol (AH5183), a compound known to block the uptake of ACh by cholinergic synaptic vesicles. We confirmed that AH5183 blocks evoked ACh release during preganglionic nerve stimulation when approximately 13-14% of the initial ganglial ACh stores had been released; periods of rest in the presence of the drug did not promote recovery from the block, but ACh release recovered following the washout of AH5183. ACh was synthesized in AH5183-treated ganglia, as determined by the synthesis of [3H]ACh from [3H]choline, and this [3H]ACh could be released by stimulation following drug washout. The specific activity of the released ACh matched that of the tissue's ACh, and thus we conclude that ACh synthesized in the presence of AH5183 is a releasable as pre-existing ACh stores once the drug is removed. We tested the relative releasability of ACh synthesized during AH5183 exposure (perfusion with [3H]choline) and that synthesized during recovery from the drug's effects (perfusion with [14C]choline: the ratio of [3H]ACh to [14C]ACh released by stimulation was similar to the ratio in the tissue. These results suggest that the mobilization of ACh for release by ganglia during recovery from an AH5183-induced block is independent of the conditions under which the ACh was synthesized. Unlike nerve impulses, black widow spider venom (BWSV) induced the release of ACh from AH5183-blocked ganglia, even in the drug's continued presence. Venom-induced release of ACh from AH5183-treated ganglia was not less than the venom-induced release from tissues not exposed to AH5183. This effect of BWSV was attributed to the action of the protein, alpha-latrotoxin, because an anti-alpha-latrotoxin antiserum blocked the venom's action. ACh synthesized during AH5183 exposure was labelled from [3H]choline, and subsequent treatment with BWSV released [3H]ACh with the same temporal pattern as the release of total ACh. To exclude a nonexocytotic origin for the [3H]ACh released by BWSV, ganglia were preloaded with [3H]diethylhomocholine to form [3H]acetyldiethylhomocholine, an ACh analogue excluded from vesicles; the venom did not increase the rate of [3H]acetyldiethylhomocholine efflux. It is concluded that a vesicular ACh pool insensitive to the inhibitory action of AH5183 might exist and that this vesicular pool is not mobilized by electrical stimulation to exocytose in the presence of AH5183, but it is by BWSV.