Antipsychotic efficacy of the antidepressant trimipramine: a randomized, double-blind comparison with the phenothiazine perazine.

Background: The tricyclic antidepressant trimipramine exhibits several features (e. g., dopaminergic effect, molecular structure similar to a neuroleptic, receptor-binding profile similar to clozapine) that suggest its potential as an antipsychotic medication.

Pituitary carcinoma: a clinicopathologic study of 15 cases.

Background: Pituitary carcinomas are rare adenohypophysial neoplasms, the definition, diagnosis, therapy, and prognosis of which are controversial.

Methods: Pituitary carcinomas were defined as primary adenohypophysial neoplasms with documented craniospinal and/or systemic metastases. The authors report a clinicopathologic study of 15 examples examined by light microscopy, immunohistochemistry, and image analysis.

New syndrome: brain malformation, growth retardation, hypokinesia and polyhydramnios in two brothers.

We report two brothers who were born after pregnancies characterized by polyhydramnios and hypokinesia. Both had brain malformation (absence of corpus callosum in one; arhinencephaly in the other), telecanthus and narrow palpebral fissures. This family and several similar phenotypes reported only in affected brothers could reflect X-linked inheritance.

Central nervous system malformations in trisomy 9.

Trisomy 21, 18 and 13 are the most common varieties of autosomal trisomy recognized at birth; most of the others lead to spontaneous abortions in the first trimester. Trisomy 9, a rare trisomy, is compatible with life, but, unlike trisomy 21, 18 and 13, the range of manifestations has not been well catalogued. Central nervous system abnormalities have been reported in the majority of cases, usually including a dilated fourth ventricle and malformed cerebellum.

Malignant tumors in the pituitary gland.

Malignant tumors of the pituitary gland may mimic pituitary adenomas both in clinical presentation and in imaging, and often present with neurologic findings including visual field loss and extraocular movement palsies. We describe a 58-year-old woman without known malignancy who presented with extraocular movement weakness, loss of facial sensation, and a sellar plasmacytoma; a 49-year-old woman with oculomotor palsy, no known malignancy, and rapidly failing vision who had metastatic lung carcinoma; and a 70-year-old woman with metastatic breast carcinoma who presented with rapidly failing vision and a metastasis to the anterior lobe of the pituitary. These cases illustrate several important features of malignancy in the pituitary fossa: that it can mimic a "nonfunctioning" pituitary adenoma in clinical presentation and imaging; that rapidly progressive visual loss, extraocular movement palsies, or facial sensory loss may help to distinguish it from a benign adenoma; and that when the pathologist evaluates an alleged "nonsecretory" or "nonfunctional" adenoma, metastases should be included in the differential diagnosis.

Clinical patterns of failure following stereotactic interstitial irradiation for malignant gliomas.

The vast majority of patients treated for malignant gliomas with surgery, conventional radiation therapy, and systemic chemotherapy recur within 2 cm of their original disease site as documented by CT scanning. We have analyzed the clinical patterns of failure in patients treated with stereotactic interstitial irradiation (brachytherapy) for malignant gliomas in order to determine if this modality has altered the recurrence pattern in this disease. Between December 1985 and December 1989, 53 patients with malignant glioma were treated with stereotactic interstitial irradiation using temporary high activity iodine-125.

Laser-induced thermal occlusion of berry aneurysms: initial experimental results.

An intravascular laser-catheter technique was used to occlude 12 experimental berry aneurysms, ranging in size from 4 X 3 mm to 8 X 6 mm (length X width), while the patency of adjacent arteries was preserved. A small steel cap on the end of an optical fiber was fluoroscopically positioned within the aneurysm. The cap was rapidly heated by the optical transmission of laser energy.

Focal occlusion of the rabbit carotid artery by endovascular laser therapy.

Laser energy was fiberoptically transmitted into the carotid artery of a series of rabbits to induce an acute focal arterial occlusion. Temporary interruption of blood flow during the treatment was necessary to achieve an occlusion. The arterial occlusive effects of three wavebands of laser energy were compared and the violet band proved the most effective when using 0.

Controlled studies on the effects of alcohol ingestion on peripheral nerves of macaque monkeys.

In two different studies, monkeys were fed diets with 50% and 30% of calories replaced with alcohol for 5 and 3 years, respectively. Nerves were studied with electrophysiological and quantitative histological methods, but no deleterious effect of alcohol was identified.

Human cerebral malaria: a pathological study.

The following report using light and electron microscopic and immunological techniques is based on a series of 19 Burmese patients who died of cerebral malaria. The principal change was blockage of cerebral capillaries by Plasmodium falciparum-infected erythrocytes. Ring hemorrhages and segmental necrosis of cerebral capillaries were common.

Fludarabine phosphate (NSC 312878) infusions for the treatment of acute leukemia: phase I and neuropathological study.

Fludarabine phosphate (NSC 312878), an adenosine deaminase resistant analogue of 9-beta-D-arabinofuranosyladenine, has entered clinical trials. Eleven patients with acute leukemia in relapse received 14 courses of fludarabine phosphate as a 5-day continuous infusion administered at doses of 40 to 100 mg/m2/day. Toxicity was characterized by uniform myelosuppression, as well as occasional nausea, vomiting, and hepatotoxicity.

Intravascular laser coagulation of experimental aneurysms.

Rebleeding after aneurysmal subarachnoid hemorrhage has a 45 per cent mortality rate. The peak incidence is within 24 hours of the initial bleed. During the ensuing 2 weeks 20 per cent of patients with suffer a second hemorrhage.

Human brain contains vasopressin and vasoactive intestinal polypeptide neuronal subpopulations in the suprachiasmatic region.

The suprachiasmatic nuclei (SCN) and retinohypothalamic tract ( RHT ) in the anterior hypothalamus have been postulated to play an important role in the timing of daily biological rhythms in mammals. Although physiological studies have described circadian rhythms in man, the presence of an RHT or SCN has not been conclusively demonstrated in the human brain. Immunocytochemical identification of distinct ventral vasoactive intestinal polypeptide (VIP) containing and dorsal vasopressin containing neuronal subpopulations in the human suprachiasmatic region provides correlative evidence of neuronal clusters which are homologous to discrete cell groups in the SCN of other mammalian species.

Central nervous system changes after radiation therapy and/or chemotherapy: correlation of CT and autopsy findings.

This is a restrospective correlative study of cranial computed tomography (CT) and autopsy findings in 50 patients after central nervous system radiation therapy and/or chemotherapy. Most patients had more than one posttherapy CT scan and all cases were autopsied. Twenty-six cases (52%) showed no posttherapy CT changes.

Transcatheter fiberoptic laser coagulation of blood vessels.

In ten rabbit ears the central auricular artery was percutaneously catheterized and subjected to doses of laser energy transmitted through a flexible optical fiber within the artery. Arterial occlusion was not produced in the initial three ears using energy levels less than 600 mW. Higher levels of laser energy, in the range of 800-1000 mW, caused arterial coagulation in six of the remaining seven rabbit ears.

Are hippocampal lesions sufficient to cause lasting amnesia?

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.

Transmissible spongiform encephalopathy (Creutzfeldt-Jakob disease). Atypical clinical and pathological findings.

A middle-aged neurosurgeon had an 18-month illness characterized by abnormal sleep patterns, paresthesias, and necrotizing cutaneous lesions with vasculitis and signs of cerebral, brainstem, vestibulocerebellar, and progressive spinal cord involvement. Biopsy specimens of nerve and skin showed an acute vasculitis with endovascular cellular proliferation in the pattern of a Köhlmeier-Degos lesion and focal epidermal necrosis. Mental changes and cranial-nerve signs developed.

Malignant carcinoid tumor metastatic to a meningioma.

Postmortem examination in a patient with a widely disseminated pulmonary carcinoid tumor revealed invasion of a fibroblastic meningioma by metastatic tumor cells. To the authors' knowledge, this case represents the first example of a malignant carcinoid tumor that has metastasized to a primary intracranial neoplasm. The literature concerning metastasis of extracranial to primary intracranial tumors is briefly reviewed.

Spontaneous pallido-nigral accumulation of iron pigment and spheroid-like structures in macaque monkeys.

Common incidental pathologic findings in Old World monkeys are spheroid-like structures and iron pigment in the substantia nigra and globus pallidus. The occurrence of each finding correlates with the number of years monkeys have spent in captivity. The spheroids are eosinophilic and argyrophilic, but are generally PAS, iron, and luxol fast blue negative.

Epidurography with metrizamide in Rhesus monkeys.

Epidurography with metrizamide was performed on 9 Rhesus monkeys; physiologic saline was substituted for metrizamide in 3 control monkeys. Metrizamide successfully outlined the epidural space without causing any adverse clinical effects or direct tissue injury.

Suprachiasmatic region of the human hypothalamus: homolog to the primate circadian pacemaker?

The suprachiasmatic nuclei (SCN) of the hypothalamus in mammals, including nonhuman primates, contain a key pacemaker of the circadian timing system. Examination of the histology of the anterior hypothalamus in human fetal, child, and adult brains indicates that there is a cluster of neurons which may be homologous to SCN. These neurons are more diffusely organized and laterally placed in human brains than is the SCN of nonhuman primates.

Spinal subarachnoid hematomas: clue to a source of bleeding in traumatic lumbar puncture.

Although damage to the veins of Batson's epidural plexus is usually considered the origin of bleeding in traumatic lumbar puncture, a lesion of these veins would not explain the cases in which postmortem examination shows blood confined to the subdural and subarachnoid spaces. In two patients who had lumbar punctures a few days before death, there was subarachnoid hematoma of the cauda equina at autopsy. In one of these cases, the radicular vessels were shown to be the source of bleeding.

Quantitative changes in astrocytes after portacaval shunting in chimpanzees and in man with normal liver parenchyma.

Chimpanzees without liver cell damage, but subjected to portacaval anastomosis, showed behavioral changes that were accompanied by "Alzheimer II" astrocyte hyperplasia and nuclear enlargement. These findings were similar to those in a human patient with encephalopathy, secondary to a portacaval shunt, whose liver was normal. Controlled quantitative study of astrocytic hyperplasia in different anatomic regions showed the hyperplasia to involve the gray matter with only moderate topographic variation.

Aphasia following infarction of the left supplementary motor area: a clinicopathologic study.

The speech disturbance of a patient with a single embolic infarct of the left supplementary motor area was characterized by initial mutism, rapid recovery to fluent speech marked by short sentences with normal grammar, persistent severe impairment of writing, and frustration and anxiety related to language tasks.