Intrasellar germinoma associated with hyperprolactinemia.

We report two young adult patients with hyperprolactinemia and neuroendocrine deficits due to predominantly intrasellar germinomas. In both cases the diagnosis of germinoma was confirmed histologically after transsphenoidal surgery. This very rare type of tumor may be intrasellar and it may mimic prolactinoma or craniopharyngioma. Dynamic testing of pituitary function and computed tomography scanning are of value in the early detection of this malignant but radiocurable lesion.

Cerebral abnormalities in hepatectomized rats with acute hepatic coma.

When hepatectomized rats develop hepatic coma, they are found to have cerebral edema, together with a failure of the blood-brain barrier to contain materials usually limited to the circulation. The present studies were carried out to characterize the associated ultrastructural changes in the barrier. Rats were allowed to develop hepatic coma after a two-stage hepatectomy. Electrocortical and behavior monitoring during this period indicated deterioration similar to that seen in man with acute liver injury; the water contents of the brains of the animals in hepatic coma were increased. Electron microscopic examination of the brains from control rats and animals with hepatic coma were carried out after perfusion fixation. The examination of the brains from the comatose animals showed the appearance of greatly increased numbers of vesicles in the capillary endothelium and a marked watery swelling of adjacent astrocytes, which seemed to begin in foot processes and then to spread through the cell. Intravenous peroxidase was given to most rats in the late stages of coma, and the tracer was found to be included within the capillary endothelial vesicles. Occasional accumulations of peroxidase in the underlying capillary basement membrane were found. No interendothelial cell distruption was found. Low molecular weight microperoxidase was used as well as horseradish peroxidase; the results were the same with both compounds. The findings indicate as association between capillary endothelial vesicle formation and the cerebral edema found in animals with hepatic coma following hepatectomy.

A post-mortem comparison of the cortical cholinergic system in Alzheimer's disease and Pick's disease.

Assessment of neurochemical markers in the frontal cortex indicates that choline acetyltransferase is significantly decreased in Alzheimer's and Gerstmann-Straussler dementias but not in Pick's dementia. It therefore appears that the cholinergic innervation of the cortex from the basal forebrain is intact in Pick's disease. Cortical somatostatin was decreased only in Alzheimer's disease (AD), indicating that loss of somatostatin is not a constant feature in different forms of dementia. Muscarinic binding sites were unaltered in Pick's disease and Gerstmann-Straussler syndrome but were decreased in a subpopulation of AD patients. These data suggest that in some cases of AD a significant loss of cholinoceptive neurones in the cortex is evident.

Distribution of cerebral lesions in acquired hepatocerebral degeneration.

The brain lesions of our patients with chronic portal-systemic venous shunts were much the same regardless of the presence or absence of primary liver disease. Alzheimer's type 2 abnormality of astrocytes and demarcated areas of spongy degeneration were found, mainly in the grey matter, with more severe involvement of the basal ganglia and the deeper layers of the frontal, parietal and occipital cortex. The spongy degeneration showed an especially close correlation with the arterial blood supply, being greatest in borderland areas that fall between the regions usually supplied by one or other of the major cerebral arteries. Previous investigations have not been primarily concerned with selective vulnerability so that comparisons are difficult, but on review, there is evidence that this pattern of involvement is a feature of both Wilson's disease and acquired hepatocerebral degeneration. The toxic effect of the portal blood is greatest in the grey matter, probably because of the greater metabolic activity there, and the distribution of lesions within this area of greater vulnerability appears to be further influenced by circulatory factors.

Electron microscopy in iris nevus syndrome.

In a patient with the clinical features of the iris nevus syndrome who was treated for glaucoma a cataract developed later. The sector of iris removed during cataract extraction was examined by electron microscopy and was found to be covered by ectopic corneal endothelium with an underlying atypical Descemet's membrane. Abnormalities in the iris included aggregates of melanophagic cells in the anterior stroma and fibrosis in relation to the ectopic endothelium. These findings suggest that many of the iris abnormalities seen in this disorder occur on a reactive basis.

The Enterobacteriaceae of South African baboons.

The results of routine rectal swab examinations, carried out on 776 baboons on the day of arrival at the colony and also on 394 animals which subsequently developed diarrhoea, are described. A dramatic increase was observed in the incidence of both pathogenic and non-pathogenic organisms during the diarrhoeic phase. The significance of bacterial species which are not pathogenic under normal circumstances as the possible cause of disease in animals subjected to stress is discussed.

Progressive multifocal leukoencephalopathy.

The radionuclide, radiographic and pathologic findings in a patient with progressive multifocal leukoencephalopathy were correlated. Radionuclide imaging demonstrated the largest two of the many lesions observed at pathology. On repeated studies, one of the lesions developed a "doughnut" sign due to central necrosis. Cerebral angiography disclosed only one lesion which was initially suggestive of tumor encasement, but four weeks later, this deteriorated into an avascular zone. There were no characteristic features of the lesions demonstrated by radionuclide imaging and cerebral angiography that could be specifically attributed to progressive multifocal leukoencephalopathy.

A modified reduced transport fluid for the preservation of Neisseria gonorrhoeae during transport.

Reduced transport fluid (RTF) was modified by altering its pH and by the addition of a yeast dialysate. This reduced transport yeast-containing fluid (RTYF) was shown to be superior to RTF in maintaining viability of Neisseria gonorrhoeae in cultures and in clinical material.

Complications of phenol neuroloysis.

Phenolic stellate ganglion blockade caused triparesis in one patient, and phenolic neurolysis of cervical posterior roots caused respiratory arrest in another. These complications illustrate the dangers of the spread of phenol beyond the intended site of neurolysis with resultant local anesthesia, direct neural damage, vascular damage, and infarcts.

Familial amyotrophic lateral sclerosis with dementia: a second canadian family.

A family with adult-onset amyotrophic lateral sclerosis (ALS) and dementia is described. The father presented with lower motor neurone disease affecting the legs. A son presented with bulbar paralysis. Neither developed dementia. A daughter presented with spastic right lower limb weakness. Two years later, she developed a rapidly progressive mental disorder. Her cortical pathology had a distinctive fronto-temporal distribution. The rarity of published reports on ALS with dementia in families outside the Western Pacific and the factor of parental consanguinity conspired to make genetic counseling for this family difficult.

Differentiation of Klebsiella-Enterobacter-Serratia organisms.

Differentiation of 625 stains of bacteria which fulfilled the requirements laid down for the definition of the tribe Klebsielleae was carried out using 6 biochemical tests. Five hundred and forty-six strains were identified as members of the genus Klebsiella, 46 of the genus Enterobacter and 33 of the genus Serratia.