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In order to study the possible etiologic role of lead in human motor neuron disease we produced chronic lead intoxication in the chicken by daily administration of lead acetate. Control animals received sodium acetate. During life, periodic measurements were made of motor function, motor nerve conduction velocity and response amplitude. After sacrifice, histologic analysis was performed on spinal cord, peripheral nerve and muscle. A syndrome was produced characterized by a fall in motor response amplitude, spinal motor neuron degeneration, motor axonal loss and atrophy of muscle, similar to that seen in human motor neuron diseases.

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In a study of chronic lead intoxication in mature chickens, blood lead levels were significantly lower in hens than in roosters receiving the same oral dose of lead. It was then shown that eggshells from lead-treated hens contained 6-12 times the lead concentration of eggshells from control hens. Similarly, the lead content of egg yolks from treated hens was significantly higher than yolks from controls. Lead-treated hens laid significantly more eggs during the period of observation of nearly 3 years because of the increased frequency of laying cycles, which was almost three times that of control hens. A further observation was histologic damage to the mature testes of the rooster.

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We studied the incidence and mortality of stroke in northern Israel to determine possible reasons for the differences previously found in mortality from this condition between the sex and ethnic groups in Israel as a whole. We identified 1,149 cases of stroke during 1984. While the age-standardized incidence was higher in men, the case-fatality rate was twice as high in women. After controlling for ethnic origin, we found that incidence was higher only in men of Western origin, while the female rates were higher in women of Asian and North African extraction. The case-fatality rate was substantially higher in women in all ethnic groups. These differences, especially in relation to the case-fatality rate, have important implications for health services in relation to both possible preventive action and to management of the acute disease phase.

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An 11-year-old boy was hospitalized with sudden blindness and sagittal sinus vein thrombosis, which were the presenting signs of acute promyelocytic leukemia (APL). The association of disseminated intravascular clotting (DIC) with APL is well-known, and DIC usually affects the smaller blood vessels. The obliteration of a large blood vessel, as in our case, is an uncommon manifestation of DIC. This presentation of acute childhood leukemia is unusual and, to the best of our knowledge, has not been previously reported.

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Three unusual cases with astereognosis caused by cervical meningioma are presented. Astereognosis of subcortical origin has been reported several times. According to these reports, the causative lesion was confined to the area extending between the lower brain stem and the fourth cervical vertebra, thus suggesting that a sensory centre for stereognosis could be confined within these well defined anatomical limits, and that therefore a lesion in this area could lead to astereognosis. It is assumed in this paper that the lesion involves the sensory system of the Nucleus Cervicalis Lateralis. Fibres from the spinothalamic tract, a specialized sensory pathway, ascend from the palms of the hands to this nucleus. From this nucleus arise fibres which decussate and reach the Ventral Posterolateral Nucleus of the thalamus. It is likely that a lesion of the nucleus itself or its related sensory tracts may cause astereognosis.

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While the association of spinal cord tumor and high-pressure hydrocephalus is well known, only 5 cases of spinal cord tumor associated with normotensive hydrocephalus have been reported. Two further cases are described here, discussing the possible pathophysiological mechanism. It is suggested that these patients go through a subclinical stage of high-pressure hydrocephalus and become normotensive later on, a process which might influence the surgical results.

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The results of evaluation of the autonomic nervous system of a patient with amyotrophic lateral sclerosis are presented. As previously reported, parasympathetic function and sympathetic adrenergic function were normal as assessed by cardiovascular reflexes. However, a disturbance in sympathetic cholinergic function as measured by the sympathetic skin response was demonstrated. We suggest that the latter test be included in all electrophysiological evaluations of autonomic function in amyotrophic lateral sclerosis.

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A case of recurrent postprandial amaurosis fugax (AF) associated with periorbital pain is described. Clinical and angiographic examination revealed moderate atherosclerosis of the cerebral vessels and narrow-angle glaucoma. Cerebral postprandial hypoperfusion combined with increased intraocular pressure probably precipitated the painful monocular blindness. The attacks of AF subsided partially after treatment of the glaucoma.

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Carbamazepine has recently been reported to have therapeutic potential in mania. We studied carbamazepine plus haloperidol v placebo plus haloperidol in excited psychoses in a controlled double-blind design. Twenty-three patients completed five weeks of carbamazepine-haloperidol therapy, and 20 patients placebo-haloperidol therapy. Brief Psychiatric Rating Scale ratings showed superior improvement in the group receiving carbamazepine plus haloperidol. This benefit was as apparent in excited schizophrenia as in mania. No unusual toxicity was observed because of the combination of haloperidol with carbamazepine.

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Midazolam in doses of 0.21-0.46 mg/kg was given to four insomniacs for 27 days, and to a fifth insomniac for an additional 124 days, to assess its short, intermediate, long-term and long-standing efficacy. Automatic analysis of the polygraphic sleep recordings was carried out employing real-time signal processing (based on linear prediction), and an off-line sequential fuzzy clustering. Total sleep length did not vary significantly during medication, whereas other efficacy parameters such as sleep onset latency, wake time after sleep onset and number of nightly awakenings decreased significantly throughout the period of active medication. In one patient, midazolam was still effective after 151 days of administration. The ultrashort action (probably 3-4 h) of midazolam could be demonstrated by the distribution of the efficacy parameters, dividing the night into 2-h periods, by the unchanged total sleep length during medication compared with baseline and by the lack of any subjective clinical symptoms of hangover. The quantitative analysis of the signals showed that, although a decrease in the total amount of slow-wave sleep during long-term medication and withdrawal was detected, the total relative power in the delta band increased during drug administration. This was interpreted as redistribution of the delta activity during active medication. A lengthening of REM sleep was found during active medication probably attributable to intranight rebound. This was not followed by any clinical symptom of clinical REM rebound.(ABSTRACT TRUNCATED AT 250 WORDS)

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A true artifact rejector which utilizes a bucketbrigade delay line is described. The delay line enables scanning of all the data in the analysis period prior to its inclusion in the average. The device is small in size, independent of the averager, and the total cost of components is under $100. This artifact rejector is compatible with any averager. Artifact rejection can be according to excessive amplitude, as described in this version, or according to externally applied signals. In addition, by a minor change in the interference detector module, rejection could be according to other criteria, such as frequency contents. The utility of the device is demonstrated on records of auditory brain stem evoked potentials.

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In two adolescent and two adult patients with Kleine-Levin syndrome, polygraphic sleep recording performed during somnolent and non-somnolent periods revealed various forms of abnormal breathing patterns during sleep. These included periodic breathing and hypopnoeic episodes associated with brief arousals and, in one adult patient, a full blown sleep apnoea syndrome. It is suggested that abnormal breathing in sleep in this syndrome may result from central hypoexcitability.

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Computerized analysis of polygraphic sleep recordings was carried out for the evaluation of midazolam, a benzodiazepine hypnotic. The analysis was carried out in real time on a small laboratory computer, and the output included the hypnogram and relative power profiles for the main electroencephalogram activities. Analysis showed a slight "intranight rapid eye movement rebound" during medication and reduction of sleep stage IV after withdrawal. The relative power of the delta frequency band did not change during medication or withdrawal.

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In 12 epileptic patients suffering from "absences" 8-channel EEG was recorded by telemetry. The autoregressive model was applied to the signal and the prediction coefficients being the basis for calculation of the poles of the predictor. The location of the poles in the z- and s-planes was described as a function of time for 0.1 s steps along the pre-seizure EEG. In 10 of the 12 patients, and in 25 of the 28 recorded seizures this presentation of the poles of the predictor showed specific pattern linked with the occurrence of the seizure. The trajectory of the "most mobile pole" during the pre-seizure period could aid in the prediction of the seizure by several seconds.

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