Secretion of human interferons by yeast.

Plasmids were constructed to direct synthesis of the human interferons IFN-alpha 1, IFN-alpha 2, and IFN-gamma in the yeast Saccharomyces cerevisiae. Expression of IFN genes containing coding sequences for secretion signals resulted in the secretion of IFN activity. A large proportion of the IFN-alpha 1 and IFN-alpha 2 isolated from the yeast cell growth media had the same amino termini as the natural mature interferons, suggesting a removal of the signal sequences identical to that of human cells. These results show that a lower eukaryote, such as yeast, can utilize and process a human signal sequence.

Combination chemotherapy and radiation therapy. The medical management of epidural spinal cord compression from testicular cancer.

Radiation and surgery are the mainstays of treatment for epidural spinal cord compression. There are reports in the literature, however, in which the use of chemotherapy alone or in combination with radiation and surgery has resulted in improved patient response. We present two patients with spinal cord compression from testicular cancer who developed progressive paraplegias that were successfully reversed with combination chemotherapy, steroids, and radiotherapy. In one case, the patient was unable to receive more than 600 rad (6 Gy) of radiation and his improvement was clearly related to the chemotherapy he received. In treating tumors causing spinal cord compression that are thought to be chemosensitive, one should consider adding chemotherapy to radiation or using chemotherapy alone if the options of surgery or radiation are not available.

Decreased computerized tomography numbers in patients with presenile dementia. Detection in patients with otherwise normal scans.

Patients in their 50s who show clinical signs of dementia (possible Alzheimer's disease) often have ocmputerized tomographic (CT) scans that appear normal. This study examined the mean CT number within a 169-pixel sample in white matter in the centrum semiovale slice. Slice sizes ranged from 6,800 to 9,000 pixels; all were without contrast enhancement. The CT numbers were higher for six nondementia cases (CT numbers of 41 and above)than for 14 dementia cases (CT numbers of 40 and below). The non-overlap in mean CT numbers between the two groups was observed independent of the presence or absence of prominent sulci. Similar low CT numbers were observed for seven patients with senile dementia. Differential diagnosis between dementia and depression may be better aided by studying the CT numbers rather than the presence of prominent sulci.

Ventricular size in patients with presenile dementia of the Alzheimer's type.

The computed tomograms (CTs) of eight mild to moderately impaired patients with presenile dementia of Alzheimer's type (aged 53 to 64 years) were compared with scans of ten healthy age-matched controls. Two computer programs and a variety of linear measurements were used to analyze the CTs. A single computerized measure of fluid volume on the slice at the maximum width of the bodies of the lateral ventricles correctly predicts the group membership of 88.89% of the subjects. Computerized measures on other CT slices do not increase discrimination between the groups. Easily performed linear measures correctly predict the group membership of 78.9% of the subjects. Computerized measures of ventricular size may provide highly valuable information for the diagnosis of Alzheimer's disease in the presenile age range.

CT density numbers in patients with senile dementia of the Alzheimer's type.

The computed tomograms (CTs) of 13 mild to moderately impaired patients with senile dementia of the Alzheimer's type (aged 65 to 82 years) were compared with CTs of 18 healthy age-matched controls. Two computer programs and a variety of linear measurements were used to analyze the CTs. A measure of the mean CT density number of the brain tissue on the slice at the maximum width of the bodies of the lateral ventricles correctly predicts the group membership of 77.42% of the subjects. The addition of a second computerized variable, the fluid volume on the slice at the maximum width of the third ventricle, increased discriminating power to 93.55%. The CT density numbers may provide highly valuable information for the diagnosis of Alzheimer's disease in the senile age range.

Computed tomographic scan hemispheric asymmetries in right- and left-handed male and female subjects.

Patterns of computed tomographic scan asymmetries in the frontal and occipital regions of the brain were examined in 172 right- and left-handed male and female subjects; these patterns were compared with those published previously to determine which asymmetries were reliable across studies. The patterns observed appeared to be unrelated to handedness or sex and suggested that, especially in the posterior region of the brain, the majority of individuals have left hemispheres longer and wider than their right hemispheres. If anatomic asymmetries are indeed substrates for functional asymmetries, it appears more likely that they are related to at least some aspects of language dominance than to cerebral dominance for handedness.

Frontal leukotomy size and hemispheric asymmetries on computerized tomographic scans of schizophrenics with variable recovery. Northampton Veterans Administration study.

The computerized tomographic (CT) scans of 17 schizophrenic men who had had bilateral prefrontal leukotomy performed 25 years earlier were examined to determine the relationship among leukotomy site, size, hemispheric asymmetries, and recovery. Six cases of good recovery (GR), five of moderate recovery (MR), and six of no recovery (NR) were studied; 16 of 17 patients were right-handed. Results showed that the GR cases had significantly larger lesions in the low orbitofrontal region (especially on the left) than did the other MR and NR cases. Also, five of six of the GR cases had significantly greater lesion size asymmetry in the low orbitofrontal region and overall than did the other MR and NR cases. There was no consistent asymmetry of lesion size (larger right or left) that was associated with recovery. Significant differences were observed in the hemispheric asymmetries of the right-handed schizophrenics vs normal subjects. Only half the cases had the expected increased left occipital width, and half had unexpected equal or increased right occipital widths. All of the GR cases had either an increased left or right occipital width; none had equal widths. Additional observation of long-standing leukotomy sites on CT scans in schizophrenia cases is recommended.

Aphasia with predominantly subcortical lesion sites: description of three capsular/putaminal aphasia syndromes.

Nine cases of subcortical aphasia with capsular/putaminal (C/P) lesion sites demonstrated on computed tomographic (CT) scans were studied. Eight cases were occlusive-vascular in etiology and one was hemorrhagic. Three subcortical aphasia syndromes and three C/P lesion site patterns were observed. Patients with C/P lesion sites with anterior-superior white-matter lesion extension had good comprehension, grammatical, but slow, dysarthric speech, and lasting right hemiplegia. Patients with C/P lesion sites with posterior white-matter lesion extension across the auditory radiations in the temporal isthmus had poor comprehension, fluent Wernicke-type speech, and lasting right hemiplegia. Patients with C/P lesion sites with both anterior-superior and posterior extension were globally aphasic and had lasting right hemiplegia. Although these cases of C/P subcortical aphasia shared certain well-known features of Broca's and Wernicke's cortical aphasia syndromes, they did not completely resemble cases of either Broca's, Wernicke's, global, or thalamic aphasia in neurologic findings, CT scan lesion sites, or language behavior. Further study of the subcortical aphasias associated with these C/P lesion sites seems to be warranted.

The long-term effects of prefrontal leukotomy.

To explore the long-term effects of bilateral prefrontal destruction, 16 schizophrenics who had undergone prefrontal leukotomy approximately 25 years earlier were studied by neurologic examination, psychiatric outcome, EEG, computerized tomography (CT), and a battery of neuropsychological tests. Five nonleukotomized chronic schizophrenics and five age-matched normal subjects served as controls. We report details on the subjects, outline the test procedures, and offer an overview of the long-term residua. In general, the larger the frontal lesion demonstrated by CT, particularly if asymmetric, the better the psychiatric outcome and the better the performance on psychological testing, but there was no correlation between frontal lesion size and either neurological or EEG abnormality.

Left-to-right transfer of language dominance: a case study.

Partial recovery from aphasia was documented in an individual rendered hemiplegic and globally aphasic by embolic infarction in the distribution of the left middle cerebral artery. Computed tomography showed total destruction of the classical left hemisphere language areas, indicating that the right hemisphere was responsible for the improved linguistic function. This observation is consistent with right hemisphere language capacity demonstrated after left hemispherectomy or commissurotomy. Right hemisphere language function may underlie much of the recovery from aphasia after injury of the left hemisphere.

Approach to and reconstruction for lesions of the posterior third of the tongue via midline labiomandibular glossotomy.

Most benign and malignant lesions of the posterior third of the tongue may be approached through a median labiomandibular glossotomy. This is accomplished by splitting the lower lip, mandible, floor of the mouth, and tongue in the midline to expose such areas as the posterior tongue, pharynx, and nasopharynx. This technique is useful for lesions of the posterior third of the tongue for several reasons: 1) it provides excellent exposure, 2) it is cosmetically superior to most other approaches, 3) it allows for several alternatives to reconstruction, such as retrusion or rotation tongue flaps, 4) the procedure sustains minimum blood loss since the tongue is bisected in the midline in an avascular plane, (5) when preoperative radiation therapy has been included, this approach minimizes the amount of surgery performed through the radiated field, and 6) postoperative tongue mobility is usually sufficient to permit articulation and deglutition to approach normal. The Cleveland Clinic Foundation's experience with this approach is reviewed, the technique is described, and a variety of cases are presented to illustrate its applicability.

Otorhinolaryngologic causes of headache.

Pain around the face and neck is common. This pain may be referred from a different area. Because patients usually present with pain and discomfort in a specific location such as the ear, nose, face, throat, or neck, this article discusses separately the innervation of each region and the most frequent causes of pain in each of these areas.

CT scan cerebral hemispheric asymmetry measurements in stroke cases with global aphasia: atypical asymmetries associated with improved recovery.

This study was undertaken in order to examine the relationship between CT scan hemispheric asymmetries and recovery in aphasia. The study had two parts. In Part I, hemispheric asymmetries were measured on the CT scans of 60 right-handed male non-aphasic (non-neurological) controls and 89 right-handed male aphasics, using a modification of LeMay's (1977) techniques. Both the non-aphasic control and aphasic data were in agreement with that of LeMay for frontal width, occipital width and occipital length. In Part II, the degree of CT scan hemispheric asymmetry was quantified for 14 right-handed male global aphasics, in whom differences in degree of language recovery were observed in the months following stroke. Atypical occipital asymmetries were significantly associated with certain aspects of language recovery (naming, single-word comprehension and single-word repetition). The authors postulate that increased capacity for right hemisphere contribution to language function might in part explain recovery in the cases exhibiting atypical occipital CT asymmetries.

Tumors of the carotid body. Experience with 41 operative cases.

Evaluation of a patient with a carotid body tumor requires a complete head and neck examination with special attention to the cranial nerves and careful search for additional paragangliomas in other sites. Angiography is very helpful in making the diagnosis and assessing the ipsilateral and contralateral carotid artery. Surgery should be performed early, since group I tumors are easily excised and are associated with a low surgical morbidity. Surgical excision shoud be performed by head and neck and vascular surgeons applying shunting or reconstructive techniques when appropriate. With improved diagnostic and surgical techniques, the morbidity and mortality should continue to approach zero.

Paired-ion reversed-phase high-pressure liquid chromatographic assay of pentobarbital-pyrilamine suppositories.

The assay of suppositories containing pentobarbital and/or pyrilamine in a water-soluble polyethylene glycol base by high-pressure liquid chromatography is described. No extraction is required. The suppository is dissolved in the mobile phase. This solution is diluted with an internal standard stock solution containing phenobarbital. Chromatographic conditions include a C18 bonded microporous silica column and a mobile phase of 65% 4 x 10(-3) M n-butyl sodium sulfonate in 1% acetic acid and 35% acetonitrile. The procedure using commercial products gave results comparable to those obtained by GLC.

An improved high-pressure liquid chromatographic assay for secobarbital in serum.

A high-pressure liquid chromatographic method for the analysis of secobarbital in serum was developed. Secobarbital was extracted from buffered serum (pH 5.5) with a solvent mix of hexane-ether-n-propanol. 5-(4-Methylphenyl)-5-phenylhydantoin was added as an internal standard. Separation of secobarbital and internal standard from serum constituents and other drugs was achieved on a 5-mum C-18 reversed-phase column using an acetonitrile-phosphate buffer (pH 4.4) mobile phase. The eluent was monitored at 195 nm. The sensitivity limit of the assay was approximately 0.02 microgram/ml with 0.5 ml of serum sample. The application of this method to pharmacokinetic studies in pediatric patients was demonstrated.

Functional endoscopic sinus surgery: evaluation, surgery, and follow-up of 250 patients.

Although much has been written about the surgical technique of functional endoscopic sinus surgery, little has appeared about its long-term results. Two hundred fifty patients underwent endoscopic nasal office evaluations and subsequent functional endoscopic sinus surgery (42 unilateral + 208 bilateral = 458 procedures) for nasal polyposis and chronic sinusitis from January 1986 to June 1988. Immediate postoperative data indicated that 8.3% developed minor complications and 0.7% developed major complications. Two hundred twenty-one patients were available for long-term follow-up at 12 to 42 months (mean = 17 months) with success rates of 89.7% for relief of sinonasal polyposis and 80.2% for relief of chronic sinusitis.

Relapsing polychondritis--report of ten cases.

Relapsing polychondritis is a rare disease of unknown etiology. There are approximately 211 reported cases in the world literature. This is a report of ten cases from the Cleveland Clinic Foundation. McAdam's diagnostic criteria for R.P. were reviewed and modified. For diagnosis, all patients had to have 1. at least three or more diagnostic criteria, histologic confirmation not necessary; 2. one or more of McAdam's signs with positive histologic confirmation; or 3. chondritis in two or more separate anatomic locations with response to steroids and/or Dapsone. Chondritis of the auricles (9/10 patients) and arthropathy (8/10 patients) are the most common presenting signs. Chondritis was also seen in the nose (6/10) and the upper respiratory tract involving the larynx and trachea (4/10). Cochlear and vestibular damage and ocular inflammation were each seen in 5/10 patients. Patients were treated with steroids and/or Dapsone. Both drugs were reliable in abating episodes of activity and in decreasing recurrences. These results further support Dapsone as an alternate form of treatment for RP.

Basal cell carcinoma of the head and neck: identification of the high risk patient.

While the majority of patients with basal cell carcinoma are cured by the initial therapeutic approach, high risk patients who have had recurrences of basal cell carcinoma have been identified. From April 1976 to November 1979, 811 patients with 1,271 cutaneous carcinomas were seen at the Mohs' Histographic Surgery Unit of the Cleveland Clinic Foundation. Of these, 496 represented recurrent basal cell carcinomas. Histologic subtype, location of the tumor, and age of the patient were studied in an attempt to identify factors which place patients at risk for persistent or recurrent carcinoma. The physician who first sees a patient with basal cell carcinoma should look for these risk factors and, after identifying such patients, consider an aggressive management with frequent follow-up.

Pharyngeal reconstruction after laryngectomy.

A method of pharyngeal reconstruction following laryngectomy is described. In 44 successive laryngectomies using this technique, no postoperative pharyngocutaneous fistulas occurred. Ten of the patients had received full courses of radiation therapy prior to the surgical procedure and had recurrent carcinomas. Other reports have noted that laryngectomy following full courses of "unplanned preoperative" radiation therapy is usually associated with a high incidence of postoperative pharyngeal fistula. The pharyngeal fistula problem, and the pharyngeal repair that was used in our series, are discussed. The pharynx was closed carefully in three layers with fine, absorbable sutures, and a submucosal inverting technique was used for the important mucous membrane closure. Tube feedings were used for two weeks after surgery. A high incidence of pharyngocutaneous fistula after laryngectomy in the irradiated patient can be prevented.