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Cerebral PET with [18F]-2-fluoro-2-deoxy-D-glucose has been performed in four patients with neurofibromatosis type 1 (NF1) to assess the relation between cerebral metabolic activity, MRI, and the presence of neurological symptoms, including seizures, as well as mental and language retardation. Widespread hypometabolism occurred in three of the patients. The lesions on MRI, which were localised in the subcortical white matter and grey structures, had normal rates of glucose metabolism. This finding suggests that the abnormalities seen on MRI are not due to defective blood supply, localised oedema, or grey matter heterotopic foci as previously hypothesised. The presence of the hypometabolic areas seems to be inconsistently related to the occurrence of seizures and is not proportional to the degree of mental impairment. This study provides evidence of a widespread cerebral hypometabolism that is not related to the presence of MRI abnormalities; conversely normal metabolism was present in the areas with an abnormal MRI signal.

IN 1942, in Panama 13 cases of acute conjunctivitis and dermatitis were observed and attributed to an agent which, so far as could be determined, had not previously been reported in a large number of cases. During maneuvers of an infantry regiment one company took up defensive positions along a stretch of Pacific Ocean beach at night. The men dug foxholes and then proceeded to camouflage them by utilizing pieces of shrub found in the vicinity. This is in accordance with good military practice, as it affords a disguise which conforms with the surrounding terrain. It so happened that "beach apple" plant was easily accessible, and hence it was used. The scientific name of the plant is Hippomane manchinella L. (Euphorbiaceae). The common names in current use are "manzanillo" and "beach apple." It is described as a gray-barked, round-topped tree found on the seabeaches of the West Indies and

The aim of this study was to evaluate, in 16 patients with drug-resistant partial epilepsy who were waiting to undergo surgical treatment, the relation between positron emission tomography (PET) findings with fluorine-18 fluorodeoxyglucose ([18F]FDG) in the interictal state and the different stereo-electroencephalography (SEEG) patterns that characterize: (a) the epileptogenic zone (low-voltage fast-activity discharge before or concurrent with ictal clinical symptoms), (b) the irritative zone (spikes, spikes and waves, isolated or grouped in short bursts) and (c) the lesional zone (continuous, sometimes polyrhythmic slow waves or continuous delta waves or very important voltage depression). SEEG was performed following an individually defined electrode implantation strategy. Whereas at least one area of hypometabolism was detected by visual interpretation of PET/[18F]FDG images in all the subjects in the study, there was poor agreement between PET/[18F]FDG quantitative measures of regional metabolism and SEEG findings. Normal metabolic rates were found in up to 62% of the areas with abnormal SEEG activity, independent of the type of electrical activity, i.e. epileptogenic, irritative, or lesional, while abnormal metabolic rates were found in up to 23% of the areas with normal SEEG activity. In conclusion, whereas the visual interpretation of interictal studies of glucose utilization in our series of drug-resistant epileptic patients consistently allowed the localization of an area of temporal hypometabolism, the quantitative and regional metabolic analysis demonstrated that such a finding is not specifically related to any of the three very different SEEG patterns (epileptogenic, irritative, lesional) or combinations thereof. These results complement those of previous interictal and ictal single-photon emission tomographic studies and of receptor studies in epileptics, suggesting functional and biochemical heterogeneity within the interictal hypoperfused/hypometabolic area in epileptic patients, and contribute to the debate on the use and interpretation of interictal PET/[18F]FDG studies in patients with medically refractory partial seizures.

Positron emission tomography with [18F]-2-fluoro-2-deoxy-D-glucose ([18F]FDG) has been used to assess the pattern of cerebral metabolism in different types of epilepsies. However, PET with [18F]FDG has never been used to evaluate drug naive patients with cryptogenic temporal lobe epilepsy, in whom the mechanism of origin and diffusion of the epileptic discharge may differ from that underlying other epilepsies. In a group of patients with cryptogenic temporal lobe epilepsy, never treated with antiepileptic drugs, evidence has been found of significant interictal glucose hypermetabolism in a bilateral neural network including the temporal lobes, thalami, basal ganglia, and cingular cortices. The metabolism in these areas and frontal lateral cortex enables the correct classification of all patients with temporal lobe epilepsy and controls by discriminant function analysis. Other cortical areas--namely, frontal basal and lateral, temporal mesial, and cerebellar cortices--had bilateral increases of glucose metabolism ranging from 10 to 15% of normal controls, although lacking stringent statistical significance. This metabolic pattern could represent a pathophysiological state of hyperactivity predisposing to epileptic discharge generation or diffusion, or else a network of inhibitory circuits activated to prevent the diffusion of the epileptic discharge.

99 The problems of military psychiatry may be classified in four general categories: i. Those concerned with induction and enlistment of soldiers. 2. Those arising during training. 3. Those arising during combat. 4. Those concerned with psychiatric casualties in the post-war period. That this is rather an arbitrary classification should be made clear, for it is obvious that the categories overlap in the actuality of the total picture. Nevertheless, for purposes of presentation this categorical separation serves a useful purpose, and the discussion of the problems relating to a separate category will point the way for correction of problems in other categories. It is for this reason that we are here presenting our experiences with the psychiatric problems encountered during a ten months’ period of training in what was, during that time, a peacetime army. The material presented covers the period from February to December, 1941. It was gathered on the neuropsychiatric section of a typical eight hundred bed station hospital serving approximately 17,000 troops in training. Of these troops approximately 12,000 were National Guard troops federalized in February, 1941, and the remainder were trainees inducted under the Selective Service Act. A word of explanation of these statistics is necessary. The National Guard troops were at this station from the time of their induction into Federal Service whereas the troops procured by Selective Service had been through at least thirteen weeks basic training at other stations prior to transfer here. Therefore it would be expected that some of the neuropsychiatric cases among selectees would have been weeded out of service prior to coming under the control of this command. Another factor is that selective service induction boards are presumed to have, and most do in the areas from which our troops were drawn, one or more psychiatrists on the medical board for the final induction physical examinations. The

This paper reports a case of Mooren's ulcer in which therapeutic keratoplasty resulted in arrest of the disease and preservation of useful vision. The medical and surgical measures employed without success are given. Two grafts were done. The reaction in the first graft is noteworthy in that a typical Mooren's-like ulcer developed in the graft itself and then progressed into the remaining uninvolved cornea. The indications for therapeutic keratoplasty are given. A brief resume of some of the forms of treatment reported in the literature is included. Therapeutic keratoplasty has become a useful tool in the management of a variety of corneal pathologic processes. Its primary objective is the arrest of the disease. Therapeutic keratoplasty, usually, if not always, employs the lamellar technique. The procedure is safer than the penetrating type. Recently the uses of lamellar keratoplasty have been greatly extended not only in this country but particularly in Europe.

The electrochemical method was used successfully to detect Escherichia coli cells retained on membrane filters. Preliminary results suggest that the combined technique could be used to predict the microbial loading of water samples.