home *** CD-ROM | disk | FTP | other *** search
Unknown | 1992-06-06 | 329.1 KB |
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MacOS 8.1
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Win98
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DOS
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Confidence | Program | Detection | Match Type | Support
|
---|
66%
| dexvert
| OS/2 Installation Package (archive/os2InstallPackage)
| ext
| Supported |
1%
| dexvert
| BeOS Installation Package (archive/beOSInstallPackage)
| ext
| Unsupported |
1%
| dexvert
| Newton Package (archive/newtonPackage)
| ext
| Unsupported |
1%
| dexvert
| Independence War 2 mod Package (other/independenceWar2ModPackage)
| ext
| Unsupported |
100%
| file
| data
| default
|
|
hex view+--------+-------------------------+-------------------------+--------+--------+
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|00000470| 04 00 f0 0a 00 00 38 30 | 00 00 00 01 f7 35 04 00 |......80|.....5..|
|00000480| 05 0d 00 00 38 31 00 00 | 00 01 fc 42 04 00 2f 0b |....81..|...B../.|
|00000490| 00 00 38 32 00 00 00 01 | 2b 4e 04 00 d1 0d 00 00 |..82....|+N......|
|000004a0| 38 33 00 00 00 01 fc 5b | 04 00 04 09 00 00 38 34 |83.....[|......84|
|000004b0| 00 00 00 01 00 65 04 00 | e3 0a 00 00 38 35 00 00 |.....e..|....85..|
|000004c0| 00 01 e3 6f 04 00 06 0f | 00 00 38 36 00 00 00 01 |...o....|..86....|
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|000004e0| 04 00 ef 0c 00 00 38 38 | 00 00 00 01 6e 95 04 00 |......88|....n...|
|000004f0| 34 0b 00 00 38 39 00 00 | 00 01 a2 a0 04 00 0e 0a |4...89..|........|
|00000500| 00 00 39 30 00 00 00 01 | b0 aa 04 00 63 0d 00 00 |..90....|....c...|
|00000510| 39 31 00 00 00 01 13 b8 | 04 00 17 0b 00 00 39 32 |91......|......92|
|00000520| 00 00 00 01 2a c3 04 00 | 27 0a 00 00 39 33 00 00 |....*...|'...93..|
|00000530| 00 01 51 cd 04 00 0f 0a | 00 00 39 34 00 00 00 01 |..Q.....|..94....|
|00000540| 60 d7 04 00 5f 0c 00 00 | 39 35 00 00 00 01 bf e3 |`..._...|95......|
|00000550| 04 00 cd 0d 00 00 39 36 | 00 00 00 01 8c f1 04 00 |......96|........|
|00000560| 7e 0f 00 00 39 37 00 00 | 00 01 0a 01 05 00 5f 0a |~...97..|......_.|
|00000570| 00 00 39 38 00 00 00 01 | 69 0b 05 00 39 10 00 00 |..98....|i...9...|
|00000580| 39 39 00 00 00 01 a2 1b | 05 00 dc 08 00 00 00 00 |99......|........|
|00000590| 00 00 00 00 7e 24 05 00 | 00 00 00 00 24 55 6e 69 |....~$..|....$Uni|
|000005a0| 71 75 65 5f 49 44 7b 59 | 52 42 31 32 33 30 30 7d |que_ID{Y|RB12300}|
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|000005d0| 6f 20 48 75 6e 64 72 65 | 64 20 54 68 69 72 74 79 |o Hundre|d Thirty|
|000005e0| 2d 45 69 67 68 74 20 43 | 61 73 65 73 20 46 72 6f |-Eight C|ases Fro|
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|00000620| 24 41 66 66 69 6c 69 61 | 74 69 6f 6e 7b 4c 6f 73 |$Affilia|tion{Los|
|00000630| 20 41 6e 67 65 6c 65 73 | 20 43 6f 75 6e 74 79 2d | Angeles| County-|
|00000640| 55 6e 69 76 20 6f 66 20 | 53 6f 75 74 68 65 72 6e |Univ of |Southern|
|00000650| 20 43 61 6c 69 66 6f 72 | 6e 69 61 20 4d 65 64 20 | Califor|nia Med |
|00000660| 43 74 72 2c 20 4c 6f 73 | 20 41 6e 67 65 6c 65 73 |Ctr, Los| Angeles|
|00000670| 7d 0d 0a 24 4a 6f 75 72 | 6e 61 6c 7b 41 72 63 68 |}..$Jour|nal{Arch|
|00000680| 20 4e 65 75 72 6f 6c 7d | 0d 0a 24 56 6f 6c 75 6d | Neurol}|..$Volum|
|00000690| 65 7b 34 35 7d 0d 0a 24 | 50 61 67 65 7b 37 37 37 |e{45}..$|Page{777|
|000006a0| 2d 37 38 30 7d 0d 0a 24 | 44 61 74 65 7b 4a 75 6c |-780}..$|Date{Jul|
|000006b0| 79 20 31 39 38 38 7d 0d | 0a 24 59 42 56 6f 6c 7b |y 1988}.|.$YBVol{|
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|00000810| 2d 2d 43 6c 69 6e 69 63 | 61 6c 20 50 73 79 63 68 |--Clinic|al Psych|
|00000820| 69 61 74 72 79 0d 0a 0d | 0a 2d 2d 2d 2d 2d 2d 2d |iatry...|.-------|
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|00000840| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000850| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000860| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000870| 2d 2d 2d 2d 2d 2d 2d 0d | 0a 4e 65 75 72 6f 63 79 |-------.|.Neurocy|
|00000880| 73 74 69 63 65 72 63 6f | 73 69 73 3a 20 20 54 77 |sticerco|sis: Tw|
|00000890| 6f 20 48 75 6e 64 72 65 | 64 20 54 68 69 72 74 79 |o Hundre|d Thirty|
|000008a0| 2d 45 69 67 68 74 20 43 | 61 73 65 73 20 46 72 6f |-Eight C|ases Fro|
|000008b0| 6d 20 61 20 43 61 6c 69 | 66 6f 72 6e 69 61 20 48 |m a Cali|fornia H|
|000008c0| 6f 73 70 69 74 61 6c 0d | 0a 0d 0a 53 63 68 61 72 |ospital.|...Schar|
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|000008f0| 20 53 6f 75 74 68 65 72 | 6e 20 43 61 6c 69 66 6f | Souther|n Califo|
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|00000960| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000970| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000980| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 0d |--------|-----...|
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|00004230| 0a 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |.-------|--------|
|00004240| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004250| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004260| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004270| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 0d |--------|-------.|
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|000042d0| 57 2c 20 50 61 6a 75 72 | 6b 6f 76 61 20 45 4d 2c |W, Pajur|kova EM,|
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|00004330| 55 6e 69 76 20 6f 66 20 | 42 72 69 74 69 73 68 20 |Univ of |British |
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|00004360| 6c 20 34 35 3a 37 36 39 | 2d 37 37 33 2c 20 4a 75 |l 45:769|-773, Ju|
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|00004380| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
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|000043a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000043b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000043c0| 2d 2d 2d 2d 2d 2d 2d 0d | 0a 0d 0a 41 62 73 74 72 |-------.|...Abstr|
|000043d0| 61 63 74 0d 0a 0d 0a 20 | 20 20 20 20 48 75 6e 74 |act.... | Hunt|
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|00004430| 76 65 6e 74 20 6f 66 20 | 72 65 63 6f 6d 62 69 6e |vent of |recombin|
|00004440| 61 6e 74 20 44 4e 41 20 | 74 65 63 68 6e 69 71 75 |ant DNA |techniqu|
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|00004460| 61 74 69 6f 6e 20 6f 66 | 20 63 6c 6f 73 65 6c 79 |ation of| closely|
|00004470| 0d 0a 6c 69 6e 6b 65 64 | 20 44 4e 41 20 6d 61 72 |..linked| DNA mar|
|00004480| 6b 65 72 73 2c 20 69 74 | 20 68 61 73 20 62 65 63 |kers, it| has bec|
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|000044a0| 64 65 74 65 72 6d 69 6e | 65 20 77 68 65 74 68 65 |determin|e whethe|
|000044b0| 72 20 61 74 2d 72 69 73 | 6b 0d 0a 70 65 72 73 6f |r at-ris|k..perso|
|000044c0| 6e 73 20 68 61 76 65 20 | 61 20 6c 6f 77 20 6f 72 |ns have |a low or|
|000044d0| 20 68 69 67 68 20 72 69 | 73 6b 20 6f 66 20 68 61 | high ri|sk of ha|
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|00004510| 6f 6d 73 20 6f 66 20 63 | 68 6f 72 65 61 20 61 6e |oms of c|horea an|
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|00004530| 20 75 73 75 61 6c 6c 79 | 20 64 6f 20 6e 6f 74 20 | usually| do not |
|00004540| 61 70 70 65 61 72 20 75 | 6e 74 69 6c 20 6d 69 64 |appear u|ntil mid|
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|00004560| 74 75 64 69 65 73 20 68 | 61 76 65 20 73 75 67 67 |tudies h|ave sugg|
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|00004590| 75 61 6c 20 63 68 61 6e | 67 65 73 20 6d 61 79 20 |ual chan|ges may |
|000045a0| 6f 63 63 75 72 0d 0a 69 | 6e 20 73 6f 6d 65 20 61 |occur..i|n some a|
|000045b0| 74 2d 72 69 73 6b 20 69 | 6e 64 69 76 69 64 75 61 |t-risk i|ndividua|
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|00004610| 69 6d 70 61 69 72 6d 65 | 6e 74 20 69 6e 20 63 65 |impairme|nt in ce|
|00004620| 72 74 61 69 6e 20 61 74 | 2d 72 69 73 6b 20 69 6e |rtain at|-risk in|
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|00004640| 74 68 65 20 63 6f 6e 73 | 69 73 74 65 6e 63 79 20 |the cons|istency |
|00004650| 6f 66 20 74 68 65 73 65 | 20 63 68 61 6e 67 65 73 |of these| changes|
|00004660| 20 77 61 73 20 6e 6f 74 | 20 64 6f 63 75 6d 65 6e | was not| documen|
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|00004680| 70 61 74 74 65 72 6e 20 | 6f 66 0d 0a 64 65 66 69 |pattern |of..defi|
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|000046a0| 6e 20 64 65 66 69 6e 65 | 64 2e 0d 0a 20 20 20 20 |n define|d... |
|000046b0| 20 54 65 6e 20 70 65 72 | 73 6f 6e 73 20 61 74 20 | Ten per|sons at |
|000046c0| 72 69 73 6b 20 66 6f 72 | 20 48 44 20 75 6e 64 65 |risk for| HD unde|
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|000046e0| 6f 6c 6f 67 69 63 61 6c | 20 65 76 61 6c 75 61 74 |ological| evaluat|
|000046f0| 69 6f 6e 20 74 6f 0d 0a | 63 68 61 72 61 63 74 65 |ion to..|characte|
|00004700| 72 69 7a 65 20 74 68 65 | 20 6e 61 74 75 72 65 2c |rize the| nature,|
|00004710| 20 65 78 74 65 6e 74 2c | 20 61 6e 64 20 63 6f 6e | extent,| and con|
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|00004730| 63 6f 67 6e 69 74 69 76 | 65 20 63 68 61 6e 67 65 |cognitiv|e change|
|00004740| 73 2e 20 54 68 65 0d 0a | 72 65 73 75 6c 74 73 20 |s. The..|results |
|00004750| 77 65 72 65 20 63 6f 6d | 70 61 72 65 64 20 77 69 |were com|pared wi|
|00004760| 74 68 20 74 68 6f 73 65 | 20 6f 66 20 44 4e 41 20 |th those| of DNA |
|00004770| 61 6e 61 6c 79 73 69 73 | 2e 20 20 54 68 65 20 31 |analysis|. The 1|
|00004780| 30 20 69 6e 64 69 76 69 | 64 75 61 6c 73 20 62 65 |0 indivi|duals be|
|00004790| 6c 6f 6e 67 65 64 0d 0a | 74 6f 20 33 20 66 61 6d |longed..|to 3 fam|
|000047a0| 69 6c 69 65 73 20 69 6e | 20 77 68 69 63 68 20 31 |ilies in| which 1|
|000047b0| 20 70 61 72 65 6e 74 20 | 77 61 73 20 61 66 66 65 | parent |was affe|
|000047c0| 63 74 65 64 20 77 69 74 | 68 20 48 44 2e 20 4e 6f |cted wit|h HD. No|
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|00004890| 66 72 6f 6e 74 61 6c 20 | 6c 6f 62 65 20 66 75 6e |frontal |lobe fun|
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|000048f0| 2e 0d 0a 20 20 20 20 20 | 54 68 65 20 70 72 6f 62 |... |The prob|
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|00004910| 67 20 69 6e 68 65 72 69 | 74 65 64 20 74 68 65 20 |g inheri|ted the |
|00004920| 48 44 20 67 65 6e 65 20 | 77 61 73 20 39 36 25 20 |HD gene |was 96% |
|00004930| 69 6e 20 35 20 70 65 72 | 73 6f 6e 73 2c 20 39 31 |in 5 per|sons, 91|
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|00004960| 65 20 33 20 48 44 2d 6e | 65 67 61 74 69 76 65 20 |e 3 HD-n|egative |
|00004970| 70 65 72 73 6f 6e 73 20 | 68 61 64 20 6e 6f 20 6e |persons |had no n|
|00004980| 65 75 72 6f 70 73 79 63 | 68 6f 6c 6f 67 69 63 61 |europsyc|hologica|
|00004990| 6c 0d 0a 69 6d 70 61 69 | 72 6d 65 6e 74 2e 20 20 |l..impai|rment. |
|000049a0| 46 69 76 65 20 6f 66 20 | 74 68 65 20 37 20 48 44 |Five of |the 7 HD|
|000049b0| 2d 70 6f 73 69 74 69 76 | 65 20 70 65 72 73 6f 6e |-positiv|e person|
|000049c0| 73 20 68 61 64 20 61 62 | 6e 6f 72 6d 61 6c 20 72 |s had ab|normal r|
|000049d0| 65 73 75 6c 74 73 20 6f | 6e 20 74 65 73 74 73 0d |esults o|n tests.|
|000049e0| 0a 74 68 61 74 20 6d 65 | 61 73 75 72 65 64 20 76 |.that me|asured v|
|000049f0| 69 73 75 6f 73 70 61 74 | 69 61 6c 20 61 62 69 6c |isuospat|ial abil|
|00004a00| 69 74 69 65 73 20 6f 72 | 20 66 75 6e 63 74 69 6f |ities or| functio|
|00004a10| 6e 73 20 61 73 73 6f 63 | 69 61 74 65 64 20 77 69 |ns assoc|iated wi|
|00004a20| 74 68 20 74 68 65 20 66 | 72 6f 6e 74 61 6c 0d 0a |th the f|rontal..|
|00004a30| 6c 6f 62 65 73 3b 20 68 | 6f 77 65 76 65 72 2c 20 |lobes; h|owever, |
|00004a40| 74 68 65 69 72 20 67 65 | 6e 65 72 61 6c 20 69 6e |their ge|neral in|
|00004a50| 74 65 6c 6c 69 67 65 6e | 63 65 2c 20 76 65 72 62 |telligen|ce, verb|
|00004a60| 61 6c 20 6d 65 6d 6f 72 | 79 2c 20 61 6e 64 20 6c |al memor|y, and l|
|00004a70| 61 6e 67 75 61 67 65 0d | 0a 61 62 69 6c 69 74 69 |anguage.|.abiliti|
|00004a80| 65 73 20 77 65 72 65 20 | 75 6e 61 66 66 65 63 74 |es were |unaffect|
|00004a90| 65 64 2e 20 20 54 68 65 | 20 6f 74 68 65 72 20 32 |ed. The| other 2|
|00004aa0| 20 48 44 2d 70 6f 73 69 | 74 69 76 65 20 70 65 72 | HD-posi|tive per|
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|00004ac0| 70 73 79 63 68 6f 6c 6f | 67 69 63 61 6c 6c 79 20 |psycholo|gically |
|00004ad0| 75 6e 69 6d 70 61 69 72 | 65 64 2c 20 73 75 67 67 |unimpair|ed, sugg|
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|00004b00| 68 65 72 20 61 77 61 79 | 0d 0a 66 72 6f 6d 20 63 |her away|..from c|
|00004b10| 6c 69 6e 69 63 61 6c 20 | 6f 6e 73 65 74 20 6f 66 |linical |onset of|
|00004b20| 20 74 68 65 20 64 69 73 | 65 61 73 65 2e 20 20 54 | the dis|ease. T|
|00004b30| 68 65 73 65 20 72 65 73 | 75 6c 74 73 20 61 72 65 |hese res|ults are|
|00004b40| 20 63 6f 6e 73 69 73 74 | 65 6e 74 20 77 69 74 68 | consist|ent with|
|00004b50| 20 6f 74 68 65 72 0d 0a | 72 65 70 6f 72 74 73 20 | other..|reports |
|00004b60| 6f 66 20 6e 65 75 72 6f | 70 73 79 63 68 6f 6c 6f |of neuro|psycholo|
|00004b70| 67 69 63 61 6c 20 64 65 | 66 69 63 69 74 73 20 69 |gical de|ficits i|
|00004b80| 6e 20 63 65 72 74 61 69 | 6e 20 69 6e 64 69 76 69 |n certai|n indivi|
|00004b90| 64 75 61 6c 73 20 61 74 | 20 72 69 73 6b 20 66 6f |duals at| risk fo|
|00004ba0| 72 20 48 44 2e 0d 0a 0d | 0a 50 6f 73 74 2d 43 6f |r HD....|.Post-Co|
|00004bb0| 6d 6d 65 6e 74 0d 0a 0d | 0a 20 20 20 20 20 54 68 |mment...|. Th|
|00004bc0| 65 20 72 65 73 75 6c 74 | 73 20 6f 66 20 74 68 69 |e result|s of thi|
|00004bd0| 73 20 63 61 72 65 66 75 | 6c 6c 79 20 63 6f 6e 73 |s carefu|lly cons|
|00004be0| 74 72 75 63 74 65 64 20 | 61 6e 64 20 63 6c 65 61 |tructed |and clea|
|00004bf0| 72 6c 79 20 70 72 65 73 | 65 6e 74 65 64 20 73 74 |rly pres|ented st|
|00004c00| 75 64 79 0d 0a 73 68 6f | 77 20 74 68 61 74 20 74 |udy..sho|w that t|
|00004c10| 68 65 72 65 20 61 72 65 | 20 69 64 65 6e 74 69 66 |here are| identif|
|00004c20| 69 61 62 6c 65 20 6e 65 | 75 72 6f 70 73 79 63 68 |iable ne|uropsych|
|00004c30| 6f 6c 6f 67 69 63 61 6c | 20 64 65 66 69 63 69 74 |ological| deficit|
|00004c40| 73 20 69 6e 20 61 20 67 | 72 6f 75 70 20 6f 66 0d |s in a g|roup of.|
|00004c50| 0a 61 73 79 6d 70 74 6f | 6d 61 74 69 63 20 69 6e |.asympto|matic in|
|00004c60| 64 69 76 69 64 75 61 6c | 73 20 77 68 6f 20 68 61 |dividual|s who ha|
|00004c70| 76 65 20 69 6e 68 65 72 | 69 74 65 64 20 74 68 65 |ve inher|ited the|
|00004c80| 20 68 61 70 6c 6f 74 79 | 70 65 20 73 65 67 72 65 | haploty|pe segre|
|00004c90| 67 61 74 69 6e 67 20 77 | 69 74 68 20 74 68 65 0d |gating w|ith the.|
|00004ca0| 0a 67 65 6e 65 20 66 6f | 72 20 48 44 2e 20 41 6c |.gene fo|r HD. Al|
|00004cb0| 74 68 6f 75 67 68 20 74 | 68 65 20 6d 6f 73 74 20 |though t|he most |
|00004cc0| 6e 6f 74 61 62 6c 65 20 | 64 65 66 69 63 69 74 73 |notable |deficits|
|00004cd0| 20 77 65 72 65 20 69 6e | 20 76 69 73 75 61 6c 20 | were in| visual |
|00004ce0| 73 70 61 74 69 61 6c 20 | 6d 65 6d 6f 72 79 0d 0a |spatial |memory..|
|00004cf0| 61 6e 64 20 69 6e 20 66 | 75 6e 63 74 69 6f 6e 73 |and in f|unctions|
|00004d00| 20 75 73 75 61 6c 6c 79 | 20 61 73 73 6f 63 69 61 | usually| associa|
|00004d10| 74 65 64 20 77 69 74 68 | 20 74 68 65 20 66 72 6f |ted with| the fro|
|00004d20| 6e 74 61 6c 20 63 6f 72 | 74 65 78 2c 20 63 65 72 |ntal cor|tex, cer|
|00004d30| 74 61 69 6e 20 74 65 73 | 74 73 0d 0a 73 65 6e 73 |tain tes|ts..sens|
|00004d40| 69 74 69 76 65 20 74 6f | 20 66 72 6f 6e 74 61 6c |itive to| frontal|
|00004d50| 20 6c 6f 62 65 20 66 75 | 6e 63 74 69 6f 6e 20 77 | lobe fu|nction w|
|00004d60| 65 72 65 20 6e 6f 74 20 | 61 66 66 65 63 74 65 64 |ere not |affected|
|00004d70| 2e 20 20 54 68 69 73 20 | 72 65 70 6f 72 74 0d 0a |. This |report..|
|00004d80| 64 65 6d 6f 6e 73 74 72 | 61 74 65 73 20 74 68 61 |demonstr|ates tha|
|00004d90| 74 20 6e 65 75 72 6f 70 | 73 79 63 68 6f 6c 6f 67 |t neurop|sycholog|
|00004da0| 69 63 61 6c 20 63 68 61 | 6e 67 65 73 20 6f 63 63 |ical cha|nges occ|
|00004db0| 75 72 20 65 61 72 6c 69 | 65 72 20 74 68 61 6e 20 |ur earli|er than |
|00004dc0| 68 61 73 20 62 65 65 6e | 0d 0a 72 65 63 6f 67 6e |has been|..recogn|
|00004dd0| 69 7a 65 64 20 70 72 65 | 76 69 6f 75 73 6c 79 20 |ized pre|viously |
|00004de0| 66 6f 72 20 70 65 72 73 | 6f 6e 73 20 61 74 20 72 |for pers|ons at r|
|00004df0| 69 73 6b 20 66 6f 72 20 | 48 44 2e 20 46 6f 72 65 |isk for |HD. Fore|
|00004e00| 6d 6f 73 74 2c 20 74 68 | 69 73 20 70 61 70 65 72 |most, th|is paper|
|00004e10| 20 69 73 20 61 6e 0d 0a | 65 78 63 65 6c 6c 65 6e | is an..|excellen|
|00004e20| 74 20 72 65 73 6f 75 72 | 63 65 20 61 6e 64 20 72 |t resour|ce and r|
|00004e30| 65 76 69 65 77 20 61 72 | 74 69 63 6c 65 20 66 6f |eview ar|ticle fo|
|00004e40| 72 20 74 68 6f 73 65 20 | 61 6d 6f 6e 67 20 75 73 |r those |among us|
|00004e50| 20 77 68 6f 20 63 61 72 | 65 20 66 6f 72 20 70 61 | who car|e for pa|
|00004e60| 74 69 65 6e 74 73 0d 0a | 77 69 74 68 20 74 68 69 |tients..|with thi|
|00004e70| 73 20 70 72 6f 66 6f 75 | 6e 64 6c 79 20 64 69 73 |s profou|ndly dis|
|00004e80| 61 62 6c 69 6e 67 20 64 | 69 73 6f 72 64 65 72 2e |abling d|isorder.|
|00004e90| 2d 2d 53 2e 43 2e 20 59 | 75 64 6f 66 73 6b 79 2c |--S.C. Y|udofsky,|
|00004ea0| 20 4d 2e 44 2e 0d 0a 24 | 55 6e 69 71 75 65 5f 49 | M.D...$|Unique_I|
|00004eb0| 44 7b 59 52 42 31 32 33 | 30 35 7d 0d 0a 24 54 69 |D{YRB123|05}..$Ti|
|00004ec0| 74 6c 65 7b 48 75 6e 74 | 69 6e 67 74 6f 6e 27 73 |tle{Hunt|ington's|
|00004ed0| 20 44 69 73 65 61 73 65 | 20 4d 6f 72 74 61 6c 69 | Disease| Mortali|
|00004ee0| 74 79 20 69 6e 20 74 68 | 65 20 55 6e 69 74 65 64 |ty in th|e United|
|00004ef0| 20 53 74 61 74 65 73 7d | 0d 0a 24 41 75 74 68 6f | States}|..$Autho|
|00004f00| 72 7b 0d 0a 4c 61 6e 73 | 6b 61 2c 20 44 4a 0d 0a |r{..Lans|ka, DJ..|
|00004f10| 4c 61 76 69 6e 65 2c 20 | 4c 0d 0a 4c 61 6e 73 6b |Lavine, |L..Lansk|
|00004f20| 61 2c 20 4d 4a 0d 0a 53 | 63 68 6f 65 6e 62 65 72 |a, MJ..S|choenber|
|00004f30| 67 2c 20 42 53 7d 0d 0a | 24 41 66 66 69 6c 69 61 |g, BS}..|$Affilia|
|00004f40| 74 69 6f 6e 7b 55 6e 69 | 76 20 48 6f 73 70 73 20 |tion{Uni|v Hosps |
|00004f50| 6f 66 20 43 6c 65 76 65 | 6c 61 6e 64 3b 20 43 61 |of Cleve|land; Ca|
|00004f60| 73 65 20 57 65 73 74 65 | 72 6e 20 55 6e 69 76 3b |se Weste|rn Univ;|
|00004f70| 20 4e 61 74 6c 20 49 6e | 73 74 20 6f 66 20 4e 65 | Natl In|st of Ne|
|00004f80| 75 72 6f 6c 6f 67 69 63 | 61 6c 20 61 6e 64 20 43 |urologic|al and C|
|00004f90| 6f 6d 6d 75 6e 69 63 61 | 74 69 76 65 20 44 69 73 |ommunica|tive Dis|
|00004fa0| 6f 72 64 65 72 73 20 61 | 6e 64 20 53 74 72 6f 6b |orders a|nd Strok|
|00004fb0| 65 2c 20 42 65 74 68 65 | 73 64 61 2c 20 4d 64 7d |e, Bethe|sda, Md}|
|00004fc0| 0d 0a 24 4a 6f 75 72 6e | 61 6c 7b 4e 65 75 72 6f |..$Journ|al{Neuro|
|00004fd0| 6c 6f 67 79 7d 0d 0a 24 | 56 6f 6c 75 6d 65 7b 33 |logy}..$|Volume{3|
|00004fe0| 38 7d 0d 0a 24 50 61 67 | 65 7b 37 36 39 2d 37 37 |8}..$Pag|e{769-77|
|00004ff0| 32 7d 0d 0a 24 44 61 74 | 65 7b 4d 61 79 20 31 39 |2}..$Dat|e{May 19|
|00005000| 38 38 7d 0d 0a 24 59 42 | 56 6f 6c 7b 31 39 39 30 |88}..$YB|Vol{1990|
|00005010| 20 59 65 61 72 20 42 6f | 6f 6b 20 6f 66 20 50 73 | Year Bo|ok of Ps|
|00005020| 79 63 68 69 61 74 72 79 | 20 61 6e 64 20 41 70 70 |ychiatry| and App|
|00005030| 6c 69 65 64 20 4d 65 6e | 74 61 6c 20 48 65 61 6c |lied Men|tal Heal|
|00005040| 74 68 7d 0d 0a 24 43 68 | 61 70 74 65 72 7b 35 2d |th}..$Ch|apter{5-|
|00005050| 31 39 7d 0d 0a 24 59 42 | 45 64 69 74 6f 72 7b 44 |19}..$YB|Editor{D|
|00005060| 72 73 2e 20 54 61 6c 62 | 6f 74 74 2c 20 46 72 61 |rs. Talb|ott, Fra|
|00005070| 6e 63 65 73 2c 20 46 72 | 61 6e 63 65 73 2c 20 46 |nces, Fr|ances, F|
|00005080| 72 65 65 64 6d 61 6e 2c | 20 4d 65 6c 74 7a 65 72 |reedman,| Meltzer|
|00005090| 2c 20 53 63 68 6f 77 61 | 6c 74 65 72 2c 20 61 6e |, Schowa|lter, an|
|000050a0| 64 20 59 75 64 6f 66 73 | 6b 79 7d 0d 0a 24 54 61 |d Yudofs|ky}..$Ta|
|000050b0| 62 6c 65 7b 54 61 62 6c | 65 20 4f 6d 69 74 74 65 |ble{Tabl|e Omitte|
|000050c0| 64 7d 0d 0a 24 43 6f 6d | 6d 65 6e 74 61 74 6f 72 |d}..$Com|mentator|
|000050d0| 7b 53 2e 43 2e 20 59 75 | 64 6f 66 73 6b 79 2c 20 |{S.C. Yu|dofsky, |
|000050e0| 4d 2e 44 2e 7d 0d 0a 0d | 0a 43 6f 70 79 72 69 67 |M.D.}...|.Copyrig|
|000050f0| 68 74 20 28 63 29 20 59 | 65 61 72 62 6f 6f 6b 20 |ht (c) Y|earbook |
|00005100| 4d 65 64 69 63 61 6c 20 | 50 75 62 6c 69 73 68 65 |Medical |Publishe|
|00005110| 72 73 2c 20 49 6e 63 2e | 2c 20 31 39 39 30 0d 0a |rs, Inc.|, 1990..|
|00005120| 0d 0a 31 39 39 30 20 59 | 65 61 72 20 42 6f 6f 6b |..1990 Y|ear Book|
|00005130| 20 6f 66 20 50 73 79 63 | 68 69 61 74 72 79 20 61 | of Psyc|hiatry a|
|00005140| 6e 64 20 41 70 70 6c 69 | 65 64 20 4d 65 6e 74 61 |nd Appli|ed Menta|
|00005150| 6c 20 48 65 61 6c 74 68 | 20 28 52 29 0d 0a 0d 0a |l Health| (R)....|
|00005160| 43 68 61 70 74 65 72 20 | 35 2d 2d 43 6c 69 6e 69 |Chapter |5--Clini|
|00005170| 63 61 6c 20 50 73 79 63 | 68 69 61 74 72 79 0d 0a |cal Psyc|hiatry..|
|00005180| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|00005190| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000051a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000051b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000051c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000051d0| 0d 0a 48 75 6e 74 69 6e | 67 74 6f 6e 27 73 20 44 |..Huntin|gton's D|
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|00005210| 44 4a 2c 20 4c 61 76 69 | 6e 65 20 4c 2c 20 4c 61 |DJ, Lavi|ne L, La|
|00005220| 6e 73 6b 61 20 4d 4a 2c | 20 53 63 68 6f 65 6e 62 |nska MJ,| Schoenb|
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|00005250| 3b 20 43 61 73 65 20 57 | 65 73 74 65 72 6e 20 55 |; Case W|estern U|
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|000052b0| 2c 20 4d 64 29 0d 0a 4e | 65 75 72 6f 6c 6f 67 79 |, Md)..N|eurology|
|000052c0| 20 33 38 3a 37 36 39 2d | 37 37 32 2c 20 4d 61 79 | 38:769-|772, May|
|000052d0| 20 31 39 38 38 0d 0a 2d | 2d 2d 2d 2d 2d 2d 2d 2d | 1988..-|--------|
|000052e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000052f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005300| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005310| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
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