[The cervicofacial manifestations of Kaposi's sarcoma and of non-Hodgkin's lymphomas in HIV-infected patients].

Infection from human immunodeficiency virus (HIV) is well known for the particular host susceptibility to a variety of opportunistic infections and unusual malignant neoplasms. Although no tumor develops exclusively in concomitance with HIV infection, malignancies in these patients have different clinical behaviour, response to treatment and prognosis than the pattern observed in HIV negative hosts. Kaposi's sarcoma (EKS) and non-Hodgkin's lymphoma (NHL) are tumors per se diagnostic of AIDS in patients with HIV infection. From 1987 to 1991, 210 HIV positive patients underwent ENT examination without symptom-related selection: 128 were intravenous drug users, 50 homosexual males, 22 heterosexuals, 4 intravenous male homosexual drug users, 3 blood recipients and 3 subjects without known risk factors. Sixteen were allocated in group II, 37 in III, 9 in IV A, 2 in IV B, 31 in IV C1, 37 in IV C2, 48 in IV D and 30 in IV E. Fourteen had head and neck EKS localization. All were males, with a median age of 40 of which 11/14 were homosexuals. The concomitant involvement of skin and mucosa was the most common manifestation and the palate was the most frequently affected mucosal site. Twenty-four had NHL localized within the head and neck: 21 males and 4 females with a average age of 38, 10 intravenous drug users, 9 homosexual males, 3 heterosexuals, 1 blood recipient, 1 subject without known risk factors. Extranodal localization was the most frequent characteristic while the gums were the most commonly involved site. The main characteristics of head and neck manifestations of EKS and NHL are reported with references to literature. The majority of HIV infected patients with EKS or NHL have ENT localizations, perhaps because lymphatic tissue, a HIV target, is well represented in this area and contamination by infectious agents (such as Epstein-Barr virus and cytomegalovirus, probably involved in the pathogenesis of EKS and NHL) can easily occur in the head and neck. The otolaryngologist should be aware of the various, and sometimes misleading, characteristics of these diseases.


[The reliability of biopsy-determined grading in laryngeal squamous cell carcinoma].

Grading evaluation is becoming increasingly more important in establishing a valid prognosis and in the choice of therapeutical strategies in dealing with squamous laryngeal cancer. It follows, therefore, that grading of bioptic tissue, made before therapy planning, must offer reliable data and correspond to data gathered through grading of the entire neoplasm. Thus the aim of our study carried out on 267 cases was to verify if grading of bioptic tissue corresponds to that of the operatory specimen. In 7% of the cases (19 in 267) bioptic grading overestimated the neoplasm in that post-operatory grading revealed a less differentiated form. On the contrary, in 16% of the cases (43 in 267) bioptic grading underestimated the form since as post-operatory grading showed a more highly differentiated form. It appears clear that these values depend on the clinical extension of the neoplasm in that the difference was inferior in the case of limited neoplasms and greater in that more largely extended ones. Generally speaking then, the less extended the neoplasm (the most frequently observed clinical form), the more coinciding the bioptic evaluation indicating good differentiation with the post-operatory evaluation. On the other hand, bioptic evaluation indicating moderate or poor differentiation is less reliable since it does not coincide with findings in approximately 16% of the neoplasms, above all those most limited (12%). This means that any reductive adoption of therapy planning made on the basis of the degree of differentiation revealed upon bioptic examination is possible only in the case of those forms more advanced with regard to extension.(ABSTRACT TRUNCATED AT 250 WORDS)


[Local immunity following treatment with S-carboxymethylcysteine-lysine in tracheotomy patients].

Pathological modification in secretory IgA values as well as in circadian rhythms were found in tracheotomized patients in both nasal and tracheo-bronchial secretions. The protective role of the mucosal immune system in addition to the frequency of severe infectious respiratory diseases in laryngectomized patients justifies the efforts of clinicians to prevent and treat such modifications. Mucoregulatory drugs have a peculiar role in these therapeutical attempts. Forty tracheotomized subjects with neoplastic disease were studied. Twenty received SCMC-Lys as a mucoregulatory drug. IgA 7S, 11S and albumin values in nasal and tracheo-bronchial secretions, were evaluated at surgery, 15 and then 40 days later. In accordance with clinical data, an improvement in local antibody production, damaged by tracheostomy, was found in the treated group. The influence of SCMS-Lys on SIgA production, whose evaluation was made by means of an original, highly selective and sensitive Immuno-IsoElectroFocusing procedure, seems to encourage the use of mucoregulatory drugs in laryngectomized patients.


[The incidence and location of inflammatory paranasal sinus lesions in CT].

Several recent studies have labelled the anterior ethmoid as the main source of chronic and/or recurrent sinusitis in the entire paranasal sinus system. In an attempt to identify other possible patterns of developing sinusitis, 1,345 computed tomographies of neurological and neurosurgical patients with no previous history of paranasal sinusitis were evaluated. These scans were made between 1985 and 1989 in the Neurosurgical Clinic of the University of Freiburg. Seventy-five of these studies revealed evidence of inflammatory changes. In 57 scans maxillary sinus disease was evident, while in 46 there was en ethmoid disease, in 24 a sphenoid sinus disease and in 17 a frontal sinus disease. Nine scans showed pansinusitis. In 24 studies, one sinus location was involved (uni- or bilaterally) and among these were 21 with maxillary, 2 with anterior ethmoidal and 1 with frontal sinus involvement. In 38.7% of the examined scans, the anterior ethmoidal complex was free of disease. This study shows that, at least radiographically, the ethmoidal infundibulum is not always the origin of paranasal sinus disease. An isolated frontal, maxillary or sphenoidal sinusitis can develop as well. These results show that a simple anterior ethmoidectomy cannot be considered the panacea for chronic and/or recurring sinusitis. Surgical therapy of inflammatory sinus disease should, on the contrary, be tailored to each patient depending on anamnesis, clinical findings and CT results.


Comparison of the incidence of intracranial hemorrhage following conventional mechanical ventilation and high frequency oscillation in beagle puppies.

Controversy exists as to whether high frequency oscillation (HFO) increases the risk of intraventricular hemorrhage (IVH) compared with conventional mechanical ventilation (CMV). We compared the risk of intracranial hemorrhage after phenylephrine-induced hypertension, combined with a hypovolemic, hypotensive insult followed by rapid volume replacement in two groups of newborn beagle puppies (one group on a piston pump HFO and the other on CMV). A total of 12 beagle puppies (6 on HFO and 6 on CMV) survived the protocol. Arterial blood gas analysis and arterial blood pressures through the study were of the same magnitude in both groups. The length of time for which the puppies remained hypertensive and hypotensive also did not vary significantly between the groups. Intraventricular hemorrhages were observed in two of six CMV puppies and two of six HFO puppies. One animal in each group had a white matter hemorrhage. Subarachnoid hemorrhages were seen in 4 animals on CMV and 3 on HFO. This study indicated that HFO does not increase the risk of any kind of intracranial hemorrhage, including IVH, in beagle puppies.


Comparison of severity of viremia and antibody responses between infants and children with measles.

Severity of viremia and neutralizing antibody responses were compared between nine young infants (less than or equal to 10 months) with measles and 18 infants and children (greater than or equal to 11 months) with ordinary measles. Peripheral blood mononuclear cell (PBMC)-associated viremia was detected between the first day of elevation of fever (day 0) and day 5 of the disease in the former group, whereas PBMC-associated and cell-free viremia were detected between day 0 and day 14 in the latter group. The number of infected PBMC during the first 7 days of the disease was 3.22 +/- 1.07 (log10, mean +/- s.d.) per 10 million PBMC in the former group, which was significantly smaller (P = 0.02) than that of the latter group (4.21 +/- 1.18). The former group reached the maximum level of antibody earlier than the latter group.


[Sandwich-graft myringoplasty: the authors' personal technic and results].

The authors describe the anatomic and functional results obtained with a sandwich myringoplasty technique (MPL) employing an endaural approach. The suggested technique is a modified sandwich MPL by endaural approach with a reduced Shambaugh incision, a systematic profiling of the canal wall bulge and separation of the meatal and tympano-meatal flaps that are maintained pedunculated. The temporal fascia is inserted between the fibrous layer of the tympanic remnant and a single pedunculated tympano-meatal cutaneous flap replaced in the original location. The authors present 72 cases operated between January 1987 and December 1989 for perforations involving up to three quadrants. In 93.1% of the cases a complete and lasting resolution of the perforation was obtained. Of the 5 failures, 4 presented a perforation smaller than the original one. An average (250, 500, 1000 Hz) functional recovery of 14.1 dB was observed compared to an average pre-operatory gap of 21.6 dB. In 25% of the cases, average recovery was greater than 25 dB and in 5 patients a slight worsening with an average difference of -3.3 dB was observed. On the whole, in 41 patients a residual post-operatory gap of only 10 dB was achieved. The anatomical results obtained with the MPL presented are similar to those found in the literature describing the classical overlay technique. However, the cases reported do not present those inconveniences associated to the latter technique (lateralization of the graft and blunting). The anatomic and functional results obtained with the technique discussed are on the whole superior to those described with the underlay and the classical overlay techniques. The Authors believe that this is mainly due to the absence of the gelfoam in the middle ear and to the double contention and vascularization of the temporal fascia graft. By means of the profiling of the canal wall the endaural approach permits a good view of the operating field. Furthermore, it is less traumatic and more acceptable to the patient than the postauricular one that has to be limited to the MPL where there are clinical indications for the exploration of antrum. The personal technique here presented implies, however, a certain presence of epithelial pearls. Their localization is nevertheless facilitated by the absence of blunting, thickening and lateralization of the graft. This allows for an early and easy removal on an out-patient basis. Other inconveniences of the technique are the length of the procedure and a more difficult control of the ossicular chain.(ABSTRACT TRUNCATED AT 400 WORDS)


[The variability of functional gain and insertion gain in hearing aid fitting].

Functional gain (FG) and insertion gain (IG) are currently used as real ear gain measurement of hearing aids. The gain differences observed with hearing aid modifications made in order to achieve the desired prescriptive target must be greater than the variability associated with repetition of measurement in order to be really useful. Limited research is available on FG and IG intratester variability. In order to evaluate single variability factors, some studies use experimental designs not common in clinical work-up while others use equipment mot available commercially. The present study evaluates intratester variability of FG and IG (Madsen IGO 1500 equipment) in a typical clinical configuration in 42 users of behind-ear hearing aids. Mean standard deviation of FG test-retest differences was 5.19 dB. Range of variability was expressed in term of centiles. 5-- and 95-- centiles were -9.8 and 8.7 dB respectively. Mean s.d. of IG test-retest differences was 3.18 dB; 5-- and 95-- centiles were -5.2 and 6.05 dB respectively. Major variability was found at higher frequencies. High variability at lower frequencies was also found probably due to sealing problems of ear molds in the ear canal. Accord between FG and IG was also examined. A good mean correspondence in mid frequency range was found (FG-IG mean difference less than 5 dB) with large inter-subject differences between the two measurements (s.d. 11 dB).


Neuroradiological findings in glutaric aciduria type I: report of four Japanese patients.

We examined neuroradiological computerized tomography (CT) findings and the clinical course of four Japanese children with glutaric aciduria type I (GA1) whose enzyme activity of glutaryl-CoA dehydrogenase was undetectable. Brain CT in all cases examined showed low density white matter, fluid collection in bilateral frontotemporal regions (particularly surrounding the Sylvian fissures), enlargement of the lateral ventricles and slight atrophy of the basal ganglia. Although these findings seemed to be characteristic for GA1, they were unlikely to be more extended, at least over 2 years after infancy. The low density white matter was observed more evidently in the neonatal or early infantile periods than in later periods. The degree of enlargement of fissures in bilateral frontotemporal regions about the Sylvian fissures appeared to correlate with the severity of symptoms such as dystonia or choreoathetosis. Magnetic resonance images (MRI) in one case showed bilateral linear-shaped low intensity in areas of the external capsules and putamen on a T1-weighted image. These CT and MRI findings, as well as clinical symptoms such as choreoathetosis or dystonia, may suggest that metabolic abnormalities in GA1, such as glutaconate, are toxic to the extrapyramidal tract system in the central nervous system, and that the clinical symptoms of the patients are attributable to atrophy of basal ganglia. Brain CT may be useful in diagnosis and evaluation of the clinical course of GA1 patients.


[Wallenberg's syndrome: an assessment of the dysphagic and postural symptomatology].

Dysphagia and postural disorders are the most important symptoms of the Wallenberg [correction of Wallemberg] syndrome, which takes in a considerable number of neurological symptoms including an alternate sensitive syndrome, the Claude Bernard Horner syndrome, paralysis of the half palate, of the half pharynx and of the vocal fold on the side of the injury, a vestibular syndrome and, finally, a cerebellar hemisyndrome. In the course of this study, four patients with the Wallenberg [correction of Wallemberg] syndrome were examined and underwent further periodical checks after injury. All the patients were fed employing a naso-gastric tube and in one case an emergency tracheostomy was performed because acute dyspnea. The diagnostic protocol following included the collection of a series of anamnestic data, an objective study of U.A.D.T. with fiberoptic endoscopy, swallowing simulation, dynamic radiologic examination (videofluoroscopy) and computerized static posturography. This routine was repeated upon every successive check. During the first observation a substantial uniformity of physiopathological characteristics was found in all the patients. Following logopedic and rehabilitation treatment, a high degree of diversity in the results obtained was observed in three patients (one of the patients was absent from successive checks). The most interesting phenomenon was the difference in time necessary to rehabilitate the swallowing reflex only after which it was possible to reassume oral alimentation. After two months of physiokinesitherapy, computerized static posturography, which initially revealed a sharp increase in the number of oscillations, showed a partial improvement of the postural disease with a reduction in oscillation amplitude. Even though the number of case followed was limited, our experience encourages us to underline importance of immediate rehabilitation therapy and of the collaboration of patients and their family members.


Partial imitation and partial sensory agnosia in mentally normal children with convulsive disorders.

Mentally normal 6-9 year old children with or without convulsive disorders were examined using the procedures of the five soft signs (SS) selected from conventional soft neurological signs and Bergès' gesture imitation tasks. In comparisons of SS between the 60 children with convulsive disorders (CD group) and the 38 without (N group), the average number of SS detected in each case and the incidence ratio of the two signs--partial imitation (PI) and partial sensory agnosia (PSA)--were higher in the CD group than the N group. Examinations of relationships between age, IQ, error index (EI; an index taken from the Continuous Performance Test) and SS, and of correlations among the SS, found two kinds of SS: age-related and El-related signs. The former included right-left confusion, clumsiness and PI, which correlated with each other, while the latter included unstableness of lateral gazing and PSA, which did not correlate with each other. Even though several factors belonging to characteristics of convulsive disorders were evaluated concerning the presence or absence of PI and PSA, there was only one relationship: PSA was more common in children with febrile convulsions than in those with epilepsy. We speculated that PSA reflected an immaturity of the brain in children with febrile convulsions.


[Mycosis of the paranasal sinuses: a report of 4 cases].

With recent advances in medicine, fungal diseases are not only being better under stood, but are also becoming increasingly important in the management of patients with paranasal sinus disease. Fungal sinus diseases range from allergic fungal sinusitis to invasive and fulminant fungal sinusitis. Although patients often have some predisposing factor, such as local tissue hypoxia or massive fungal ++exposure, most patients are not immuno-compromised. Invasive fungal sinusitis may be treated with the traditional Caldwell-Luc surgical technique or with newer endoscopic procedures. Fulminant fungal sinusitis generally occurs in immuno-suppressed patients and requires aggressive surgical excision and debridement as well as systemic chemotherapy, usually amphotericin B. In this article we review fungal diseases of the paranasal sinuses and present four cases of paranasal fungal sinusitis.


Oscillatory variations of cutaneous blood flow in newborns using a laser Doppler flowmeter.

Oscillatory variations of cutaneous blood flow were studied using laser Doppler flowmetry in 20 newborns. Simultaneous monitoring of cardiorespiratory state was also performed. The frequency and amplitude of oscillatory curve varied, even on identical skin regions in each infant. When their respiration and heart rate were irregular, the frequencies of oscillatory curves were significantly higher and with a larger amplitude than when cardiorespiratory function was regular. The frequencies of oscillatory curves at two symmetrical points of an individual were not different, but a significant difference in the oscillatory cycle was recognized at two asymmetrical points. Distributions of peak-to-peak time periods of oscillatory curves were studied in nine healthy and four sick newborns. Seven of nine healthy newborns had more than two peaks in their distributions, while only one peak with a narrowly-spread distribution was observed in the four sick newborns with almost exclusively periodic breathing throughout monitoring. In conclusion, we speculate that cardiorespiratory state and some neurogenic control affects the variations observed. In addition, the narrowly-spread distribution of each time period appeared to be an important indicator of morbidity.


[Histomorphological changes induced by recurrent tonsillitis].

Palatine tonsils are lymphoepithelial mucosal structures whose particular role as a defense mechanism in the human immune system makes them fundamental in protecting organs of much greater importance. If follows, therefore, that dealing with recurrent tonsillar phlogosis--diagnosis as well as therapy choice, surgical or medical--is today problematic and shrouded in doubt. The authors examined tonsillar tissue specimens of 65 patients (age range 4-30 years) who had previously undergone tonsillectomy. Light microscopy and immunocytochemistry were used to study subepithelial tissue while scanning electronic microscope was employed to observe epithelial ultrastructure in order to determine which alterations were most meaningfully correlated to the history and clinical picture of the subjects. In 100% of the cases the cryptic reticular epithelium was hyperplastic while in 44% a squamous metaplasia was observed. Epithelial alteration in various forms was also revealed with scanning electronic microscope: cellular disjunction ridging of the cryptic floor, conrifying squamous epithelial cells, plasma cells and infiltrated lymphocytes. The authors suggest that it is precisely epithelial alteration which, due to inadequate antigen uptake, triggers the series of events which leads from tonsillar disorders to systemic metafocal manifestation.


Balloon valvuloplasty for congenital aortic valve stenosis in an infant and children.

Percutaneous balloon aortic valvuloplasty (BAV) was performed in 14 patients, including one critically ill infant with congenital valvular aortic stenosis (AS). BAV was effective in 13 patients (except the infant). The peak systolic pressure gradient between the left ventricle (LV) and the ascending aorta decreased from 76.6 +/- 21.6 to 29.5 +/- 15.3 mmHg (P less than 0.001). Follow-up cardiac catheterization was performed for eight patients between 1 and 3 years (1.6 +/- 1.1 years) after BAV. Restenosis was found in only one patient, and the efficacy of BAV continued significantly. Aortic regurgitation developed or increased in severity in 5 of 13 children immediately after BAV. Any other severe complication was not observed. Dilatation by BAV was not sufficient for the infant with critical AS, and acute myocardial infarction (AMI) in the lateral wall of the LV occurred during the BAV procedure. The infant died 3 days after the procedure due to AMI. It was concluded that the retrograde double balloon technique was superior to the retrograde single balloon technique. In two cases, the single balloon technique was ineffective because it was impossible to fix the balloon at the aortic annulus. However, the double balloon technique was effective in every patient. BAV is effective for AS in children, and an optional repeat trial may enable BAV to be the first choice for AS. Although BAV may be effective for neonates and infants with critical AS as an emergency treatment, much attention must be paid during the procedure.


Methacholine inhalation challenge in children with idiopathic chest pain.

Bronchial reactivity to inhaled methacholine (MCH) was evaluated in 32 patients with 'idiopathic' chest pain. Each pain was recurrent in nature. The incidence of cases with a provocative concentration causing a 20% fall in the forced expiratory volume in 1 sec (PC20) of 10 mg/ml or less was 62.5% (20 cases), while it was only 11.1% (three cases) in 27 healthy controls. Seventeen patients had no personal history of allergic diseases, elevated serum IgE level or positive house dust mite-specific IgE antibody. Among these 17, eight (47.1%) had a PC20 of 10 mg/ml or less, the incidence of which was also higher than that of the healthy controls. During the challenge, eight patients complained of chest pain similar to that experienced before. The present results indicate that bronchial hyper-reactivity is an important cause of 'idiopathic' chest pain. Patients with unexplained chest pain should be considered for inhalation challenge.


The measles outbreak in Chikuhou District, Fukuoka, Japan, 1990: correlation between herd immunity level and outbreak size.

A measles outbreak occurred in the Chikuhou district of Fukuoka, Japan from May to October 1990, during which 71 patients were cared for at the Itoda Public Hospital. Hospital records revealed a large outbreak in the adjacent town of Kanada. In order to characterize the outbreak, questionnaires were sent to all preschool-age children in Itoda (73% effective response) and in Kanada (76% effective response) requesting information about their vaccination and/or history of measles. The number of patients was 22 (4%) in Itoda and 63 (14%) in Kanada, most of these being preschoolers, while the vaccination rate was 61% and 44%, respectively. The herd immunity levels in age-specific groups were compared between the two towns. Before the epidemic, the immunity level of 1 year old children in Kanada, who showed the higher attack rate, was lower (18%) than that in Itoda (39%), while after the epidemic it rose above 60% in both towns. When we studied the correlation between the attack rate and the vaccination rate, or the number of children susceptible to measles (susceptibility rate) in each preschool, the attack rate correlated negatively with the vaccination rate (correlation coefficient [CC] = -0.818; P less than 0.01), and positively with the susceptibility rate (CC 0.860; P less than 0.01). The regressed equation on the correlation indicated that the immunity level should be more than 70% to keep the attack rate under 5% in preschools. After the epidemic, the immunity levels of all preschoolers reached above 70%.(ABSTRACT TRUNCATED AT 250 WORDS)


Prenatal diagnosis in high risk pregnancies for Zellweger syndrome.

Zellweger syndrome is a lethal disorder. At present, no effective therapies are known for the patients of Zellweger syndrome. Recently a typical case of Zellweger syndrome in Japan was observed. In spite of intensive care, the patient died at the age of 3 months. Following this, the parents requested prenatal diagnosis for their following two pregnancies. We investigated levels of very long chain fatty acids (VLCFA), levels of bile acids in amniotic fluid and immunoblotting of peroxisomal beta-oxidation enzymes in cultured amniocytes. We report that immunoblotting using cultured amniocytes is an effective method for prenatal diagnosis of Zellweger syndrome. Furthermore, if we use immunoblotting for prenatal diagnosis, we can discriminate pseudoZellweger syndrome from pseudoneonatal adrenoleucodystrophy. Following prenatal diagnosis, two healthy babies were delivered. After birth, no abnormal levels of VLCFA in either serum or red blood cell membranes were confirmed. In this paper, we report that we can diagnose a healthy fetus in a high risk pregnancy for Zellweger syndrome.


Cardiac beriberi (shoshin beriberi) caused by excessive intake of isotonic drink.

A 21 month old female had voluntarily ingested 0.5-1.51 of isotonic sports drink daily from 10 months of age. She developed hyponatremia and beriberi heart disease, which resulted in metabolic acidosis and cardiogenic shock (shoshin beriberi). Mechanical ventilation was applied for pulmonary edema. Right heart failure was improved after administering vitamin B1. However, 5 days after the shock, hypoxemia and diffuse radiographic infiltrates progressed, and a diagnosis of adult respiratory distress syndrome (ARDS) was made. After the occurrence of an air leak, the patient died of respiratory failure. The cardiogenic shock and pulmonary edema due to cardiac beriberi may have triggered the ARDS.


Disseminated intravascular coagulation syndrome in anorexia nervosa.

A 15 year old boy with anorexia nervosa developed disseminated intravascular coagulation syndrome (DIC). Because of severe cachexia he had been admitted to the Shimane Prefectural Central Hospital. During his hospitalization he developed generalized massive ecchymosis. Laboratory data revealed not only DIC but also multiple organ complications. The patient was treated intravenously with FOY (gabexate mesilate, a protease inhibitor), heparin, a transfusion of fresh frozen plasma, antithrombin III concentrates and platelets. Intravenous hyperalimentation was also administered. The laboratory data, the general condition and the emotional state of the patient improved remarkably. We emphasize the importance of keeping in mind coagulopathy as a complication in anorexia nervosa.


Long duration of erythrocyte hypoplasia after bone marrow transplantation.

Bone marrow transplantation was performed on a 15 year old girl with chronic myelogenous leukemia. The bone marrow was obtained from her younger sister, who was human leukocyte antigen haplo-identical but major ABO incompatible. As a result, the condition of pure red cell aplasia (PRCA) persisted over a long period of time. In order to overcome major ABO incompatibility, erythrocytes were eliminated from the bone marrow graft before transplantation, and methotrexate and cyclosporine (CsA) were used to prevent graft-versus-host disease (GVHD). Administration of erythropoietin proved ineffective. B19 parvovirus infection could not be detected during that time. Agglutinin titers decreased to less than fourfold in parallel with the recovery of erythrocytes. Reports on similar PRCA have been limited to cases of transplantation with ABO incompatibility and cases where CsA was administered to prevent GVHD. This suggests that ABO incompatibility and CsA might be related to the development of PRCA.


A case of ulcerative colitis induced by oral ferrous sulfate.

We report a case of ulcerative colitis (UC) in a 15 year old female undergoing treatment for anemia with oral ferrous sulfate. We suggest that the oral ferrous sulfate initiated the typical symptoms of UC in this case. This case is the first clinical report to our knowledge supporting the 'iron-catalysed oxidant-mediated ischemic injury theory' of UC.


Gallbladder changes in neonatal hepatitis: markedly thickened wall and lack of contractility.

The gallbladder wall changes were observed on ultrasonography during the course of a patient with neonatal hepatitis. The gallbladder was not detected at 53 days of age, but on the next day its wall was observed to be markedly thickened and without contraction following the administration of cerulein. It had a thinner wall at 57 days of age and reacted to cerulein. The wall thickness and contractility went together with the improvement of jaundice and liver function tests. Histological diagnosis was compatible with neonatal hepatitis. Ultrasonographic detection of the gallbladder has been helpful to differentiate neonatal hepatitis from biliary atresia. It is reported to be compatible with neonatal hepatitis to detect a normal-sized gallbladder or its contraction following cerulein administration or feeding. Since this case did not meet these criteria initially, thickened wall of the gallbladder may be an additional finding indicating neonatal hepatitis. The importance of repeated ultrasonography and clinical correlation was stressed.


Immature gastric teratoma in an infant.

A 45 day old boy presented with progressive abdominal distension, tarry stools and anemia. A plain roentgenogram of the abdomen showed irregular, coarse calcifications in the left upper quadrant. The ultrasonography and computerized tomography of the abdomen revealed a large heterogeneous tumor with calcified parts in the left hemiabdomen. At operation, a 12 cm x 11 cm x 10 cm, multilobular, exogastric and endogastric tumor, including a portion of the anterior wall of the stomach, was extirpated. The pathological examination revealed a gastric teratoma with immature neural elements. Eight years after the total excision of the tumor there has not been any recurrence. This study includes a review of 88 cases (including the present case) of gastric teratoma reported in the English and Japanese literature.


Repressive adaptation and family environment.

The hypothesized connection between adaptive style, specifically repressive adaptation, and the family environments of adolescent clinical samples was investigated. Adolescent patients (n = 221) were studied, who were then divided into four groups matched for sex, age, and socioeconomic status (mean age = 15.7 years, SD 2; sex = 14% boys, 86% girls; SES = 2.4). Grouping was based on the Marlowe Crowne Social Desirability Scale and Spielberger's Trait Anxiety Inventory Scores [repressors (n = 43), impression managers (n = 54), high anxious (n = 55) and low anxious (n = 69)]. Results by MANOVA, Scheffe and discriminate function analysis confirmed our hypothesis. Repressors had distinct family environments as measured by the Family Environment Scale (p = 0.0001). Families were characterized by high levels of cohesion, expressiveness, independence, and organization, displaying correspondingly low levels of achievement orientation, conflict, control and incongruence. Repression may be an effort to adapt to an idealized family environment.


An evaluation of the effectiveness of psychiatric treatment on adolescent in-patients and out-patients.

The psychopathology of 33 adolescents (11 inpatients and 22 out-patients) was measured by a variety of standardized and non-standardized instruments, immediately prior to treatment (baseline), and 10 weeks later (outcome). Their parent were assessed on measures of current mood and personality traits, over the same time interval, also on quality of life, marital satisfaction, and amount of contact with family, friends and relatives, at baseline only. Together with extensive measures of family life and demography, a psychosocial profile of subjects and their families was obtained. The demographic homogeneity of the sub-groups was demonstrated, the only significant differences being that in-patients were older, and out-patients' households larger. Significant clinical differences at baseline were also few; all in-patients were clinically disordered, as were 19 out-patients. There was an even spread of disorders (conduct, emotional, and mixed) between sub-groups. Parents of in-patients rated their children as more disordered than out-patient's parents rated their children. Outcome measures, including the repeated measure of child psychopathology, indicated more significant and substantial trends for improvement over baseline conditions for in-patients than for out-patients, although both sub-groups were less disordered, overall. Both sub-groups of mothers were depressed at baseline, and out-patients' mothers remained so, at outcome. Anxiety in mothers of in-patients was significantly less at outcome. Personality traits among both sub-groups of parents were similar, showing slight introversion and neuroticism, and these traits remained stable over time.(ABSTRACT TRUNCATED AT 250 WORDS)


General event representations of young children in a child psychiatric clinic.

Thirty-nine Children (5-8 years old) in a child psychiatric clinic and 50 5-year-old and 50 7-year-old schoolchildren were interviewed about two events: "getting dressed" and "a day in school". Both the children in the clinical and in the normal group formed general representations of these events. Children in the clinical group mentioned fewer acts, props and locations. Nearly all the children in both groups described how one gets dressed in the correct temporal order, but fewer children in the clinical than in the normal group described a day in school in the correct temporal order. Fewer children in the clinical than in the normal group gave causal explanations. Within the clinical group children with cognitive/attentional deficits tended to have less complete and less organized representations than children whose primary problems are relational.


The outcome of childhood suicidal behaviour.

A group of children under 16 years of age who were admitted to hospital after episodes of deliberate self-poisoning, were followed up after one year. Ninety of the original sample of 100 were traced, and interviewed. Almost half of the subjects were improved after one year but the remaining children continued disturbed. Improvement was most marked in relation to "school problems" and "running away from home". There was significant improvement for some children in their family relationships. Ten per cent of children had been involved in further self-poisoning during the follow-up period. Extended follow-up some seven years later traced 41 of the original subjects. The repetition rate for self-poisoning was 20% although the majority of these episode occurred within a year of the original self-poisoning. Overall, the situation of subjects was judged as improved by them and their families although significant psycho-social difficulties remained for some.


The hyperkinetic child. A historical review.

A historical review of the concepts and classification of the hyperkinetic child is presented, ranging from the supposed biological origins in the late nineteenth century to the hyperkinetic impulse disorder, and then to the concept of minimal brain dysfunction. The differences in European and North American approaches are described.


Savant capabilities of autistic persons.

Various savant abilities, mostly those in intellectual fields, found in autistic people, namely in music, memory, mathematics, specific knowledge and drawing, are presented. Their social importance is discussed. As an interpretation three hypotheses are offered. In autistic people perception and storing of perceived impulses function differently from in normal people (comparable to those of eidetics). The memory process and the storing function abnormally. Outstanding abilities are reinforced unilaterally by the environment and are produced as a kind of avoidance material, because many usual abilities cannot be performed.


Music therapy in the treatment of autistic children. Medico-sociological data from the Federal Republic of Germany.

Related to the theoretical research on the use of music therapy in the treatment of autistic children there was made a postal survey about the attitude towards and the application of music therapy. The data of established paediatricians and paediatric institutions in FRG show that music therapy is already accepted in the treatment of autistic children. The implications of these medico-sociological data are discussed.


Treatment of incarcerated offenders. Possibilities and problems.

The author discusses in detail the operations of a prison treatment program for youthful offenders. Although a model program and an exception to the typical prison, the treatment program had problems. One is the inherent difficulty of working with anti-social people. The other, analyzed in detail, is the unpleasant nature of many of the prison staff, several of whom were unqualified to work in a treatment setting. Suggestions are made for humanizing the staff.


Self-organisation of cognitive processes and psychosis. Development and test of a theoretical model.

The development of a theory of self-control of brain processes leads to a model of disturbance of integration of brain processes in psychotic persons. The theory is that the "novelty-familiarity relation" of the current state of the processed information normally dominates the current mode of information processing. In the second part of the study adults with schizophrenia in remission and children with infantile autism were tested as to the manner in which they used newly introduced elements. The psychotic persons took the different character of the new elements less into consideration. The difference from the normal control persons is significant.


Naltrexone open trial with a 5-year-old-boy. A social rebound reaction.

The neurobiological rationale for an opiate antagonist pharmacotherapy of autism is presented. Naltrexone efficacy in decreasing autistic behaviour and in increasing social-affiliative behaviour was explored in a 5-year-old autistic boy. Naltrexone (0.5 mg/kg 3 times peer week) was effective in immediately decreasing gross motor activity and stereotyped behaviour and caused a delayed increase of crying, smiling and rough-and-tumble play. This single case presents preliminary evidence that a therapeutically valuable rebound reaction is possible and that the human opioid system modulates social-affective processes. The possibility of psychological factors being instrumental in achieving this effect is discussed as being suitable for future clinical trials.


The Benton test in school counselling diagnostics. An exploratory study.

The Visual Test is subject to a critical appraisal, according to the standards of psychological tests. Investigating the test results of clients from a school counselling service it is shown that this test does not comply with the requirements of item analysis and reliability; referring to validity this test might be useful to estimate the general intelligence of pupils.


Defense style and adaptation in adolescents with depressions and eating disorders.

Maturity of defense style has been associated with the level of adaptive functioning, but few studies have assessed defense style using self-report questionnaires which can provide ratings with great reliability and objectivity. We compared self-perception of defense style (using Bond's Defense Style Questionnaire) with ratings of adaptation assessed retrospectively by two independent raters (using the DSM III-R Global Assessment of Functioning scale) in a population of 100 adolescent girls diagnosed as having either an eating disorder or depression. There was significant correlation between maturity of defense style and level of adaptation, with greater maturity of defense style being associated with higher levels of adaptive functioning. This effect was independent of diagnosis within this population.


Effects of nicotinamide and its isomers on iron-induced renal damage.

The effects of three isomers of pyridinecarboxamide (picolinamide (2-pyridinecarboxamide), nicotinamide (3-pyridinecarboxamide) and isonicotinamide (4-pyridinecarboxamide)) on iron-induced renal damage were studied. Pyridinecarboxamide (250 mg/kg body weight, ip) was administered 10 min before injection of ferric nitrilotriacetate (Fe(III)-NTA) (7.5 mgFe/kg body weight, ip). In picolinamide-treated rats, the renal tubular necrosis induced by Fe(III)-NTA was attenuated and serum creatinine did not increase. Picolinamide most efficiently suppressed renal lipid peroxidation in vivo-induced by Fe(III)-NTA. Non-heme iron levels in the kidneys after Fe(III)-NTA injection did not differ in groups to which pyridinecarboxamides were administered. To elucidate the protective effects of picolinamide, we studied the action of pyridinecarboxamides on lipid peroxidation and DNA damage in vitro. These isomers inhibited iron-induced lipid peroxidation of linolenic acid. Picolinamide had no effect on DNA damage, but nicotinamide and isonicotinamide promoted DNA damage by iron, especially when ascorbate was used as a reductant. None of these pyridinecarboxamide isomers changed the chlelate structure of Fe(III)-NTA as shown by electronic absorption spectra. Among the three isomers, picolinamide most effectively protected the kidneys against iron-induced renal damage, since it not only inhibited iron-induced lipid peroxidation, but also had little enhancing action on DNA damage by iron.


Characterization of transmural and subendocardial infarction by typing and grading of ischemic lesions in autopsied human hearts.

Two types of myocardial infarction, transmural and subendocardial, were macroscopically examined, and the gross and microscopic findings were correlated. The transmural type usually consisted of yellowish-brown coagulation necrosis in the center of an infarcted focus and coagulative myocytolysis at the marginal zone. The subendocardial type was characterized by coagulative myocytolysis throughout the entire focus. Wavy fiber and colliquative myocytolysis of non-specific ischemic lesions were seen only microscopically in both peripheral and subendocardial areas of infarcted foci. Coagulation necrosis was associated with obstructive thrombus formation in 79% of cases as a result of absolute ischemia in the transmural type. Coagulative myocytolysis was associated with obstruction by plaque hemorrhage in 27% of cases, and multivessel disease was frequently encountered in the subendocardial type due to insufficient blood supply. Based on histochemical and immunohistochemical examinations, the ischemic lesions were graded in descending order of coagulation necrosis, coagulative myocytolysis, wavy fiber, and colliquative myocytolysis. The close relation between coagulation necrosis and the transmural type as well as that of coagulative myocytolysis with the subendocardial type suggests two different pathogenetic mechanisms of transmural and subendocardial infarction.


Primitive neuroectodermal tumors of bone and soft tissue. With reference to histologic differentiation in primary or metastatic foci.

Primitive neuroectodermal tumors (PNET) of the bone and soft tissue were reviewed by immunohistochemistry and partly by morphometry, focusing particularly on histologic changes in recurrent or metastatic foci, in order to elucidate their probable histogenetic relationship with Ewing's sarcoma (ES) and its extraskeletal counterpart (EES). Eleven cases of bone tumor (average patient age; 15.1 yr) and 12 cases of soft tissue tumor (average patient age; 22.1 yr) which disclosed unequivocal Homer-Wright rosettes and/or at least foci of ganglion cell differentiation either in a given primary tumor or metastatic (or recurrent) foci were selected from small round cell tumors primarily categorized as ES or EES. Most of the cases for which follow-up biopsy samples were available disclosed prominent Homer-Wright rosettes in the metastases, whereas the primary tumors showed features of ES and lacked rosettes. In only one case, Homer-Wright rosettes were absent in the metastatic tumor. Most cases had been treated by combined intensive chemotherapy and radiotherapy, which might have influenced cell differentiation. Neural markers (neuron-specific enolase, neurofilament protein and others) were positive in most cases. Three cases with otherwise typical histologic features of ES or EES showed minute foci of ganglion cell differentiation, as confirmed by morphometry and neural markers. These results suggest that ES (or EES) and PNET are histogenetically related, but represent different stages of cell differentiation.


Light chain nephropathy in a 19-month-old boy with AIDS.

A 19-month-old boy with AIDS developed clinically unexplainable proteinuria. Biopsied renal tissue was examined by light microscopy, transmission electron microscopy, and immunofluorescence. Findings included an increase of mesangial matrix with occasional nodular sclerosis, mesangial hypercellularity, and glomerular deposits of kappa and lambda light chains. There were deposits of kappa, but not lambda, light chains in the arteriolar walls, and around the tubular and interstitial capillary basement membranes. Quantitative urinary immunoelectrophoresis revealed an extremely high urinary concentration of kappa light chain. These changes are diagnostic of light chain nephropathy. The rarity of light chain nephropathy in childhood and its occurrence in a patient with AIDS make this case unusual.


Cardiac rupture complicating hemorrhagic infarction after intracoronary thrombolysis.

An 80-year-old woman with acute myocardial infarct received intracoronary thrombolysis by a large dose of urokinase four hours after the onset of chest pain. Despite the patient having no chest pain after intracoronary thrombolysis and her general condition being stable, she died suddenly on the 4th hospital day. Autopsy revealed hemopericardium due to cardiac rupture, which occurred at the center of the transmural hemorrhagic infarction of the anteroseptal wall. The massive hemorrhagic infarction was promoted by reperfusion from thrombolytic therapy. She had also classic risk factors for cardiac rupture, such as hypertension, senility, female gender, and first acute myocardial infarct. Therefore, the present case demonstrated that hemorrhagic infarction increased the incidence of cardiac rupture.


Unusual huge intramuscular granuloma with calcium phosphate crystal deposition in the buttock.

An unusual case of a huge granuloma featuring marked calcium phosphate crystal deposition in muscle is presented. A 58-year-old male demonstrated a well-circumscribed, large, elastic firm mass which had slowly grown over 8 years in the left buttock. Clinical examinations including X-ray, ultrasonography and computed tomography all suggested a neoplastic growth. Surgical excision revealed three inter-connected irregular-shaped masses, measuring up to 11 x 10 x 6 cm in size. The histological appearance was of granulomas composed of numerous small crystals surrounded by reactive mononuclear cells embedded in fibrous tissue containing many foreign body type giant cells. Chemical analysis demonstrated the crystals to be made up of calcium phosphate.


[Synthesis of 2 beta-(4'-methyl-1'-piperazino)-3 alpha-hydroxyl-16,17- substituted-5 alpha-androstanes].

According to some studies, the vicinal amino-alcohol compounds of 5 alpha-androstane possess to a certain extent biological activities in cardiovascular system. In order to find new antiarrhythmic agents, seven new 2 beta-(4'-methyl-1'-piperazino)-3 alpha-hydroxyl-16, 17-substituted-5 alpha-androstanes were synthesized through 2 alpha,3 alpha-epoxyl-5 alpha-adrostan-17-one from epiandrosterone. Preliminary results of biological experiment showed that they possess to a different extent antiarrhythmic activities among which compounds VI, XI and XIV showed higher activities than others.


[Selective long-range DEPT NMR technique and its application to structural study of glycoside].

This paper reports a new NMR technique: selective long-range DEPT. The result obtained showed that the technique can be used to assign NMR signal of 13C, 15N and 31P nuclei, and connect the spin systems separated by quaternary carbon or heteroatom. This paper deals mainly with applying the technique for determining the glycosidation position in aglycone moiety and sequence of sugar moiety in a natural glycoside.


[The structure identification of pyridinemono terpene isocantleyine].

Siphonostegia chinensis Benth. as a traditional Chinese medicine "liujinu" has been used for centuries in China, but up to date little has been reported about its chemistry. Now, four compounds have been isolated from the aerial parts of this genus. On the basis of spectroscopic analysis (UV, IR, MS, 1HNMR, 13CNMR and 2D-NMR) and chemical evidences, compound I was shown to be a new pyridinemonoterpene alkaloid which is a stereoisomer of the known compound cantleyine, and named isocantleyine. Its structure was determined as 5H-2-pyridine-4-carboxylic acid, 6,7-dihydro-6-hydroxy-7-methyl-methyl ester. Compound III was identified as the known compound loliolide. The other two (II and IV) are still under investigation. This paper deals mainly with the structure identification of compound I.


[Studies on the chemical components of Rhodiola crenulata].

Six chemical components I-IV were isolated from the roots of Rhodiola crenulata (Crassulaceae). Five (I-V) of them were identified as known salidroside (I), p-tyrosol(II), pyrogallol, gallic acid, and beta-sitosterol, based on comparison of its Rf(TLC), mmp and spectral data with those of authentic samples. The sixth component was found to be a new delta 1-isopentenyl-3-O-beta-D-glucopyranoside and named crenulatin(VI). Its structure was confirmed on the basis of its spectral data (IR, MS, 1H- and 13C-NMR).


[Isolation and identification of yibeissine].

A new steroidal alkaloid, yibeissine (II), with a know alkaloid (I) was isolated from the bulb of Fritillaria pallioiflora Schrenk by column chromatographic techniques. Their structures have been determined based on spectral and chemical data.


[Studies on iridoid glycosides from Swertia angustifolia].

Five secoiridoid glycosides were isolated from Swertia angustifolia Buch. -Ham. ex D. Don. The structures of two new compounds, angustiamarin (I) and angustioside (II) with three known compounds sweroside (III), swertiamarin (IV) and epi-eustomoside (V) were elucidated by means of spectroscopic and chemical methods.


[Quantitative analysis of compound injection of aminopyrine by dual-wavelength linear regression spectrophotometry].

A dual-wavelength linear regression spectrophotometry has been introduced and evaluated. Depending on a group of standard mixture solutions the optimal wavelengths and calibration curve can be determined simultaneously by linear regression method. The deviation of absorption resulting from molecular interaction can be calibrated by this method and the results are more accurate. The validity of this method has been confirmed through its use in the analysis of compound injection of antipyrine with satisfactory recoveries. Results obtained by Kalman filtering (KF), partial least squares (PLS) and target factor analysis (TFA) are also given.


[Studies on first derivative differential pulse polarography and its applications].

First derivative differential pulse polarography was developed and used for the quantitative analysis of chlorphenamine maleate, haloperidol, pyridoxine and their preparations. The method is simple, swift, sensitive and accurate.


[The kinetics of ascorbic acid oxidation catalyzed by Cu(II)/H2DCA in the presence of DNA].

In phosphate buffer (pH 7.40), at 20.00 +/- 0.05 degrees C, the visible spectra of Cu(II) and Cu(II) complexes and the kinetics of ascorbic acid oxidation catalyzed by Cu(II)/H2DCA in the presence of DNA were studied. Measurements were reported on rate of .OH formation by the oxidation of ascorbic acid in the presence of Cu(II)/H2DCA. It showed that ternary complex Cu(II)/H2DCA/DNA may exist in the system in which DNA strand was broken by ascorbic acid in the presence of Cu(II)/H2DCA, and it was assumed that the DNA-breaking action of ascorbic acid in the presence of Cu(II)/H2DCA conformed to site-specific Fenton reaction mechanism. All the result of DNA-breaking action can be explained in terms of this site-specific Fenton reaction mechanism.


[X-ray diffraction studies on tolbutamide solid dispersion].

D860 (tolbutamide) solid dispersions prepared with urea, polyvinyl pyrrolidone (PVP), and polyethylene glycal (PEG) 6000 as carriers were studied by X-ray diffraction, relating to their dissolution rates. D860 in D860-PVP dispersion was shown to be in an amorphous state and to have greater dissolution rate. D860-urea and D860-PEG melts were found to be partly in miscible solid solution state and partly in microcrystal state and possess higher activity and greater dissolution rate. D860-PEG coprecipitate was a physical mixture and its dissolution rate is slower than its melt. No variation in the crystal structure of the D860 dispersions was observed during the ageing test.


[Synthesis and antitumor activity of beta-germanyl-alpha-amino acid derivatives].

Some beta-germanyl-alpha-amino acid derivatives were prepared from the reaction of HGeCl3 with substituted oxazolines. The compositions of the above compounds were studied using IR, element analysis and so on. Experimental results were as follows: for 1-substituted-2-amino-2-carboxyethylgermanium susquioxide (such as IIIb), the po LD50 for mice was found to be above 10 g/kg. When given ip, a maximum inhibition of 50% of the growth of S180 was obtained for IIIb, whereas an inhibition of 42% was achieved for 5-Fu under the same experimental condition.


[Determination of active constituents in shi-wei (Folium Pyrrosiae) by high performance liquid chromatography].

A new analytical method for the simultaneous determination of three constituents, viz, mangiferin, isomangiferin and chlorogenic acid in Folium Pyrrosiae using high performance liquid chromatography was developed. A Zorbax-CN column (4.6 mm x 25 cm) was used; methanol--water--phosphoric acid (pH 2.5) (20:80:0.1) was used as the mobile phase. The method was rapid, sensitive, precise and showed good reproducibility. The three constituents in crude drugs were completely separated within 15 min. Recoveries of three constituents were 96.78-101.3%, with coefficients of variation 1.8-4.7%. Mangiferin and isomangiferin were separated for the first time. Pyrrosia plant materials were analyzed as follows: The powdered sample was refluxed with methanol for 4 hours, the extract was transferred into a 25 ml volumetric flask and diluted to 25 ml with methanol. A definite amount of this sample solution was injected for HPLC. The content of constituents in Folium pyrrosiae was calculated from the relevant peak height or peak area. The content of these three constituents in 7 species of Chinese Pyrrosia collected in 17 districts were determined. The results showed that these constituents varied greatly with the plant species and varied with the districts for the same species also, and should be evaluated accordingly.


[Studies on secondary derivative differential pulse polarography and its applications].

Secondary derivative differential pulse polarography was developed and used for the quantitative analysis of ribostamycin sulfate, kanamycin and their preparations. By using sodium hydroxide-potassium dihydrogen phosphate solution as the base solution, ribostamycin sulfate and kanamycin showed good peaks at 0.105 V and -0.37 V (vs Ag/AgCl) respectively. The linear relationship of ribostamycin sulfate and kanamycin between concentration and peak height was obtained in the concentration range of 1.8-10.8 x 10(-4) mol/L and 3.1-18.6 x 10(-4) mol/L and the determination limit was 7.2 x 10(-9) mol/L and 4.6 x 10(-8) mol/L respectively. This method is simple, rapid and sensitive. The result is accurate.


[Measurement of dopamine in rat striatum in vivo with a biomicroelectrode made from mixed plant tissue-carbon paste].

The mixed plant tissue-carbon paste electrode was prepared and their electrochemical characteristics were investigated. The sensitivity and selectivity of this bioelectrode were found to be good because of the utility in biocatalysis. It may work continuously with high stability for 10 h in vivo. The principal advantages of the new bioelectrodes are shorter in response time and longer in stability. These advantages meet the requirements of in vivo determination. Using these electrodes, the dopamine contents in rat striatum were measured by anodic stripping voltammetry. The drug-induced changes in dopamine levels were monitored. From the results, we can conclude that the biomicroelectrode is a very economic biosensor for its low cost and easiness to prepare and is a valuable tool for studying dopamine function. It will provide a good method for the evaluation of drug actions on dopamine neurones.


[The lead generation of protein tyrosine kinase inhibitors by quantitative structure-activity relationship analysis].

Analysis of the quantitative relationship between a series of substituted benzylidenemalononitriles and the inhibitory action on protein tyrosine kinases were carried out using the Hansch-Fujita method. The results indicate that the presence of two or three hydroxy groups attached to a phenyl ring, which connects an extended (trans form) conjugated chain, is essential to the inhibition. Compared with the structure of other kinds of inhibitors, a presumable basic structure for inhibiting the enzyme was generated.


[Antioxidative effect of three water-soluble components isolated from Salvia miltiorrhiza in vitro].

The antioxidative effect of three water-soluble components isolated from Salvia miltiorrhiza has been investigated. All the three components were found to inhibit both NADPH-vit C and Fe(2+)-cysteine induced lipid peroxidation (malondialdehyde formation) in rat brain, liver and kidney microsomes in vitro. The order of their inhibitory effect is as follows: salvianolic acid A, salvianolic acid B and rosmarinic acid. The inhibitory effect on lipid peroxidation induced by NADPH-Vit C was more than that induced by Fe(2+)-cysteine. In addition, the three compounds lowered the production of superoxide anion radical (O2-) in xanthine-xanthine oxidase system. The order of their potency was similar to that in antilipoperoxidation. The above results suggest that the three components have strong antilipoperoxidant activity in vitro, which may be partly through scavenging O2-..


[Effect of arteether on Schistosoma japonicum].

NIH mice infected with Schistosoma japonicum cercariae for 3, 7, 14, 21 or 35 d were treated ig either with arteether or artemether at the daily dose of 100-200 mg.kg-1 for 2 d, the efficacy produced by both drugs was similar. The d 7 schistosomules and d 35 adult worms were more susceptible to arteether or artemether with respective worm reduction rates of 77.5%-87.2% and 51.7%-61.3%. Histological and histochemical studies showed that d 7 and d 35 schistosomes, harbored in mice treated with arteether 300 mg.kg-1.d-1 for 2 d appeared in cloudy swelling and vesiculation in the tegument, distension of intestine, apparent decrease or even disappearance of glycogen and inhibition of alkaline phosphatase activity in the tegument and parenchymal tissues, as well as formation of dead worm granuloma.


[Studies on biotransformation of etheofazine in isolated perfused rat liver].

The biotransformation of etheofazine (EDMTP), a new anticancer drug, was studied by using isolated perfused rat liver. Two main metabolites were separated from the perfusate by HPLC and TLC and their chemical structures were determined by MS, 1H-NMR and IR. EDMTP-I is the parent compound. EDMTP-II is 7-ethyl-8-aminotheophylline. EDMTP-II was also separated and identified from the blood of mice after iv of 10 mg/kg. Species difference of biotransformation of EDMTP between rat and mouse seems to be not significant in this study.


[Acute and chronic hypotensive effect of m-nifedipine].

Three groups of adult stroke--prone spontaneously hypertensive rats (SHRsp) were treated with m-nifedipine (m-Nif) 2.5, 5 and 10 mg.kg-1 by intraperitoneal injection. The systolic blood pressure (SBp) decreased significantly. The hypotensive effect persisted for 2-4, 6-8, and 12 h respectively and the peak effect appeared in 1 h. The range of hypotension was markedly greater than that of nifedipine (Nif). In SHPsp, treatment with m-Nif 10 or 30 mg.kg-1.d-1 for 4 weeks reduced significantly the SBp, but the hypotensive action is about the same as Nif.


[Studies on the alkaloids of Cephalotaxus. VII. Structures and semi-synthesis of two anticancer cephalotaxine esters].

Two new alkaloids, namely neoharringtonine (1) and anhydroharringtonine (2) with significant antileukemic activity were isolated from Cephalotaxus fortunei Hook f.. Their structures have been established by spectral analyses and semi-synthesis. Seven known alkaloids, deoxyharringtonine (3), isoharringtonine (4), isocephalotaxinone (5), acetylcephalotaxine (6), cephalotaxine (7), harringtonine (8) and homoharringtonine (9), were also isolated and identified.


[Studies on the alkaloids of Cephalotaxus. IX. Semi-synthesis of cephalotaxine esters and their anti-leukemic activity].

Harringtonine, homoharringtonine, deoxyharringtonine and isoharringtonine isolated from Cephalotaxus plant are the esters of cephalotaxine with significant inhibitory activity against P-388 leukemia. In this investigation seventeen new esters of cephalotaxine type alkaloids have been synthesized. Preliminary pharmacological examination showed that compounds 1, 2, 2 + 3, 6 and 8 showed similar antileukemic activity as homoharringtonine. Compounds 4, 5, 15 and 16 showed moderate inhibitory activity. Some structure activity correlations of these esters were discussed.


[Studies on the chemical constituents of Annona squamosa].

Twelve compounds were isolated from Annona squamosa. Their structures were identified as liriodenine (AS-1), moupinamide (AS-2), -(-)-kauran-16 alpha-ol-19-oic acid (AS-3), 16 beta, 17-dihydroxy-(-)-kauran-19-oic acid (AS-4), anonaine (AS-5), 16 alpha, 17-dihydroxy-(-)-kauran-19-oic acid (AS-6), (-)-isokaur-15(16)-en-17,19-dioic acid (AS-7), squamosamide (AS-8), 16 alpha-methoxy-(-)-kauran-19-oic acid (AS-9), sachanoic acid (AS-10), (-)-kauran-19-al-17-oic acid (AS-11), daucosterol (AS-12). Among them, AS-8 is a new amide, AS-9 is a new natural product.


[Application of 2D NMR techniques in the structure determination of chrysanthetriol].

Chrysanthemum indicum L. is a Chinese traditional drug used for antifebrile, detoxication and hypotensive purposes. In continuation of our efforts to search for the active principles of this species, a new sesquiterpene compound, named chrysanthetriol was isolated from the more polar fraction of the title plant. Chrysanthetriol is a colorless oil, [alpha]D20-31.8 degrees (c 0.3, MeOH). HRMS showed the molecular formula to be C15H26O3. The structure and stereochemistry of chrysanthtriol was elucidated as I by the use of 1H-1H COSY, 1H-13C COSY, 1H-13C COLOC 2D NMR spectroscopy.


[The application of circular dichroism on the structure analysis of natural products--diterpenoid dilactones and tylophorines].

In this paper, circular dichroism (CD), sector projection and reverse octant rule projection of four diterpenoid dilactones and five tylophorines (two of them, 6, 8, are new compounds) are reported in which reverse octant rule projection is the first application to the configuration determination of diterpenoid dilactone. By using these rules, the predicted Cotton effects of these compounds coincided with the result of previous determinations, so, their absolute configurations are assigned.


[Structure of lamiophlomiol C].

A new highly oxygenated iridoid, lamiophlomiol C isolated from the alcohol soluble fraction of the roots of Lamiophlomis rotata (Labiatae), was shown to have the molecular formula C11H14O7. On the basis of UV, IR, MS and NMR spectroscopic data, particularly X-ray crystallographlic analysis, structure I has been assigned to this iridoid.


[Studies on the triterpenoid saponin of Cinopodium chinense (Benth) O. Kuntze].

A new triterpenoid saponin named clinopodiside was isolated from Clinopodum Chinense (Benth) O. Kuntze. The structure of clinopodiside A was elucidated by spectroscopic and X-ray diffraction analysis as 3-O-beta-D-glucopyranosyl (1----6)-[beta-D-glucopyranosyl (1----4)]-beta-D-glucopyranosyl-olean-11, 13 (18)-diene-3 beta, 16 beta, 23, 28-tetrol.


[Computer-aided prediction of optimal composition of multicomponent mobile phase in high performance liquid chromatography].

This paper proposed a systematic optimizing method for the composition of multicomponent mobile phase in high performance liquid chromatography. A new chromatographic response function (CRF) has been constructed according to the fundamental retention equation and rule of peak width at half-height, and the optimal composition of multicomponent mobile phase can be automatically predicted by a computer with CRF. This paper improved the known complex method, therefore, the optimal mobile phase composition in the global area may be found by means of this modified complex method. The optimal separation conditions of four vitamins and three nitrophenols were determined by use of the optimizing method reported in this paper. The results predicted by the computer were verified by the experimental data obtained in HPLC using ternary mobile phase.


[Studies on analysis of Belladonna alkaloids by capillary GC and GC-MSD].

A method for analyzing belladonna alkaloids--hyoscyamine, scopolamine, anisodamine and anisodine, by means of capillary GC and GC-MSD was described. The retention data and characteristic ions of the parent and TMS derivatives of these alkaloids are given and will be very useful for identification of unknown alkaloids. The derivatization of different silylation reagents was compared, and the derivatization with MSTFA was found to be better than with BSA and BSTFA. The method has been used for studying biotransformation of these alkaloids in biosynthesis. Analysis of anisodamine and anisodine by CGC and GC-MS has not been found in the literature. In addition, the advantages of TMS derivatization are also discussed.


[Study on pilules of indomethacin--PEG 6000].

Indomethacin (IDM)-PEG 6000 pilules were prepared using PEG 6000 as the carrier. The solubility of IDM in IDM-PEG 6000 pilules was about twice as much as pure IDM. When the effective dose of IDM-PEG 6000 was only half that of IDM tablet, the irritation of IDM-PEG 6000 pilule on rat stomach was reduced significantly but it still manifested the action of inhibiting the secretion of basal gastric acid.


[Development of rapid-dissolution armillarisin-A tablet and study on its choleretic action in rats].

For increasing the choleretic action of armillarision-A, a new formulation of rapid-dissolution tablet (A) was developed. The effect of A, a marketed amillarisin-A tablet (B) and a armillarisin-A Na sterile power (C) on rats biliation in vivo were investigated. The dissolution rates of A and B were also determined. The results demonstrate that the choleretic action of A is equal to C but superior to B, and the dissolution rate of A is higher than B. Moreover, the armillarisin-A dissolved percentage of A in vitro at time t was well correlated with the biliation net accumulative amount in vivo at time 3t.


[Synthesis and properties of 3,17-disubstituted estrogenic steroids].

In order to develop new radio protectors of low estrogenic activity and high potency and to study the structure-activity relationships, 10 estrogenic steroids were synthesized from the view point of drug latentiation, and by substitution with active groups in different positions of the steroidal skeleton. The compounds were tested in mice for estrogenic activity and radioprotective effect. The results showed that the introduction of hydroxyalkylimido or hydroxy group into 17-position resulted in reduction of estrogenic activity. Hydroxyalkylimides (2d, e) showed better protective effect in 750 rad of 60CO gamma-irradiation in mice by the reduction of radiation dose of 144-156 rads than estradiol (reduction of 62.2 rad). Whereas 2a-c and 4a, b showed weak or no protective effect. Compounds 1, 3, and 5a, b increased the 30-day survival rates by 35-80% in mice exposed to 900 rad of irradiation, when administered ip 0.1 mg per mouse 24 h before irradiation.


Should be biologic marker be sensitive and specific?

Potential biologic markers in psychiatry are often subjected to tests of sensitivity and specificity. However, in many instances, clinically diagnosed diseases may not be truly singular in their pathophysiology, and these tests may be inappropriate. One may distinguish between diagnostic markers useful in clinical pathology, linkage markers specifying genetic location and pathophysiologic markers that are primarily valuable as research tools. The latter are probably most useful in present-day psychiatry but they may not be sensitive or specific in their correspondence to clinical diagnosis.


Exploration and support in psychotherapeutic environments for psychotic patients.

Clinical experience and previous investigations suggest that insight-oriented milieu therapy with psychotic patients presupposes a specific balance of explorative and supportive factors in the milieu. Explorative and supportive factors were translated here to two optimal ward atmosphere profiles using the subscales in the Community-oriented Programs Environment Scale (COPES) as profile variables. Three Swedish therapeutic communities for psychotic patients were then studied by means of COPES. The study showed distinct patterns in these units regarding deviations from the optimal profiles, differences in the balance between the explorative and supportive factors, divergences between explicit treatment philosophy and the perceived ward atmosphere, and differences between patient and staff perceptions of the ward atmosphere. These patterns followed a continuum from a self-governing, nonhierarchical and nonmedical organization to a hierarchical unit that is an integral part of the medical care organization. The conclusion was that a beneficial psychotherapeutic environment requires consistency in the applied treatment model, including an organization and setting that corresponds to the explicit treatment philosophy, well mirrored in the patients' perceptions.


Discriminant validity of a reduced set of Mini-Mental State Examination items for dementia and Alzheimer's disease.

Linear discriminant analysis was used to construct a series of discriminant functions including subsets of demographic variables and Mini-Mental State Examination item responses for a case series and a population sample. A 9-item discriminant function including the variables for time orientation, recall, calculation, copying a figure, age, writing, 3-step command, naming, and race distinguished demented subjects from community controls with 91% sensitivity and 88% specificity. The same discriminant function classified Alzheimer's disease patients and controls with 96% sensitivity and 98% specificity. This discriminant function has been cross-validated as a potential screening instrument for Alzheimer's disease in a community-based sample.


Detecting psychopathology in young adults: the Young Adult Self Report, the General Health Questionnaire and the Symptom Checklist as screening instruments.

This study compares the screening capacity of an age-adjusted child-oriented questionnaire, the Young Adult Self Report (YASR) with two adult-oriented questionnaires, the General Health Questionnaire-28 (GHQ-28) and Symptom Checklist-90 (SCL-90) in a sample of young adults (18-25 years). The YASR performed just as well as the SCL-90 and both performed better than the GHQ-28. The relatively poor performance of the GHQ-28 compared with the YASR and SCL-90 could not be attributed to instrument characteristics or to the use of referral status as indicator of psychopathology. In assessing psychopathology in young adults an age-adjusted child-oriented instrument might be a good alternative to the existing adult-oriented instruments, especially when one takes into account the problem of data comparability over time in longitudinal studies in which children are followed into adulthood.


The course of thyroid abnormalities during lithium treatment: a two-year follow-up study.

A total of 116 patients on lithium treatment were followed up for 2 years to determine the course and the clinical relevance of thyroid abnormalities. Elevated thyroid-stimulating hormone (TSH) concentrations were transitory in most patients, except those with serum antithyroid antibodies. The patients who initially had microsomal antibodies remained positive, with an increase in titre in two-thirds of cases. Three young patients of both sexes developed thyroid autoimmunity early in the treatment. The risk of developing hypothyroidism was higher in women, especially in the presence of antibodies. TSH concentrations were significantly lower when carbamazepine was combined with lithium.


The thyrotropin response to thyrotropin-releasing hormone as a predictor of response to treatment in depressed outpatients.

We evaluated the predictive value of the thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) in 32 depressed outpatients completing a double-blind placebo-controlled trial of s-adenosyl-l-methionine (SAMe), which failed to show any significant difference between SAMe and placebo. Treatment response was defined as the change in Hamilton Rating Scale for Depression (HRSD-24) score between baseline and the end of the six-week trial. Subjects with TSH response outside the normal range (7-25 uU/ml) had a significantly greater response than patients with a normal response. There was also a significant correlation between absolute deviations from the mean TSH response (16 uU/ml) and changes in HRSD-24 scores.


Cases of buprenorphine abuse in India.

Buprenorphine was introduced as a potent analgesic with low abuse potential. Reports of buprenorphine abuse by opiate abusers have accumulated over the years, highlighting its use as a cheap alternative to heroin. The lower potency compared with heroin is being compensated by using a cocktail of buprenorphine with benzodiazepines or cyclizine. This study of 18 cases seen over 3 years broadly confirms these findings. Four cases reported haematemesis during acute withdrawal, a symptom not reported in earlier studies.


Clinical staging of dementia in a population survey: comparison of DSM-III-R and the Washington University Clinical Dementia Rating Scale.

In a population survey in Stockholm, 224 dementia cases were staged using two scales: the Washington University Clinical Dementia Rating Scale and DSM III-R. Both scales had to be modified by adding additional specifications and, in the case of DSM III-R, a new category of questionable dementia. After modification, the comparison of the two scales showed good agreement when all stages were analyzed (kappa = 0.60), but moderate agreement on the questionable and mild stages (kappa = 0.47). These results confirm the staging of mild dementia as the most problematic issue. Finally, the scales both showed moderate agreement with the categorized Mini-Mental State Examination (MMSE) (0-17 for severe and moderate forms; 18-23 for mild cases). Our data suggest new cut-off points for the MMSE when used as a staging scale.


Antidepressants may not assist recovery in practice: a naturalistic prospective survey.

A total of 130 people attending psychiatric hospitals within 6 months of onset or relapse of an episode of depressive disorder were interviewed about their symptoms and treatment at the time of their initial contact. After a mean 4-month interval, 119 were reassessed to test the hypothesis that patients treated with antidepressants would be significantly more likely to be clinically improved compared with those untreated. Severity and duration of the episode emerged as the only significant clinical predictors of clinical improvement. Patients on treatment with antidepressants at the start of the study showed a nonsignificant trend for a lesser degree of clinical improvement, even when clinical severity and compliance were taken into account. Those who were not commenced on treatment until later in the study also fared no better than those who were never prescribed antidepressants. The effect of low doses of antidepressants (almost always a tricyclic) appeared to be less beneficial than either higher doses or clinical management without antidepressant drugs. The need for further experimental and naturalistic studies conducted over various periods of time and the implications for clinical practice, medical audit and the appropriate use of health outcome indicators are discussed.


The Nordic concept of reactive psychosis--a multicenter reliability study.

Reactive psychosis is a common diagnosis in the Nordic countries (Norway, Sweden, Denmark, Finland and Iceland) and in several other parts of the world. In ICD-9 and DSM-III-R, the concept is defined more narrowly than in the Nordic tradition. In this study we examined the interrater reliability of the Nordic concept by the case-summary method between clinicians from 9 university departments in the Nordic countries. The results show that Nordic psychiatrists have a reasonably reliable concept of reactive psychosis, and that this psychosis can be diagnosed as reliably as schizophrenia and affective psychosis.


Suicidal acts on metro systems: an international perspective.

Suicide is a problem experienced by railway networks worldwide. The epidemiology of this method of suicide has not been described in any detail. To investigate the characteristic features of railway suicide, data were gathered from 23 metro systems around the world. The similarities in the nature of this problem across systems were striking. Universally the victims were young (aged less than 40 years); most incidents involved men; case fatality was generally less than 60%; there was no consistent seasonal variation in incidence; the peak time of day for incidents was 1000-1200; proximity to psychiatric institutions was possibly a risk factor. This method of suicide may be prevented by environmental modification of the railway system. Strategies for reducing the opportunities for suicide on railways are discussed.


The Bible suicides.

Death by suicide is described in the Holy Bible. The number of characters affected ranges from 3 to 11, depending on the inclusion of the Apocrypha, the definition of suicide adopted and the version of the death accepted when there is more than one account. The Bible treats suicide in a factual way and not as wrong or shameful.


Risk of deliberate self-harm and factors associated with suicidal behaviour among asymptomatic individuals with human immunodeficiency virus infection.

The study was aimed at evaluating the risk of deliberate self-harm (DSH) and factors associated with suicidal behaviour in 213 asymptomatic individuals with human immunodeficiency virus (HIV) infection in 3 transmission categories (68 gay men, 123 intravenous drug users and 22 heterosexuals). The results showed that 12 HIV-seropositive (HIV+) subjects were involved in DSH after the notification of a positive HIV test result, of which 8 occurred within 6 months and 4 between 6 months and 3 years. HIV+ subjects with a past psychiatric history showed a 7.7-fold increase in the relative risk of DSH, and HIV+ subjects with a history of DSH showed a 5-fold increase in the relative risk of DSH compared with HIV+ individuals without a past psychiatric history and a history of DSH. Professionals involved in the care of HIV+ individuals need to be aware of this risk, especially in the first few months after notification of HIV status and also at later stages of acquired immunodeficiency syndrome.


Suicides in the former Soviet republics.

The suicide rate in the former Soviet Union rose from 17.1 per 100,000 inhabitants in 1965 to 29.6 in 1984. In regions of long-standing traditional lifestyles, strong religious faith and multi-generation families (the Caucasus and central Asia), the suicide rate was low, whereas in regions with sociopolitical antagonisms (Baltic States) and forced social changes (Russia), it was high. A significant decline in the suicide rate (34.5%), from 29.6 to 19.4 per 100,000 inhabitants, occurred in 1984-1988 throughout the Soviet Union, in the hopeful period of social democratization and stiff restrictions on the sale of alcohol. Rates varied widely between different republics - from 1.8 in Armenia to 26.3 in Lithuania and 24.3 in the Russian Soviet Federated Socialist Republic (RSFSR) in 1988. In contrast to the pattern in several countries in western Europe, the suicide rates in the Russian SFSR were much higher in the rural regions than in the urban ones.


Trends in psychiatric hospitalization in Denmark: a 10-year register-based investigation.

Information about all admissions to psychiatric hospitals and departments in Denmark in 1977, 1982 and 1987 and about all resident patients on census days in the same years were extracted from the central psychiatric register. The number of available beds decreased by 43% from 1977 to 1987. The admission rates decreased for all diagnostic groups but schizophrenia, which increased. The group of younger schizophrenic men declined in size, which is alarming if mentally ill homeless people are considered. The census study shows a decrease in all diagnostic groups, most pronounced in the elderly age groups. Patients with neuroses disappear from the available beds in the mental hospitals and departments. The changes in the psychiatric service system from mostly hospitalization to outpatient treatment and community psychiatric treatment require a comprehensive personal registration of treatment regardless of the administrative affiliations of these services.


Therapeutic sleep deprivation in a depressed patient: prolongation of response with concurrent thyroxine.

A 53-year-old woman with major depression was studied throughout 7 trials of therapeutic sleep deprivation (SD). Under conditions where the patients was either medication-free or receiving antidepressant therapy, improvement with SD was followed by full relapse on returning to sleep. Four SD sessions conducted while the patient was receiving thyroxine each resulted in remission, sustained for several days. These results suggest that the beneficial effects of SD may be mediated by thyroid hormones, or associated activity in the hypothalamic-pituitary-adrenal axis.


Distressing behaviour of schizophrenics at home.

The care of mentally ill people at home is being encouraged nowadays. As a result, the family members feel an increased burden of care and find it difficult to cope with the care of a schizophrenic patient at home. We interviewed the relatives of 62 schizophrenics systematically regarding the behaviour of the patients that was perceived to be distressful. This was done using the Scale for Assessment of Family Distress. It was noted that behaviours related to activity and self-care were perceived to be most distressful, and not aggressive or psychotic behaviour. Distress was more often reported by younger relatives and those with more education. The findings have implications in planning appropriate family intervention methods.


A population-based survey of the characteristics of high school students with and without a history of suicidal behavior.

In a sample of 570 15- and 16-year-old normal high school students, the characteristics of those with and without a history of suicidal behavior were compared. In a written inquiry, information was obtained on family background, emotional and behavioral problems, sexual and physical abuse and suicidal thoughts and behavior. Differences between the students with and without a history of suicidal behavior were statistically analyzed for boys and girls separately by a matched control design. The results for both boys and girls indicated that the experience of sexual abuse, feelings of loneliness, depressed mood, low self-esteem and the use of drugs were particularly strongly related to suicidal thoughts and behavior; for girls, physical abuse and for boys, low self-reported academic achievement appeared to be clearly related aspects. Furthermore, the strong interrelations between all of these variables is underlined, suggesting a multi-problem background of youngsters with a history of suicidal behavior.


Incidence of anorexia nervosa in Denmark.

From 1970 to 1989, 915 people were admitted for the first time to psychiatric institutions in Denmark and had as their main diagnosis an eating disorder, ICD-8 306.50-59. The incidence of these admissions increased from 0.42/100,000 population in 1970 to a maximum of 1.36/100,000 in 1988. During the time of our investigation, the number of discharges of patients with an eating disorder as the main diagnosis was constant from somatic hospitals, whereas discharges from psychiatric institutions increased.


Reciprocated self-disqualification among parents of schizophrenics.

Is deviant parental communication an interactional phenomenon? If it is, is this interaction stronger or weaker among parents of schizophrenics (S) than among parents of non-schizophrenic psychiatric controls (NS) and normals (N)? These two questions were investigated by using sequential analysis of parental interaction during Spouse Rorschach. Parents' deviant communication was measured by the self-disqualification (SD) category in the Relationship Control Coding System. Results showed that self-disqualification clearly depended on the quality of the previous parental communication: an SD utterance greatly increased the probability of an SD response from the spouse among S (n = 17), NS (n = 15) and N (n = 14). However, this increased probability was significantly higher among S parents. Furthermore, S parents' communication was significantly less dependent on their own previous communication than NS and N parents' communication was. However, the sheer magnitude of parental SD communication was a significant predictor of offspring diagnosis even when the interaction between the spouses was controlled for. Thus, the results indicate that the high rate of deviant communication among S parents is partly due to individual characteristics of the parents and partly due to reciprocation of the other spouse's deviant communication. The results are discussed with reference to possible gene-environment interaction in both schizophrenia and deviant communication.


Vigilance deficits in schizophrenics and affectively disturbed patients.

Vigilance is a concept associated with the early levels of information processing. Vigilance deficits have repeatedly been found in schizophrenic patients. It has not been clear, however, whether such cognitive dysfunctions are specific to schizophrenics or not. In this study, 28 schizophrenics were compared with 19 affectively disturbed patients and 17 normals on a vigilance test that is a hybridization of a Continuous Performance Test (CPT) and a Span of Apprehension Test (SAT). The results showed that schizophrenics performed significantly below the normals only on target hits on the CPT. There were no differences between the two patient groups, either on number of correct hits or on commission errors. On the SAT measures, normals performed better than the two psychiatric groups on all measures. Schizophrenics had more commission errors than the affectives, but there were no differences between the two groups with respect to target hits. Neither CPT nor SAT deficit, thus, seem to be specific schizophrenic characteristics.


Risk factors for depression in elderly people: a prospective study.

In 1982-1983 a random sample of 1486 people aged 65 years and above was generated from general practitioner lists; 1070 were interviewed in the community using the Geriatric Mental State and a Social History questionnaire. The cohort was followed up by interview 3 years later. At year 3 the diagnostic computer program AGECAT diagnosed 44 incident cases of depression. Information from the depressed group's initial and further interviews was compared with a control group (which excluded cases of affective or organic mental illness). Univariate analysis yielded three factors that were significantly associated with the development of depression 3 years later: a lack of satisfaction with life; feelings of loneliness; and smoking. Multivariate analysis confirmed their independent effects and revealed 2 further factors attaining significance: female gender and a trigger factor, bereavement of a close figure within 6 months of the third-year diagnosis. Some other factors traditionally associated with depression, such as poor housing, marital status and living alone, failed to attain significance as risk factors.


The effect of long-term lithium treatment on the mortality of patients with manic-depressive and schizoaffective illness.

Clinical research centers in Aarhus, Berlin, Hamilton and Vienna collected mortality data for 827 manic-depressive and schizoaffective patients given lithium treatment for more than 6 months. The average duration of the treatment was 81 months and the total time on lithium 5600 patient-years. For each patient, the mortality risk was calculated by entering the appropriate national life tables for the general population. The number of observed deaths was 44; the number of expected deaths was 49.7. The standardized mortality ratio, 0.89, did not differ significantly from 1.0. The mortality of manic-depressive patients is 2-3 times that of the general population. Our data show that the mortality of manic-depressive and schizoaffective patients given long-term lithium treatment does not differ significantly from that of the general population.


Somatization in primary care: pattern and correlates in a clinic in Nigeria.

During a study of mental disorder in a primary care clinic in Nigeria, 214 patients, selected on the basis of their scores on the General Health Questionnaire, were interviewed with the Composite International Diagnostic Interview, a structured clinical interview that allows for a systematic assessment of somatization symptoms. Only 1.1% of this clinical sample fulfilled the DSM-III-R criteria for somatization disorder, but 4.7% and 10.8% met the criteria for somatoform pain disorder and undifferentiated somatoform disorder, respectively. Age, gender and the presence of a DSM-III-R diagnosis of depression or dysthymia accounted for significant variability in the number of reported somatization symptoms. On factor analysis, a factor with close similarity to DSM-III-R somatization disorder was obtained. This factor is associated with the demographic features commonly found among patients with DSM-III-R somatization disorder.


Does an attempted suicide actually have a cathartic effect?

It has been suggested in empirical studies that an attempted suicide has a cathartic effect. However, only one study used a control group of depressives who had not attempted suicide. A replication of these results using more strictly defined patient groups and a more comprehensive assessment of the psychopathology during index treatment was not possible. Major depressives with and without suicide attempts before index admission displayed similar courses of their depressive symptoms and somatic complaints during index treatment. The cathartic effect of a suicide attempt may be restricted to a severe major depression or to a violent suicide attempt.


Trends in suicide rates among military conscripts.

The purpose of this study was to analyse the trends in suicide rates among conscripts in Finland and to compare them with suicide rates in men of the same age in the general population. The suicide rates among conscripts slightly increased from the mid-1960s until the mid-1970s, but this rise was less marked than among young men in the population as a whole. In the 1970s and 1980s, the suicide mortality among conscripts was half of that among civilian men of the same age in the population. The implications for suicide prevention are discussed.


The Parental Bonding Instrument in adolescent patients with anorexia nervosa.

The Parental Bonding Instrument (PBI) was administered to 54 adolescent patients with anorexia nervosa. Scores were compared with those of matched groups of normal and of nonanorectic adolescents referred for assessment to an adolescent psychiatric unit. Significant differences between the 3 groups were demonstrated with respect to care and protection dimensions. Overall scores of subjects in the anorectic group resembled those of normals rather than those of referred patients. Anorexia nervosa patients described their fathers and mothers as being more caring and their mothers as being less overprotective than did psychiatrically referred peers. The study raised questions concerning the use of the PBI in adolescents, in particular those with anorexia nervosa, and the role of the family in the aetiogenesis of this condition.


The course of alcohol amnestic disorder: a three-year follow-up study of clinical signs and social disabilities.

Forty-four patients with alcohol amnestic disorder were prospectively studied from 1987 to 1990. The cognitive impairment, social disability and mental symptoms of patients under different conditions were compared. Thirty-three patients (75%) had no symptoms of Wernicke's disease nor a medical history to suggest its existence. The course of mean cognitive impairment of patients in different settings was stable. Change in intelligence quotient correlated with alcohol consumption during the study. The development of social disability differed remarkably in different settings. Patients in a large nursing home deteriorated and patients in small-scale sheltered accommodation improved.


Extent and determinants of burden among families of patients with affective disorders.

The burden of care experienced by family members of 90 patients with major affective disorder was evaluated. The extent of burden in these families was considerable. The burden was significantly more among families of bipolar patients than those of major depression. Prolonged illness and high levels of dysfunction among patients correlated consistently with severity of burden. Severity of illness, higher age of the patient and number of episodes of the illness also influenced the extent of burden. Variables such as gender of the patient, religion, education, occupation, family type and size and the locus of control of both patients and relatives did not influence the extent of burden significantly. These results have substantial implications for the planning of intervention strategies.


Parasuicide during Ramadan in Jordan.

To investigate the impact of national and religious events on the rate of parasuicide, a comparison was made between the number of reported parasuicides during the month of Ramadan and the month before and after Ramadan in Jordan, for the years from 1986 to 1991. Significantly fewer parasuicides were reported during Ramadan than the month preceding it and the month that follows Ramadan. The findings confirm previous observations that national events reduce the rate of parasuicide, but the protective effect does not persist into the month that follows Ramadan.