Biomedical subjects
Publications and source records attributed to E Coleman.
We report the successful use of lithium carbonate to promptly extinguish life-threatening behavior in a case of autoerotic asphyxia occurring in a 26-year-old male. In addition to his paraphilia, the patient met the DSM-III-R criteria for dysthymia, and had an avoidant personality disorder secondary to verbal, physical and sexual abuse inflicted during childhood and adolescence.
The current research literature regarding male-juvenile prostitution activity is reviewed. An attempt is made to develop some theoretical understanding of the development of this activity among gay and bisexual adolescents. A predisposition, resulting from faulty psychosexual and psychosocial development, appears to make these boys vulnerable to the situational variables that they encounter. More severe disruptions in psychosexual and psychosocial development seem to result in more destructive and non-ego-enhancing prostitution activities. A clinical case study is presented which illustrates the development of this activity. Recommendations are made to help reduce the amount of self-destructive prostitution activity among male adolescents.
The concentrations of dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA), and 5-hydroxyindole-3-acetic acid (5-HIAA) in CSF obtained from the cisterna magna of 21 nonneurologically compromised dogs were determined by high-pressure liquid chromatography and electrochemical detection. A rapid method of sample preparation, which involved single filtration through a deproteinizing membrane, was used. Canine CSF obtained in this manner contained 5.78 +/- 0.78 ng of DOPAC/ml, 72.19 +/- 4.09 ng of HVA/ml, and 29.95 +/- 1.67 ng of 5-HIAA/ml. Linear regression analysis between HVA and 5-HIAA yielded a correlation coefficient of 0.4804. The neurotransmitter index, HVA/5-HIAA, was found to be more indicative of the dopaminergic metabolite HVA than the acid metabolite of serotonin, 5-HIAA (correlation coefficient with HVA = 0.5529 vs a correlation coefficient with 5-HIAA = -0.4462). A poor relationship (correlation coefficient = -0.1715) was found to exist between the 2 dopaminergic metabolites DOPAC and HVA in the CSF.
Neurotransmitter metabolites (dihydroxyphenylacetic acid [DOPAC], homovanillic acid [HVA], and 5-hydroxyindoleacetic acid [5-HIAA]) in CSF of 10 healthy dogs were evaluated with reverse-phase high-pressure liquid chromatography and electrochemical detection. Neurotransmitter metabolite concentrations determined in CSF collected from the cisterna magna were compared with those values in CSF collected from the lumbar dorsal subarachnoid space. Amounts of DOPAC (P = 0.0444), HVA (P = 0.0001), and 5-HIAA (P = 0.0316) were significantly lower in lumbar spinal fluid compared with those values in the cervical spinal fluid. Metabolite concentrations in cervical and lumbar CSF were: DOPAC = 2.81 +/- 0.73 ng/ml of CSF and 1.28 +/- 0.57 ng/ml; HVA = 98.29 +/- 12.42 ng/ml and 4.68 +/- 1.61 ng/ml; and 5-HIAA = 46.29 +/- 8.17 ng/ml and 36.96 +/- 4.07 ng/ml, respectively. Cytologic evaluations of cervical and lumbar CSF revealed a similar concentration of 3 +/- 1 WBC/microliters in both fluids. A significant (P = 0.0002) difference in protein concentration between the 2 regions was observed, with 16.1 +/- 1.8 mg of protein/dl in the cervical CSF and 27.2 +/- 2.3 mg of protein/dl in the lumbar CSF. Between the cisterna magna and lumbar dorsal subarachnoid space of dogs, a rostrocaudal gradient existed for neurotransmitter metabolites, and a caudorostral gradient existed for protein.
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This paper reviews the multitude of methods which have been utilized to assess sexual orientation. The basic assumption of most of the previous methods of assessment is that sexual orientation is determined by one's gender or genitalia and the gender or genitalia of the individual one is attracted to. This assumption is challenged and the complexity of sexual orientation is illustrated. Consequently, a model for assessment of sexual orientation is proposed which includes nine dimensions: current relationship status, self-identification identity, ideal self-identification identity, global acceptance of their current sexual orientation identity, physical identity, gender identity, sex-role identity, and sexual orientation identity as measured by behavior, fantasies and emotional attachments, and finally the individual's past and present perception of their sexual identity compared to their idealized future.
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Pedophiles constitute a heterogeneous group of sex offenders. Direct physiological assessment of sexual arousal has significantly increased our diagnostic skill and capability of monitoring treatment response. Erectile response studies have indicated that the majority of pedophiles and incest offenders show arousal to other paraphilias and frequently to appropriate adult sexual stimuli. Many sexual offenders deny or minimize their problem during initial interviews, but when confronted with laboratory results indicating deviant sexual arousal, they often acknowledge and elaborate on the paraphilia(s). Complete data and diagnoses are crucial in integrating treatment in the cognitive-behavioral paradigm.
The number of sexual attacks on children is staggering, yet it is extremely difficult to understand what effective treatments are available for the pedophile by reviewing the literature. Therefore, the authors present an update of the changing conceptualizations regarding the offenders and their victims. An overview of the currently used modalities to treat the pedophile is presented with emphasis on the promising cognitive-behavioral approach. A brief description of this approach is given with two case illustrations.
Thirty-five patients who had received a penile implant were interviewed to assess their pre- and postsurgical ejaculatory and orgasmic experience. Prior to surgery, most men were able to experience ejaculation (71%) and orgasm (80%) even though erectile capability was impaired or lost completely. The implantation of a prosthetic device did not interfere with ejaculation or orgasmic functioning. Two patients who lost their ejaculatory functioning following surgery did so because of advances in their illnesses. Five men who had been non-orgasmic earlier reported having orgasm after surgery. In these cases of psychogenic orgasmic dysfunction, the penile prosthesis helped overcome the psychological barriers to this function.
A clinical sample of women who were currently or previously married were surveyed regarding demographics, homosexual experiences before marriage, problems in marriage, and sexual orientation. The average age of the 45 participants was 35.9. Before marriage, 21 (47%) were somewhat aware of their homosexual feelings but were much less likely to have thought of or identified themselves as homosexuals. Sexual difficulties were very common in these marriages (89%), the most cited sexual difficulty being a lack of sexual desire for their spouse (62%). Based upon Kinsey-type ratings, the sample could be described as almost exclusively heterosexual in behavior and fantasies before marriage. Some changes could be seen during marriage toward more of a homosexual orientation. The dramatic change, however, occurred following marriage, when the women reported even more of a homosexual orientation, tending toward the homosexual end of the Kinsey continuum. At the time of the study, a majority of the sample was, in fact, relating almost exclusively to other women. This study found that, compared to homosexual men who have been married, these women are more likely to marry at an earlier age, unlikely to be aware of their homosexual feelings prior to marriage, and more likely to terminate their marriage earlier because of conflicts arising as a result of their bisexual orientation and sexual dissatisfaction.
Eighteen couples who had originally entered therapy because of conflicts created by the husband's bisexuality were studied to determine the dynamics and adjustment of their marriages. All the couples, to varying degrees, had been openly dealing with the husband's bisexuality for at least two years. Through questionnaires and psychological instruments, couples indicated that openness and communication helped the relationship. The greatest difficulties they encountered were in their sexual relationships. Marital satisfaction and adjustment was found to be negatively correlated with increasing age, number of children, later onset of homosexual activities, increased emotional involvement with male partners, increased numbers of people who know about the husband's homosexual activities, and increased sexual dissatisfaction and conflict. Basically, this study reinforced the notion that some marriages can survive by way of open communication, acceptance and understanding, dynamics which help compensate for the inherent conflicts these couples face.
Recently a murine monoclonal antibody (A2B5) has been described that reacts with a membrane associated GQ ganglioside common to peptide secreting normal cells and tumors. In vitro binding data demonstrated the presence of this ganglioside on neurons, adrenal medulla, and pancreatic islets, along with neuroendocrine tumors such as insulinomas, pheochromocytomas, melanomas and neuroblastomas. Negative binding has previously been shown for tissue sections from liver, kidney, colon, lung, stomach, and tumors not derived from the neural crest. Because of the specificity at A2B5 in vitro, this monoclonal antibody was labeled with 131I for in vivo tumor localization studies. Daily radionuclear scans were obtained in 5 KX rats bearing the radiation induced rat insulinoma with disappearance of the label from the blood pool and concentration in the tumor so that by the fourth day, the only activity present by scan was in the insulinoma. Tissue-counting data showed tumor/blood ratios (av +/- SE, 1.29 +/- 0.25) of A2B5 activity two to ten times the average activity found in other organs (0.28 +/- 0.05). No tumor concentration of the control nonspecific monoclonal antibody P3X63 was evident (0.27 +/- 0.04). In addition A2B5 also localized to five different human melanoma cells lines grown in nude mice with high tumor/blood levels (1.04 +/- 0.27) compared to normal tissues (0.32 +/- 0.05) (P = .0005), while no localization is seen in nudes carrying osteosarcomas, colon, bladder, and renal cell carcinomas. In addition antibody A2B5 did not concentrate in any normal tissue though the antigen is present on several. The finding that A2B5 reacts across species lines (mouse, rat, man) lends itself to obvious diagnostic and therapeutic possibilities.
Monoclonal antibody A2B5 reacts with the cell surface of a series of amine precursor uptake decarboxylation (APUD) cells and their tumors in many vertebrate species including chicken, rat, mouse, and man. We have studied the in vivo and in vitro binding of iodinated monoclonal antibody A2B5 to rat insulinoma cells. In vitro, radiolabeled A2B5 binds specifically to RINm5F insulinoma cells and the binding of 125I-A2B5 is inhibited by unlabeled A2B5 or a ganglioside extract of RINm5F cells. In vivo, scintigrams taken Day 0 to Day 5 after injection of 131I-labeled A2B5 showed a striking localization of 131I-A2B5 in transplanted RIN tumors grown in syngeneic rats. Other control radiolabeled monoclonal antibodies did not concentrate in the tumors. 131I-labeled A2B5 did not concentrate in other transplantable tumors (colon adenocarcinoma, osteosarcoma, renal cell carcinoma, and bladder transitional cell carcinoma) grown in nude mice. The tumor/blood ratio detected 5 days after antibody injection, was approximately two to 12 times higher in the insulinoma compared to other organs and only in the insulinoma did 131I-A2B5 show a higher concentration than control antibody 125I-P3X63.
Lymphoscintigraphy using technetium-99m atimony sulfur colloid was performed in 22 patients with melanoma referred to Duke University Comprehensive Cancer Center in an attempt to identify patterns of regional lymphatic drainage. Scans from six patients revealed lower extremity lesions with three located below the knee, one in the popliteal space, and two others proximal to the knee joint. Despite the location of the primary, all scans but one showed initial drainage to the inguinal nodes bypassing the popliteal lymph node group. Of the three patients who had primary melanoma of the posterior scalp, the lymphatic drainage was directed to the posterior cervical nodes. No drainage to the parotid nodes or anterior neck nodes was visualized. The knowledge gained from lymphoscintigraphy resulted in posterior neck dissections instead of the standard anterior neck dissection and superficial parotidectomy. In areas of ambiguous lymphatic drainage from the trunk, radiocolloid scanning can identify areas at risk for developing metastatic disease. Six lesions within 5 cm of the midline demonstrated bilateral axillary or groin drainage in 83 per cent of the patients. For two lesions near Sappey's line colloidal uptake to the ipsilateral axilla and groin was the rule. After a 3-year follow-up, during which time 70 to 90 per cent of lymph node metastases are predicted to occur, no nodal metastases were ever documented in areas that did not show colloidal uptake. No correlation was found between amount of radiolabel in positive compared to negative nodes, although those nodes that were completely replaced by tumor contained no 99mTc activity and were negative on scanning.(ABSTRACT TRUNCATED AT 250 WORDS)
An attempt was made to characterize, in vivo, specific binding to the muscarinic cholinergic receptor in the calf using the radioiodinated ligand quinuclidinyl benzilate (123I-OH-QNB) and single photon detection emission computed tomography (SPECT). The supratentorial brain activity was significantly increased after the intravenous infusion of 123I-OH-QNB as compared to free 123I. Scopolamine, a muscarinic cholinergic receptor antagonist, decreased the measured brain activity when infused prior to 123I-OH-QNB consistent with pharmacologic blockade of specific receptor binding. Quantitative in vitro tissue distribution studies obtained following SPECT imaging were consistent with regionally distinct specific receptor binding in the striatum and cortical gray matter, nonspecific binding in the cerebellum, and pharmacologic blockade of specific binding sites with scopolamine. Although 123I-OH-QNB is not the ideal radioligand, our limited success will hopefully encourage the development of improved binding probes for SPECT imaging and quantitation.