Biomedical subjects
Publications and source records attributed to G Charles.
We report a non-significantly higher growth hormone (GH) response to intravenous clonidine administration (150 micrograms) in 10 male patients with panic disorder who had never received antidepressant therapy than in 10 matched controls. These results are consistent with data suggesting a normal or increased adrenergic receptor sensitivity in panic disorder patients.
We studied 26 inpatients (17 females; mean age +/- SD: 41.2 +/- 14.3 years) who met the DSM III criteria for a major depressive episode and had a mean (+/- SD) Hamilton Depression Score of 19.3 +/- 8.0. All patients were drug free and medically healthy at the time of experimentation. We found a significant correlation between the CD4/CD8 ratio and the Hamilton Anxiety Score (r = 0.57, p less than 0.005). When splitting our sample in dexamethasone suppression test suppressors (DST-S) and nonsuppressors (DST-NS), this relationship appeared only in DST-NS (DST-NS: r = 0.81, p less than 0.005; DST-S: r = 0.20, p = NS). These results are discussed in terms of heterogeneity among major depressive disorders and possible relationships between catecholaminergic activity and the immune system.
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Although refugee health care emerged as a special interest in the United States following the influx of almost a million Southeast Asians since 1975, few studies have been done of the influence of refugee traditions on the use of Western medical services. The illness patterns, medical beliefs, and health care behavior of a Southeast Asian refugee group, the Mien from Laos are described in this study. A cohort of 119 Mien refugees living in Richmond, California, was observed for a 6-month period. In-home interviews were undertaken about all episodes of ill health, including treatment and health care decisions. This study shows that the Mien integrate traditional healing beliefs and practices with the use of American health services. Such findings are important because the increasing cultural diversity in the United States, particularly in Western states, necessitates that health care professionals understand the importance of cultural factors for access to and the use of health care by all patients including refugees and other immigrant groups.
Forty-seven patients with recurrent head and neck cancer in a previously irradiated field were treated with surgical resection and intraoperative radiation therapy (IORT). Recurrent disease occurred at a median of 18 months from primary treatment, and was at the primary tumor site in 31 and metastatic to regional lymph nodes in 16. Recurrences were squamous cell carcinomas in 42 and adenoid cystic in five. Surgical resection left microscopic residual disease in 41 and gross residual in six. All patients received IORT with a median of 20 Gy. Two-year actuarial survival is 54.9%, and 15 patients are alive and disease free with a median survival of 29 months. Two-year actuarial local control is 61.5%. A trend toward increased survival (P less than 0.09) and local recurrence control (P = 0.05) was noticed when treating microscopic residual disease as opposed to gross residual disease. Perioperative mortality was seen in 8.5% and there was no increase in morbidity secondary to IORT. The authors believe that surgical resection and IORT is an effective treatment modality for head and neck cancers recurrent in previously irradiated fields and is adaptable to tertiary care hospitals.
The Research Diagnostic Criteria (RCD) and the Schedule for Affective Disorders and Schizophrenia (SADS) were developed in the mid-1970s by researchers at the New York State Psychiatric Institute and at Columbia University. This article shows their clinical and research interests. The authors of the french translations, compare them to the recent DSM-III. These criteria represent a widely used nosologic system for clinical research in psychiatry. The SADS was developed in an effort to provide research investigators with a clinical procedure which reduce information variance in both diagnostic and descriptive evaluations of subjects.
Growth hormone (GH) responses to i.v. clonidine administration (150 micrograms) were compared in untreated depressed patients and controls. There were 8 controls (6 males, 2 females), 16 patients with a major depressive episode (8 males, 8 females), and 16 matched patients with a minor depressive episode according to Research Diagnostic Criteria. Differences in the GH response to clonidine only occurred between male patients and controls. These results suggest that endocrinological variables are important in the interpretation of this neuroendocrine test. Findings in the subgroup of unmedicated male patients with a nonendogenous major depressive episode support the hypothesis of decreased noradrenergic receptor sensitivity.
REM latency and awakening latency were analyzed in a sample of 26 major depressive inpatients and 8 male controls recorded for two consecutive nights. A significant inverse relationship appeared between REM latency and awakening latency in depressed patients. The relationship was more marked in male than in female patients. No significant correlation between REM latency and awakening latency was observed in male healthy volunteers. The hypothetical cholinergic supersensitivity in major depression is proposed to explain the present relationship. These results suggest that awakening latency might also be taken into account in the evaluation of sleep disturbances in depressive illness.
We have observed a significantly higher growth hormone (GH) response to clonidine administration (150 micrograms i.v.) in 14 patients with a major depressive disorder who had never received antidepressant therapy than in 14 matched depressive patients who had not received tricyclic drugs for at least 15 days. Compared with a control group of eight subjects, untreated depressed patients, as a group, had a normal response, while matched patients had markedly blunted response. Results for the group of untreated depressed patients showed that some patients had a blunted response while others had a response in the normal range. The results suggest that studies on the GH response to clonidine in psychiatric patients need to take into account the confounding and long-lasting effects of tricyclics.
Cancer of the ovary together with pregnancy is rare. The authors report two new case histories which are of particular interest because of advanced cancer of the ovary and a continuing pregnancy, and also because of the anatomophathological type of the malignant tumour, which was an immature (malignant) teratoma of the ovary. Looking at these cases carefully makes it possible to describe the characteristics of this very serious combination and to describe the principles for deciding on the method of treatment.
The authors report a case of a severe thermal burn (70% of the surface of the body) in a pregnant woman who had 15 weeks amenorrhoea. The survival of the mother and the continuation of the pregnancy to term allowed a normal live baby to be born. As far as the authors know this is the fourth case history of a severe (more than 60% of the body) burn published occurring in the first trimester of pregnancy and carried through successfully to term. A study of the literature has shown that the physiopathological results of severe burns do explain the usually poor prognosis for mother and fetus. Large quantities of prostaglandins are released into the circulation of the mother because of the thermal insult to tissues and because of the infection that usually accompanies such burns. These prostaglandins can stimulate the myometrium, which gives rise to fatal obstetric complications. The urgent acute treatment for a severe burn in a pregnant woman, which should preferably be carried out in a special centre, consists in water and electrolyte resuscitation, assisted respiration and prevention of bacterial contamination. These measures are just as important for the fetus. At the same time obstetric care should be started. Good collaboration between the obstetricians and those who carry out the resuscitation all bring about the measures that are needed to allow the mother and fetus to survive.
Gossypol showed primary antimitochondrial activity in yeast cells in that the drug (1) inhibited growth of cells utilizing mitochondrial substrates as carbon and energy sources, and (2) selectively inhibited mitochondrial protein synthesis. Primary antimitochondrial activity was demonstrated in guinea-pig keratinocytes (GPK) by early arrest of growth and loss of viability in medium with glutamine (a mitochondrial substrate) as carbon and energy source compared with cells utilizing glucose. Gossypol depressed oxygen uptake directly in respiring cells. Gossypol interacted with the known antimitochondrial agents ethidium bromide and 5-fluorouracil (FU), potentiating the activity of FU but reversing that of ethidium bromide in yeast and GPK. Also, the activity of the mitochondrial inhibitor oligomycin was reversed by the presence of gossypol in yeast cells but not tested in GPK. The uptake and retention of the mitochondria-specific dye rhodamine 123 were much depressed by gossypol in GPK. Gossypol showed little or no inhibitory effects in yeast or GPK in the presence of ethanol (0.2-0.5%). The drug was not mutagenic with respect to the yeast mitochondrial system. It was tentatively suggested that mitochondrial perturbation could explain the antifertility effect of gossypol if it is assumed that mitochondria have a special role to play in spermatogenesis and sperm motility, making these tissues more sensitive to mitochondrial inhibitors than somatic cells.
The growth hormone (GH) response to clonidine administration (2 micrograms/kg) was compared in three groups of subjects: seven panic disorder patients, seven depressed patients matched for age and sex, and seven normal controls. As previously reported, patients with affective disorders show a blunted GH response to clonidine. Only one panic disorder patient had a blunted GH response to clonidine, and this patient had recently received a tricyclic antidepressant.
The increase in the number of persons age 65 and over-the Medicare-age group-and the increasing cost of providing medical care to patients in this group have focused attention on enrollment of these persons in capitated plans as a means of containing costs. Although much is known about resources used for inpatient care for Medicare-age patients, detailed information organized on a per-patient, per-year basis about ambulatory care of these patients is lacking. In order to address this problem and to investigate possible differences in resource use by age groups within the Medicare-age population, a study was made of a primary care group practice in which 523 patients, including 174 patients in the Medicare-age group, were followed for one year to determine their use of ambulatory care resources. A comparison of annual resource use by patients age 75 and over with patients age 65 through 74 showed that patients age 75 and over made more visits for primary care (8.15 vs. 6.46), made more visits to specialty and subspecialty clinics (3.41 vs. 2.33) and had higher total charges for ambulatory care ($749 vs. $623). The pattern of use of specialty and subspecialty clinics suggests that the primary care physicians functioned effectively as gatekeepers because most medical problems were handled without referrals to medical subspecialty clinics. The pattern also suggests that the projected rapid increase between now and the year 2000 in the number of persons age 75 and over may result in a greater than anticipated demand for services provided by ophthalmologists, podiatrists, and otolaryngologists.
P300 and Dexamethasone Suppression Test (DST) have been carried out on 60 depressed patients classified according to the DSM-III and compared to controls. DST discriminated with a high specificity (85%) and sensitivity (80%) melancholics from controls and from other groups of depressed patients: post-dexamethasone cortisol levels were significantly higher in the former. The amplitude of P300 was significantly smaller in depressives as compared to controls. This was more pronounced in the melancholic group but was not specific to them. On the other hand, correlation analyses showed that the weaker the P300 amplitude, the higher the score at the Hamilton Rating Scale for Depression [Acta psychiat. belg., 87, 694-703 (1987)].
The authors report a new case of abdominal pregnancy with living baby. The analysis of this observation permits to present then the clinical and paraclinical characteristics of this exceptional localization of pregnancy and emphasize the surgical principles involved with its treatment, around the time of the term delivery.
More rhinoplastic surgeons are using the external (combination) rhinoplasty approach for selected patients. Although several large series report few complications, the initial experience of newcomers may be different. A series of 26 external rhinoplasty approaches was examined, representing the initial experience of supervised residents. The most common complication was incising the anterior margin of the lower lateral cartilage at the juncture of the lateral and medial crura. To prevent this problem, it is recommended that the skin be elevated off the lower lateral cartilages from both a medial direction up over the domes and a lateral direction downward. To repair this complication, a figure-of-eight suture is used to reapproximate the incision.
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