Adult pica. A clinical nexus of physiology and psychodynamics.
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Adult↗
Biomedical subjects
M Goldstein
Publications and source records attributed to M Goldstein.
Anesthesia for cesarean delivery in a patient with Ehlers-Danlos syndrome type II.
BACKGROUND AND OBJECTIVES: Ehlers-Danlos syndrome, an inherited connective tissue disease, is rarely seen in pregnancy. Presentation may be mild or severe, depending on which type of the syndrome the patient possesses. METHODS: A 38-year-old woman with Ehlers-Danlos syndrome type II presented for cesarean delivery at 34 weeks' gestation with premature rupture of membranes and breech presentation. RESULTS: A subarachnoid block was chosen to provide surgical anesthesia. No adverse side effects or complications developed. CONCLUSION: In patients with Ehlers-Danlos syndrome, it is important to be aware of which type is present and to be knowledgeable about and prepared for any potential complications.
Adult↗
Amplified DNA with limited homology to myc cellular oncogene is shared by human neuroblastoma cell lines and a neuroblastoma tumour.
Amplified cellular genes in mammalian cells frequently manifest themselves as double minute chromosomes (DMs) and homogeneously staining regions of chromosomes (HSRs). With few exceptions both karyotypic abnormalities appear to be confined to tumour cells. All vertebrates possess a set of cellular genes homologous to the transforming genes of RNA tumour viruses, and there is circumstantial evidence that these cellular oncogenes are involved in tumorigenesis. We have recently shown that DMs and HSRs in cells of the mouse adrenocortical tumour Y1 and an HSR in the human colon carcinoma COLO320 contain amplified copies of the cellular oncogenes c-Ki-ras and c-myc, respectively. Both DMs and HSRs are found with remarkable frequency in cells of human neuroblastomas. We show here that a DNA domain detectable by partial homology to the myc oncogene is amplified up to 140-fold in cell lines derived from different human neuroblastomas and in a neuroblastoma tumour, but not in other tumour cells showing cytological evidence for gene amplification. By in situ hybridization we found that HSRs are the chromosomal sites of the amplified DNA. The frequency with which this amplification appears in cells from neuroblastomas and its apparent specificity raise the possibility that one or more of the genes contained within the amplified domain contribute to tumorigenesis.
Cell Line↗
Presence of NADPH-cytochrome P450 reductase in central catecholaminergic neurones.
The cytochrome P450-containing mixed function oxidases metabolize a variety of endogenous and exogenous compounds including drugs, carcinogens, fatty acids and steroids. Mixed function oxidases have been detected in several tissues, including brain. The enzyme system consists of a lipid fraction (phosphatidylcholine), cytochrome P450 and NADPH-cytochrome P450 reductase. NADPH-cytochrome P450 reductase has been purified to apparent homogeneity and demonstrated to supply reducing equivalents from NADPH to cytochrome P450 (refs 5-7). Detection of NADPH-cytochrome P450 reductase thus represents an indirect means of demonstrating the presence of cytochrome P450. Although the role of cytochrome P450 in the central nervous system (CNS) is not known, it may include such different functions as metabolism of xenobiotics, aromatization of androgens to oestrogens and the formation of catecholoestrogens. Despite the potentially very important role(s) of cytochrome P450 in brain function, its exact regional distribution remains essentially unknown. Using a specific antibody against rat liver NADPH-cytochrome P450 reductase in combination with immunohistochemical techniques, we have now localized this enzyme to define catecholamine (CA)-containing structures of the rat and monkey brain.
Animals↗
Increase of corticotropin-releasing factor staining in rat paraventricular nucleus neurones by depletion of hypothalamic adrenaline.
In response to stress, adrenocorticotropic hormone (ACTH) is released by corticotrophs in the anterior pituitary under the control of several central and peripheral factors including corticotropin-releasing factor (CRF), which was recently isolated from the brain and sequenced. Immunocytochemical studies have shown that most of the CRF-containing cell bodies that project to the median eminence are present in the hypothalamic paraventricular nucleus (PVN). A dense PNMT(phenylethanolamine-N-methyltransferase)-containing fibre network was also observed in the same region--PNMT is the final enzyme in the biosynthesis of adrenaline and has been demonstrated in the brain. In the present study we found an association of adrenergic nerve fibres and CRF neurones by immunohistochemistry using antisera to PNMT and CRF. To examine the functional significance of the adrenergic projection to the PVN, we blocked the synthesis of adrenaline using a specific inhibitor of PNMT. The depletion of adrenaline resulted in an increase in CRF immunoreactivity. The present results suggest that, as well as catecholamines which regulate ACTH release at the anterior pituitary level via a beta 2-adrenergic receptor mechanism, central catecholamines (mainly adrenaline) also affect ACTH release through their action on CRF cells. Peripheral catecholamines seem to have a direct stimulatory effect on the pituitary corticotroph cells, whereas the present findings suggest that central adrenaline-containing neurones have an inhibitory role in the physiological response to stress.
Animals↗
Soundings: a psychological equivalent of medical percussion.
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Emotions↗
Humoral immune responses in healthy heterosexual, homosexual and vasectomized men and in homosexual men with the acquired immune deficiency syndrome.
In homosexual men, the acquired immune deficiency syndrome (AIDS) is associated with sexual promiscuity and the appearance of circulating immune complexes (CICs) and antibodies to spermatozoa which crossreact with lymphoid cells. A comparative study was initiated to determine whether similar humoral responses existed in 38 heterosexual men lacking sperm antibodies, 13 heterosexuals with sperm antibodies, 42 heterosexual vasectomized men, 22 healthy homosexual men, 26 homosexuals with lymphadenopathy and 16 with AIDS or Kaposi's sarcoma (KS). Sperm antibodies were detected in 12% of the vasectomized heterosexual men, 23% of the healthy homosexuals, 35% of the lymphadenopathy patients and 44% of the men with KS-AIDS. IgG reactive with peripheral blood T lymphocytes was present in only 3% of heterosexuals lacking sperm antibody and 5% of vasectomized men. In contrast, 23% of heterosexuals with sperm antibody, 36% of healthy homosexuals, 31% of men with lymphadenopathy and 62% of KS-AIDS patients were positive in this assay. Antibodies to the neutral glycolipid asialo GM1 were found in none of the vasectomized men, 3% of the heterosexuals without and 8% with sperm antibodies, 17% of healthy homosexuals and 38% and 31% in patients with lymphadenopathy or KS-AIDS, respectively. Lastly, the incidence of CICs, determined by the Raji cell assay, was 0% in vasectomized men, 3% in heterosexuals lacking sperm antibody, 31% in heterosexuals with sperm antibody, 69% in healthy homosexuals, 81% in lymphadenopathy patients and 87% in KS-AIDS. In the homosexuals with lymphadenopathy and KS-AIDS, levels of CICs, T cell-reactive IgG and asialo GM1 antibody were positively correlated (p less than 0.01). Sperm antibody levels were negatively correlated (p less than 0.01) with CICs levels and T cell reactive IgG in heterosexuals and lymphadenopathy and KS-AIDS patients. The results demonstrate that vasectomized men do not manifest at all, and that non-vasectomized heterosexuals with sperm antibodies manifest to a much lesser extent the range of humoral immune responses exhibited by the three homosexual groups. Thus, the route of sperm immunization and/or exposure to autologous vs. heterologous spermatozoa may be of critical importance for eliciting specific immune responses.
Acquired Immunodeficiency Syndrome↗
Stress selectively increases fos protein in dopamine neurons innervating the prefrontal cortex.
Stress-induced alterations in expression of c-fos protein (Fos) in mesencephalic dopamine (DA) neurons of the rat were examined in order to discern which midbrain DA neurons are metabolically activated by stress. Restraint stress for 30 min increased the number of DA neurons exhibiting Fos-like immunoreactivity in the ventral tegmental area (VTA), but not in the substantia nigra or retrorubral field. Stress elicited an increase in the number of DA neurons expressing Fos in specific nuclei within the VTA. Administration of the anxiogenic beta-carboline FG 7142 also increased the total number of VTA DA neurons expressing Fos protein, whereas pretreatment with an anxiolytic benzodiazepine (diazepam) partially prevented the stress-induced increase in Fos expression. Restraint stress for 30 min increased concentrations of the DA metabolite 3,4-dihydroxyphenylacetic acid (DOPAC) in the nucleus accumbens and striatum, as well as in the prefrontal cortex. Retrograde tracer studies revealed that stress increased Fos protein expression in a distinct subset of DA neurons projecting to the prefrontal cortex. In contrast, Fos expression was not increased in any DA neurons projecting to the nucleus accumbens. The present data indicate that there are at least two functionally distinct DA systems embedded within the prefrontal cortex of the rat.
Animals↗
Treatment of Parkinson's disease with dopamine agonists: a review.
Bromocriptine and lergotrile were administered to 81 patients with Parkinson disease (PD) and increasing disability despite optimal treatment with levodopa (secondary levodopa failures). Sixty-six patients were treated with bromocriptine and 53 patients were treated with lergotrile. Both groups had significantly decreased rigidity, tremor, bradykinesia and gait disturbance upon addition of bromocriptine or lergotrile to levodopa. Twenty-five patients improved at least one-stage on bromocriptine, and 21 improved at least one-stage on lergotrile. The mean dose of bromocriptine was 47 mg, and the mean dose of lergotrile was 49 mg, permitting a 10% reduction in levodopa. Bromocriptine was discontinued in 29 of 66 patients because of adverse effects, including mental changes (14 patients) and involuntary movements (9 patients). Lergotrile was discontinued in 33 of 53 patients because of adverse effects including hepatotoxicity (11 patients) and mental changes (12 patients). The results of treatment with bromocriptine or lergotrile were comparable, with patients either responding or not. Bromocriptine will shortly be available for use in PD. Lergotrile, because of the hepatotoxicity, will not.
Aged↗
Glutamate-like immunoreactivity in medulla oblongata catecholamine/substance P neurons.
Immunofluorescence histochemistry was performed on sections of the rat medulla oblongata with a well characterized antibody to the amino acid glutamate (GLU) combined with antisera to catecholamine synthesizing enzymes and substance P. GLU-like immunoreactive (LIR) neurons were seen in many areas of the medulla, and were particularly intensely stained in the rostral ventrolateral medulla. In this area, nearly all adrenaline neurons were GLU-LIR. This immunoreactivity was also seen in catecholamine neurons of the C2, C3, A1 and A2 cell groups. Many adrenaline neurons, especially of the C1 group, contained substance P-LI in addition to GLU-like immunoreactivity (LI).
Animals↗
Influence of Kt/V and protein catabolic rate on hemodialysis morbidity. A long-term study.
Urea clearance over time, divided by volume of total body water (Kt/V) and protein catabolic rate (PCR), were calculated monthly in 88 long-term hemodialysis patients. Patients were divided into four groups: Group A (n = 40), Kt/V > 1.0 and PCR > 1.0 g/kg/day; Group B (n = 7), Kt/V > 1.0 and PCR < 1.0; Group C (n = 24), Kt/V < 1.0 and PCR > 1.0; and Group D (n = 17), Kt/V < 1.0 and PCR < 1.0. Various clinical, biochemical, and morbidity factors were compared. Group A had significantly less morbidity than did the other groups (p < 0.05). Blood urea nitrogen, serum creatinine, serum albumin, and phosphorus were lower in Group B than in the other groups (p < 0.05). These data suggest that determination of Kt/V and PCR is important for predicting dialysis morbidity and that they should be monitored together for adequacy of therapy and dialysis quality assurance.
Aged↗
"The disappearing lens": failure of CT to image the lens in traumatic intumescent cataract.
The CT scans of three patients whose eyes were lacerated by trauma failed to demonstrate the lens. A slit-lamp examination of those eyes clearly indicated that the lenses were present behind the iris but that they were swollen and opaque (intumescent cataract). Apparently, a shift of water into the injured lens had reduced the expected hyperdense CT image of the lens to a level that it was no longer discernible.
Adult↗
Cardiovascular activity of SK&F 64139 in the hypertensive rat.
SK&F 64139 (7,8-dichloro-1,2,3,4-tetrahydroisoquinoline) produces a dose-related antihypertensive effect in rats treated with desoxycorticosterone acetate and administered saline in their drinking water (DOCA-salt rats), lowering both systolic and diastolic blood pressure by 40 mm Hg after an oral dose of 25 mg/kg in a conscious animal. This antihypertensive effect can also be observed after intravenous infusion in an anesthetized DOCA rat. The fall in blood pressure is accompanied by bradycardia, which can be blocked by the combination of propranolol plus vagotomy, and a decrease in peripheral vascular resistance. In contrast to the results in the DOCA rat, only minimal effects on blood pressure were produced in normotensive rats. Although SK&F 64139 is a potent inhibitor of phenylethanolamine N-methyltransferase (PNMT), the time course of blood pressure reduction is not consistent with PNMT inhibition as a mechanism for its antihypertensive action. SK&F 64139 decreases the turnover rate of cardiac norepinephrine in DOCA-salt rats, suggesting that its antihypertensive effect may results from a centrally mediated inhibition of sympathetic outflow to the periphery.
Animals↗
Comorbidity, smoking behavior and treatment outcome.
BACKGROUND: A sizeable sector of the population continues to smoke cigarettes despite our efforts to prevent and treat this addiction. We explored the relationships between lifetime comorbidity, psychiatric symptomatology, smoking behavior and treatment outcome to better understand vulnerability to smoking and treatment response. METHODS: One hundred and twenty smokers at two sites were enrolled in a multicenter, double-blind, randomized, 10-week smoking cessation trial with fluoxetine and behavioral treatment. The Structured Clinical Interview for DSM-III-R and Hamilton Depression Rating Scale were administered prior to treatment initiation. Self-report measures were used to assess psychiatric symptoms throughout treatment and during a 6-month follow-up period. RESULTS: Overall 62.3% of our sample were diagnosed with a lifetime mood, anxiety or substance use disorder despite stringent study exclusion criteria. Lifetime comorbidity was shown to be related to higher smoking rates and nicotine dependence, depressed mood and greater self-report of anxiety and stress. Lifetime comorbidity, however, alone or in combination with treatment condition, failed to predict treatment outcome (at posttreatment or follow-up). Baseline depression scores (Beck Depression Inventory, BDI) were related to treatment outcome only for smokers without a positive history of any psychiatric disorder or depression, with lower BDI scores more frequent in those who were abstinent. CONCLUSIONS: High prevalence rates of lifetime psychiatric illness and substance use disorders are reported for chronic smokers. Subsyndromal psychiatric symptoms may play a role in smoking behavior in combination with diagnosable disorders. Clinicians need to carefully assess both psychiatric diagnoses and symptoms in chronic smokers to optimize patient-treatment matching.
Adolescent↗
Treatment of impending stroke.
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Aspirin↗
Cerebrovascular disease type specific mortality: 1968-1977.
Death certificates for the period 1968-1977 were examined to determine the trend, in the United States, of cerebrovascular disease death rates by type of event and demographic subgroup. The largest declines were for hemorrhagic strokes and among nonwhites. The number of hemorrhagic stroke deaths declined by 45 percent and th age-adjusted rate declined by 53 percent. Similar figures for nonwhites were 18 percent and 36 percent, respectively. It was surprising to note that the number of cerebrovascular deaths reported as poorly defined rose by 17 percent. Data on hypertension were examined. The possibility that the results with respect to hypertension are artifactual indicates the need for clinical studies which will examine the relationship between hypertension and cerebrovascular disease mortality.
Age Factors↗
Cerebrovascular research: the opportunity has never been better.
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Cerebrovascular Disorders↗
A tribute to neuroepidemiologist Dr. Bruce Schoenberg 1942-1987.
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Epidemiology↗