Acute hospital-induced hyponatremia in children: a physiologic approach.
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Psychogenic polydipsia is recognized as a dangerous and potentially life threatening disorder. Few studies have focused on the treatment of polydipsia presenting in the outpatient setting. A review of the behavioral treatment literature pertaining to psychogenic polydipsia is presented. This review is followed by a case illustration of an outpatient behavioral approach to the treatment of psychogenic polydipsia in a non-psychiatric, primary car, adult, male patient suffering from intractable hiccup. An ABA single-case design was used, with sodium concentration as the dependent variable. This behavioral method appears promising in settings where restriction of fluid intake is not practical.
The volume of certain brain structures, particularly those in the anterior medial temporal lobe, may be reduced to a greater extent in hyponatremic/hypo-osmolemic polydipsic schizophrenics than other schizophrenic patients. To explore if volume reduction is specific to this particular brain region, and if it is fundamentally associated with polydipsia, we imaged the anterior hippocampi/subicula and adjacent temporal lobes in normal males (n = 10) and polydipsic schizophrenic patients with (n = 7) and without (n = 6) hypo-osmolemia. Bilateral hippocampal/subicular (p < .01), but not temporal lobe (p < .30), volumes were diminished in the hypo-osmolemics relative to the other two groups, who resembled each other on these measures. No recognized or putative factor could explain these findings. Thus anterior medial temporal lobe structures appear to be preferentially diminished in hypo-osmolemic polydipsic schizophrenics. Additional studies are needed to more precisely define these anatomic differences and their relationship to these patients' impaired water excretion and severe mental illness.
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Effects of tetraethyl lead (TEL) and derivatives triethyl lead (TriEL), diethyl lead (DiEL), and inorganic lead (Pb) on lorica formation of the unicellular alga Poterioochromonas malhamensis were investigated by light and electron microscopy. Lorica formation is microtubule (MT)--mediated and disturbed by agents interfering with MTs. TEL, largely ineffective as such, inhibited lorica formation of P. malhamensis when the lead compound was illuminated during or before the experiment. TriEL inhibited most; DiEL produced qualitatively effects similar to those of TriEL at about 10 times higher concentrations. Inorganic lead was even less toxic and did not selectively inhibit lorica formation of the algae. Low concentrations of TriEL (5 to 7.5 microM) selectively disturbed lorica formation, causing formation of numerous stalk-less loricae which exhibited gross and ultrastructural alterations like those induced by the antimitotic drug colchicine. The effects of TriEL on mitosis and cytokinesis of P. malhamensis were also investigated. The most sensitive mitotic phase was metaphase, which, however, accumulated only up to 5% after treatment of the cells with toxic concentrations (10 microM) of TriEL for 24 hr (control, 2%). On the other hand, up to 15% telophases (including binucleated cells) and even multinucleated cells with up to eight nuclei per cell were found, indicating that cytokinesis was considerably more effectively disturbed by TriEL than mitosis. In giant multinucleated algae, mitoses normally proceeded synchronously; some asynchronous mitoses were found. Beside normal-looking mitotic spindles in giant algae, multipolar spindles, disoriented spindles, and metaphase-like chromosome arrays completely lacking MTs were observed by electron microscopy. The effects of TriEL on cytokinesis of the algae were largely reversible. Giant cells spontaneously recovered and underwent cytokinesis after transferred into TriEL-free growth medium. Colchicine acted qualitatively identical to TriEL (accumulation of metaphases and telophases: 5 and 19%, respectively), but TriEL was about 600 times more toxic than colchicine. Unlike colchicine, its derivative, colchicine, which is known not to interfere with MTs, remained without any selective inhibitory influence on mitosis and cytokinesis of the algae, although much more toxic than the parent compound. From the inhibitory effects of TriEL and the close qualitative similarities to the effects of colchicine, it is concluded that TriEL selectively interferes with cytoplasmic and mitotic MTs of the algae, thereby causing the observed inhibitory effects on lorica formation, mitosis, and cytokinesis.
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Carcinogenesis in urinary bladders may not be represented by a continuum of pathological lesions beginning with papillary tumors or flat dysplasias/atypias. In a previous experiment, sterile water and saline continuously infused via catheters connected to ALZA mini-pumps were shown to induce papillary urothelial lesions indistinguishable from tumors considered to be carcinomas in most histological classification schemes. The animals in the initial experiment were followed for relatively brief periods which did not allow for determination of potential reversibility of the process and did not distinguish the effects of the catheters versus those of the infused substances. The present study was designed to control for these variables. Rats were divided into seven groups to examine the urothelial changes after: surgery alone, continuous infusion of the sterile water and mitomycin C, and chronic indwelling catheters with and without infusion. The results indicated that chronic irritation with indwelling catheters was a strong stimulus for the induction of urothelial neoplasms and that continuous infusion of certain substances, even sterile water, might play a small role in the process of carcinogenesis. Comparing the frequencies of papillary urothelial tumors appearing after brief exposure to sterile water and catheters in the initial experiment (75 per cent) and papillary lesions appearing long after removal of the sterile water and catheters in the current study (0 per cent) indicates that these lesions are reversible and probably not neoplastic.
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Among the malignant tumors of nonendocrine origin that are capable of producing polypeptide hormones and of manifesting as different endocrine syndromes discussed here are ectopic ACTH syndrome, SIADH, and ectopic gonadotropin-producing tumors.
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