[Medical mangement of Crohn's disease (author's transl)]

Medical management of Crohn's disease is above all symptomatic. According to the severeness of the case, treatment varies and may be simple (regimen, antidiarrheic agents and sulfamid drugs) or more sophisticated (continous parenteral alimentation). Sulfamids and antibiotics have a definite although temporary action. Pathogenic medication includes: 1) steroid therapy who is active, but its effects are not long stand; 2) immunosuppressors who allow for the reduction of steroid therapy dosages; 3) immunostimulants as proposed by Geffroy. Among those presently studied are Calmette-Guérin vaccine, either given orally or by scarification, and two anti-parasitic drugs, metronidazole and levamisole. Short term results are good but they worsen with time. The main problem is to know when to discuss surgery. As need be, resection although mutilating, should be timely indicated.

Clinical patient management and the integrated health information system

Emerging progress in clinical applications of patient care computing is identified. The essential clinical skill is understanding what data are appropriate in any given patient care situation and extracting enough information to make the correct management decision. The value of the computer has less to do with the internal intellectual process of diagnosis than its contribution to the more manifest actions in support of clinical patient management. Techniques with which the computer is assisting in improving the clinical decisionmaking process are reviewed, and a mechanism to link them to active patient care settings is described. In addition, a trend toward the integration of various independent subsystems, so that expensive resources can be optimized for patient needs, is noted.

[Cystic pneumatosis affecting the sigmoid. Information provided by colonic mucography (double contrast enema) and endoscopy. One case; diagnostic significance of the "puzzle" appearance (author's transl)]

On the basis of one case of colonic sub-mucosal cystic pneumatosis explored by double contrast enema, the authors emphasise the pathognomic diagnostic value of the "puzzle" appearance. This appearance is made by precise adaptation of the opaque colonic mucosa depressed in the form of a "cupola" over the intraparietal gas bubble which results in the deformity. Endoscopy failed to reveal the disorder in the case reported here.

[Ambulatory preparation for double contrast enema. Retrospective study involving 100 nonhospitalised patients (author's transl)]

The authors present a technique of preparation for double contrast barium enema, using the oral route only. It was used in 100 consecutive, suitable non-hospitalised patients with the following results: colonic empyting was perfect in 64% of cases, satisfactory in 25% and inadequate in 11%. Tolerance was deemed to be good. The authors do not suggest that the technique should be used in hospitalised patients, often proving inadequate under such circumstances.

Analgesic and tranquilizing activity of 5,8-disubstituted 1-tetralone Mannich bases

5,8-Disubstituted 1-tetralone Mannich bases represent semirigid variants of classical (i.e., chlorpromazine) neuroleptic agents. 8-Chloro-5-methoxy-2-morpholinomethyl-1-tetralone exhibits neuroleptic potency in the thiothixene range in animal models. Of greater potential interest, however, is the analgesic potency of the 8-chloro-5-methoxy-2-pyrrolidinomethyl analogue which was in the morphine range. This compound did not induce tolerance nor was its activity reversed by naloxone. Structure-activity relationships of the series are discussed.

[The preponderant role of the radiologist in the prevention of recto-colonic carcinoma by the detection of polyps (author's transl)]

The adenomatous polyp is considered to be the precursor of recto-colonic carcinoma. The detection of polyps would appear to be ensured with maximum effectiveness by double contrast barium enema and the authors recommend the routine use of this technique for this purpose. The aim of the radiologist should no longer be merely that of the diagnosis of carcinoma of the colon and rectum, but also its prevention by enabling colonoscopic excision of glandular polyps.

The discriminability of apsirin in arthritic and nonarthritic rats

Aspirin, 56 mg/kg IP, was shown to be mildly, but significantly discriminable from saline in a group of 12 nonarthritic rats exposed to a 2-lever fixed ratio 10 drug discrimination protocol for 56 trials. In a concurrently-tested group of 12 rats made arthritic by injection of Mycobacterium butyricum into a hind paw, the discrimination of aspirin from saline was enhanced. The results exemplify how drug discriminability may vary depending on the pathological state of the subjects exposed to drug-discrimination training.

Classification of suicidal behaviors. II. Dimensions of suicidal intent

A factor analysis of a scale to assess suicidal intent showed four major dimensions: expectancies and attitudes, premeditation, precautions against intervention, and oral communication. Certain types of actions associated with attempted suicide such as seeking help or social isolation appear to be revealing of particular behavioral patterns or motives. Dealing with intent only as a global concept is an oversimplification. Suicidal ideation and suicidal acts are seen as complex patterns of behavior requiring increasingly thorough analyses for better understanding, prediction, and prevention.

The communication of suicidal intent. A reexamination

Verbal expressions and nonverbal indicators of suicidal intent have been frequently regarded as pleas for rescue and help. We investigated the clinical and empirical significance of verbalizations of suicidal ideas, putting one's affairs in order, and previous suicide attempts as forms of "communication of suicidal intent." The patient sample consisted of 211 suicide attempters: 71 "communicators" and 140 "noncommunicators." The results indicated the following: (1) there is no clear evidence that verbal communication, final acts, and previous suicide attempts are justifiably labeled together as ways of communicating suicidal intent; (2) prior verbalization of suicidal ideation or intent bears little relationship to the extent of the wish to die experienced at the time of the suicide attempt; and (3) "talking" or "not talking" about suicidal plans may be a manifestation of personal style rather than an index of despair or hidden motives.

Alcoholism, hopelessness and suicidal behavior

A study of alcoholic and nonalcoholic suicide attempters indicated that hopelessness was the key determinant of suicidal intent in both groups.

Penfluridol blockade of apomorphine: dependence of duration on species and endpoint

Penfluridol, at relatively low doses, blocks apomorphine-elicited emesis in dogs and apomorphine-elicited floor pecking in pigeons for over a month. In mice tested for apomorphine-elicited hypothermia, and in rats tested for apomorphine-elicited chewing behavior, however, the anti-apomorphine activity of penfluridol does not persist for longer than 2-3 days even when high doses of penfluridol are given. In rabbits tested for apomorphine-induced hyperthermia and gnawing, on the other hand, penfluridol blocks apomorphine for about a week. Thus, of the 5 species tested, only in rabbits does the duration of penfluridol's anti-apomorphine action approximate the 1-week duration reported from human therapeutic trials. In mice given high-dose penfluridol apomorphine consistently elevates body temperatures, rather than exerts its usual hypothermic response. Conversely, in rabbits given penfluridol apomorphine tends slightly to decrease body temperatures, rather than exert its usual hyperthermic response.

The use of suicidal motives in the psychotherapy of attempted suicides

Patients' reasons for their suicide attempts were categorized and related to levels of hopelessness and depression. The findings are discussed in the light of the psychotherapy of suicidal individuals.