[Wallenberg syndrome in childhood secondary to the striking by lightening]

Wallenberg's Syndrome (WS) is exceptional in childhood. We present a case of a 10 year-old girl with a WS caused by an embolism in the right lateral portion of the medulla secondary to an electrofulguration, but with an unusual progressive outcome, developing clinical signs of medial medullar injury, leading even into a respiratory failure 30 days after admittance. She only became stable after surgical lesion decompression. There was no evidence of vascular malformation, finding only a great oedema. The pathology only showed changes compatible with brain infarction. This case makes again clear the superiority of MRI upon CT-scan to diagnose a WS. We think that the unusual progression of the lesion was due to great medullar oedema found on surgery, involving the brain regional flow.

[Pharmacological treatment of depression]

Major depression is a frequent and incapacitating illness. Recent research has established its natural course, often characterised by chronicity or recurrent episodes, leading to long-term pharmacotherapy. Effective pharmacologic treatments are available for depression, including tricyclic antidepressants, monoamine oxidase-inhibiting agents, and newer medications. Successful pharmacotherapy for depression requires consideration of the profile of the antidepressant drugs, to balance their therapeutic effects and side effects profiles.

[Primary coronary angioplasty as early reperfusion treatment of acute myocardial infarction]

Between March 1990 and July 1993, 21 patients with an evolving acute myocardial infarction were treated with coronary angioplasty after 2-9 hours of chest pain (mean 3.9). Thirteen had a clinically and electrocardiographically large infarction, including 3 in cardiogenic shock. The dilated arteries were the left anterior descending in 14, the left circumflex in 4 and right coronary artery in 3 patients. With angioplasty successful reperfusion of the infarct area was obtained in 18 patients (86%). The procedure was well tolerated by most patients and the in-hospital mortality rate was 5%.

Effect of lipid supplements on the production and glycosylation of recombinant interferon-gamma expressed in CHO cells

The effects of lipids on the glycosylation of recombinant human interferon-gamma expressed in a Chinese Hamster Ovary cell line were investigated in batch culture. Lipids form an essential part of the N-glycosylation pathway, and have been shown to improve cell viability. In control (serum-free) medium the proportion of fully-glycosylated interferon-gamma deteriorated reproducibly with time in batch culture, but the lipoprotein supplement ExCyte was shown to minimise this trend. Partially substituting the bovine serum albumin content of the medium with a fatty-acid free preparation also improved interferon-gamma glycosylation, possibly indicating that oxidised lipids carried on Cohn fraction V albumin may damage the glycosylation process.

[Value of electrocardiogram in localization of the coronary artery occlusion in acute inferior wall myocardial infarction]

Early EKG changes may contribute to predict the site of coronary artery occlusion during acute inferior myocardial infarction (MI). Its interpretation is relevant to therapeutic clinical decisions. We have prospectively evaluated early EKG changes of 40 consecutive patients with acute inferior MI and correlated them with the site and location of the coronary artery culprit lesion. Proximal right coronary artery occlusion was characterized by negative ST-T wave changes in leads D1 and aVL and ST segment elevation in leads D3 > D2. However the most distinctive EKG pattern of proximal right coronary artery occlusion was ST segment elevation with positive T wave in V4R (specificity 96%, predictive value 89%, p < 0.001). Distal right coronary artery occlusion was characterized by a positive T wave without ST segment elevation in V4R. Finally circumflex coronary artery occlusion was defined by a positive R/S > 1 relationship in V1, ST segment elevation in V5 and V6. Again lead V4R with flat or negative ST-T wave morphology had the highest predictive value for circumflex coronary artery occlusion (100%). Thus early EKG changes may contribute to precise the site and location of coronary artery occlusion and may help to implement clinical therapeutic strategies in patient with inferior MI. Right precordial leads are most useful in the EKG interpretation of inferior MI.

Alprazolam and amitriptyline in the treatment of major depressive disorder: a double-blind clinical and sleep EEG study

This study was designed to compare the antidepressant effects of alprazolam and amitriptyline in a group of 30 inpatients suffering from a severe major endogenous depression, diagnosed by Research Diagnostic Criteria and the Newcastle Rating scale, and to examine the effects of alprazolam and amitriptyline on two biological markers of depression, the dexamethasone suppression test and sleep EEG parameters. The 6-week study was double-blind with a random allocation of treatment. Patients were treated with flexible doses of 4-9 mg of alprazolam and 100-225 mg of amitriptyline. After 4 weeks of treatment the antidepressant effects of amitriptyline significantly exceeded those of alprazolam, as measured on the Hamilton Rating Scale for Depression. There was a high drop-out rate in the alprazolam group because of ineffectiveness of treatment. Alprazolam showed similar effects on sleep parameters as amitriptyline: lengthening of the REM latency and a tendency to shorten stages 3 and 4 and stage REM. These negative clinical results should be interpreted with caution, because of the severity of our selection criteria, and should not be extended to all depressive disorders.

Age and gender effects on the diagnostic power of the DST

Among 365 major and 158 minor depressive inpatients, the dexamethasone suppression test (DST) yielded an overall diagnostic sensitivity of 50%, a specificity of 85%, and a confidence level of 88%. Age was significantly correlated with the post-dexamethasone cortisol levels in the whole sample (r = 0.11; P less than 0.01); however, this low relationship disappeared when all subgroups defined by gender or diagnostic were considered. Gender did not appear to influence DST results; however, among the patients between 30 and 39 years, the diagnostic performance of the DST was significantly lower among female as compared to male patients, suggesting possible interferences with endocrine variables.

[New diagnostic and neuroendocrine approaches to the borderline syndrome]

The recent literature reflects a growing interest in Borderline Disorders. This paper summarizes the recent developments on nosological, genetical and biological aspects of the Borderline syndrome. Original neuroendocrine results from our group are presented and discussed. They suggest that an endogenomorphic depressive spectrum may be associated with the Borderline personality disorders.

[Recent findings concerning morphologic anomalies of the central nervous system in psychopathology]

Recent investigations with CT scan have reopened the question of structural brain abnormalities in psychiatric illnesses. Clinical aspects and possible genetic factors involved in these morphological abnormalities are also reviewed.

Study of the diagnostic value of the dexamethasone suppression test in endogenous depression

The diagnostic value of the dexamethasone suppression test (DST) in "endogenous" depression was evaluated in 209 psychiatric inpatients. A high incidence of abnormal DST results was observed in "endogenous" depressives (52%), schizo-affective (69%) and borderline patients (38%). However, 25% of the patients with other psychiatric disease also failed to suppress on the DST. Diagnostic criteria, previous history of alcoholism, psychiatric drug treatment, age and sex did not significantly affect DST performance. The present data do not indicate that the DST represents a highly specific marker of "endogenous" depression.