[Sexual and nonsexual crimes of patients institutionalized for treatment of sex offenses]

The authors compare the sexual and non-sexual criminality of five of the most frequent diagnostic groups of patients having sexuological in-patient treatment: homosexual delinquents, sexual aggressors, delinquents with polymorphous deviate activities, heterosexual peadophils and exhibitionists. The large number of individuals prosecuted for non-sexual crimes in the group (42%) is surprising, although in all diagnostic groups non-sexual delinquency of patients is lower than sexual delinquency. In the sexual sphere the criminal relapse rate is higher in patients with deviant activity (exhibitionists, sexual aggressors and polymorphous deviant subjects), in the non-sexual sphere in patients with deviations as regards the object (in particular in homosexuals). The results provide evidence of the necessity of more widely conceived provisions within the framework of the therapeutic and preventive approach to this type of patients.

[Echocardiography in emergency medicine: tool or toy?]

In cardiovascular emergency medicine echocardiography allows in many patients a quick and gentle bedside examination. In particular in patients with acute arterial hypotension, suspected or known acute coronary heart disease and its complications and in patients with acute heart failure due to valvular heart disease a valuable narrowing down of the differential diagnosis can be achieved by the use of echocardiography. However, the use of echocardiography in acutely ill patients demands highly skilled investigators to avoid potentially dangerous errors. The echocardiographic examination in intensive or emergency care patients represents an invaluable diagnostic tool today and becomes a toy only in inexperienced hands.

Progressive functional deterioration of bioprostheses assessed by Doppler ultrasonography

Doppler echocardiography was used to study the function of bioprosthetic heart valves by noninvasive means in 32 patients aged 29 to 72 years at various postoperative intervals. There were 24 Ionescu-Shiley, four Hancock, and four Carpentier-Edwards prostheses, 19 in the aortic and 13 in the mitral position. Initial studies were performed at a mean of 2.3 years after implantation and were repeated one, two, and three years thereafter. Flow velocities in the mitral orifice, left ventricular outflow tract, and ascending aorta, as well as mitral pressure half-time, were measured from pulsed-wave or continuous-wave Doppler recordings. Mitral and aortic valve areas and aortic pressure gradients were calculated. In aortic prostheses the valve area decreased and pressure gradient increased progressively in relation to the time from implantation. The mean value (+/- SD) of the aortic valve area was 67 +/- 17 percent of the manufacturer's nominal value at the first examination and 57 +/- 20 percent one year later, 51 +/- 14 percent two years later, and 46 +/- 11 percent three years later (overall differences, p less than 0.01). In mitral prostheses, reduction of the valve area was not related to the time from implantation. The mean mitral valve area was 45 +/- 12 percent of the nominal value at rest and increased to 68 +/- 18 percent during exercise at a mean of 45 months after implantation. There was no change in these values at the one-year repeat study. It is concluded that in a population with predominantly pericardial bioprostheses, (1) aortic tissue prostheses showed a progressive functional deterioration demonstrable by Doppler echocardiography, most probably due to degenerative changes; and (2) in mitral tissue prostheses, there was no significant reduction of orifice area in relation to time from implantation. Reduction of mitral valve areas may, to some extent, reflect a less than full opening at rest.

[Hemiparesis and torsade de pointes under low-dose sotalol therapy]

An 81-year-old woman with recurrent epileptic attacks, hemiparesis and rapidly changing consciousness is described in whom the most probable reason for the clinical picture was polymorphous ventricular tachycardia (torsade de pointes). Sotalol (Sotalex), which the patient received for two weeks at a dose of 80 mg twice daily because of asymptomatic ectopic ventricular beats, was identified as the causative agent. Torsade de pointes disappeared after a single intravenous injection of 2 g magnesium sulfate. The patient left the hospital a few days later completely recovered from all neurological deficits.

[Anti-angina effect of amiodarone versus delayed-action propranolol. A double-blind randomized study]

Long-acting Propranolol (160 mg/day) and Amiodarone (200 mg/day after impregnation) were compared in chronic stable angina pectoris. Forty-three patients with stable angina of effort were included in a randomised double blind trial (19 in the amiodarone and 24 in the propranolol group). The duration of the study was 8 weeks; the placebo phase (2 weeks) was followed by 6 weeks of active treatment. An exercise stress test was performed before and after the treatment period. The number of episodes of angina and the consumption of glyceryl trinitrate decreased significantly (p less than 0.001) in the same proportion with both drugs with respect to the placebo period. The time to the appearance of criteria of positivity of the exercise stress test increased from 6.82 +/- 0.50 mn to 8.35 +/- 0.50 mn with amiodarone, and from 7.15 +/- 0.47 mn to 9.50 +/- 0.52 with the propranolol preparation. This improvement was very significant compared with the placebo phase (p less than 0.001) but the difference between the two drugs was not statistically significant (p = 0.39). The other parameters which were studied (time to onset of angina, total duration of exercise, maximum heart rate, double product, maximum ST depression) changed in a parallel fashion significantly versus placebo. There were no differences between the two treatment groups with the exception of the resting heart rate which decreased more in patients on propranolol (80.94 +/- 3.92 to 62.47 +/- 1.97) than in patients on amiodarone (84.87 +/- 2.63 to 73.41 +/- 2.01; p less than 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

[The effect of marital relations of the parents on the level of general adaptation in sexual offenders]

The authors seek in a group of 297 treated sexual delinquents differences between the group of patients perceiving the relationship of their parents during childhood as harmonious and the group of those who consider it disharmonious. The assembled results are unequivocally to the disadvantage of patients of the second group. The authors found the most marked differences in the sphere of basic psychiatric characteristics (higher number of patients with psychiatric heredity, suicides in the family, alcoholism), characteristics of the initial family (higher incidence of fathers and mothers who were alcoholics, convicted fathers patients with abnormal relations with parents and siblings, spending part of the childhood without the family) and in the sphere of social adaptation (more frequently incomplete basic education, no skilled training, more frequent absenteeism and fluctuations at work). In the sphere of adaptation to partnership and as regards forensic sexological characteristics, there was a less significant, nevertheless convincing, trend shifting the patients from disharmonious families in a direction unfavourable for them. According to the authors' view it may be assumed that these findings are consistent with similar results in other groups of subjects with social problems and that they may be rather associated with a generally criminogenic influence of dysfunctional nuclear families in the delinquent population.

The integration of computers into the occupational therapy department

Despite the growing interest in and use of microcomputers as an occupational therapy assessment and treatment modality, many factors still limit their widespread adoption in the clinical milieu. Such factors include inadequate background preparation; insufficient financial resources; the overwhelming number of choices of computer hardware, software, and adaptive devices; lack of product support; rapidity of change; and skepticism of administrators and clinicians. The purpose of this paper is to outline procedures that will facilitate the integration of microcomputers into the clinical milieu by (a) identifying the reasons why and how these devices are used improperly; (b) proposing ways to correct these problems; (c) providing recommendations concerning the acquisition of major microcomputer hardware, software, and adaptations; and (d) providing an annotated list of resources for further information.

Support of cooperative work by electronic circulation folders

ProMInanD's migration system deals with cooperative office work on different types of office tasks which consist of steps to be carried out by person playing office roles. This typical kind of cooperation is supported by ProMInanD's Electronic Circulation Folders (ECF). Instantiations of task related types of ECF's migrate automatically through an office organization. In the contents of an ECF the office workers' contribution to a task are kept as arbitrary kinds of documents. The migration specification of an ECF describes the steps to be performed, their possible sequences and the roles which have to be played for their performance. However, in many cases neither the number of steps nor the persons involved in an office task are in advance. Often, there is a need for deviations from predefined migration routes and for exception handling. Also, there are tasks which ask for completely unformalized migrations. Moreover, in all these cases, non-deterministic human behavior has to be taken into account. These problems are all solved by ECF's. In this paper their design, processing and implementation are considered.

[Right-sided lung hypoplasia in a 13-year-old boy]

Initially a right sided pulmonary hypoplasia was diagnosed in our patient at the age of 9 years. The previous years were characterized by recurrent pneumonia, bronchitis and daily coughing fits. Findings of the chest radiograph suggested the diagnosis of right sided hypoplasia. The right hemithorax was small with mediastinal structures being pushed to the right and a clearly reduced blood flow on the same side. DSA of the arteria pulmonalis showed hypoplasia of the right arteria pulmonalis and confirmed our diagnosis. In addition to that an obstructive airway disease was assessed by measurement of lung function. Since the time when the diagnosis was found our patient has inhaled DSCG and beta 2-adrenergic drugs and no surgical treatment has been required as there have been no further episodes of pneumonia.

[Short-term dobutamine therapy in severe cardiac insufficiency]

The feasibility of heart transplantation has stimulated new interest in the therapy of severe refractory congestive heart failure even as an interim solution. We studied the hemodynamics, clinical efficacy and practical implications of a 72-hour dobutamine infusion in 11 patients with NYHA IV refractory congestive heart failure (age 40-73, average 55 years). The dose was 250-1000 micrograms/min, with the goal of increasing cardiac output by 30-50%. Changes in the pharmacokinetics of lidocaine were studied by single dose kinetics in 7 patients. Cardiac output increased from 2.94 +/- 0.68 to 4.77 +/- 1.1 l/min and stroke volume from 35 +/- 10 to 56 +/- 12 ml (p less than 0.001). Pulmonary capillary wedge pressure decreased from 28.5 +/- 5 to 21 +/- 6 and central venous pressure from 14 +/- 6 to 7 +/- 3 mm Hg (p less than 0.007). There was marked worsening of hemodynamics 24-48 h after starting dobutamine. However, after withdrawal of dobutamine a significantly higher cardiac output and stroke volume (3.73 +/- 0.43 l/min, 42 +/- 7 mm Hg. p less than 0.05) persisted. Both clearance and distribution volume of lidocaine increased, while half life decreased significantly (6.61 +/- 1.43 to 5.33 +/- 0.77 h. p less than 0.05). 9 of 11 patients developed Lown IVb ventricular arrhythmia, while in 4 massive diuresis occurred necessitating volume substitution. 6 patients left hospital clinically improved, 2 were transplanted and 3 patients died 1 day to 3 weeks after ending dobutamine. Dobutamine had salutary hemodynamic and clinical effects outlasting the duration of dobutamine therapy. Due to its arrhythmogenic effects it should be administered under ECG monitoring. In patients treated with lidocaine, upward dose adjustments may be necessary with improving hemodynamics.

[Sexologic forensic expert evaluation of sex offenders]

The authors differentiate between deviant and nondeviant sexual delinquents and focus attention in particular on the forensic evaluation of deviantly conditioned delinquents. They describe some differences in the psychosexual development of deviant delinquents and some anamnestic facts which signalize a deviant structure of the sexual motivation system. They emphasize the necessity of a comprehensive examination of the delinquent, incl. thorough sex diagnosis, psychological diagnosis of the personality, a detailed analysis of controlling and recognizing ability of the time of the crime and they submit suggestions for health measures.

Identification of the metabolic defect in sialuria

Sialuria is a rare inborn error of metabolism, the hallmarks of which are moderate developmental retardation, coarse facial features, and an enormous amount of free N-acetylneuraminic acid (sialic acid) in the urine. Until now, the basic biochemical defect in this disorder has remained uncertain. In this report, the activity of the rate-limiting enzyme in the biosynthesis of sialic acid has been measured directly in whole cell lysates by a highly sensitive assay. With this technique, the basic defect in sialuria has been identified unequivocally as the loss of feedback control of uridine diphosphate N-acetylglucosamine 2-epimerase by cytidine monophosphate N-acetylneuraminic acid with resultant overproduction of sialic acid.

[Forensic and sexual characteristics in patients undergoing institutional sex therapy]

Based on the examination of 238 patients having institutional sexuological treatment, the author assessed the basic differences between homosexual sexual delinquents, sexual aggressors, polymorphic sexual delinquents, paedophiliacs and exhibitionists as regards the number of sentences on account of sexual delicts in the case-history, the presence of alcohol during the sexual delict, antialcoholic treatment in the past, the number of sexuological treatments received, age when the first sexual abnormal manifestations occurred, the age when first prosecuted on account of sexual delinquency and the diagnosis of the deviation.

Population pharmacokinetics of tobramycin

1. Population pharmacokinetic parameters of tobramycin were determined in a heterogenous group of 97 patients using serum samples drawn for the routine monitoring of tobramycin concentrations, following multiple dosing regimens. 2. To describe the accumulation kinetics of tobramycin a two-compartment pharmacokinetic model was required. The best fit to the data was obtained when drug clearance (1 h-1) was related linearly to creatinine clearance (proportionality constant: 0.059 +/- 0.002 x CLcr (ml min-1)) and initial volume of distribution (1) was related linearly to body weight (proportionality constant: 0.327 +/- 0.014 x body weight (kg)). The intersubject variability in these two parameters was 32% and 3%, respectively, whilst the residual or intrasubject variability amounted to 21% of the tobramycin concentration. The terminal half-life of tobramycin, 26.6 +/- 9.4 h, was appreciably shorter than previously reported. 3. The population pharmacokinetic model was validated against data obtained from 34 independent patients and the predicted and observed concentrations were found to be in good agreement. The population pharmacokinetic model was used to design a priori dosing recommendations for tobramycin.

[Psychological predictors of recidivism in sex offenders]

Based on comparison of results of psychological examinations of 24 recidivists and 25 patients having compulsive sexuological treatment, who within a three-year period after taking a specialized sexuological course did not relapse, the author detected some differences which appear to be significant for the prediction of successful treatment. As to psychodiagnostic methods (Hand test, Raven, EPI, DOPEN, MAS, Sullivan-Adelson, ICL, MMPI), the most marked differences between the investigated groups were found in Raven's test of progressive matrices and in the Minnesota personality inventory. Based on the assembled results it may be assumed that there is a higher risk of relapses of sexual delinquency in patients with inadequate defence against mental weakness, in psychoasthenic and schizoid personalities. Higher intelligence is in this context a favourable prognostic factor.

Ligand-induced modulation of the hepatic receptor for asialoglycoproteins. Evidence for the role of cell surface hyposialylation

In a previous paper, we reported a ligand-induced modulation of the asialoglycoprotein receptors on HepG2 cells whereby these receptors were rendered functionally inert while remaining immunologically intact on the plasma membrane. At that time, it was speculated that the loss in receptor-binding ability was a direct result of a concomitant decrease in cell surface sialic acid residues. Experiments designed to test that hypothesis are presented. The results revealed: 1) an identical response in binding activity and sialic acid content in cells subjected to minimal exposure to neuraminidase; 2) a parallel and synchronous recovery of both parameters following modulation; 3) an invariant binding of high affinity ligands, and 4) the ability of galactose oxidase to restore, at least partially, the cell's ability to bind asialoglycoprotein. These results indicate that ligand-induced surface hyposialylation directly diminishes expression of the asialoglycoprotein receptor.

[Analgesic effect and side-effects of buprenorphine in acute coronary heart disease. A randomized double-blind comparison with morphine]

The analgetic effect and the side effects of buprenorphine (Temgesic) and morphine were compared in a double blind randomised study in 76 patients with suspected acute coronary heart disease. In 68 patients the acute coronary heart disease could be proven, in 61 patients the protocols could be entirely analysed. In 7 of 30 patients on buprenorphine and in 10 of 31 on morphine the analgetic effect was not sufficient (n.s.). The observed side effects were hypotension, bradycardia, nausea, vomiting, vertigo, reduction in respiratory rate and sedation. There were no significant differences in the rate of these side effects in the two groups. The average reduction in respiratory rate was more prominent in the buprenorphine group (-8 vs. -3/min. p less than 0.001) but we found no significant difference in both groups in the number of patient with a respiratory rate less than 12/min. We conclude that buprenorphine is safe for use in the pain therapy of patients with acute coronary heart disease and has a similar analgetic effect and profile of side effects as morphine. It can be used as an alternative to morphine in acute coronary heart disease.

[Thrombolysis in acute myocardial infarct. Initial experiences in a Swiss university hospital]

Preliminary experience with thrombolytic therapy in patients with acute myocardial infarction and its practicability in a CCU of a Swiss university hospital are presented. Out of 674 patients with a transmural or non-transmural infarction, 72 (11%) have been treated with thrombolytic agents since March 1986. 53 of these patients were included in the "European Cooperative Study Group" multicenter trial and treated with recombinant tissue plasminogen activator (rt-PA) or placebo; the other 19 patients received streptokinase i.v. with the same inclusion/exclusion criteria. The results corresponded to the well known effects of early thrombolysis with improvement in infarct size reduction, cardiac performance and early mortality.--The importance of the time factor and the implications regarding information of potential patients and practitioners and organization of rapid hospitalization are outlined. Follow-up (after a mean of 14 months) of our 72 thrombolysis patients revealed a high percentage of patients still dependent on medical care, reduced physical capacity in almost half of the patients and (a favourable result) a large number of patients who stopped smoking after the infarction. --In view of the slight additional stress caused by this therapy for patients, physicians and nursing staff, the use of thrombolytic agents in acute myocardial infarction should (with strict inclusion/exclusion criteria) be rapidly generalized in the hospitals of Switzerland.

Heart valve replacement with St. Jude Medical valve prosthesis. Long-term experience in 743 patients in Switzerland

Between November 1978 and June 1986, 828 St. Jude Medical valves were implanted in 743 patients whose mean age was 57 years (range, 1-83 years) and who had been admitted to the University Hospitals in Basel, Berne, and Lausanne, Switzerland. Aortic valve replacement was performed in 456 patients, mitral valve replacement in 200, tricuspid valve replacement in six, double valve replacement in 77, and triple valve replacement in four. In 187 patients, additional surgical interventions were performed. Operative mortality was 1.6%, and the 4-week postoperative mortality was 4.0%. During a mean follow-up period of 2.6 years, the annual mortality rate was 3.1%, and the annual cardiac mortality rate was 2.1%. The thromboembolic rate per 100 patient-years was 1.3 after aortic valve replacement, 3.0 after mitral valve replacement, and 1.0 after multiple valve replacement. The incidence of major bleeding was 1.3 per 100 patient-years. Valve dysfunction attributable to thrombotic obstruction occurred in three patients, and that attributable to leaflet dislocation in one (annual dysfunction rate, 0.2%). Twelve patients developed infectious endocarditis, six of whom died. However, in four patients, reoperation and, in two patients, antibiotic treatment alone were successful in treating the infection. A paravalvular leak necessitating reoperation developed in 10 patients. In three patients, the leak was caused by infectious endocarditis. Reoperation had no operative mortality. In three patients (0.4%), a mild hemolytic anemia was found.(ABSTRACT TRUNCATED AT 250 WORDS)