Psychiatry and the criminal justice system: testing the myths

Several states are changing legislation and treatment programs for mentally ill offenders without knowing how current laws and programs operate. To address this problem the authors linked data from police records, court reports, and clinical files for 2,735 psychiatric referrals from the criminal justice system of Alaska from 1977 through 1981. They found that only 0.2%-2.0% of all schizophrenic persons in the community were arrested for violent crimes each year, accounting for 1.1%-2.3% of all arrests for violent crimes; that psychiatrists agreed about competency and responsibility in 79% of the cases evaluated by more than one clinician; and that a successful insanity defense occurred in 0.1% or less of all criminal cases.

Initial experiences with subcutaneous pulsatile human menopausal gonadotropin administration: successful induction of ovulation in patients with polycystic ovarian disease

Human menopausal gonadotropin (hMG) was administered to 10 patients with polycystic ovarian disease (PCOD) who had failed to ovulate in response to clomiphene citrate. Five patients (group 1) were treated with intramuscular hMG injections daily, on an individually adjusted regimen. Five others (group 2) were stimulated with subcutaneous hMG in a pulsatile fashion by means of a portable infusion minipump. The pulse doses ranged between 3.5 and 7.7 IU FSH per pulse at a constant frequency of 90 minutes. Sixteen of 18 treatment cycles were ovulatory, 9 under intramuscular, and 7 under subcutaneous treatment. A total of two patients conceived with singleton pregnancies, one in each treatment group. Neither ovarian hyperstimulation nor complications of injections were noted. The amount of subcutaneous hMG required to achieve ovulation was significantly less (46.5%; P less than .001) than that needed with intramuscular administration. However, there were no differences in the duration of stimulation periods, the lengths of luteal phases, or serum E2 and gonadotropin levels between the groups. In conclusion, pulsatile subcutaneous hMG administration may be an alternative delivery mode for patients with PCOD.

Calcitonin secretion by human placental tissue

We have investigated the synthesis in vitro of calcitonin (CT) by human placenta at term. Separate placental tissue samples were incubated in culture medium with various Ca concentrations for 6 h. The CT concentrations in the medium were determined by radio-immunoassay. In addition the effect of DB-cAMP on the synthesis was also studied. We could demonstrate CT secretion in all experiments. The CT concentrations were determined by two different antibodies. Both antibodies registered the CT secretion. Addition of DB-cAMP to the culture medium stimulates the synthesis.

Bacterial colonization of intrauterine devices (IUDs)

The bacterial colonizing of the intrauterine device (IUD) and its tail were studied in 152 IUDs obtained from 70 symptomless IUD wearers, 13 women with dysfunctional bleeding, 23 women with pelvic inflammatory disease, 31 women in whom the tail of an IUD was no longer visible and 17 women who were pregnant with an IUD in situ. The IUDs were either removed by the transcervical route or through a fundal incision in the uterus after hysterectomy. Most IUD were heavily contaminated by bacteria, especially Staphylococcus epidermidis, Enterococci and anaerobic Lactobacilli. The number of colonies was higher in women with dysfunctional bleeding and pelvic inflammatory disease than in others with a predominance of pathogenic bacteria, namely beta-hemolytic Streptococci, Staphylococcus aureus and Escherichia coli. Almost half of the IUDs without a tail protruding through the cervix were sterile. With pregnancy in the presence of an IUD, 71% of devices grew bacteria which were mainly anaerobic.

Treatment of hyperprolactinemic amenorrhea with Metergoline

The ergoline derivative, Metergoline, in a dosage of 4 to 24 mg/day, was administered for one to eight months to 42 patients with hyperprolactinemic amenorrhea. Mean serum prolactin (PRL) concentrations before treatment were 91.2 ng/mL in the patients with functional hyperprolactinemia (N = 29) and 256.9 ng/mL in the patients with pituitary tumor (N = 13). Within four weeks, Metergoline treatment reduced these PRL concentrations to 39.5 ng/mL and 82.9 ng/mL, respectively. In this study Metergoline treatment resulted in restoration of menstruation in a total of 37 patients; 28 patients ovulated, and eight became pregnant. It is considerably more effective in functional hyperprolactinemia than in hyperprolactinemia caused by adenoma.

Degradation of parathyroid hormone by placental homogenate

Degradation of the bovine parathyroid hormone (PTH) fragment (amino acids 35-84) up to 70% was observed during passage through human placenta in an in vitro perfusion model. Fractionation of the subcellular fractions of human placental homogenate revealed the degradation to take place only in the mitochondrial fraction. It is concluded that human placenta, like kidney and liver, has the ability to degrade PTH.

Placental transfer of parathyroid hormone

We investigated the in vitro transfer of three parathyroid hormone (PTH) fragments (amino acids 35-84, 44-68 and 65-84) through human placenta at term. The perfused and transferred fragments were measured radioimmunologically and identified by three different methods: high-pressure-liquid chromatography (HPLC), preparative flat-bed electrofocusing (PEGG), and gel filtration (GF). The study demonstrated that PTH fragments traverse the human placenta. The transferred and perfused fragments were identical. We observed a significant degradation of the perfused hormone during the passage through the placenta in both fetal and maternal directions. In addition, we measured the PTH concentrations on forty samples of maternal and umbilical cord artery and vein plasma obtained immediately after delivery. A highly significant correlation of PTH concentrations in the maternal and umbilical cord vessels was observed. These findings support the contention that human placenta at term is permeable for PTH fragments.

[Death following fructose and sorbitol infusions]

Hereditary Fructose Intolerance (HFI) is a rare inherited metabolic disease. Because of the wide application of infusions containing fructose and sorbitol, patients suffering from this disease are at special risk. The disease is frequently not diagnosed until adulthood and the danger associated with this delay is insufficiently recognized. This report therefore included a case history in which this is highlighted.

Metabolism of dehydroepiandrosterone (DHA) in the mature perfused human placenta (I)

A design for the perfusion of one (monoperfusion) or two (parallelperfusion) cotyledos of one placenta was developed for studies of the metabolism of the precursor steroid dehydroepiandrosterone (DHA). Several parameters are used as viability criteria: vascular resistance, glucose and oxygen consumption, lactate/pyruvate ratio, activity of lactate-dehydrogenase (LDH) in the perfusate, extent of perfusion by dye infusion, and morphological description by electron microscopy. A dosage of 2 mg DHA with 2.5 microCi 14C-radioactive labelled marker is given for testing the metabolizing capacity of the placenta. The labelled metabolites DHA, androstenedione (A), testosterone (T), estrone (Oe 1), and estradiol-17 beta (Oe 2) are separated by thin-layer chromatography and measured by scanning and measurements of scraped radioactive spots by scintillation counting. The steroidogenesis is evaluated with the concentrations of Oe 1 at 15 min (Oe 1.15'), Oe 1 + Oe 2 at 90 min (Oe tot, 90'), total aromatization rate (from perfusate and homogenate after 120 min). Results comparable to DHA are found using DHA-sulphate (DHA-S) as precursor, higher amounts of estrogens are metabolized from A. Mature placentas metabolize DHA in relation to the initial DHA concentration: optimal aromatization is found at 250-350 pmol DHA/ml/g, decreased aromatization at higher or lower concentrations. Oe 1 represents the main placental metabolite.

[Comparison of two methods for the determination of oestrogens in pregnancy urine (author's transl)]

A method based on the inhibition of hemagglutination for the determination of estriol-16-alpha-glucuronide is compared to the method of Kober and Ittrich. A sufficient degree of correlation (p less than 0.001) is found, when the daily estrogen production (Kober-Ittrich) in the last trimenon is compared to the estriol-concentration in the morning urine, analyzed by the hemagglutination method, which is suitable for the total estrogen determination too. Results below 23 microgram estriol/ml morning urine are pathological. Advantages of this method result from the fact, that no special equipment is required to carry out this fast assay.

Homicide and blackout in alaskan natives: a report and reproduction of five cases

Alcoholic amnesia was reproduced clinically in 5 Alaskan Native men who had committed homicide during previous alcoholic blackouts but had no recollection of events.

Influence of bromocriptine on plasma levels of prolactin and steroid hormones in the 20th week of pregnancy

The influence of bromocriptine, a prolactin antagonist, on maternal plasma and amniotic fluid prolactin (PRL) was investigated in two pregnancies at the 20th week with medical indication for abortion. Voluntary consensus of the patients was obtained. Blood sample determinations demonstrated that bromocriptine inhibits the secretion of PRL both in plasma and amniotic fluid. Since no changes were observed in peripheral maternal steroid concentrations of dehydroepiandrosterone, dehydroepiandrosterone-sulfate, delta 4-androstene-3, 17-dione, testosterone, estradiol, estriol, and cortisol, it is concluded that PRL does not seem to affect maternal and fetal adrenal cortex as supposed in amenorrhoic patients with hyperprolactinemia.

[Diagnostic assessment of normal and risk pregnancies. 1. Comparison of two radioimmunological methods for the determination of human placental lactogen (author's transl)]

The HPL-concentrations of 103 plasma samples from normal and 58 samples from risk pregnancies were analyzed with two radioimmunological assay kits from Pharmacia/Freiburg (I) and Ames/Frankfurt (II). Intra- and inter-assay-variation of both methods are similar. The absolute values of HPL-concentrations analyzed by the two methods correspond to a value of about 3.5 microgram/ml (about week 24 of pregnancy). Above this value higher concentrations are analyzed with method II. These differences probably result from use of different standards and different methods of separation of free and bound hormone. Analysis of variance shows a high degree of correlation (r = 0.93, P less than 0.001, n = 147) of the results obtained by both methods.

[Clinical and biochemical studies in three pregnancies with placental sulphatase deficiency (author's transl)]

Three pregnancies (two I. parae and one II. para) with abnormally low urinary estrogen excretion of less than 5 mg estrogens per day have been investigated in this study. After intravenous injection of 100 mg DHA-S to the mothers no increase of estrogen production was observed. The level of human placental lactogen, was found within normal range. Ultrasonographic measurement of fetal size and monitoring of the fetal heart rate have demonstrated fetal benefit. At the end of pregnancy the cervix of both did not dilate after infusion of Syntocinon. Healthy male infants were delivered by Caesarean sections in both cases. The II. para, however, developed spontaneous labour and delivery at term. Clinical and laboratory tests have indicated the possibility of rare placental sulphatase deficiency. After delivery the placental steroid sulphatase activity was measured as the rate of hydrolysis of (6,7-3H) oestrone-sulphate or (4-14C) dehydroepiandrosterone-sulphate during in vitro incubation with the homogenate or the microsomal fraction from the pathological placentae. In all three cases the specific activity of 3-sulphatase was considerably (more than 80%) decreased when compared to three normal placentas, whereas the activity of the other enzymes (17beta-hydroxysteroidoxidoreductase, delta4/5-isomerase, aromatizing enzyme system) was found within the normal range.

Steroid metabolism in the perfused human placenta. I. Metabolism of dehydroepiandrosterone sulphate

A new model for the perfusion of human term-placentas has been developed for studies on the placental biogenesis of C-18 and C-19 steroids. For viability criteria, the glucose- and oxygen-consumption, regional perfusion control by dye-infusions or scanning after injection of 99Tc-labelled macroparticles, and the histological qualification were chosen. The recycled perfusate was investigated for the steroids oestrone (Oe1), oestradiol-17β (Oe2), oestriol (Oe3), 4-androstene-3,17-dione (A), testosterone (T), and human placental lactogen (HPL) by radioimmunoassay in controls and perfusions with the foetal steroid precursor dehydroepiandrosterone sulphate (DHA-S). In control perfusions, steroid hormones were found in constant ratios (Oe1:Oe2:Oe3:T:A = 30:1.5:100:0.35:1). Following the administration of 10 mg DHA-S for testing the metabolic capacity of the organ, high concentrations of Oe1 (90–720 ng/ml = 250–3970 % as compared to 100% pre-injection values) were found, shortly preceded by a rapid increase of A (66–1000 ng/ml = 100–16 000 %). A typical surge of T (5.3–147 ng/ml = 265–4640 %) preceded the normally slower increment of Oe2 (22–220 ng/ml = 1570–4330 %). The concentrations of Oe3 and HPL remained nearly unchanged. From different steroid patterns after DHA-S-load, two distinct responses of term-placentas could be differentiated: Group I (n=12) showed high concentrations of Oe1 (3200 ± 940 %), a small increase of T (1020 ± 500%), as well as low and delayed values of Oe2 (1660 ± 450%). In Group II (n = 5), values were high for T (3160 ± 1020%) and Oe2 (3300 ± 1110%), whereas Oe1 was found in a lower range (508 ± 302%).

In contrast to in vivo findings in maternal venous blood after DHS-S injection to the mother, oestrone was found in perfusions as the main oestrogen fraction from DHA-S. Thus, the analysis of such metabolic differences might be of help in the interpretation of complex results from the DHA-S-loading test.

Hemorrhage induced by intrauterine devices: control by local proteinase inhibition

The intrauterine application of proteinase inhibitors, tranexaminc acid and the pancreatic trypsin inhibitor (Trasylol), reduces or eliminates menorrhagia and intermenstrual bleeding (spotting) produced by an intrauterine device (IUD). A decrease in pain and vaginal (cervical) discharge is also frequently observed. A single application is usually sufficient, more than three never being required. The effect lasts for an average of three cycles. In addition to the clinical use of these agents for the treatment of uterine hemorrhage, the slow release of proteinase inhibitors from an IUD may well be useful in minimizing its side effects without interfering with its contraceptive activity.