Association between borderline personality structure and history of childhood abuse in adult volunteers

Childhood abuse has been implicated as a leading factor in the development of borderline personality disorder (BPD). Data in this report, drawn from an ongoing study of the therapeutic effect of fluoxetine in BPD patients, were gathered in an attempt to replicate previous findings indicating a history of physical abuse in 71% and sexual abuse in 67% of adult BPD subjects. Thirty-one subjects for a study of the pharmacological treatment of BPD or BPD traits met criteria for the study. Those who had been previously hospitalized for a psychiatric disorder, who had recently been suicidal, or who had recent histories of self-mutilation were excluded. Specific information about childhood abuse was gathered using questions from a previous study of abuse histories in BPD patients. All subjects were then interviewed in greater depth regarding past experiences of abuse as part of the ongoing study of the relationship of childhood attachment experience and adult psychopathology. Six of 31 subjects (19.4%) reported a definite history of childhood physical and/or sexual abuse. Four of these subjects met criteria for full BPD, and two met criteria for BPD traits. Three of 31 subjects reported a history of physical abuse (9.7%); five reported a history of sexual abuse (16.1%). Two of the six who reported abuse reported both physical and sexual abuse. A history of childhood abuse is not necessarily linked to the development of BPD or BPD traits in all individuals. The following hypothesis is suggested: BPD may represent a spectrum of symptomatic severity.(ABSTRACT TRUNCATED AT 250 WORDS)

Bleeding angiodysplasia of stomach associated with severe ischemic congestive cardiomyopathy--a case history

The authors present a case of gastric angiodysplasia with upper gastrointestinal bleeding, associated with severe ischemic congestive cardiomyopathy.

ICI 206,970: a novel eukalemic diuretic with calcium channel blocking activity

ICI 206,970, an aminomethylphenol pyrazine derivative, produced diuretic and saluretic effects, but caused only minimal alterations in kaliuresis in dogs and rats after oral and parenteral administration. ICI 206,970, unlike HCTZ, increased diuretic activity in a more clearly defined dose-related manner, and did not reach the plateau level even up to a dose of 100 mg/kg p.o. The diuretic and natriuretic response is believed to be a combination of a direct effect on tubule function and changes in GFR, particularly at higher doses. Based upon studies in in vitro amphibian models for mimicking mammalian nephron, ICI 206,970 appeared to possess a furosemide-like activity in toad cornea and amiloride-like activity in toad bladder. It is concluded that ICI 206,970 is a potent eukalemic diuretic with the potential of multiple sites of renal action.

Dissociative disorders in psychiatric inpatients

OBJECTIVE

This study attempted to determine 1) the prevalence of dissociative disorders in psychiatric inpatients, 2) the degree of reported childhood trauma in patients with dissociative disorders, and 3) the degree to which dissociative experiences are recognized in psychiatric patients.

METHOD

A total of 110 patients consecutively admitted to a state psychiatric hospital were given the Dissociative Experiences Scale. Patients who scored above 25 were matched for age and gender with a group of patients who scored below 5 on the scale. All patients in the two groups were then interviewed in a blind manner, and the Dissociative Disorders Interview Schedule, the Traumatic Antecedent Questionnaire, and the posttraumatic stress disorder (PTSD) module of the Structured Clinical Interview for DSM-III-R, Nonpatient Version, were administered. Chart reviews were also conducted on all patients.

RESULTS

Fifteen percent of the psychiatric patients scored above 25 on the Dissociative Experiences Scale; 100% of these patients met DSM-III criteria for a dissociative disorder. These patients had significantly higher rates of major depression, PTSD, substance abuse, and borderline personality than did the comparison patients, and they also reported significantly higher rates of childhood trauma. Chart review data revealed that dissociative symptoms were largely unrecognized.

CONCLUSIONS

A high proportion of psychiatric inpatients have significant dissociative pathology, and these symptoms are underrecognized by clinicians. The proper diagnosis of these patients has important implications for their clinical course.

Air pollution and daily mortality in Birmingham, Alabama

Several recent studies have reported associations between common levels of particulate air pollution and small increases in daily mortality. This study examined whether a similar association could be found in the southern United States, with different weather patterns than the previous studies, and examined the sensitivity of the results to different methods of analysis and covariate control. Data were available in Birmingham, Alabama, from August 1985 through 1988. Regression analyses controlled for weather, time trends, day of the week, and year of study and removed any long-term patterns (such as seasonal and monthly fluctuations) from the data by trigonometric filtering. A significant association was found between inhalable particles and daily mortality in Poisson regression analysis (relative risk = 1.11, 95% confidence interval 1.02-1.20). The relative risk was estimated for a 100-micrograms/m3 increase in inhalable particles. Results were unchanged when least squares regression was used, when robust regression was used, and under an alternative filtering scheme. Diagnostic plots showed that the filtering successfully removed long wavelength patterns from the data. The generalized additive model, which models the expected number of deaths as nonparametric smoothed functions of the covariates, was then used to ensure adequate control for any nonlinearities in the weather dependence. Essentially identical results for inhalable particles were seen, with no evidence of a threshold down to the lowest observed exposure levels. The association also was unchanged when all days with particulate air pollution levels in excess of the National Ambient Air Quality Standards were deleted. The magnitude of the effect is consistent with recent estimates from Philadelphia, Steubenville, Detroit, Minneapolis, St. Louis, and Utah Valley.

Bioactivity of human growth hormone in serum: validation of an in vitro bioassay

GH, in clinical practice, is determined by RIA, but RIA estimates may not accurately reflect serum GH bioactivity. The available measures of GH bioactivity lack either sensitivity, specificity, or a physiologically relevant end point. The objective of this research was to develop a physiologically relevant GH bioassay which would not only measure the bioactivity of purified GH preparations, but would also have sufficient sensitivity to measure GH bioactivity in human serum. The method consisted of incubating murine 3T3-F442A adipocytes in serum-free medium containing BSA, 14C-glucose, and increasing concentrations of GH or test materials for 24 h, followed by measurement of conversion of glucose to lipid. Interference by nonspecific serum factors was reduced by the addition of 10 micrograms/liter insulin, 25 nM dexamethasone, and 37 nM estradiol to the medium. In the presence of 10 micrograms/liter insulin, 50 micrograms/liter insulin-like growth factor-1 did not alter the ability of GH to suppress lipid accumulation. Epinephrine and glucagon could suppress lipid accumulation but only at concentrations greatly in excess of the physiological range in serum. Twenty two thousand dalton hGH produced dose-dependent suppression of lipid accumulation which was linear between 0.625 and 10 micrograms/liter (r = 0.926; P = 0.0001) with a half-maximal response of 3.0 +/- 0.2 micrograms/liter (n = six experiments). The intra- and interassay coefficients of variation were 7% and 19%, respectively. The assay was specific for GH since addition of human PRL produced suppression of lipid accumulation only at concentrations where contamination of the preparation by GH became a significant factor. ACTH also suppressed lipid accumulation but only at doses of 1000 micrograms/liter or greater. Human placental lactogen and hLH, hFSH, and hTSH did not cross-react with GH in this assay. Addition of human serum did not alter the slope of ED50 of the GH dose-response curve. Pools of serum from prepubertal and pubertal boys and girls, subjects treated with arginine or insulin, a diabetic girl, and a boy with gigantism who had a serum GH content of 80 micrograms/liter by RIA and 40 micrograms/liter by bioassay, produced dose response curves parallel to that of the GH standard curve. Serum from patients with hypopituitarism did not produce significant suppression of lipid accumulation in any assay. Recovery of 5 micrograms/liter GH added to human serum was 94%. Twenty thousand dalton GH also suppressed lipid accumulation in this assay, but was 2-fold less potent than 22,000 dalton GH.(ABSTRACT TRUNCATED AT 400 WORDS)

SCH 38057: a picornavirus capsid-binding molecule with antiviral activity after the initial stage of viral uncoating

The activity of a new water-soluble molecule, SCH 38057, against picornaviruses is described. SCH 38057 inhibited plaque formation of selected entero- and rhinoviruses in a range of 10.2 to 29.1 microM (50% endpoint) and had a therapeutic index of 10 against poliovirus type 2 (polio 2) in HeLa cells. When administered orally or subcutaneously, SCH 38057 protected mice infected with either coxsackievirus B3 (CVB3) or echovirus-9 from mortality. The molecule provided a low level of protection against thermal inactivation of virus, indicating that SCH 38057 interacts with the picornavirus capsid. Binding studies with [3H]SCH 38057 revealed that the molecule binds to CVB3 and human rhinovirus 14 (HRV14) in a ratio of 29 and 19 molecules per viral particle, respectively. The affinity constant for SCH 38057 binding to CVB3 was 7.0 x 10(-4) M. When added to cultures of infected cells at 3 h after infection, SCH 38057 markedly inhibited viral RNA synthesis. This finding with lack of inhibition of attachment and loss of infectious virus after attachment were interpreted to indicate that, although SCH 38057 binds to the viral capsid, the molecule exerts its antiviral effect after the initial stage of picornavirus uncoating, i.e., after conversion of the 156S infectious viral particle to smaller subviral species.

Particulate air pollution and hospital emergency room visits for asthma in Seattle

Recent studies have associated short-term exposure to respirable particulate matter (PM10) exposure with peak flow decrements, increased symptoms of respiratory irritation, increased use of asthma medications, and increased hospitalization for asthma. Increased mortality from chronic respiratory disease has also been reported. To help confirm whether PM10 exposure is a risk factor for the exacerbation of asthma, we compiled daily records of asthma emergency room visits from eight hospitals in the Seattle area. In Poisson regressions controlling for weather, season, time trends, age, hospital, and day of the week, the daily counts of emergency room visits for persons under age 65 were significantly associated with PM10 exposure on the previous day. The mean of the previous 4 days' PM10 was a better predictor (p < 0.005). The relative risk for a 30 micrograms/m3 increase in PM10 was 1.12 (95% confidence interval 1.20 to 1.04). Daily PM10 concentrations never exceeded 70% of the current ambient air quality standards during the period. The consistency of investigations of the health effects of PM10 suggest that increased attention should be given to the control of particulate matter air pollution.

Head-up tilt testing with and without isoproterenol infusion in healthy subjects of different ages

Passive head-up tilt testing with or without infusion of isoproterenol is used in the investigation and management of patients with syncope. Twenty-five healthy asymptomatic volunteers prospectively grouped according to age (young [28 +/- 1.7 years]: n = 9; middle [51 +/- 3.3 years]: n = 11; elderly [81 +/- 2.4 years]: n = 5; mean +/- SE) were studied during: (1) supine carotid sinus massage; (2) 60 degrees head-up tilt alone; and (3) infusion of isoproterenol to raise the heart rate 20% above supine baseline, prior to 10-minute repeat tilt. Symptoms occurred in three subjects (12%) and only occurred with passive tilting alone. Two young subjects had syncope with sinus pauses greater than 10 seconds. One elderly subject developed atrial flutter. No subject had symptoms or hypotension during tilt plus isoproterenol or a pause greater than 3 seconds with carotid sinus massage. With passive tilt, mean heart rate increased by 16 +/- 6 beats/min and 18 +/- 7.8 beats/min in the young and middle aged subjects (P < 0.05), but only by 6 +/- 5 beats/min in the elderly (P = NS, supine vs 60 degrees in each group). With head-up tilt plus isoproterenol infusion, the mean heart rate elevation in response to tilt was 17 +/- 9 beats/min, 8 +/- 3 beats/min, and 12 +/- 4 beats/min for the young, middle, and elderly subjects, respectively (P < 0.05, supine vs 60 degrees in each group).(ABSTRACT TRUNCATED AT 250 WORDS)

Baroreflex buffering of pressor response to vasopressin is mediated by V1, not V2, receptors in conscious rats

Arginine vasopressin (AVP) enhances reflex buffering of its own pressor response, thus attenuating its vasoconstrictor potential in vivo. To investigate the extent to which this effect of AVP is mediated by V1 or V2 receptors, mean arterial pressure (MAP) and heart rate (HR) changes were examined in response to graded injections of AVP or [Phe2,Orn8]oxytocin, a potent, selective V1-receptor agonist, in the absence and presence of infusion of [Val4,D-Arg8]VP, a selective V2-receptor agonist. Responses were compared in intact and autonomically blocked conscious rats. During autonomic blockade with methscopolamine and hexamethonium, the pressor sensitivities to AVP and [Phe2,Orn8]oxytocin were similarly increased. Infusion of the V2-receptor agonist had no effect by itself on MAP or HR in conscious intact rats. It also did not alter the pressor responses to the V1 agonist, in either intact or autonomically blocked rats. In the presence of the V2 agonist, the decrease in heart rate induced by the V1 agonist was enhanced. These results indicate that reflex buffering of the pressor response to AVP in the conscious rat is mediated by V1 and not V2 receptors. However, V2 receptors may be involved in modulating the heart rate response to AVP.

Oral cancer inhibition by micronutrients. The experimental basis for clinical trials

Extensive research has been carried out in experimental animals to demonstrate the anticancer activity of retinoids, carotenoids and tocopherol on oral cancer and oral precancerous leukoplakia. The anticancer properties of these micronutrients have been studied in experiments dealing with inhibition of carcinogenesis, prevention of oral cancer development and regression of established oral carcinoma. Synergism has been demonstrated in the anticancer activity of beta carotene and alpha tocopherol. Synergism has also been demonstrated between beta carotene and anticancer alkylating agents such as melphalan and cyclophosphamide. Micronutrients such as beta carotene have been found to inhibit both major phases of carcinogenesis--initiation and promotion. Animal studies of oral cancer inhibition, prevention and regression have been substantiated by tissue culture studies, using animal and human derived oral cancer cell lines and normal epithelial cells. Mechanisms of the anticancer activity of the micronutrients on experimental oral cancer have been explored. They include stimulation of elements of the immune system to kill cancer cells, and enhanced expression of heat-shock proteins and repressor genes such as P 53.

The effectiveness of a mixture of beta-carotene, alpha-tocopherol, glutathione, and ascorbic acid for cancer prevention

Previous studies have shown that beta-carotene and alpha-tocopherol can act synergistically to inhibit the growth of experimentally induced oral cancer. The initial studies on the synergistic anticancer activity of antioxidants have been extended to include reduced glutathione and ascorbic acid. Sixty male hamsters (4-5 wks old) were divided into six equal groups. Groups 1-6 were treated with 7,12-dimethylbenz[a]anthracene (DMBA) (0.5% solution). Group 2 received a mixture containing equal amounts of beta-carotene, dl-alpha-tocopherol (vitamin E), glutathione, and l-ascorbic acid (vitamin C) (12.5 micrograms) delivered orally by pipette. Groups 3-6 were treated with beta-carotene alone (50 micrograms), vitamin E alone (50 micrograms), glutathione (50 micrograms) alone, and vitamin C alone (50 micrograms). Animals were euthanized at 12 and 14 weeks. Tumors were counted and measured, and tumor burden was calculated for each experimental group. The mixture of antioxidants significantly reduced tumor burden, whereas the beta-carotene, vitamin E, and reduced glutathione treatments also reduced tumor burden. beta-Carotene and glutathione provided greater levels of chemoprevention than vitamin E as single agents. In contrast, vitamin C treatment produced no antitumor effect but increased tumor burden by Week 14. This mixture of antioxidants produced a significant synergistic chemoprevention of oral cancer.

Peripheral blood leukocyte count and respiratory symptoms

The relationship of peripheral blood leukocyte count to respiratory symptoms was explored in data from the Second Annual National Health and Nutrition Survey (NHANES II). The study sample consisted of 9237 white and nonwhite US adults between the ages of 30 and 74 years. Three respiratory symptom outcomes were utilized: physician-diagnosed chronic cough and chronic bronchitis and self-reported frequent wheeze apart from colds or flu in the past 12 months. Peripheral blood leukocyte counts were performed using a Coulter counter, model FN. Logistic regression analysis was performed for each of the three respiratory symptom outcomes controlling for age, race, gender, and cigarette-years of smoke exposure. The peripheral blood leukocyte count was a significant predictor for each symptom. For a standard deviation increase in the log leukocyte count, the relative odds of wheezing was 1.93 (95% confidence level [CI], 1.47 to 2.52); for chronic cough, 2.29 (95% CI, 1.74 to 3.00); and for bronchitis, 2.44 (95% CI, 1.77 to 3.35). Analyses restricted to never smokers gave similar results. These data suggest that peripheral blood leukocyte count correlates with respiratory symptoms and are consistent with the hypothesis that the leukocyte count is a serum marker of inflammation.

Inhibition of oral carcinogenesis by glutathione

Forty young adult Syrian hamsters (Mesocricetus auratus) were divided into four groups of 10 animals each. In Group 1 (tumor control), the right buccal pouches were painted three times per week with a 0.5% solution of 7,12-dimethylbenz[a]anthracene (DMBA) in heavy mineral oil (USP) with a no. 4 sable brush. In Group 2 (experimental group), the right buccal pouches were painted with DMBA, as in Group 1. In addition, Group 2 received 1 mg of reduced glutathione in 0.5 ml of mineral oil three times per week on days alternate to the DMBA application. The glutathione was administered systemically by mouth with a pipette. Group 3 received only glutathione, and Group 4 was untreated (control groups). Animals were sacrificed after 14 weeks, and tumors were counted and measured. Both right and left pouches were photographed, excised, fixed in formalin, sectioned in paraffin, and studied histologically. The animals receiving glutathione demonstrated significantly fewer and smaller tumors. The mean tumor burden was 315 mm3 in the glutathione-treated group and 3,040 mm3 in the untreated group. The statistical significance by Student's t test was < or = 0.0001. Histological study also revealed significantly fewer areas of dysplastic leukoplakia in the group treated with glutathione. This study represents the first demonstration of the anticancer effect of systemically administered reduced glutathione.

Air pollution and daily mortality: associations with particulates and acid aerosols

The association between total daily mortality and air pollution was investigated for a 1-year period (September 1985 through August 1986) in St. Louis and in the counties in eastern Tennessee surrounding Kingston/Harriman. The purpose of this study was to evaluate the relative importance of various measures of particulate and gaseous air pollution as predictors of daily mortality. Concentrations of inhalable particles (PM10), fine particles (PM2.5), the elemental composition of these particles, and aerosols acidity were measured daily during the period of study. The effect of each air pollutant on daily mortality was estimated after controlling for meteorologic and seasonal influences. Total mortality in St. Louis was found to increase 16% (95% CI-1 to 33%) for each 100 micrograms/m3 increase in PM10, and by 17% (95% CI-12 to 57%) in eastern Tennessee. Positive but progressively weaker associations were found with PM2.5, sulfate, and aerosol acidity concentrations in both communities. Associations with gaseous pollutants--sulfur dioxide, nitrogen dioxide, and ozone--were all far from statistical significance. Because of the short monitoring period for daily particulate air pollution, the power of this study to detect associations was limited. Nevertheless, statistically significant associations with PM10 were found in St. Louis, and, more importantly, the estimated effects were consistent between the two communities studied and with other reported analyses of the effects of particles on daily mortality. These data suggest that the acidity of particles is not as important in associations with daily mortality as the mass concentrations of particles.

The short-term psychological health of alcoholic and non-alcoholic liver transplant recipients

In response to limited resources and overwhelming clinical need, we previously developed an approach to alcoholic patient selection for liver transplant based on factors reported to predict short- and long-term sobriety in prospective studies of alcoholics. The present study reports follow-up data comparing alcohol dependent (n = 22, DSM-3-R criteria) and non-dependent (n = 39) subjects followed from 6 months to 3 years post-transplant. Nine percent of the alcoholics had returned to symptomatic drinking with 14% reporting some exposure to ethyl alcohol. Nearly half (46%) of the non-alcoholic group reported occasional social alcohol use. The alcoholic patients were less likely to be in their first marriage and more likely to be asked about alcohol use at follow-up clinic visits. In most other respects the two groups resembled each other more often than they differed. The alcoholic group reported continued high rates of prognostic factors associated with long-term abstinence although the content of these shifted noticeably between pre- and postoperative assessment. Members of both groups reported high frequencies of medication side effects, of missed doses of medications, and of depressive symptoms. Most felt the transplant had improved their lives but had brought on significant financial burden. There were no differences in subjective appraisals of either psychological or physical health between the two groups. These follow-up data suggest that carefully selected alcohol dependent patients will do as well as non-dependent patients after liver transplant.

Growth hormone synergizes with serum growth factors in inducing c-fos transcription in 3T3-F442A cells

GH is a major regulator of growth and metabolism, but cellular effects of GH alone have been difficult to demonstrate. Accordingly, suggestions have arisen that GH works in conjunction with other agents in producing its characteristic long term biological effects. In 3T3-F442A cells, in addition to eliciting long term changes, GH rapidly increases the transcription of c-fos. The present study uses this rapid response to examine whether GH interacts with other factors early in its action, and whether such interactions lead to changes in gene expression. The induction of c-fos mRNA in response to the combination of GH (2.2 nM) and 10% calf serum or fetal calf serum was more than 3 times the additive effects of GH and either of the sera alone, indicating synergism between GH and serum. Insulin-like growth factor-I (IGF-I), which also induces c-fos, had an effect with GH that was greater than the additive responses to the two agents. Nuclear run-off experiments indicated that the synergism between GH and IGF-I occurred at the level of transcription of c-fos. However, synergism between GH and serum in inducing c-fos transcription was greater than synergism between GH and IGF-I, suggesting that factors in addition to IGF-I contribute to the interaction of GH with serum. Insulin and fibroblast growth factor also synergized with GH in inducing c-fos expression. Platelet-derived growth factor and epidermal growth factor appeared to induce c-fos additively with GH, suggesting that different types of interactions occur between GH and the various growth factors. In inducing c-jun, which works coordinately with c-fos in transcriptional regulation, the effect of GH was additive with that of IGF-I and synergistic with that of serum. These findings indicate that early in its action, GH interacts with other growth factors in inducing protooncogene expression in 3T3-F442A cells. Such interactions between GH and serum or specific growth factors result in synergistic induction of the expression of c-fos. These findings suggest a generalized mechanism in which a major contribution of GH to cellular growth regulation is to synergize with other growth-promoting signals early in transduction of such signals in targets cells, resulting in enhanced gene transcription.

Caffeine intake and asthma symptoms

Methylxanthines in the form of coffee and tea may be dietary factors that function as pharmacologic bronchodilators. To examine this hypothesis, we analyzed data from the Second National Health and Nutrition Examination Survey (NHANES II). NHANES II was conducted on a sample representative of the civilian noninstitutionalized US population, which included white and black adults aged 30 years or older. We examined the relationship of usual coffee and tea consumption from a medical history questionnaire to the presence of asthma and wheezing symptoms. Subjects who drank coffee on a regular basis had a 29% reduction in the odds of having current asthma symptoms (odds ratio, 0.71; 95% confidence interval, 0.55 to 0.93) when compared with non-coffee drinkers. The effect exhibited a significant dose-response relationship, with the number of cups of coffee consumed per day being inversely related to asthma prevalence. This relationship was independent of age, gender, and cigarette smoking. Tea consumption was not significantly related to asthma prevalence in this cohort.

Dihydropyrimidine calcium channel blockers. 4. Basic 3-substituted-4-aryl-1,4-dihydropyrimidine-5-carboxylic acid esters. Potent antihypertensive agents

We have examined a series of novel dihydropyrimidine calcium channel blockers that contain a basic group attached to either C5 or N3 of the heterocyclic ring. Structure-activity studies show that a 1-(phenylmethyl)-4-piperidinyl carbamate moiety at N3 and sulfur at C2 are optimal for vasorelaxant activity in vitro and impart potent and long-acting antihypertensive activity in vivo. One of these compounds (11) was identified as a lead, and the individual enantiomers 12a (R) and 12b (S) were synthesized. Two key steps of the synthesis were (1) the efficient separation of the diastereomeric ureido derivatives 29a/29b and (2) the high-yield transformation of 2-methoxy intermediates 30a/30b to the (p-methoxybenzyl)thio intermediates 31a/31b. Chirality was demonstrated to be a significant determinant of biological activity, with the dihydropyridine receptor recognizing the enamino ester moiety (12a) but not the carbamate moiety (12b). Dihydropyrimidine 12a is equipotent to nifedipine and amlodipine in vitro. In the spontaneously hypertensive rat, dihydropyrimidine 12a is both more potent and longer acting than nifedipine and compares most favorably with the long-acting dihydropyridine derivative amlodipine. Dihydropyrimidine 12a has the potential advantage of being a single enantiomer.

Holt-Oram syndrome in an elderly patient--a case history

The authors present a typical case of Holt-Oram syndrome in an eighty-year-old woman. The patient had atrial-septal defect and phocomelia but was independent in the activities of daily living.