The effects of swabbing the skin on apparent blood ethanol concentration

The swabbing of the arm with ethanol before venepuncture significantly raised the apparent blood ethanol concentration, when compared to the unswabbed arm. In contrast, when isopropanol was substituted for ethanol in these studies, no change in the blood ethanol concentration was determined.

Dietary intake and clinical, anthropometric and biochemical indices of malnutrition in elderly demented patients and non-demented subjects

Anthropometric and biochemical indices of nutritional status and weighed dietary intake have been studied in hospitalized patients with senile dementia, demented patients living in the community and age-matched control subjects who were not cognitively impaired. Demented patients were lighter than control subjects, and had a lower body mass index, skinfold thickness, mid-arm circumference and arm muscle bulk. The hospitalized patients were more seriously affected than those living in the community, and body weight was significantly negatively correlated with duration of hospitalization. Over a 6-month period the hospitalized patients showed a further weight loss, while those living in the community did not. Both groups of demented patients had higher intakes of energy, protein, vitamins and minerals than the control subjects. The diet of the hospitalized patients was slightly, but not significantly, superior to that of the patients living in the community. Biochemical evidence of specific vitamin inadequacy was equally prevalent in all three groups of subjects, and there were no significant correlations between the degree of cognitive impairment or behavioural disorder and any of the indices of nutritional state. Clinical signs suggestive of malnutrition were not correlated with either biochemical evidence of deficiency or cognitive impairment and behavioural disturbance.

The activation of red blood cell transketolase in groups of patients especially at risk from thiamin deficiency

Erythrocyte transketolase activation by thiamin diphosphate has been studied in elderly patients with moderate or severe chronic dementia, acute alcoholic admissions and chronic alcoholics with evidence of brain damage, mostly of the Wernicke-Korsakoff type. Significantly more patients in each group than controls showed abnormal activation of transketolase, not only by 0.3 mM thiamin diphosphate (TDP) but also in further activation by increase to 3 mM. This indicated the presence in a proportion of the alcoholic and the demented patients of an abnormal enzyme variant, similar to that previously found in vitro. The modified transketolase activation test may warn not only of marginal thiamin deficiency but also independently, of susceptibility to brain damage in patients at risk.

Adaptation of coenzyme stimulation assays for the nutritional assessment of vitamins B1, B2 and B6 using the Cobas Bio centrifugal analyser

Adaptation of coenzyme stimulation assays for the nutritional assessment of thiamine, riboflavin and pyridoxine on the Cobas Bio centrifugal analyser are described. Whole blood was collected into acid-citrate dextrose, which preserves the erythrocytes, prior to assay for several days. Washed erythrocytes stored at -70 degrees C and subsequently thawed, showed altered enzyme activities. The methods offer improved precision over existing procedures and take advantage of the high throughput capabilities of the instrumentation.

Exchange transfusion and quinine concentrations in falciparum malaria

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The effect of lithium on choline transport in human erythrocytes

Erythrocytes from lithium treated patients were separated according to the time they had been circulating in the plasma. Choline transport and choline content were measured in the erythrocyte fractions separated according to age, in order to investigate the relationship between decreased choline transport and increased choline content seen in lithium treated patients. The most recently formed erythrocytes of normal subjects had the greatest choline content and the most active choline carrier. The erythrocytes of lithium treated patients had reduced choline carrier activity and increased choline content in all age bands. However the greatest accumulation of choline and least inhibited choline carrier activity was seen in the most recently formed cells. The alteration in phospholipid concentrations measured could not of themselves account for elevated erythrocyte choline levels seen in lithium treated patients. It is concluded that the increase in choline content levels in lithiated erythrocytes does not have a simple inverse relationship with the deficiency in choline transport. The inhibition of the choline carrier is caused by modification due to circulation in lithiated plasma rather than a lack of its synthesis in reticulocytes.

Headaches after childbirth

71 women were examined daily for the presence of headache in their first post partum week. Post natal headache (PNH) occurred in 27, (39%) of the women and was most frequent on days 4-6 post partum. PNH was significantly associated with a previous or family history of migraine and pre-menstrual migraine. Although 83% of those with PNH had a migraine diathesis, they did not describe their headache as one of their usual migraines as it was considerably milder. Headaches were more frequent among multigravida but as rather more multigravida had a previous migraine diathesis this may reflect a sampling bias. PNH subjects had significantly more tension and depression suggesting that at least some PNH may be tension headache. Around 3 or 4 days post partum, women began to lose weight and the onset of headache often coincided with the start of this weight loss. 12 women with, and 12 without PNH took part in a metabolic study, and collected sequential 24 h urine samples from days 2-7 post partum. Potassium and oestrogen excretion were increased on day 3, and progesterone on days 3, 4 and 5. Differences in the excretion pattern of these hormones might reflect small changes in renal function and further work measuring plasma hormone levels could help to clarify this. PNH, like pre-menstrual headache and pill withdrawal headache may represent a further example of the triggering effect that a fall in sex hormone level has on the migraine diathesis.

Premorbid social competence and the revolving door phenomenon in psychiatric hospitalization

The relation between premorbid social competence and length of initial hospitalization was examined in 381 male state hospital patients in four diagnostic categories: schizophrenic, affective reaction, psychoneurotic, and personality disorder. A significant relation was discovered between diagnosis and outcome, with schizophrenic patients having the longest and personality disorder patients the shortest lengths of initial hospitalization. Premorbid social competence was related to outcome, as assessed both by length of initial hospitalization, and by whether the patient was rehospitalized. These two outcome measures were found to be positively related, thus supporting the developmental formulation that premorbid social competence is indicative generally of prognosis. The findings were employed to generate the inference that patients at differing levels of premorbid social competence require different treatment modalities.

A psychofeedback approach to schizophrenia

Annitto (1981) has criticized my work on the nature of hallucinations (March 1979). One of his points--the need to take the patient's affective state into account--is valid. His other criticisms--that I propose to use my outline of hallucination types for diagnostic purposes and that I have blamed the patient--are serious misconstructions of my work. A number of psychological techniques used for alleviating hallucinations in an acute schizophrenic patient are described. A psychofeedback approach, based on the biofeedback model used in psychosomatic medicine, is proposed as a modifying treatment for some schizophrenic patients.

Inter-relationships among hospitalization measures of psychiatric outcome

In a diagnostically heterogeneous sample of 381 first admission male state hospital patients, no consistent correlations appeared among three commonly employed hospitalization measures of outcome. The possibility that psychiatric hospitalization may be a multidimensional criterion is considered and the implications for outcome research are discussed.

Premorbid social competence and outcome among schizophrenic and nonschizophrenic patients

The relation between premorbid social competence and outcome was examined with 381 male state hospital patients in four diagnostic categories: schizophrenia, affective reaction, psychoneurotic disorder, and personality disorder. Outcome was assessed using the measures of length of initial hospitalization, total length of rehospitalization, and number of readmissions. The follow-up period was 3 years after discharge from the first hospitalization. On all outcome measures, higher social competence was significantly related to favorable outcome. The four diagnostic groups differed significantly in social competence level, but no evidence was found to indicate that the social competence-outcome relation was influenced by diagnosis. Results were interpreted as consistent with a developmental formulation and as indicating that the relation between premorbid social competence and outcome is not unique to schizophrenia but obtains over a broad range of diagnoses.

Visual hallucinations during hallucinogenic experience and schizophrenia

The visual hallucinations experienced by a 26-year-old woman under the influence of hallucinogens and during schizophrenia are described. Three types of hallucinations are delineated: (1) superimposed hallucinations, (2) spatial and depth distortions, and (3) animations. These three types of hallucinations appear to represent consecutive gradations on a continuum of the ego function of reality testing, with superimposed hallucinations revealing the least and animations the greatest degree of disorientation. The findings of the present study indicate the need for a research design that compares the hallucinations of schizophrenics to the toxic hallucinations of nonschizophrenics.

Intravenous fat tolerance. Correlation with very low density lipoprotein apoprotein B kinetics in man

The intravenous fat tolerance test (IVFTT) has been introduced as a measure of the fractional catabolic rate of the endogenous triglyceride of plasma. To assess the validity of this test we have compared this test in 21 normal and hyperlipidaemic subjects with direct measurement of the fractional catabolic rate of autologous radio-iodinated VLDL. There was a strong positive correlation between the rate constant K2 of the IVFTT and the fractional catabolic rate of VLDL-apolipoprotein B (r=+0.87). The two rates were considerably different in magnitude. The IVFTT appears to be a valid index of the fractional catabolic rate of VLDL. Its limitations and uses are discussed.

A quenched-flow study of the reaction catalysed by creatine kinase

The reaction catalysed by creatine kinase was studied in both directions by quenched-flow techniques to follow the initial product formation in the millisecond range. In both directions the amount of product formed increases linearly with time, and the turnover number corresponds to the steady-state value. Extrapolation to zero time indicates the absence of either a large transient phase or a large lag phase in both directions. This indicates that the actual chemical reaction is rate-limiting, and that all possible isomerizations before or after the chemical step must be much more rapid.

Cholesterol turnover, synthesis, and retention in hypercholesterolemic growing swine

Studies of the interaction of cholesterol absorption, excretion, synthesis, and retention were carried out with growing swine through the application of sterol and isotopic balance procedures to a non-steady state situation. The animals were fed either a low-fat commercial mash diet (MA), a commercial mash diet plus 2.4 g/day of crystalline cholesterol (MAC), or a high-fat milk diet containing 2.4 g/day cholesterol (MKC). [(14)C]Cholesterol and beta-[(3)H]sitosterol were used to measure fecal neutral steroid losses. Final plasma cholesterol levels averaged 91, 85, and 195 mg/100 ml for MA, MAC, and MKC animals, respectively. Total carcass dissection followed by cholesterol measurement revealed that accumulation of cholesterol in most body tissues was directly related to increase in body size in the rapidly growing swine. The only notable exceptions were plasma, liver, and bone with marrow of the MKC group, where cholesterol concentrations were significantly elevated. Absorption of cholesterol was significantly greater in animals fed MKC than MAC-fed swine (726 mg/day vs. 142 mg/day), whereas synthesis of cholesterol was significantly greater in MAC animals than in MKC animals (863 mg/day vs. 112 mg/day). Excretion of neutral and acid steroids into the intestine was not significantly different between MAC and MKC groups, but both classes of steroids were more efficiently reabsorbed in MKC animals. The overall differences between swine fed mash-cholesterol and those fed milk-cholesterol diets appear to result from more efficient absorption of both neutral and acid steroids in the milk-cholesterol group only partially compensated for by decreased cholesterol synthesis.