Contribution of alcohol abuse to cerebellar volume deficits in men with schizophrenia

BACKGROUND

It is controversial whether cerebellar tissue volume deficits occur in schizophrenia and, if so, what regions and tissue types are affected. Complicating such investigations is the high incidence of alcoholism comorbidity in patients with schizophrenia that itself can contribute to cerebellar abnormalities.

METHOD

We studied 61 healthy men (control subjects), 25 men with alcoholism, 27 men with schizophrenia, and 19 men comorbid for schizophrenia and alcoholism with the use of magnetic resonance imaging. Cerebellar structures were outlined manually, tissue classification was determined statistically, and regional volumes were corrected for normal variation in head size and age.

RESULTS

Patients with schizophrenia alone had enlarged fourth ventricles (1.5 SD relative to controls) but showed no cerebellar tissue volume deficits. The alcoholic group had gray and white matter vermian deficits (-0.5 SD), most prominent in anterior superior lobules, and gray matter hemisphere deficits (-0.8 SD), but not fourth ventricle enlargement. The comorbid group had cerebellar hemisphere (-1.3 SD) and vermian gray matter volume deficits (-0.7 SD) and fourth ventricular enlargement (1.6 SD); these abnormalities were greater than in either single-diagnosis group, despite significantly lower levels of alcohol consumption compared with the alcoholic group. Gray matter volume in the anterior superior vermis correlated with lifetime alcohol consumption in the schizophrenic and comorbid groups when combined.

CONCLUSIONS

Cerebellar tissue volume deficits were detected in schizophrenia only when accompanied by alcoholism. By contrast, fourth ventricular enlargement occurred in schizophrenia even without alcoholism, although it was exacerbated by alcoholism. These findings support a model of cerebellar supersensitivity to alcohol-related tissue volume deficits in schizophrenia.

Cerebellar volume decline in normal aging, alcoholism, and Korsakoff's syndrome: relation to ataxia

The authors used magnetic resonance imaging to measure gray and white matter volumes in cerebellar hemispheres and 4 vermian regions in 61 normal control (NC) men aged 23-72 years, 25 men with uncomplicated alcoholism (ALC), and 8 men and 1 woman with alcoholic Korsakoff s syndrome (KS). NC and ALC took quantitative gait and balance tests. Gray but not white matter volume declined with normal age in both hemispheres and anterior-superior vermis. ALC had gray but not white matter cerebellar hemisphere volume deficits, whereas KS had deficits in both tissue types. ALC and KS had gray and white matter volume deficits in anterior superior but not posterior inferior vermis. ALC had a 1 SD ataxia deficit, significantly and selectively correlated with white matter volume in anterior superior vermis. Regional distribution but not severity of cerebellar volume deficits is similar in alcoholic individuals whether or not complicated by KS and relates to ataxia.

In vivo mammillary body volume deficits in amnesic and nonamnesic alcoholics

BACKGROUND

Neuropathological studies use the presence of mammillary body (MB) pathology as a cardinal, diagnostic feature of Wernicke's encephalopathy (WE) in neuropsychiatric diseases, most notably alcoholism. Although Korsakoffs Syndrome (KS), which is marked behaviorally by dense global amnesia, is a typical sequela of WE, it remains controversial whether these two conditions necessarily co-occur and whether MB pathology is therefore a diagnostic requisite for KS.

METHODS

We investigated these issues by examining, in vivo, 24 nonamnesic alcoholics (ALC), 5 amnesic alcoholics (KS), and 51 normal controls with three-dimensional MRI and memory testing. MB volume was determined from successive, 1 mm thick slices.

RESULTS

The ALC group had significantly smaller MB volumes bilaterally (mean = 54.5 +/- 22.0 mm3) than controls (mean = 66.3 +/- 17.1 mm3), and the KS group had even smaller MB volumes than the ALC group (mean = 20.7 +/- 14.8 mm3). Only 2 ALC patients met historical clinical criteria for past WE, and their MB volumes were well within range of the remaining 22 ALC patients. Although all five KS patients met historical clinical criteria for WE, three KS did not have accompanying dementia and had the same degree of MB volume loss as the ALC; the remaining two KS had accompanying dementia and MB volumes half the volume of the ALC group and of KS patients without dementia.

CONCLUSIONS

These findings provide volumetric in vivo evidence that: (1) MB volume deficits do occur in alcoholics without amnesia, although these deficits are not present in ail such alcoholics; (2) greater MB volume deficits are present in alcoholics with clinically detectable amnesia or dementia; (3) MB shrinkage is related to severity of cognitive and memory dysfunction, which suggests a continuum of MB pathology in chronic alcoholism to KS; and (4) the presence of WE in all of the KS patients and in the two ALC patients with the greatest long-term declarative memory deficit supports the possibility of an additional and unique pathology distinguishing nonamnesic and amnesic alcoholism.

Impact of fluorodeoxyglucose positron emission tomography on the clinical management of patients with glioma

The past decade has seen the identification of many clinical settings in the treatment of primary brain tumors in which information from fluorodeoxyglucose positron emission tomography (FDG-PET) might be useful, if not essential, to therapeutic formulation. FDG-PET is currently used at referral centers in the management of primary brain tumors. The clinical pattern of FDG-PET use was assessed and its value compared to other information sources in clinical decision making. The clinical records of 75 glioma patients who were evaluated by FDG-PET were reviewed. The range of circumstances in which FDG-PET was employed included: pretherapeutic baseline studies for monitoring the effect of a therapy (1% of all cases), mapping of hypermetabolic regions before surgery or biopsy (2%), mapping of hypermetabolic regions before radiotherapy (2%), postsurgical evaluation for residual tumor (2%), assessment of the malignancy of a mass as a substitute for biopsy (11%), and distinguishing between radiation necrosis and recurrent tumor (87%). Other sources of information that contributed to the therapeutic management of patients included: gadolinium-enhanced MRI, contrast-CT, and clinical findings.

Management of thyroid carcinoma with radioactive 131I

PURPOSE

To evaluate the role of radioactive 131I in the management of patients with well differentiated carcinoma of the thyroid.

METHODS AND MATERIALS

Between 1965 and 1995, a total of 117 patients with well-differentiated carcinoma of the thyroid underwent either lobectomy or thyroidectomy followed by 100-150 mCi of 131I.

RESULTS

With a median follow-up of 8 years, only four patients (3%) developed a recurrence of their disease. The 5-year actuarial survival was 97% with a 10-year survival of 91%. There were no severe side effects noted after 131I therapy.

CONCLUSIONS

Radioactive 131I is a safe and effective procedure for the majority of patients with well-differentiated thyroid carcinoma. We currently recommend that all patients undergo a subtotal or total thyroidectomy followed by 131I thyroid scanning approximately 4 weeks after surgery. If the thyroid scan shows no residual uptake and all disease is confined to the thyroid, we recommend following patients with annual thyroid scans and serum thyroglobulin levels. If there is any residual uptake detected in the neck or if the tumor extends beyond the thyroid, we recommend routine thyroid ablation of 100-150 mCi of radioactive 131I.

The "revolution" in outpatient care

Although the concept of outpatient care is not a new one, the growth in ambulatory facilities has revolutionized medical care in the United States. The growth in ambulatory surgery centers, imaging centers, and cancer centers in Florida is explored in detail. With the many changes forthcoming in health care, ambulatory care will play an increasing role in delivering good health care at a reasonable cost.

Management of pterygium with surgery and radiation therapy. The North Florida Pterygium Study Group

PURPOSE

To compare our results in the management of pterygium using a higher total dose with other reported results.

METHODS AND MATERIALS

Between 1971 and 1991, 690 patients were treated with complete surgical excision followed by beta irradiation for primary or recurrent pterygium. Of these patients, 129 had two or more areas involving both eyes for a total of 825 lesions treated. Only 17 patients (2%) had temporal lesions with the rest of the patients having nasal pterygia. All patients underwent complete surgical resection of the pterygium before undergoing radiation therapy. One hundred forty-nine patients had undergone previous surgical resection alone but developed recurrence. After surgical excision, all patients were treated with Strontium-90 applicators starting immediately within 24 hr of surgery. Our standard policy was six weekly applications, each delivering a surface dose of 1000 cGy. The total dose delivered was 6000 cGy. Minimum follow-up was 1 year with a median of greater than 8 years.

RESULTS

There were only fourteen recurrences (1.7%) out of a total of 825 lesions treated. Nine of the fourteen patients received suboptimal therapy undergoing less than five applications of Strontium-90. There were no major complications.

CONCLUSION

The combination of surgical excision followed by adequate Strontium-90 applications is highly effective in the management of pterygium. The optimal total dose appears to be in the range of 2000 cGy to 6000 cGy.

Effect of a trypsin inhibitor from soybeans (Bowman-Birk) on the secretory activity of the human pancreas

This study was undertaken to clarify the issue of whether feedback regulation of pancreatic enzyme secretion occurs in humans. A naturally occurring inhibitor of trypsin and chymotrypsin, the Bowman-Birk inhibitor of soybeans, was used to reduce the activities of these enzymes normally secreted by the pancreas into the duodenum. Pure pancreatic juice was collected by endoscopic retrograde cannulation of the pancreatic duct in a protocol consisting of three periods: period 1 (15 min), collections of juice without return to the duodenum ("washout phase"); period 2 (35 min), intraduodenal infusion of juice to which buffered saline or heat-inactivated Bowman-Birk inhibitor had been added; and period 3 (55 min), intraduodenal infusion of juice in which greater than 90% of the trypsin and chymotrypsin activities had been abolished by treatment with the active inhibitor. Control experiments were included in which untreated juice was infused in period 3 as well as period 2. Enzyme analyses (trypsin, chymotrypsin, elastase, and amylase) of samples of juice collected at 5-min intervals revealed a twofold to threefold increase in the output and concentration of all four enzymes in period 3 compared with period 2. These results thus confirm the existence of feedback control in humans.

Lorazepam in the treatment of refractory neonatal seizures. A pilot study

Seven neonatal patients with severe seizures unresponsive to conventional anticonvulsant therapy were treated with lorazepam. Immediate cessation of seizure activity occurred in all patients within five minutes. Although seizures recurred in two infants eight hours later, frequency and severity diminished. There were no apparent significant side effects attributed to the medication.

Massive post-transplant proteinuria. Biopsy proven nil disease

A case of massive proteinuria following an A-match living donor transplantation is described. All attempts to define the cause of the proteinuria failed. The proteinuria resolved while the patient was on triple-drug therapy. Presently, the patient remains well with minimal proteinuria and excellent renal function.

The subcutaneous implantation of xenogeneic decalcified teeth

Decalcified matrices obtained from bone and dentin have been used in xenogeneic implantation experiments. It is observed that such implants generally do not induce new bone but in many cases result in recalcification of old matrices. Treatment of the matrices with the enzyme inhibitor, iodoacetic acid, prior to implantation also did not enhance or improve the osteoinductive potentiality of these matrices. It is therefore suggested that the bone morphogenetic protein (BMP) to which the osteoinductive potentiality has been attributed by Urist et al. is a highly species-specific moiety and that the xenogeneic implant is hence a poor choice for its determination.

The use of a thermoelectric osmometer to measure the osmotic coefficients of aqueous solutions of sodium salicylate at 25 degrees

The use of a thermoelectric osmometer to measure osmotic coefficients for the binary system water-sodium salicylate at low concentrations (0·0 to 0·3 molal) is described. The accuracy and reproducibility of the instrument have been enhanced by employing a microscope to measure sample and reference drop sizes. Activity coefficients, calculated from the osmotic coefficients obtained in these experiments, have been combined with density and diffusional measurements to calculate frictional coefficients for the system.

Isothermal diffusion measurement on the system water-sodium salicylate-sodium chloride at 25 degrees at one composition

The main and cross-term diffusion coefficients for the system water-sodium-salicylate-sodium chloride have been measured at the compositon 0·05 g cc−1, and the results indicate that sodium chloride is effective in producing a flow of sodium salicylate at this concentration. Density, refractive index, partial specific volumes and gravitational data are also reported. The system has been assumed to be 3-component.