[Cerebral blood flow and depression]

Regional cerebral blood flow is an index of cerebral metabolism. We have studied with the Xenon 113 inhalation method, regional cerebral blood flow (CBF) in patients with various types of depression and in remission. A left frontal hypervascularisation and a right posterior hypovascularisation have been found in primary major depression, but not in minor depression and bipolar depression in remission. These results confirm and complete results from other authors who have studied the physiopathology of depression with other technics.

Comparison of two therapeutic regimens using the same topical corticoid for stable psoriasis

In a masked, randomized, concurrently controlled clinical trial we compared the therapeutic response of two regimens in which the same topical corticoid was used to treat 52 men who had stable psoriasis. One regimen, called reduced dose, consisted of once-a-day application of a representative potent fluorinated topical steroid ointment, fluocinonide (Lidex), combined with three-times-a-day application of its vehicle. The other regimen, called traditional dose, consisted of four-times-a-day topical application of the same steroid. Patients were assigned to one of the two regimens and observed for six weeks. Confidence intervals for the difference in true mean response under these two regimens provide good evidence that for these patients the traditional dose was not clinically superior to the reduced dose.

Regional cerebral blood flow and lateralized hemispheric dysfunction in depression

Cerebral blood flow is known as an indicator of cerebral metabolism. Using the 133Xenon inhalation method, we studied the regional cerebral blood flow (r-CBF) in patients with different subtypes of depression and in remission. A left frontal hypervascularization and a right posterior hypovascularization were found in major depressives, compared to normal subjects, minor depressives, and normothymic bipolar patients. These results tend to confirm the existence of cerebral dysfunction in both hemispheres in major depression, as reported by other authors using different techniques.

[Dexamethasone suppression test and suicide]

Suicidal behavior may be related to perturbations of the hypothalamo-pituitary axis. We administered the DST to 51 patients admitted for suicide attempt on admission day. No correlation is found between DST result and type of suicide attempt. The DST's diagnostic predictive value was absent for our population. Neither alcoholism, nor repeat of suicide attempt, nor suicidal behavior rating scales were correlated with DST results. Drug interference effects and the "stress" factor may explain our DST results on a population of suicide attemptors.

The dexamethasone suppression test in affective disorder: relationship to clinical and genetic subgroups

Plasma cortisol suppression after dexamethasone administration in 113 consecutively hospitalized patients (54 patients with primary depression, 41 with secondary depression and 18 non-depressed controls) showed early morning hypersecretion of cortisol and cortisol non-suppression after dexamethasone mainly in patients with primary depression. The sensitivity of the dexamethasone suppression test was 79 per cent in unipolar and bipolar primary depressed patients, specificity 79 per cent and diagnostic confidence of a positive test 82 per cent. Non-suppression to dexamethasone was observed in 81 per cent of patients with psychotic depression but only 37 per cent of those with nonpsychotic depression. Age, sex and severity of depression, menopausal status, or benzodiazepines did not influence results. There was no association between cortisol non-suppression and any genetic subgroup of affective disorder.

[Compatibility between AMDP scales and "Research Diagnostic Criteria" (RDC) for the diagnosis of endogenous depression]

Research Diagnostic Criteria represent the most widely used system in research in biological psychiatry to select homogenous samples of patients with a defined psychiatric illness. The AMDP system represents the most complete system for documentation and quantification of psychopathology. On the conceptual point of view, it seems possible to use AMDP psychopathological and somatical scales to select patients who meet criteria of "major depressive disorder" of RDC. In fact, equivalents exist for most of the criteria. For an optimal correspondence, only two psychopathological reserve items--in place of little useful items--and two somatical reserve items could easily be included. A preliminary study has enabled to control the sense of this methodology. A more complete study that verifies the compatibility of both approaches and the ability to automatically select endogenous depressives from AMDP scales is ongoing.

[The necessity for standardized diagnosis in research in biological psychiatry. Attempted integration of "Research Diagnostic Criteria" into the AMDP system]

Standardization of diagnosis is an essential preliminary in the clinical research in biological psychiatry. Between the different systems of nosographical selection, Research Diagnostic Criteria (RDC) are the most internationally diffused. After having recalled the spirit of RDC, we have looked for seven major illnesses (major and minor depressive disorders, endogenomorphic major depressive disorder, schizophrenia, manic disorder, panic disorder and generalized anxiety disorder) equivalents of RDC criteria in psychopathological and somatical items of AMDP system. With a minimum of modifications (adjonction of some reserve items for each illness), AMDP scales could become compatible. The verification of this theorical equivalence secondly makes it a duty to use jointly RDC and AMDP scales and to analyse both of them separately. After this methodological control, patients who meet RDC criteria could be automatically selected from AMDP scales.

[The dexamethasone suppression test in affective disorders. A review]

The Dexamethasone Suppression Test (DST) is a new tool to help in the diagnosis of depression. The authors present the clinical methodology for in- and out-patients and review the current literature on the DST. Some show a correlation between cortisol non-suppression after dexamethasone and the diagnosis of endogenous or primary depression. The authors illustrate the interest of the DST by providing there personal experience of this test. The influence of clinical state, severity of depression and other variables, such as age, sex, menopause and family history, are reviewed in reference to the neuro-transmitters control of the DST.

Plasma and urinary cortisol levels after dexamethasone in affective disorders

The validity of the dexamethasone suppression test was evaluated for the differential diagnosis of primary and secondary depressions. Forty hospitalized psychiatric patients (14 primary depressed, 15 secondary depressed and 11 non-depressed controls) were studied. The Research Diagnostic Criteria of Spitzer et al. (1978) were used to classify these patients. Eight out of the 14 primary depressed patients had an abnormally high plasma cortisol at 4 p.m. after dexamethasone. Only 2 out of the 15 secondary depressed patients and none of the 11 controls had an abnormal response to dexamethasone. Based on these results, the dexamethasone suppression test has a sensitivity of 57%, a specificity of 87% and a predictive value of 80%. The determination of urinary free cortisol excretion does not improve the performance of the test.

Absence of anemia in maintenance hemodialysis

Anemia is usual in untreated uremia. Persistent anemia is thought to be universal in uremic patients treated by maintenance hemodialysis (MH). A retrospective chart analysis of 549 patients on (MH) at five facilities in Brooklyn, found that eleven (2%) of these patients had a hematocrit (Hct) in the normal range (40%). To distinguish this subset of patients from the majority of MH, we compared both groups for: (1) etiology of the renal disease, (2) presence of residual renal function, (3) dialysis prescription, (4) decreased arterial O2 saturation, (5) greater use of vitamins or anabolic steroids, (6) absence of parathyroid disease. The relatively high hematocrit was not explained by any factor evaluated in this small subset of MH patients.

[Comparative statistics of cancers in Sahara (author's transl)]

Statistics of 204 cases of cancer observed in Saharian populations from 1969 to 1976 and a comparison with studies previously made in this area and statistics from other countries. Skin cancer have a special frequence which may be related to climatic and atmospheric environment.

A problem-oriented approach to medical information systems: an application in a primary care group practice

A relatively simple computer-based information system developed for a primary care group practice at the San Francisco Veterans Administration Hospital contributes to the management of the practice, to improvement of medical care for patients within the group, and to research studies on resource utilization in the management of chronic diseases and the evaluation of care of chronically ill patients. Preliminary results from the use of the information system are encouraging and demonstrate that much may be achieved by information systems that do not attempt to computerize the entire medical record.

A physician extender training program based on clinical algorithms

The ability of physician extenders to provide patient care in a variety of settings has been reported widely. Less attention has been paid to training programs, especially those of short duration, for physician extenders. A three-month training program for physician extenders at a large teaching hospital was based on teaching the skills needed to run 39 clinical algorithms. The course content and the methods used to test the students during the three months may prove of value to those preparing similar programs.

[A rare case of cavernous haemangioma of the bladder (author's transl)]

The authors report a case of haemangioma of the bladder treated by partial cystectomy in a young man aged 17 years and review the world literature. Less than 70 cases have been published up to the present time. In 30 per cent of cases, the presence of signs of vascular dysplasia of the limbs is also noted.