Opportunities on the Internet for child and adolescent psychopharmacologists: net access and mailing lists

The Internet, a system linking computers around the world, provides clinical and research psychopharmacologists with a convenient and efficient way to exchange information and offers a growing number of services to facilitate patient care. These opportunities are not theoretical, not in the future, and not for a select few. Many patients are already benefitting from practitioners who have sought guidance for their clinical work on the Internet. This article describes, for the novice user, how to begin the Internet journey. It also discusses psychopharmacology-related mailing lists, including a site that specializes in child and adolescent psychopharmacology. Subsequent articles will (1) show how to use Medlines to conduct literature searches and retrieve abstracts and articles from the computer screen, (2) describe ways to enter and traverse the World Wide Web (the "multimedia" portion of Internet), and (3) survey the use of "Web browsers" to find specialized psychopharmacology resources and databases, electronic journals, pertinent bulletin boards, and support services for patients and families-all with an emphasis on direct benefits to the practicing psychopharmacologist.

Temperature regulation as possible prognostic indicator in patients with acute intracranial lesions

24 patients, 16 after severe head injury and 8 after spontaneous intracranial haematoma, were investigated by external cold load in order to determine their thermoregulatory capabilities. Tympanic temperature, several skin temperatures and oxygen consumption were measured. The patients where examined for SSEP and AEP. The cold induced thermoregulatory threshold temperature was determined by calculating the mean body temperature and by determining mean body temperature at which oxygen consumption increased due to the external cold load. In all patients core temperature and mean body temperature were significantly elevated by 1 degree C compared to controls. There was no difference of the course of the various body temperatures during cold load in the patient groups. In the trauma group 8 patients were able to increase oxygen use (VO2) during cold exposure, the other 8 patients showed no physiological thermoregulatory reaction. The heatproduction threshold temperature was increased by 1 degree C in the patient groups compared to controls. There was no significant correlation of AEP and SSEP findings to a preserved or disturbed thermoregulatory reaction. In the trauma patients, who were able to respond to a cold load, the outcome was significantly better (GOS = 3-5), than in those patients, who did not show a physiological increase of VO2 due to the cold load (GOS = 1-2). In conclusion, measurement of body temperatures alone is not sufficient to determine termoregulatory capacities. An examination using thermophysiological methods however provides more information about the function and structure damaged after severe head injury. An intact thermoregulatory systems seems to be correlated with a better prognosis after head injury.

Comparison of thermoregulatory characteristics of patients with intra- and suprasellar pituitary adenomas

Thermoregulatory capabilities under physiologic cold and heat exposure of 37 patients with suprasellar pituitary adenomas (As) and 10 patients with intrasellar adenomas (Ai) were analyzed and compared to each other and to 13 controls (Ctr.) In Ai no shift of the thermoregulatory threshold temperatures was observed. In As the regulation was shifted to a 0.5 degrees C higher mean body temperature in 82% of the patients, indicating a "set-point" elevation. The accuracy of the regulation against thermal loads was maintained, the velocity was reduced. Postoperative examination of As revealed a normalisation of the "set-point". Modifications of the hypothalamic amine systems by the compressive effect of the suprasellar adenomas are discussed to be the most probable cause for the observed thermoregulatory alterations.

Development of resistance by Enterobacter cloacae during therapy of pulmonary infections in intensive care patients

The emergence of resistance during therapy and the efficacy of different antibiotic therapy regimens were studied in 38 intensive care patients suffering from pulmonary infections caused by Enterobacter cloacae. Every three days a fresh isolate was obtained from each patient and tested in vitro for susceptibility to 16 antibiotics by determination of the minimal inhibitory concentrations. During therapy with cefotaxime and tobramycin the E. cloacae strains from 47% of the patients became resistant to cefotaxime within 6 days. In all cases resistance encompassed all other broad-spectrum penicillins and cephalosporins tested, as well as aztreonam. Development of resistance regularly led to persistence of bacteria. Resistance to tobramycin, ciprofloxacin or imipenem was not observed. Treatment of 25 patients with persisting E. cloacae infections was successful in 17 out of 18 patients treated with imipenem and in 6 out of 7 patients receiving ciprofloxacin.

[Anesthesia in familial hyperkalemic periodic paralysis]

A 53-year-old woman was scheduled for elective surgery of a L4-L5 lumbar disc prolapse. Preoperatively, she reported of a hereditary muscle disease in her family which could be identified as familial hyperkalaemic periodic paralysis. In patients with familial periodic paralysis, only limited information is available in the current anaesthesiological literature. This is especially true of the hyperkalaemic form which was separated from the hypokalaemic form in 1957. Most patients suffering from periodic paralysis will develop myotonic symptoms in time, but evidence is lacking that the incidence of malignant hyperthermia (MH) is higher than in normals. However, abnormalities of the electrocardiogram (ECG) due to changes in the potassium serum levels are not unusual, and the anaesthesiologist must be aware of cardiac arrhythmias. In the present case, the patient was anaesthetized using fentanyl, midazolam, and vecuronium, and ventilated with 66% nitrous oxide in oxygen. Radial artery blood pressure, end-tidal CO2, and nasopharyngeal temperature were monitored continuously. Surgery was completed after 2 hours with no abnormalities in the intraoperative course. Recovery from anaesthesia was uneventful. During the postoperative follow-up for 1 week, further attacks of paralysis, intermittent sodium-potassium imbalance of the muscle cell membrane appears to be the primary pathogenetic factor. In this special disease, prevention of carbohydrate depletion and the avoidance of muscle relaxants are recommended in the anaesthesiological literature. However, a specified regimen of general anaesthesia has not yet been outlined. In our special case, the use of anaesthetics deemed to be safe in MH susceptible patients produced an uneventful perioperative course.(ABSTRACT TRUNCATED AT 250 WORDS)

Modifications of thermoregulation in patients with suprasellar pituitary adenomas

Thermoregulation was investigated pre and postoperatively in 5 and only preoperatively in 7 patients with suprasellar pituitary adenomas by exposing them to external cold and heat in a climatic chamber. Five healthy subjects served as controls. Body core and skin temperatures, oxygen consumption, electromyographic activity, skin blood flow and local sweating rates were continuously measured. Threshold temperatures for activation of heat production and heat loss were calculated from these data. Hormone analysis was performed before and after stimulation with releasing factors. In the patients, core temperatures as well as threshold temperatures for heat production and heat loss were elevated by about 0.5 degrees C as compared with controls. This elevation of core and threshold temperatures was achieved, despite a reduced resting metabolic rate, by a reduction of skin blood flow indicated by a low mean skin temperature. After successful operation the thermoregulatory alterations normalized. Serum levels of growth hormone were reduced preoperatively and stimulation by GHRF did not cause an appropriate increase. Prolactin was elevated in 6 patients with prolactinomas, but there was no correlation with changes in thermoregulatory threshold temperatures. Stimulation of the other hypophyseal hormones by the combined anterior pituitary function test revealed a normal hormonal response. Apart from prolactin there were no significant hormonal changes postoperatively. It is concluded that disturbances of temperature regulation are present in patients with suprasellar adenomas, but that they are not detectable by routine clinical methods. These alterations probably depend on a disturbance of hypothalamic function and are reversible by surgery.

Rupture of giant cerebral aneurysms during angiography. Case report and review of literature

A case of a giant aneurysm of the internal carotid artery which ruptured during cerebral angiography is reported. 30 other cases from literature of the last 35 years are reviewed. The majority of aneurysms ruptured during angiography was located at the internal carotid artery. 21 out of 30 patients were females. Fatal outcome was connected in general with intracerebral or intraventricular hemorrhage. Factors connected with the examination procedure and therapy are discussed.