Comparison of the neuroendocrine control of pubertal maturation in girls and boys with spontaneous puberty and in hypogonadal girls

Puberty in boys is characterized by a nocturnal increase in mean LH concentration and LH pulse frequency. To determine whether similar mechanisms exist in girls, nocturnal serum LH concentrations were determined in 16 girls with constitutional delay of adolescence or idiopathic short stature who had or have subsequently been shown to have spontaneous puberty. Mean LH and LH pulse frequency and amplitude were analyzed in 3-h blocks and compared to those in 20 pubertal boys. Girls had an increase in mean LH concentration from 3.6 +/- 0.7 IU/L at 2000-2250 h to 4.8 +/- 0.9 IU/L at 0200-0450 h. LH pulse frequency increased from 0.27 +/- 0.11 pulses/girl.h at 2000-2250 h to 0.54 +/- 0.10 pulses/girl.h at 0200-0450 h. The increase in LH pulse amplitude, from 2.0 +/- 0.8 IU/L at 2000-2250 h to 4.1 +/- 1.1 IU/L at 2300-0150 h, did not achieve statistical significance because many girls had no pulses from 2000-2250 h. With advancing age, the day/night differences in LH concentration and LH pulse frequency disappeared in girls, but were preserved in boys of same pubertal stage. The effect of lack of estrogen on LH pulse characteristics was inferred by analyzing the LH profiles of 15 girls with gonadal dysgenesis who were age-matched to girls with spontaneous puberty. The girls with gonadal dysgenesis had an increase in mean LH concentration after 0200 h, but LH pulse frequency was rapid in all time blocks; the nocturnal increase in LH concentration was secondary to a significant increase in LH pulse amplitude. Older girls with gonadal dysgenesis had a loss of nighttime augmentation of LH secretion similar to that seen in girls with spontaneous puberty. These data suggest that the apparent slower LH pulse frequency encountered in girls with spontaneous puberty during waking hours may be related to estrogen suppression of LH pulse amplitude, which masks the true daytime LH pulse frequency. With or without pubertal estrogen exposure, developmental progression of LH secretion occurs more rapidly in girls than in boys. Thus, intrinsic sex differences exist in the timing and tempo of endocrine control of pubertal maturation between boys and girls.

The pathway to care in post-natal depression: women's attitudes to post-natal depression and its treatment

Women suffering from post-natal depression were interviewed about their symptoms, help-seeking behaviour and treatment. Over 90% recognized there was something wrong, but only one-third believed they were suffering from post-natal depression. Over 80% had not reported their symptoms to any health professional.

Demographic and obstetric risk factors for postnatal psychiatric morbidity

BACKGROUND

Postnatal depression follows 10% of live births but there is little consensus on the risk factors associated with its development. Previous smaller studies have been unable to quantify the impact of independent risk factors as relative and attributable risks.

METHOD

The Edinburgh Postnatal Depression Scale (EPDS) was used to screen a systematic sample of 2375 women, six to eight weeks after delivery. Information on socio-demographic and obstetric variables was collected at the screening interview. The risk factors associated with high EPDS scores (> 12) were determined and entered stepwise into a regression model.

RESULTS

Four independent variables were found to be associated with an EPDS score above this threshold. These were an unplanned pregnancy (OR 1.44); not breast-feeding (OR 1.52), and unemployment in either the mother, i.e. no job to return to following maternity leave (OR 1.56), or the head of household (OR 1.50). These four variables appeared to explain the risk associated with other risk factors.

CONCLUSIONS

Although a direct aetiological role for these risk factors is not certain, they may indicate strategies for the prevention of affective morbidity in postnatal women. These may include reducing unwanted pregnancy and employment for women after childbirth.

The economic life of seriously mentally ill people in the community

OBJECTIVE

The study examined economic disincentives and incentives to work among people with serious mental illness.

METHODS

Fifty people with severe and persistent mental illness who were living in the community were interviewed about the amount and sources of their income and expenses. In addition, a randomly selected group of 100 people with schizophrenia or schizoaffective disorder was interviewed about work, income, and wage requirements.

RESULTS

In the first sample, the mean total cash and noncash income of unemployed subjects ($929 a month), which was derived mainly from disability supports and rent subsidies, was only slightly lower than that of subjects with part-time employment ($1,028 a month). The limited difference was largely a consequence of reductions in entitlement income when subjects worked. To overcome these disincentives, most subjects in the second sample felt they needed to earn between $5 and $6 an hour to make working worthwhile. The mean monthly cost of psychiatric treatment for unemployed subjects was $2,083, compared with $910 for those with part-time employment and $292 for those working full time.

CONCLUSIONS

The findings emphasize the importance of developing higher-paying jobs for this population and reforming entitlement programs to incorporate work incentives for the mentally disabled population.

Cryoablation of unresectable malignant liver tumors

BACKGROUND

Unresectable malignant liver tumors, particularly metastases of gastrointestinal origin, are rapidly lethal in a vast majority of patients, regardless of treatment.

PATIENTS AND METHODS

We evaluated 58 patients by laparoscopy and/or laparotomy. Thirty-nine were treated with cryoablation of liver tumors using a liquid-nitrogen cryoprobe delivering a tumoricidal temperature of -196 degrees C with intraoperative ultrasound monitoring. Histologic evaluation showed that 25 patients had colorectal metastases, 3 had gastric tumors, 4 hepatocellular carcinomas, 6 carcinoids, and 1 gastrinoma.

RESULTS

All patients who received complete cryoablation are alive with a mean follow-up of 14 months. Five whose treatment could not be completed died between 3 and 9 months postoperatively. Thirteen patients (28%) have recurrent disease and 20 (51%) have no evidence of disease. There were no operative mortalities. Postoperative transient elevation of liver function tests and thrombocytopenia were noted. All patients received postoperative chemotherapy.

CONCLUSION

Cryoablation is an active and safe treatment for advanced liver malignancies.

The economic advancement of the mentally ill in the community: 2. Economic choices and disincentives

In order to evaluate the extent to which economic factors influence the life choices of people with mental illness, we interviewed 50 mentally ill people living in Boulder, Colorado. Subjects experience significant financial disincentives to work. The average total cash and noncash income of part-time employed subjects ($1,028 a month) is only modestly higher than that of unemployed subjects ($929 a month). Most clients calculate that $5 is the minimum hourly wage which makes work economically practical. Work disincentives could be improved by a more appropriately graduated scheme for reducing disability benefits for beginning workers. A wage subsidy would provide a work incentive to underproductive clients. Psychiatric treatment costs for unemployed subjects in this sample are twice those for the part-time employed. We suggest that research is needed to determine if treatment costs can be reduced by paying clients a wage subsidy.

The economic advancement of the mentally ill in the community: 1. Economic opportunities

Consumer cooperatives have been shown to be feasible in Europe for generating adequately reimbursed jobs for the mentally ill, and may be viable in the U.S.. Such businesses can gain a market advantage by offering goods and services to mental health agencies or to the consumer group. Interviews with 50 mentally ill people living in Boulder, Colorado, identified sizable markets controlled by consumers: the average mentally ill person in the sample consumes $2,000 a month in psychiatric treatment, accommodation, food, medication and other goods and services. The findings suggest several income-generating opportunities. Consumers can be employed as mental health service providers, under certain conditions a consumer-cooperative pharmacy may be established, and some types of housing cooperative are viable.

Time trends in schizophrenia: changes in obstetric risk factors with industrialization

The frequency of schizophrenia may have increased during the early stages of industrialization and may now be declining. Early in the process of development, the illness appeared to be more common among the upper classes and later, more common in the lower classes. As with certain other diseases, the occurrence of schizophrenia may be influenced by the transition from poverty to affluence. Explanations for such a pattern of occurrence include the combined effect of (1) variation in the rate of birth complications owing to cephalopelvic disproportion secondary to changes in nutrition, and (2) increased infant survival following improvements in obstetric and neonatal care. These effects help elucidate the pattern of occurrence of schizophrenia in immigrant groups.

Substance use among the mentally ill: prevalence, reasons for use, and effects on illness

Substance use among a random sample of mentally ill, community-based patients was examined. Current use was found to have declined substantially from a high lifetime prevalence, and a family history of substance abuse was associated with moderate to heavy use. No association was found between heavy substance use and elevated psychopathology, hospitalization, or medication noncompliance. Hospital admissions and some symptoms were less prevalent among users preferring marijuana.

Primary prevention of parenting dysfunction in high-risk cases

Evaluation of high-risk cases treated via a tri-agency, interdisciplinary, early-intervention program suggests that a better outcome was achieved in the treatment program than in a control group of similar high-risk families receiving standard care. The number of treated cases requiring child protection services decreased during treatment, and confirmed episodes of child abuse were fewer in the treated group than in the control group.

Psychopathology and quality of life among mentally ill patients in the community. British and US samples compared

Sixty-nine mentally ill patients in treatment in an intensive community support system in Boulder, Colorado, were evaluated using the same measures of quality of life and psychopathology as were used in assessing mentally ill patients in hospital and community facilities in Manchester. Psychopathology was greater in the Boulder samples, but quality-of-life scores were no worse for the American patients. The relationship of these findings to systems of care and availability of psychiatric hospital beds is discussed.

Using technique factors to predict patient ESE

This paper describes a formula for estimating patient skin entrance exposures from representative techniques used in radiographic facilities. A flexible nomogram has been formatted to the parameters of patient dimensions and focal film distance. The corresponding exposure rate (mGy/mAs) is expressed for any assumed projection and selected kilovoltages. This measured approach is a valuable tool for exposure assessment and is in compliance with emerging government standards and the pursuit of the ALARA (as low as reasonably achievable) concept.

Analysis of disease progression from clinical observations of US Air Force active duty members infected with the human immunodeficiency virus: distribution of AIDS survival time from interval-censored observations

A non-parametric estimator of the AIDS survival time (after developing AIDS) is computed for the AIDS data set from the US Air Force (USAF). Survival times are unobservable. They are censored by the screening mechanism. The Armstrong Laboratory's Epidemiologic Research Division maintains data on over 954 active duty US Air Force (USAF) individuals who tested positive for human immunodeficiency virus (HIV) antibodies. Many have been clinically evaluated seven times since 1986. The HIV-positive individual is classified in seven stages of the disease complex as time progresses. Exact times of transition from one stage to the next are unknown. It is known that transition occurred between two consecutive evaluations. The aim of this study is to analyse distributions of the times that individuals spend in each stage of the HIV disease complex. We will discuss methods used to obtain non-parametric estimators of the distribution of times that individuals spend in stage 6. Finally, it is hoped to model the median time spent in each stage of the disease. This, along with incidence and separation data, will allow the prediction of the impact of HIV disease on USAF individuals and medical care systems.

A cylindrically symmetric magnetic shield for a large-bore 3.0 Tesla magnet

A 3.0 Tesla, 0.80-m bore magnet replaced our previous 1.9 Tesla, 0.76-m magnet. The 3.0 Tesla replacement magnet had a dipole moment of 1.7 with respect to that of the 1.9 Tesla magnet. The pre-existing cylindrically symmetric passive steel shielding was modified to confine the fringe fields of the replacement magnet to match those of the previous magnet. A cylindrically symmetric inner shield insert of about 20,000 kg was designed, fabricated, and installed. Upon energization of the magnet, the combined shielding met all design criteria. Alternative designs, optimization of cylindrically symmetric designs, and costs of fabrication, are presented herein.

Case management, quality of life, and satisfaction with services of long-term psychiatric patients

Two scales developed in Great Britain, the QOL Profile and the General Satisfaction Questionnaire, were used to examine the relationship between type of case management services and quality of life and satisfaction with treatment of 68 long-term psychiatric patients in Colorado. Factor analysis identified three types of case management activities that tended to occur together: assertive outreach (direct help, out-of-office visits, and monitoring), brokerage (referral to other agencies), and counseling and assessment. Monitoring was the only variable positively associated with quality of life for all patients; brokerage was the only variable negatively associated with acceptability of services. The number of case management contacts was negatively associated with treatment satisfaction.

Male rat copulation following 6-OHDA lesions of the medial preoptic area: resistance to repeated administration and rapid behavioral recovery

Dopamine (DA) in the medial preoptic area (MPOA) has been shown to facilitate male rat sexual behavior. However, injections of the catecholamine (CA) neurotoxin 6-OHDA into the MPOA did not impair copulation in tests 3 days after injection. In the present study, three weekly (serial) injections produced no copulatory deficits compared to animals that received a single injection or to preinjection copulatory behavior scores. However, blocking CA synthesis, which did not impair control rats, produced deficits in both single and serial lesion animals, with significantly fewer serial than single lesion animals initiating copulation. Biochemical analysis of tissue punches showed no difference in MPOA concentrations of dopamine, norepinephrine, epinephrine, or the dopamine metabolite DOPAC between the two groups. Additional animals were tested at earlier intervals after 6-OHDA injections into the MPOA. Tests conducted 30 min after an MPOA injection of 6-OHDA revealed that all measures of copulation were impaired, relative to scores 24 h later. However, these scores were not significantly different from animals tested 30 min after a vehicle injection. A final group, tested 4 h after injection, showed impairment of all measures of copulation compared to vehicle injections and to tests 24 h later. Furthermore, in the tests 24 h later, 6-OHDA animals were not different from vehicle animals. Results from all experiments show that 6-OHDA injections into the MPOA impair copulation for at least 4 h, but that behavioral recovery is complete 24 h later. However, deficits can be reinstated by inhibiting DA synthesis, suggesting that increased synthesis in undamaged terminals contributed to behavioral recovery.

Ventilation system to minimize airborne bacteria, dust, humidity, and ammonia in calf nurseries

We installed a ventilation system that minimizes airborne bacteria, dust, humidity, and ammonia levels; conserves animal heat during the winter months by precise control of the amount of fresh air admitted to the calf nursery; and prevents cross transfer of airborne pathogens between neighboring calves by providing uniform air distribution throughout the calf nursery. Because of the effectiveness of air filtration and uniform air distribution within the nurseries, respiratory problems of calves were reduced greatly. Airborne dust and bacteria as small as .5 mu were filtered from the air.

Effects of time required for reperfusion (thrombolysis or angioplasty, or both) and location of acute myocardial infarction on left ventricular functional reserve capacity several months later

The purpose of this study was to determine whether reperfusion of acute myocardial infarction (AMI) by recombinant tissue-type plasminogen activator (rt-PA) or percutaneous transluminal coronary angioplasty, or both, would improve left ventricular (LV) function when it is measured several months later at rest or maximal bicycle exercise, or both. Radionuclide angiography was performed in 44 patients 5 months (range 6 weeks to 9 months) after AMI to assess function, and tomographic myocardial thallium-201 imaging was performed at maximal exercise and delayed rest to determine whether there was any evidence of myocardial ischemia. As expected, no patient had chest pain or redistribution of a thallium defect during the exercise test, because patients had undergone angioplasty (n = 28) or coronary bypass graft surgery (n = 5) where clinically indicated for revascularization. The LV ejection fraction was plotted as a function of the time elapsed between the onset of chest pain and the time when coronary angiography confirmed patency of the infarct-related artery (achieved in 91% of 44 patients by rt-PA [n = 31] or percutaneous transluminal coronary angioplasty [n = 9] ). Functional responses differed markedly between patients with anterior (n = 20) versus inferior (n = 24) wall AMI. LV ejection fraction during exercise correlated with time to reperfusion in patients with an anterior wall AMI (r = -0.58; standard error of the estimate = 11.9%; p less than 0.02) but not in patients with an inferior AMI (r = 0.10; standard error of the estimate = 13.1%; difference not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

A pharmacokinetic model for isosorbidedinitrate, isosorbide-2-mononitrate, and isosorbide-5-mononitrate

A pharmacokinetic model is proposed to describe the plasma levels of isosorbidedinitrate (ISDN) and its two pharmacologically active metabolites, isosorbide-2-mononitrate (IS-2MN) and isosorbide-5-mononitrate (IS-5MN), following the oral administration of several 20-mg sustained release formulations of ISDN. Absorption of ISDN from the gastrointestinal tract appears first-order. A three compartment model is used to describe ISDN systemic plasma levels with t1/2 alpha = 7 min, t1/2 beta = 48 min and t1/2 gamma = 7.5 hr. The long t1/2 gamma is due to the slow release of ISDN from a peripheral compartment. ISDN undergoes extensive first-pass hepatic metabolism to IS-2MN and IS-5MN. The metabolic pathways appear to be close to saturation at an ISDN dose of 20 mg. Both IS-2MN and IS-5MN systemic plasma levels can be described by one compartment models with first-order elimination (respective elimination half-lives are 1.9 and 5.1 hr). The central compartment volumes of distribution for ISDN, IS-2MN and IS-5MN (116, 57, and 38 liters, respectively) are in agreement with reported literature values. This model is of particular usefulness as a formulation tool in designing sustained release ISDN formulations of the type investigated here since the observed first-order absorption rate constant correlates well with the in vitro first-order dissolution rate constant. Therefore, for these formulations, plasma levels can be simulated using data generated from in vitro dissolution studies, thus obviating the need for multiple human bioavailability studies.

Bronchogenic carcinoma treated by concomitant resection of lung and chest wall

Chest wall invasion by bronchogenic carcinoma is found in 5% of all cases of pulmonary carcinoma. During the last 3 years, 11 cases of lung cancer with chest wall involvement have been encountered at the Jackson Veterans Administration Medical Center. We reviewed these cases to reassess the role of concomitant resection of the lung and chest wall. From this experience, we have concluded that (1) chest wall involvement is potentially curable; (2) chest wall resection adds little if any morbidity to the procedure; (3) resections of fewer than four ribs usually require only soft tissue coverage, without a prosthesis; (4) patients with squamous cell cancer have longer survival; (5) chest wall resection is highly effective in the relief of pain due to invasion of the chest wall; and (6) survival is greater than in other stage III lung carcinomas and is more closely related to nodal involvement than to chest wall invasion.

Serotonin involvement in analgesia induced by transcranial electrostimulation

The experiments described here were intended to investigate whether serotonin (5HT) may be involved in analgesia induced by low current transcranial electrostimulation (TE). The TE stimulus is a 10 mu-ampere, 10 Hz, pulsed current transmitted via electrodes in the pinnae. Combinations of the following were given as intraperitoneal injections: 300 mg/kg p-chlorophenylalanine (pCPA) 48 hours before testing, 100 mg/kg 5-hydroxytryptophan (5HTP) 30 min before testing and the saline vehicle for these drugs. Rats were tested prior to and 30 minutes after TE or sham TE. Testing for analgesia consisted of putting progressively increasing pressure on the rat tail 1/4 inch from the tip with a pneumatically driven, right angle wedge. The amount of pressure at which the rat moved its tail was measured both before and after TE, or sham TE, and recorded as the difference in tolerated peak pressure (DTPP). TE produced analgesia as manifested by a 613 percent increase in DTPP compared with sham TE treatment values. Among TE treated rats, pretreatment with pCPA decreased DTPP 91.5 percent compared with saline control values, indicating 5HT involvement. 5HTP restored TE induced analgesia in pCPA treated rats to the level of saline treated control animals, confirming 5HT involvement.