Comparison of second trimester biometry in singleton and twin pregnancies conceived with assisted reproductive techniques

The objective of this study was to investigate the size of singleton vs twin pregnancies at the time of a second trimester dating scan. The analysis included 86 infants from 63 pregnancies achieved with assisted reproductive techniques, comprising 40 singletons and 46 twins. Measurements of second trimester biparietal diameter (n = 85) and femur length (n = 74) were plotted against the precisely known gestational age. A common regression line was calculated for each parameter and the residuals for singletons and twins were compared. Gestational age and weight at birth were also analysed for each group. There was no significant difference between singletons and twins in biparietal diameter or femur length in second trimester. In contrast, twins had a lower mean birthweight, gestational age at birth, and weight-for-gestational age centile compared with singletons. Singleton babies from these pregnancies had an average birthweight centile of 49.8% (i.e. close to the median for spontaneously conceived pregnancies in our population). We concluded that the same pregnancy dating charts can be used for singletons and twins. At corresponding gestational age, twins are smaller than singletons at birth because of slower growth in the third trimester.

Consistency of symptoms in recurrent catatonia

This study examined the consistency of symptom profiles across episodes of catationia. A recently developed standardized examination and symptom scale systematically rates 23 motor signs of catatonia, permitting symptom analysis of recurrent illness. Patients from the emergency room or inpatient unit were prospectively examined using the 23-item Bush-Francis Catatonia Rating Scale (BFCRS), both on initial presentation and during a later episode of catatonia. Five cases were identified, with a variable interval (mean, 10.7 months; range 4.5 to 20) between episodes. All five met DSM-IV motor criteria for catatonia (293.89) and research criteria of more than two BFCRS signs. They showed a mean of 9.6 (range, 7 to 15) catatonic signs in the first episode, and 9.6 (range, 4 to 14) signs in the second. Of the 23 individual BFCRS motor signs, a mean of 16.6 (range, 13 to 21) showed agreement of signs (absence or presence) between the two episodes. The catatonic syndrome shows consistency of motor symptoms on recurrent episodes and the BFCRS facilitates the systematic study of catatonia.

Polymorphisms in the human apolipoprotein-J/clusterin gene: ethnic variation and distribution in Alzheimer's disease

Apolipoprotein-J/clusterin (APOJ/CLI) shares many biological properties with apolipoprotein-E (APOE) including, but not limited to, avid binding with beta-amyloid peptide. Thus, APOJ/CLI warrants scrutiny as a candidate Alzheimer's disease (AD) susceptibility gene. We identified seven nucleotide sequence polymorphisms in APOJ/ CLI, two of which, in exon 7, after the predicted amino acid sequence. The JVIIB variant is an asparagine-to-histidine substitution, which deletes a glycosylation signal at amino acid 317; the JVIIC variant is an aspartate-to-asparagine substitution, which forms a new glycosylation signal at position 328. Both of these coding variants, as well as two neutral polymorphisms in exon 2, were more frequent in African-Americans than Hispanics and were rare in Caucasians. However, no individual coding or noncoding variant was consistently associated with AD. At the population level, APOJ/CLI polymorphisms are frequent among persons of African descent, but probably do not alter susceptibility to AD.

Genetic variation in immediate and delayed postictal refractory period in rats

We determined postictal refractoriness in Sprague-Dawley rats by comparing lengths of two suprathreshold ECS seizures given 15 s to 24 h apart. A bimodal (immediate and delayed) decrease in seizure duration was found, suggesting ECS alters mechanisms of seizure termination. Since adenosine is implicated in seizure termination, we determined immediate (30 s) and delayed (24 h) postictal ECS refractoriness in Wistar-Kyoto (WKY) and spontaneously hypertensive (SHR) rats which vary in adenosine properties and initial ECS seizure length. At 30 s, the decrease in seizures did not differ between WKY (-44%) and SHR (-36%) rats. At 24 h, SHR rats showed no change while the WKY rats showed a 20% decrease in seizure length (P < 0.01). These two strains also differed in the ability of the adenosine antagonist caffeine (50 mg/kg, i.p.) to prolong ECS seizures (no change for WKY, +13% for SHR, P < 0.001). The results suggest immediate and delayed postictal refractoriness are subject to genetic variation and may depend on central adenosine mechanisms.

Trimethaphan (Arfonad) control of hypertension and tachycardia during electroconvulsive therapy: a double-blind study

STUDY OBJECTIVE

To ascertain the optimal dose of trimethaphan camsylate administered by intravenous (i.v.) bolus injection for the control of hypertension and tachycardia during electroconvulsive therapy (ECT).

DESIGN

Prospective, double blind, within-subject study.

SETTING

Treating room of the psychiatric unit of the University Hospital at Stony Brook, NY.

SUBJECTS

Patients undergoing ECT for major psychiatric illnesses.

MEASUREMENTS AND MAIN RESULTS

Fifteen ASA status I or II patients received in a random sequence placebo, or 5, 10, or 15 mg boluses of trimethaphan during their second to fifth treatments. Blood pressure (BP) and heart rate (HR) were recorded every 30 seconds by automated oscillometric recorder. Recordings taken before administration, during seizure, 5, and 20 minutes after seizure were examined. All doses ameliorated BP (systolic, diastolic, and mean), HR, and rate pressure product (RPP) increases during the seizure, compared with placebo. The group that received 15 mg exhibited smaller increases in RPP, i.e., 67.7% increase compared with 155.4%, 110.9%, and 98.7% increases for the placebo, 5, and 10 mg, respectively. The 10 mg and 15 mg doses caused a faster return to baseline than did the 5 mg dose or placebo. No rebound hypertension, prolonged hypotension, arrhythmias, or other side effects were noted. Trimethaphan did not alter seizure duration.

CONCLUSIONS

Trimethaphan is safe, practical, and effective in the management of the hyperdynamic response to ECT. An i.v. bolus injection of 15 mg is more effective than 10 mg or 5 mg.

Catatonia. II. Treatment with lorazepam and electroconvulsive therapy

Case material and retrospective studies support the use of both lorazepam and ECT in treating catatonia, but few prospective investigations exist and none employ quantitative monitoring of response. In this study we test their efficacy in an open, prospective protocol, and define a "lorazepam test' with predictive value for treatment. Twenty-eight patients with catatonia were treated systematically with parenteral and/or oral lorazepam for up to 5 days, and with ECT if lorazepam failed. Outcome was monitored quantitatively during the treatment phase with the Bush-Francis Catatonia Rating Scale (BFCRS). In 16 of 21 patients (76%) who received a complete trial of lorazepam (11 with initial intravenous challenge), catatonic signs resolved. A positive response to an initial parenteral challenge predicted final lorazepam response, as did length of catatonic symptoms prior to treatment. Neither demographic variables nor severity of catatonia predicted response to lorazepam. Four patients failing lorazepam responded promptly to ECT. It is concluded that lorazepam and ECT are effective treatments for catatonia. The rating scale has predictive value and displays sensitivity to change in clinical status.

Catatonia. I. Rating scale and standardized examination

To facilitate the systematic description of catatonic signs, we developed a catatonia rating examination, rating scale and screening instrument. We constructed a 23-item rating scale and a truncated 14-item screening instrument using operationalized definitions of signs ascribed to catatonia in published sources. Inter-rater reliability was tested in 44 simultaneous ratings of 28 cases defined by the presence of > or = 2 signs on the 14-item screen. Inter-rater reliability for total score on the rating scale was 0.93, and mean agreement of items was 88.2% (SD 9.9). Inter-rater reliability for total score on the screening instrument was 0.95, and mean agreement of items was 92.7% (SD 4.9). Diagnostic agreement was high based on criteria for catatonia put forth by other authors. Seven per cent (15/215) of consecutively admitted patients to an academic psychiatric in-patient facility met criteria for catatonia. It is concluded that catatonia is a distinct, moderately prevalent neuropsychiatric syndrome. The rating scale and screening instrument are reliable and valid. Their use facilitates diagnosis, treatment protocols, and cross-study comparisons.

Reduced proconvulsant activity of caffeine in rats after a series of electroconvulsive seizures

A variety of neurotransmitter receptor changes occur after a course of electroconvulsive seizures (ECS) in rats, including an increased density of adenosine A1 sites. Adenosine antagonism has been related to the proconvulsant action of methylxanthines such as caffeine. We determined tonic-clonic seizure duration in rats given ECS with caffeine (0-175 mg/kg, IP) after a course of one or six daily ECS. A single day of ECS did not affect the dose-dependent proconvulsant action of caffeine. After six daily ECS, the proconvulsant action of caffeine was reduced. After nine daily ECS, an A1 antagonist (8-cyclopentyl-1,3-dipropylxanthine) and an A2A antagonist (1-allyl-3,7-dimethyl-8-p-sulfophenylxanthine) showed reduced proconvulsant activity. The results suggest that the reduced proconvulsant action of caffeine after chronic ECS depends on adenosine antagonism.

Continuation ECT: relapse prevention in affective disorders

Relapse rates after the acute treatment of affective disorders with drugs or electroconvulsive therapy (ECT) are high (often 50-95%), despite preventive pharmacotherapy. In practice, some patients receive continuation and maintenance ECT after successful treatment of the index episode with ECT. We reviewed the charts of patients with affective illnesses who received continuation ECT (C-ECT) in our inpatient service from 1985 to 1991. In 33 courses of C-ECT, mean intertreatment interval was 10.1 days and the average duration of treatment was 10 weeks. One-year follow-up was available for 21 patients. Seven (33%) patients relapsed and needed re-admission within 1 year. The relapse rate for the patients with delusional depression was 42%, lower than the 95% reported for patients with delusional depression maintained on continuation pharmacotherapy before the C-ECT program started in our facility. No single factor examined was a significant predictor of relapse except C-ECT, which exhibited a sustained prophylactic effect for the year after the index episode.

Caffeine augmentation of electroconvulsive seizures

Caffeine has been used clinically to increase seizure length in electroconvulsive treatment (ECT). The present study was designed to establish an animal model of caffeine-augmented seizures for further study of mechanisms and effects of pharmacological manipulation of seizure length. Increasing doses of caffeine (0-200 mg/kg, IP) were given before electroconvulsive stimulation (ECS) in rats and resulting seizure lengths were quantified by timing of classical tonic-clonic convulsive movements. With this paradigm, caffeine led to a dose-dependent increase in seizure duration. This proconvulsant action of caffeine was detectable within 1 min after dosing, persisted for at least 230 min and was reversible. The results suggest that seizure length is a practicable measure in pharmacological modification of electroconvulsive seizures. They also suggest that pharmacologically-modified ECS can be modeled effectively in animals.

Simultaneous presentation of sarcoidosis and acute myeloid leukaemia: predisposition to pulmonary haemorrhage

A case of coexistent acute myeloid leukaemia and sarcoidosis is reported. This was complicated by recurrent pulmonary haemorrhage during reinduction and consolidation chemotherapy. A review of published papers on malignancy and sarcoidosis, in particular acute leukaemia is given. The outcome of most cases of acute leukaemia and sarcoidosis is poor with respiratory complications a frequent cause of death in this group. It is proposed that modifications to treatment to avoid pulmonary toxicity and maintenance of platelet counts above 40 x 10(9)/l are warranted to reduce the risk of this complication.

Interval between symptom onset and hospitalization in mania

Previous studies of illness onset in mania lack a frequency distribution for the interval between symptom onset and hospitalization (hospital latency), although a bimodal distribution of illness onset been suggested. We identified 100 patients hospitalized for mania and found a unimodal distribution, with mean +/- SD of 3.3 +/- 3.2 weeks for hospital latency. Cases with short hospital latency (< 1 week, n = 15) were younger and had briefer psychiatric histories. The data were compared to other studies of hospital latency in mania.

A simple and rapid method of high quantity DNA isolation from cervical scrapes for detection of human papillomavirus infection

Infection with human papillomavirus (HPV) is an important etiological factor in the development of cervical cancer, and detection of the viral genome is of prognostic importance, particularly for preneoplastic lesions. We developed a simple, easy and efficient non-organic method of DNA extraction from cervical scrapes for reliable detection of HPV DNA sequences. The method involves incubation of cell nuclei in higher concentration of proteinase K at 65 degrees C for 2.5 h. Following prolonged incubation at higher temperature, the enzyme is autoinactivated and the DNA isolated can be used directly for analysis without further purification. The recovery of DNA is more than 95% and it can be easily cleaved by restriction enzymes and is suitable for amplification by the polymerase chain reaction (PCR). The whole procedure is carried out in a single Eppendorf tube and a large number of specimens can be processed at a time without any error of handling. DNA extracted from a single smear sample is sufficient to conduct as many as four different molecular biology tests. This provides an opportunity for verification of sensitivity, specificity and reliability of each test for diagnosis of HPV infection without resorting to biopsy.

Comparison of saliva and blood for human immunodeficiency virus prevalence testing

Testing saliva for the detection of human immunodeficiency virus (HIV) antibodies has many potential advantages for epidemiologic surveillance. A commercial ELISA kit and a standardized in-house immunoblot (IB) system were slightly modified to enhance antibody detection in saliva. Frozen saliva specimens from Toronto Sexual Contact Study participants (including sequential saliva specimens collected during seroconversion) were tested as were fresh saliva samples collected from a population of street-based intravenous drug users (IVDUs). HIV antibody results on saliva were compared with HIV serostatus determined by ELISA and IB on serum or dried blood spots. The overall sensitivity was 98.3% (117/119) for the kit and 99.2% (118/119) for IB; the specificity was 100% (429/429). In the IVDU population, compliance in the voluntary submission of specimens increased from 69% agreeing to provide blood samples to 89% agreeing to provide blood, saliva, or both. Saliva specimens can be easily collected under difficult field conditions with minimal training and provide a valuable alternative to testing blood for HIV-seroprevalence studies.

Cellular localization of MAO A and B in brain: evidence from kainic acid lesions in striatum

The cellular localization of the two forms of monoamine oxidase (MAO A and MAO B) was studied by measuring their activities in rat striatum following unilateral stereotaxic injection of kainic acid to produce selective degeneration of striatal neurons and subsequent proliferation of astrocytes. The results demonstrated a persistent loss of 15-20% in MAO A activity, whereas MAO B activity decreased initially by 25% and then increased to more than twice the control value by 54 days after lesions. The changes in activity were compared to parallel estimates of the postsynaptic neuronal enzyme markers glutamic acid decarboxylase (GAD) and neuron-specific enolase (NSE), astroglial enzyme markers glutamine synthetase (GS) and non-neuronal enolase (NNE), and the presynaptic enzyme marker DOPA decarboxylase (DDC). The results suggest that a small amount of striatal MAO A is present in kainic acid-sensitive postsynaptic striatal neurons and that MAO B is probably localized in both neurons and astrocytes.

Sulfate conjugation of dopamine in rat brain: regional distribution of activity and evidence for neuronal localization

Brain tissue contains at least two forms of phenolsulfotransferase that are involved in the sulfate conjugation of biogenic amines and their metabolites. Two apparent Km values were obtained for p-nitrophenol at pH 7.4 (0.6 microM and 0.3 mM) but only one enzyme had the capacity to conjugate dopamine (Km = 130 microM). Dopamine sulfotransferase activity was found to vary 17-fold in different brain regions, with the highest levels in diencephalon, hippocampus, and striatum. To determine the cellular localization of the enzymes, phenolsulfotransferase activity was measured in striatum following selective destruction of striatal neurons by stereotaxic injection of 2 micrograms kainic acid. Fourteen days after injection the catecholamine sulfotransferase activity in the lesioned striatum was reduced to approximately 40-50% of that in the control contralateral striatum. There was a statistically significant correlation between the ratio of lesioned to control activity for the sulfotransferase and the neuronal marker enzymes glutamate decarboxylase and neuron-specific enolase. p-Nitrophenol sulfotransferase activity was also decreased in the lesioned striatum. These results suggest that PST activity is present within the kainic acid-sensitive neurons of the striatum. The regional variation in activity, together with the results of the kainic acid studies, suggest that sulfate conjugation of biogenic amines and their metabolites in brain may take place within specific types of neurons.

Psychiatric abnormality and brain calcification over four generations

An association between basal ganglia calcification and psychiatric abnormality, mainly schizophrenia, is described in three generations of a family; schizophrenia is also recorded in the previous generation. The mode of inheritance appears to be an X-linked dominant one. Unusual sensitivity to neuroleptics also occurred in four members of the family. No comparable family study is believed by the authors to have been reported previously.