Hemispheric asymmetry in the expression of positive and negative emotions. Neurologic evidence

Three retrospective studies were conducted to examine functional brain asymmetry in the regulation of emotion. In the first study, reports of 119 cases were collected of pathological laughing and crying associated with destructive lesions. Pathological laughing was associated with predominantly right-sided damage, whereas pathological crying was associated with predominantly left-sided lesions. In the second study, 19 reports detailing mood following hemispherectomy were collected; right hemispherectomy was associated with euphoric mood change. In the third study, lateralization of epileptic foci was assessed in reports of 91 patients with ictal outbursts of laughing (gelastic epilepsy). Foci were most likely to be predominantly left-sided. The findings are congruent with studies of the effects of unilateral brain insult on mood, and a general model of hemispheric asymmetry in the regulation of emotion is presented.

5-azactidine and zorubicin for patients with previously treated acute nonlymphocytic leukemia: a Cancer and Leukemia Group B pilot study

Twenty-nine adults with advanced acute nonlymphocytic leukemia were treated with an intensive chemotherapy program consisting of 5-azacitidine and zorubicin. Overall, eight patients (28%) achieved a complete remission. Although only one of 19 patients with refractory leukemia responded, seven of ten patients who were treated immediately following relapse from a prior remission achieved another complete remission. The duration of remission ranged from 5 to 33 weeks (median, 14). Treatment resulted in severe toxic reactions including myelosuppression, renal tubular dysfunction, and elevations in liver enzymes. In addition, each of the 15 patients who died of treatment-associated complications had a severe infection. This combination of 5-azacitidine and zorubicin is relatively ineffective for truly refractory leukemia, but it may be a useful alternative following relapse.

The oral flor as a source of septicemia in patients with acute leukemia

This study was performed to determine the role of the oral cavity in causing septicemia in patients with acute leukemia. Thirty-three patients with acute nonlymphocytic leukemia were investigated prospectively via clinical, hematologic, and microbiologic techniques. The mouth was the most likely source of septicemia in seven of twelve cases. Necessary dental treatment prior to chemotherapy was accompanied by a significant reduction in the rate of septicemia. The authors conclude that oral sources of bacteremia should be eliminated prior to chemotherapy in patients with acute leukemia.

Herpetic esophagitis

Four patients with herpetic esophagitis were examined. In three of them, the presenting symptom was odynophagia. Early in the course of herpetic esophagitis, shallow round and oval ulcers were seen on barium esophagograms. Later, the ulcers filled with fibrinous exudate, forming nodular plaques that projected into the esophageal lumen. Although these findings are diagnostic of esophagitis, they are not specific for a herpes virus infection. The definitive diagnosis must be established by histologic examination, which demonstrates the cytopathic effect of the herpes virus infection within the squamous epithelium.

Acute myelocytic leukemia in two brothers with polyposis coli and carcinoma of the colon

Two brothers developed multiple adenomatous polyps of the colon and colonic adenocarcinoma, the classic features of familial polyposis coli. Both also developed acute myelocytic leukemia. This constellation of neoplasms is distinct from other genetic syndromes that feature polyposis coli. The parents of the brothers are first cousins, suggesting autosomal recessive inheritance of these multiple neoplasms. Autosomal dominant of X-linked transmission is also possible and should be evaluated in other affected families.

Rhinomaxillary mucormycosis in a kidney transplant patient

Rhinomaxillary mucormycosis is an uncommon but important pathologic entity with a rapidly fatal course if treatment is delayed. This is of particular interest to dentists, since many of the earliest clinical signs appear in the oral and perioral regions. Successful therapy demands early diagnosis by biopsy, institution of amphotericin B therapy, and surgical débridement. A case of nonfatal rhinomaxillary mucormycosis is presented, and all other reported cases in transplant patients are reviewed.

The determination of oxalic acid in urine by high performance liquid chromatography with electrochemical detection

A system for the determination of oxalic acid in human urine using ion exchange-ion pair, high performance liquid chromatography with electrochemical detection (HPLCEC) is described. Urine is acidified with HCl, and excess CaCl2 is added to precipitate oxalate ion. The precipitate is isolated, redissolved in dilute sulfuric acid, and separated on a strong cation exchange column using an acetic acid-solium acetate-tetrabutylammonium tetrafluoroborate mobile phase adjusted to pH 2.8. Using an electrochemical detector at 1.25 volts vs. the saturated calomel electrode (SCE), oxalic acid exhibits a linear dynamic range from 1 to 1000 mg/liter with a detection limit of 0.1 mg/liter. Quantitative data are obtained by the method of standard addition in the clinically significant range from 5 to 40 mg/liter. Percentage recovery for spiked urine samples was 97.8% with a relative standard deviation of 2.5%.

A comparison of differential pulse and d.c. amperometric detection modes for the liquid chromatographic determination of oxalic acid

Oxalic acid determinations are made using two modes of electrochemical detection, namely, classical d.c. and differential pulse, after separation by ion-pair, ion exchange high performance liquid chromatography. Peak height ratio plots are constructed and compared for uric acid and oxalic acid mixtures using both electrochemical detection modes. The enhanced selectivity realized by use of the differential pulse electrochemical detection mode is demonstrated.

High-performance liquid chromatographic determination of theophylline and its derivatives with electrochemical detection

Theophylline and its derivatives are determined by high-performance liquid chromatographic separation on a C8 reversed-phase column with electrochemical detection. The analyte is oxidized at 1.24 V (vs. the standard calomel electrode) on a wax-impregnated graphite electrode using classical d.c. and current sampled d.c. modes, and the results obtained compared with those of a 254 nm ultraviolet (UV) detector. Polarographic detection offers greater sensitivity for theophylline than UV detection; further, interferences which hamper UV detection may be selectively eliminated with polarographic detection.

Oral infection in immunosuppressed renal transplant patients

The most common cause of death in patients taking immunosuppressive (IS) drugs is infection. Many of the microorganisms which infect these IS patients may be found in the mouth, but the mouth has not been investigated as a potential source of lethal infection. In view of this, we studied twenty-seven IS patients taking Imuran and prednisone for 6 to 61 weeks and eighteen normal controls. The patients were followed monthly, and the incidence of oral and systemic complications was recorded. There were no deaths due to infection during the 10-month study period. Oral infection occurred as frequently as pneumonia or urinary tract infection. Systemic factors which were related to the development of dental infection were lymphocyte count and length of time on immunosuppressive drug therapy.

Determination of the microscopic and macroscopic acid dissociation constants of glycyl-L-histidyl-L-lysine and related histidine peptides

Proton magnetic resonance studies of the acid-base chemistry of the glycyl ammonium, histidyl imidazolium, and lysyl ammonium groups of glycyl-L-histidyl-L-lysine and of the glycyl ammonium and histidyl imidazolium groups of glycyl-L-histidine and glycyl-L-histidylglycine are described. Chemical-shift data indicate that, at the molecular level, the glycyl ammonium and the histidyl imidazolium groups are titrated over the same pH range, with the acidity of the imidazolium group some 8 to 10 times that of the glycyl ammonium group, depending on the peptide. The lysyl ammonium group of Gly-His-Lys is much less acidic and is titrated over a higher pH range. Microscopic and macroscopic acid-dissociation constants were determined from chemical-shift data for each of the peptides. It is shown how microscopic formation constants for protonated metal complexes of these ligands, which are being used increasingly as models for the binding of metal ions by proteins, can be calculated from the macroscopic formation constants and the microscopic acid-dissociation constants. The acid-base chemistry of Gly-His-Lys is discussed with respect to its recently discovered biological activity.

Heinz body hemolytic animea. "Bite cells" -a clue to diagnosis

Morphologically abnormal red blood cells were noted on routine Wright-stained peripheral blood smears of two patients with Heinz body hemolytic anemia. The abnormal cells had the appearance of having had a piece bitten and are, therefore, termed "bite cells". In the two cases presented, these bite cells led to the suspicion of oxidative hemolysis, which was demonstrated in each case. Both patients were being treated with phenazopyridine hydrochloride when anemia developed. In each case, withdrawal of this drug led to correction of the anemia and the disappearance of bite cells from the blood.

Autoimmune neutropenia

Serologic tests for antineutrophil antibodies were used to determine if autoantibodies cause neutropenia. The serums of five patients with idiopathic neutropeniaopsonized normal neutrophils, causing them to be ingested by rabbit macrophages or else to activate glucose oxidation rates of other normal neutrophils by at least twice the rate of controls. Some of the serums inhibited the ability of normal neutrophils to ingest by 62 to 56 per cent. At splenectomy in two of the patients splenic macrophages contained ingested neutrophils, suggesting that the opsonic activity of the serum demonstrated in vitro had pathogenetic importance. In two adults, and possibly in an infant, corticosteroids raised the neutrophil count, although antibody activity remained in the serum of the adults. The findings indicate that autoantibodies are the basis of some cases of idiopathic neutropenia, and that they act by promoting the clearance of neutrophils by mononuclear phagocytes.

General dentistry and oral medicine in the hospital

General dentistry in a hospital should not be confined to restorative dentistry happens to be performed in a hospital dental clinic. In addition to expertise in restorative dentistry and other dental specialties, general practitioners participating in hospital programs must also be students of two major areas-- diagnosis of diseases involving the head and neck as well as dental management of patients with severe medical disease. In the preceding short review a few examples of disorders about which the hospital dentist may be consulted were reviewed along with the proper protocol for requesting and answering consultations. This list is necessarily short and incomplete. A different group of disorders could have been discussed in this article. The competent hospital dentist must be a continual student of disease and its possible effect upon dental treatment and oral diagnosis. The task is formidable but rewarding and interesting.