Nosology and diagnosis of alcoholism. Issues and perspectives in subtyping (DSM III) simple alcoholism and alcoholism associated with other psychopathologies

The presence of psychopathological syndromes in alcoholic in-patients was assessed using the NIMH-Diagnosis. The most stricking finding of this study was the high percentage of additional psychopathological syndromes associated to alcoholism. Based on this finding, a tentative classification of alcoholism is proposed. The urgent need for a comprehensive diagnostic scheme for alcoholism is underlined.

Isotope lymphography: a new method of investigating the role of the lymphatics in chronic limb oedema

A method of investigating the lymphatic system by radionuclide imaging in patients with chronic lower limb oedema is described. The clearance of 99mTc rhenium sulphur colloid from the interdigital space of 55 limbs and its appearance in the ilio-inguinal lymph nodes 30 min, 1, 2 and 3 h later has been measured using a gamma camera in 34 limbs (26 patients) with the clinical and radiological features of primary lymphoedema, 10 limbs (8 patients) with venous oedema and 12 control limbs (6 volunteers). On visual interpretation the sensitivity of this technique in diagnosing lymphoedema was 97 per cent and its specificity 100 per cent, while it clearly differentiated between lymphoedema and venous oedema. Estimation of the percentage uptake of the colloid in the ilio-inguinal lymph nodes at 1/2, 1, 2 and 3 h showed a markedly decreased lymph flow in the 34 lymphoedematous limbs and an increased flow in the 10 limbs with venous oedema. The results suggest that this technique can be used as a simple diagnostic outpatient technique in the investigation of chronic limb oedema.

Long term results of the enteromesenteric bridge operation in the treatment of primary lymphoedema

Eight patients with primary lymphoedema secondary to iliac lymph node and vessel obstruction were treated in 1977 and 1978 by the construction of an enteromesenteric bridge. All patients have been followed clinically for periods of 2.5-7 years. Six patients showed sustained clinical improvement. Two failed to improve and subsequently required leg reducing operations. Contrast lymphography was performed in the early postoperative period on all cases and showed function of the bridge in five. Isotope lymphography 6-7 years postoperatively showed normal clearance of isotope from three of the four limbs studied. In one patient contrast lymphography, performed 7 years postoperatively, confirmed continued conduction of lymph by the enteromesenteric bridge. These results have encouraged us to reintroduce this operation for suitable patients.

Lymphoedema: pathophysiology and classification

This paper reviews current knowledge and hypotheses about the physiology of lymph production and lymph flow and the aetiology and classification of lymphoedema. One of the earlier contributions in the 1930's by Allen suggested that primary lymphoedema was caused by congenital underdevelopment of lymph vessels. At that time he described two clinical varieties (congenital and praecox) but later suggested a further subdivision into inflammatory and non-inflammatory types of lymphoedema. Kinmonth in 1957 produced the first clinical classification dividing all cases into primary or secondary lymphoedema but at that time gave no indication as to the cause of the primary variety. In the 1950's Kinmonth also developed a radiological classification which has contributed considerably to our knowledge of the anatomical abnormalities of the lymphatic system in primary lymphoedema. However, despite the widespread use of Kinmonth's classification the lymphographic appearances in primary lymphoedema give little or no clue to the aetiology of the disease process. The aetiology of primary lymphoedema is not known. There are various descriptive classifications based on age of onset and radiological findings for instance, but none attempts to explain the pathophysiology of the disease. We have therefore described our current knowledge of the known physiology and the potential abnormalities of the collection and passage of lymph from the interstitial space to the blood system. Based on this we have presented a simple classification of the aetiology of lymphoedema. Thus primary lymphoedema may be defined as lymphoedema caused by a primary abnormality or disease of the lymph conducting elements of the lymph vessels or lymph nodes. Secondary lymphoedema is oedema caused by disease in the nodes or vessels that began elsewhere (e.g., neoplasia or filariasis), or lymphocytic proliferative disorders such as Hodgkin's disease or following surgical extirpation of lymph nodes or vessels. There are three groups of primary lymphoedema in which the functional abnormality and its cause are known; namely (a) large vessel abnormalities such as congenital aplasia of the thoracic duct or cysterna chyli, (b) congenital lymphatic valvular incompetence or congenital aplasia and (c) lymph node fibrosis. The remainder are characterised by a reduced number of lymphatics on lymphography. Such patients can be described as having obliterated lymphatics. If they present within a few years of birth they were probably born with too few lymphatics. However, those who present later in life may have acquired obliterative disease, the cause of which is still obscure.(ABSTRACT TRUNCATED AT 400 WORDS)

1984 and medical manpower

Although the medical profession has proposed several solutions to medical manpower problems, government reactions have been simplistic. In 1983, the British Columbia government proposed and implemented rationing of billing numbers in order to cut the costs of physicians' services. Professional freedoms and rights were ignored by this rationing principle and the medical profession has elected to withdraw from the process. However, solutions must be found which do not compromise patient care or professional freedom.

Pretibial myxoedema

This paper reviews the clinical, endocrine and lymphatic status of 6 patients with pretibial myxoedema. The lymphatics were studied to determine whether they were involved in the pathogenesis of the disease. The main lymph trunks were normal although there was occasionally some collateral flow and some of the lymph nodes had small irregular filling defects. These changes suggest compression of the lymphatics by the myxomatous material and the deposition of mucinous material in the lymph nodes. There was no evidence of a primary lymphatic abnormality.

Evidence for a role of myosin phosphorylation in the initiation of the platelet shape change response

When platelets were stimulated with ADP to cause shape change without aggregation or secretion, myosin 20,000-Da light chain phosphorylation was rapid and appeared to precede slightly the shape change response. While the shape of the platelets remained spheroidal, myosin phosphorylation was transient and after 2-5 min returned to the same level as that of unstimulated cells. Phosphorylation of the 47,000-Da platelet protein was minimal under these conditions. The phosphorylation time course was not altered by the addition of indomethacin or allowing the cells to aggregate. The dose-response curve of myosin phosphorylation very closely paralleled that of shape change with a midpoint at 0.7 microM ADP. ATP, a competitive antagonist of ADP, inhibited both shape change and myosin phosphorylation with the same concentration of ATP causing 50% inhibition of each response. Similarly, when platelets were stimulated with either 15-hydroxy-9,11-azo-prostadienoic acid or collagen, myosin phosphorylation slightly preceded shape change. These results suggest that myosin phosphorylation is required for the initial change in platelet shape but is not necessary for maintenance of the spherical shape.

Abnormal fibrinolysis: the cause of lipodermatosclerosis or "chronic cellulitis" in patients with primary lymphedema

Blood fibrinolytic activity was measured in 20 patients with primary lymphedema, ten without and ten with skin changes usually attributed to "chronic cellulitis". The patients with abnormal skin showed reduced fibrinolytic activity, a finding previously described in patients with chronic venous disease and lipodermatosclerosis . It is postulated that changes of "chronic cellulitis" are identical to lipodermatosclerosis and are produced by a similar mechanism, namely reduced fibrinolysis.

Galvanic vestibular tests in the assessment of coma and brain death

Galvanic stimulation over the mastoid process elicits oculovestibular responses that provide a measure of brainstem function. The equipment is simple and is available in most neurodiagnostic laboratories. This type of test provides an advantage over caloric testing in the presence of external and middle ear disease and basal skull fracture and can be a useful adjunct in the evaluation of coma and brain death.

Influence of low levels of ochratoxin A on egg production, egg-shell stains, and serum uric-acid levels in Leghorn-type hens

Ochratoxin A, when fed at 0.0, 0.5, or 1.0 PPM to adult white Leghorn chickens, produced significant reduction in egg production and an increase in serum uric-acid levels, with a concomitant increase in egg-shell stains. These egg-shell stains were clinically similar to those described in the case report.

Mental health treatment and referral practices of clergy and physician caregivers

Consistent with previous literature, the results of a detailed survey mailed to clergy and physicians from a community known for its longstanding, excellent mental health system indicated extensive treatment and referral of mental health problems by clergy and physicians. Clergy and physicians, though, displayed very limited knowledge of mental health services and personnel, particularly innovative approaches and workers. Receiving mental health training was identified as a key factor, particularly for physicians, in terms of knowledge of services and personnel, referral to a mental health center, and treatment of serious mental health problems. Strategies were, therefore, outlined to provide more accurate information to this natural treatment and referral system.

Sialidosis type 1: cherry red spot-myoclonus syndrome with sialidase deficiency and altered electrophoretic mobilities of some enzymes known to be glycoproteins. 1. Clinical findings

A family is described with three affected brothers, two of whom were examined, born to consanguineous parent, who in early adult life began to experience ataxia, intention myoclonus, and progressive visual failure. The brothers examined had cherry red spots at the maculae and cataracts. They were of normal intelligence. The intention myoclonus responded partially to treatment with clonazepam and pheneturide, but not to 5-hydroxytryptophan in combination with carbidopa or to sodium valproate. Studies in one patient showed the excretion of large quantities of sialylated oligosaccharides in the urine. Both patients showed deficient sialidase activity in their cultured fibroblasts. Further studies on cultured skin fibroblasts revealed increased electrophoretic mobility of six glycoprotein enzymes that was returned approximately to normal by treatment with sialidase. The clinical and biochemical findings indicate that these patients are further cases of the newly described condition sialidosis type 1.

Sialidosis type 1: cherry red spot-myoclonus syndrome with sialidase deficiency and altered electrophoretic mobility of some enzymes known to be glycoproteins. II. Enzymes studies

Observations have been made on two brothers who had progressive ataxia, intention myoclonus and visual failure starting early in the third decade of life. Their parents were consanguineous. The brothers showed bilateral cherry red spots at the maculae and bilateral perinuclear cataracts; their intelligence was preserved. Urine was found to contain large amounts of sialylated oligosaccharides; cultured skin fibroblasts showed deficiency of the enzyme sialidase (neuraminidase). Studies on leucocytes and cultured skin fibroblasts showed aberrant electrophoretic mobilities of six enzymes all of which are known to be glycoproteins, and this has been attributed to excessive amounts of sialic acid on the enzyme molecules. The clinical features together with the biochemical findings indicate that these are further cases of the newly described condition Sialidosis Type 1 and it is suggested that the electrophoretic findings might be typical of the condition.

Reduction of ischemic myocardial damage in the dog by lidocaine infusion

The effects of lidocaine infusion on the ultrastructural damage induced in cardiac muscle by normothermic cardiopulmonary bypass were assessed in 15 dogs. Six dogs received no medication other than sodium pentobarbital (25 mg/kg, intravenously) while 9 dogs were treated with lidocaine after anesthesia. Lidocaine was given as a 2-mg/kg loading dose 10 minutes prior to ischemic arrest and a 2-mg/min continuous infusion during the entire experimental period. Biopsy samples of the left ventricular apex were taken 15 and 45 minutes after the start of ischemic arrest and 5 minutes after resumption of coronary blood flow. Biopsy samples were also obtained from 4 animals after thoracotomy to serve as controls for experimental procedures. Myocardial ultrastructure in the 4 control animals was comparable to that reported by other investigators. Five of 6 of the nontreated dogs and 8 of 9 lidocaine-treated dogs survived the entire period of ischemia and 5 minutes of coronary reperfusion. However, the extent of ultrastructural damage varied considerably between the two groups. In the experimental dogs receiving no lidocaine, mitochondria were swollen, cristae were absent, the mitochondrial matrix was cleared, and sarcomeres were disrupted. Myelin figures and contraction bands were also observed. None of the surviving lidocaine-treated animals had ultrastructural changes comparable to the worst ones in nontreated dogs. Damage was limited to some swelling of mitochondria with focal clearing of matrix. Most cristae remained intact. There were no myelin figures and few contraction bands. The results suggest that lidocaine protects the integrity of ischemic myocardium. It is suggested that this protection resulted from stabilization of plasma and/or mitochondrial membranes. (Am J Pathol 87:399-414, 1977).

Morphological features in a neutral lipid storage disease

The morphological changes in a patient with a generalized storage disease characterized by the intracellular deposition of neutral lipid are described. There is widespread accumulation of lipid in the cytoplasm of many cells and in occasional nuclei. Diagnosis may be facilitated by the recognition of clear vacuoles in the cytoplasm of granulocytes in blood films. In jejunal biopsies vacuolation of the epithelial cells may simulate the appearances of a-betalipoproteinaemia. The lipid inclusions consist largely of normal triglycerides and are free in the cytoplasm, unassociated with any organelle. The biochemical basis of the lesions is uncertain. Although there are lipoprotein abnormalities the primary defect appears to be intrinsic to the cell and may involve either a defective cytoplasmic lipase or an impaired uptake and utilization of fatty acids by mitochondria.

Neutral-lipid storage disease: a new disorder of lipid metabolism

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Mitochondrial inclusions in fibroblast culture from a patient with beta-methylcrotonylglycinuria

Electron microscopy of fibroblasts grown from a patient with biotin responsive β-methylcrotonylglycinuria revealed unusual deposits within their mitochondria.

Fabry's disease: specific inclusions found on electron microscopy of fibroblast cultures

Electron microscopy of fibroblasts cultured from skin biopsies of two sibs with Fabry's disease has shown characteristic crystalline cytoplasmic inclusions.

Trends in therapeutic abortion in San Francisco

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SAVING TIME AND STORAGE IN BREEDING SUGAR-BEETS

(1) By seeding sugar-beets in the greenhouse in early December or sooner, by exposing the growing beets to electric light for a few hours in the evening and by transplanting the roots into the field in spring, a seed generation may be produced every year. (2) The beets must have reached a minimum stage of maturity at transplanting time, otherwise many may fail to produce seed. (3) Storage for one month in a cellar before transplanting failed to give any observable benefit.