Biomedical subjects
Publications and source records attributed to C Weiner.
The authors report a 34-year-old woman with a history of extensive cocaine abuse who developed choreodystonic dyskinesias and an obsessive-compulsive behavior disorder. The abnormal movements and behavior disorder persisted after a 20-month cocaine-free period.
The frontal and temporal lobes have been implicated as pathogenic sites for schizophrenia, although there is a marked heterogeneity of brain function and structure between individual patients. It is currently unclear whether some patients with schizophrenia exhibit primarily frontal lobe dysfunction, while others exhibit primarily temporal-lobe dysfunction. The current investigation examined this issue in a preliminary way by using neurocognitive tests to discriminate test performances of patients with schizophrenia from patients without schizophrenia who had definitive neurological evidence of either frontal- or temporal-lobe dysfunction. Of the patients with schizophrenia, 20.7% were classified as having a frontal lobe dysfunction profile, while 19.3% had a temporal lobe dysfunction profile. Results further clarify neurobiological heterogeneity in schizophrenia by demonstrating that a substantial number of patients with schizophrenia exhibit either primarily frontal- or temporal-lobe dysfunction. Results may partially explain the inadequacy of neurobiological models for schizophrenia that do not consider these differential patterns of dysfunction.
The purpose of this study was to examine the factors that make for 'successful aging'. In particular, we examined the relationship between the degree of religious or traditional observance on overall life satisfaction, health, function, and activity of an elderly population. The subjects chosen were aged from 68 to 75 and were divided into two groups: 37 percent were traditionally observant ('traditional') and 67 percent religiously observant ('religious'). Overall the sociodemographic features of both groups were similar. The results of the study did show, however, that the most significant factors in influencing the subjects' life satisfaction were religiosity and functional adequacy. Our conclusions from these findings indicate that the religious observant elderly person, who is religiously active, retains a social status that earns him respect because of this activity. This status even provides him with a source of power in his social group, as a result of which he functions more effectively and is more satisfied with life.
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We report the prevalence of aborted suicide attempts in which the essential characteristics are (i) intent to kill oneself (ii) a change of mind before making an actual suicide attempt and (iii) the absence of physical injury. The lifetime history of aborted suicide attempts was assessed by semi-structured interview of 733 patients, aged 18-59 years, who were consecutively admitted to a psychiatric hospital. In the study group, 46% of subjects had made a suicide attempt and 29% had made at least one aborted attempt during their lifetime. Subjects who had made aborted attempts were more likely to have made actual attempts. Approximately 11% of the subjects in the study group had a history of aborted attempts of potential high lethality, such as going to a height in order to jump, or holding a gun to the head. There were no major demographic differences between those with and without a history of aborted attempts. However, among those with no prior history of actual attempts, subjects with depression and a family history of suicide were more than twice as likely as those without such a history to have made an aborted attempt. Aborted suicide attempts are a common suicidal behaviour among psychiatric in-patients. Whether they predict actual attempts or suicide warrants prospective investigation.
OBJECTIVE: The authors determined the rates and patterns of violence toward persons by psychiatric patients before admission to the inpatient service of the Payne Whitney Clinic and determined which factors were associated with a greater risk of violence. METHOD: During hospitalization, 763 patients were interviewed by a research assistant using a structured interview instrument. The interviewer inquired about demographic and socioeconomic information and about history of violence and alcohol and drug use. RESULTS: Having physically attacked another person in the month before admission was equally likely among male (13.6%) and female (14.7%) patients. The patterns of violence were similar for men and women in terms of target, severity of injuries, use of a weapon, and place of occurrence. Univariate analyses showed that only youth was associated with violence for male patients, while youth, low socioeconomic status, substance abuse, and axis II pathology were associated with a greater risk of violence for female patients. Logistic regression analyses showed that recent cocaine use was significantly associated with violence by female patients when age, socioeconomic status, and axis II pathology were controlled for. For male patients, recent heroin use was related to a greater risk of violence. CONCLUSIONS: The frequency of violence by female patients was 150% higher than it was in a study at the Payne Whitney Clinic a decade ago. The frequency of violence by male patients was 50% higher than it was a decade ago. In the current study, substance abuse was associated with greater risk of violence by patients.
Medical fetal therapy describes any therapy in which a pharmacological agent is administered to a woman or her fetus in order to avoid or alleviate fetal disease. Treatment of the fetus with blood products or injection of other agents can also be considered to be medical fetal therapy. This chapter reviewed the application of medical fetal therapy to the prevention of NTDs, treatment of endocrinological and metabolic disorders, such as CAH, thyroid disease and others, and the medical management of cardiac arrhythmias. Several haematological disorders and reviews of recent advances in genetic manipulation involving the use of stem-cell implantation were discussed. The field of medical fetal therapy has been extremely exciting and continues to evolve at a rapid pace. No doubt, future advances involving genetic manipulation or the use of molecular genetic techniques for diagnosis will continue to keep this field at the forefront of treatment and prevention of fetal disorders.
OBJECTIVE: Several studies suggest that a low cholesterol concentration is associated with a greater than normal risk of mortality from suicide. The authors sought to determine whether a low cholesterol level is associated with a history of serious suicide attempts among psychiatric inpatients. METHOD: Lifetime history of attempted suicide of 650 patients, aged 18-59 years, consecutively admitted to a psychiatric hospital was assessed by semistructured interview. The seriousness of an attempt was rated on the basis of the resulting medical injury. Serum cholesterol levels, obtained from the admission biochemical profiles, were divided into quartiles. RESULTS: Compared to men with low cholesterol levels (defined as less than or equal to the 25th percentile), men with cholesterol levels above the 25th percentile were less likely to have ever made a serious suicide attempt when age, weight, race, socioeconomic status, alcohol use, and depression were controlled for. There was no association between cholesterol level and attempted suicide in women. CONCLUSIONS: Male psychiatric patients with low cholesterol levels were twice as likely to have ever made a medically serious suicide attempt than men with cholesterol levels above the 25th percentile. Low cholesterol concentration should be further investigated as a potential biological marker of suicide risk.
Increased hypoxia has been found after beta 2 adrenoceptor agonists (but not adrenaline) in asthmatics. Combined with hypokalaemia and sympathomimetic stimulation, this may predispose to cardiac arrhythmias. We have compared the effects of nebulized adrenaline and a selective beta 2 agonist (salbutamol) on the arterial oxygen saturation (SaO2), minute ventilation (VE), forced expiratory volume in 1 s (FEV1), plasma potassium and the electrocardiogram (ECG) in patients with chronic stable asthma. Six patients were studied according to a randomized, placebo-controlled, double-blind cross-over protocol. Adrenaline (5 mg), salbutamol (5 mg) and placebo were administered during 4 min tidal breathing using a nebulizer driven by air. There was a fall in SaO2 after both adrenaline (mean % fall (SEM) 3.3 (0.2)) and salbutamol (4.0 (0.7)) associated with an increase in FEV1, with no change in VE. Therefore, the fall in SaO2 must have been caused by increased ventilation-perfusion imbalance. There was an increased heart rate after both adrenaline and salbutamol and ventricular ectopic beats and a short run of parasystole were recorded on the ECG in one patient after adrenaline and in two patients after salbutamol. No change was found in plasma potassium levels. We conclude that both adrenaline and a selective beta 2 agonist salbutamol can cause a fall in SaO2 and ventricular ectopy in some asthmatic patients.
Fetal therapy continues to be an exciting yet controversial field. In utero treatment of a variety of fetal conditions is discussed: parvovirus B19 infection, fetal thyroid dysfunction, fetal ovarian cysts, twin-twin transfusion syndrome, and fetal hemolytic disease. Fetal surgery continues to be controversial. Despite considerable publicity, fetal surgery appears to be rarely, if ever, truly indicated. A new area of fetal therapy, ie, antenatal transplantation of fetal liver stem cells, is discussed.
During pregnancy, vascular reactivity of the uterine artery is characterized by decreased contraction to norepinephrine and increased relaxation to acetylcholine. We investigated whether 1) relaxation to A23187 is increased during pregnancy and 2) endothelium-derived relaxing factor (EDRF) and/or prostaglandins are responsible for the decreased uterine artery sensitivity to norepinephrine during pregnancy. Isolated rings of uterine and carotid arteries were obtained from pregnant and nonpregnant guinea pigs. Relaxation to sodium nitroprusside in uterine but not carotid artery was reduced during pregnancy. Relaxation of both uterine and carotid arteries to the calcium ionophore A23187 was unaffected by pregnancy. During pregnancy, contractions to norepinephrine were reduced in the uterine artery compared with arteries from nonpregnant animals. Indomethacin slightly enhanced the contractions of uterine artery to norepinephrine during pregnancy. However, indomethacin-treated uterine arteries from pregnant animals were still less responsive to norepinephrine than control uterine arteries from nonpregnant animals. Methylene blue enhanced the efficacy of norepinephrine in uterine arteries of nonpregnant animals as well as carotid arteries of pregnant and nonpregnant animals but not in uterine arteries of pregnant animals. In contrast, N-monomethyl-L-arginine, a specific inhibitor of EDRF synthesis, not only enhanced uterine and carotid artery responses to norepinephrine in both pregnant and nonpregnant animals but fully reversed the blunted potency of norepinephrine on uterine arteries of pregnant to that of nonpregnant animals.(ABSTRACT TRUNCATED AT 250 WORDS)
Nonimmune hydrops secondary to atraumatic, massive fetomaternal hemorrhage was diagnosed at 33.5 weeks' gestation by a maternal Kleihauer-Betke stain, confirmed by funipuncture. The initial fetal hematocrit was 6.5%. Kleihauer-Betke testing revealed a fetomaternal hemorrhage of approximately 230 mL. Fetal karyotype, total immunoglobulin M, and liver function tests were normal. Maternal parvovirus serology was negative. Treatment with two fetal intravascular transfusions provided only transient improvement because the fetomaternal hemorrhage proved to be unrelenting.
We describe a new low-frequency antigen as the cause of immune hydrops fetalis in a fetus presenting at 27 weeks with a hematocrit of 6%. The fetus was treated successfully by intravascular transfusion. This antigen, temporarily identified as HJK, has been detected in only one family.
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We investigated the affect of cordocentesis (n = 36) and intravascular transfusion (n = 14) performed with a fixed needle guide on maternal serum alpha-fetoprotein levels. In 50% of the procedures, the placenta was anterior and punctured. For all patients, maternal serum alpha-fetoprotein levels rose 70.8% +/- 28%. The magnitude of the rise was unrelated to the number of attempts necessary, gestational age, or the initial maternal serum alpha-fetoprotein levels concentration. The location of the placenta was the sole identified variable related to the rise. A total of 44% of the patients had a significant increase in maternal serum alpha-fetoprotein level when the placenta was anterior. In contrast, only 4% of the patients had a significant rise in maternal serum alpha-fetoprotein level when the placenta was other than anterior. There was no difference in the frequency of a significant rise in maternal serum alpha-fetoprotein level concentration between the patients who underwent cordocentesis and those who underwent intravascular transfusion. On the basis of these findings, we recommend that when maternal isoimmunization is a potential concern and the placenta is anterior, the umbilical cord should be approached either through a window or laterally from the placenta.
The relaxation of isolated blood vessels by acetylcholine is dependent on the presence of intact endothelium and its release of a smooth muscle relaxing nitroso-like compound. Pregnancy is associated with altered vascular responsiveness to a variety of agents. Because many of these agents stimulate the release of endothelium-derived relaxing factor, we investigated in vitro the effect of pregnancy on acetylcholine-mediated relaxation of guinea pig uterine and carotid artery rings. The presence of intact and functional endothelium was confirmed both by examination under the scanning electron microscope and by vessel relaxation after the addition of acetylcholine. The addition of acetylcholine to the vessel bath produced dose-dependent relaxation of both carotid and uterine artery segments obtained from pregnant and nonpregnant animals after they had been submaximally preconstricted with phenylephrine. There was a significant increase in both response and efficacy to acetylcholine during pregnancy for both uterine and carotid arteries (p less than 0.0001 for each). The concentrations of endothelial cells (cells per square micrometer) were similar in uterine arteries from pregnant and nonpregnant animals. We conclude that the most likely explanation for these findings is a pregnancy-mediated enhancement of endothelium-derived relaxing factor activity.