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Biomedical subjects

R Durst

Publications and source records attributed to R Durst.

At least 55 records · Page 3Linked to original sources
PubMed1996

Elevation of serum creatine phosphokinase and its MB isoenzyme during normal labor and early puerperium.

BACKGROUND: Chest pain or discomfort are infrequent complaints among women during labor and early puerperium, but when present they raise the suspicion of myocardial ischemia. The diagnosis of the latter is based upon serum elevatIon of certain enzymes, such as aspartate amino transferase, lactate dehydrogenase and creatine phosphokinase. Nevertheless, the normal patterns of these enzymes in the serum during labor and early puerperium have not been characterized well. OBJECTIVE: To determine serum creatine phosphokinase, lactate dehydrogenase and aspartate amino transferase levels in late pregnancy, and throughout labor and early puerperium. METHODS: Fifty women having normal pregnancies followed by uneventful vaginal deliveries were prospectively studied for serum lactate dehydrogenase, aspartate amino transferase and creatine phosphokinase including its MB isoenzyme before, during and after labor. Cardiac status was evaluated in all women using serial electrocardiographic and physical examinations. RESULTS: All women were found to have low to normal antepartum serum enzymes levels. However, during labor total creatine phosphokinase increased markedly, reaching a peak of 2-4 fold baseline levels 24 hours postpartum. It then declined gradually back to baseline. Nulliparous women reached substantially higher levels than multiparous women. The MB or so-called cardio-specific isoenzyme was found to be an important contributor to creatine phosphokinase surge in most women. Correlation was demonstrated between length of the active phase of labor and both total and MB creatine phosphokinase activity. There was no clinical or electrocardiographic evidence for cardiac muscle damage in any of the study patients. Serum lactate dehydrogenase and aspartate amino transferase were not altered during or after labor. CONCLUSIONS: Serum total creatine phosphokinase and its MB isoenzyme increase substantially during normal vaginal labor without evidence of myocardial ischemia. The uterus and placenta, two organs which were reported to embody substantial amounts of these enzymes, and which participate actively in the process of labor, are thought to release these enzymes to the circulation during labor. Knowing the normal patterns of these enzymes in the serum during labor and puerperium may prevent erroneous diagnoses of myocardial ischemia or infarction. Lack of electrocardiographic abnormalities and low lactate dehydrogenase and aspartate amino transferase levels may assist in excluding such diagnoses.

Aspartate Aminotransferases↗
PubMed1996

Transculturation, psychosis and koro symptoms.

Koro is a clinical syndrome characterized by the conviction of penile retraction and fear of inevitable death upon its disappearance into the abdomen. The syndrome is generally considered culture bound, yet an increasing number of sporadic cases were attributed to psychiatric, systemic or neurologic pathology. In the following article, sporadic koro cases associated with paranoid psychosis or schizophrenia have been assembled, indicating that immigration is an important factor in the pathogenesis of the clinical phenomenon. The interplay between psychosis, transculturation and cultural influence affecting koro development is discussed.

Adult↗
PubMed1996

Jacob--the case of a serial killer.

This paper describes a rare forensic psychiatric syndrome which has been the subject of massive publicity in the last decade. Despite the widespread interest, the psychodynamic process whereby a person becomes a serial murderer remains largely unknown. "Jacob" was convicted of a series of murders that he carried out over a decade. The case material is based on the psychiatric reports that were presented to the court and the many articles published in the local press at the time. Despite the limitations imposed by the material, the available information on "Jacob" bears some similarity to the phenomenological and psychodynamic models described in the literature. An attempt is made to understand the transformation of a person into a serial killer considering the life events, psychopathology and stressors that lead to the emergence from the world of imagination and fantasy of a potential murderer to the deeds that comprise the syndrome.

Adult↗
PubMed1995

The koro (genital retraction) syndrome and its association with infertility: a case report.

The koro syndrome is a psychiatric disorder characterized by acute anxiety and a deep-seated fear of shrinkage of the penis and its ultimate retraction into the abdomen, which will cause death. Concurrence of the koro (genital retraction) syndrome with a pathological condition of the urogenital system has rarely been described. We report a case of koro associated with infertility. Within 3 weeks of treatment with haloperidol the classic symptoms of koro disappeared. To our knowledge this case represents the sixth report of the koro syndrome associated with urogenital pathology and the first report of its association with infertility.

Adult↗
PubMed1994

Phenothiazine-associated supraventricular tachycardia.

Psychotropic medications, mainly phenothiazines, are known to be associated with cardiac insult. The case report presented here describes nearly fatal arrhythmia (sustained supraventricular tachycardia) consequent to phenothiazine treatment. The authors aim to alert psychiatrists to the possible adverse, and even fatal, effects of phenothiazines.

Adult↗
PubMed1994

[Lithium-associated psoriasis].

A number of medications including clonidine, digoxin and beta-blockers have been reported to cause psoriasis. Lithium has also been implicated especially among women. We describe a 45-year-old man who developed diffuse psoriatic lesions 1 year after treatment with lithium was started. Various topical dermatological preparations failed to alleviate the lesions. Several weeks after discontinuation of lithium the psoriasis resolved. We discuss the possible mechanisms for lithium-associated psoriasis and alert clinicians to the possibility of this troublesome side-effect in lithium-treated patients, with or without a family history of psoriasis.

Humans↗
PubMed1993

[Koro syndrome--clinical and cultural aspects].

Koro syndrome is a triad which includes a deep-seated fear that the penis will shrink, disappear into the abdomen, and that death will follow. The patient experiences profound anxiety and performs preventive manoeuvres, such as pulling his penis outward. The disorder is considered culture-related, and is endemic in South-East Asia and China, where it occurs in epidemic and sporadic forms. Sporadic cases appear in the western hemisphere, often in association with an underlying psychiatric or organic disorder, usually of the central nervous system. 6 cases of koro have been published from Israel.

Adult↗
PubMed1993

Idiopathic unconjugated hyperbilirubinemia (Gilbert's syndrome) and concurrent psychotropic drug administration.

Gilbert's Syndrome is a benign familial condition in which unconjugated hyperbilirubinemia occurs in the absence of structural liver disease or hemolysis. Phenothiazines and tricyclic medications are often withheld in patients with preexisting liver disease. The authors present four patients with Gilbert's Syndrome and concurrent psychiatric illness. Administration of phenothiazine antipsychotics or tricyclic antidepressants proved beneficial and produced no adverse effects on hepatic function. The authors discuss clinical aspects of Gilbert's Syndrome in psychiatric patients and conclude that phenothiazine antipsychotic medication should not necessarily be withheld from these patients.

Adult↗
PubMed1993

Platelet dysfunction associated with clozapine therapy.

Clozapine, an atypical antipsychotic agent used in cases of treatment-resistant schizophrenia, is known for its relative absence of extrapyramidal side effects and its potential hazardous effect on white blood cell function. We have described a case of clozapine-associated epistaxis and reduction of the platelet count. Discontinuance of clozapine therapy resulted in cessation of epistaxis followed by normalization of the platelet count. We suggest routine monitoring of platelet count and function in patients treated with clozapine.

Amobarbital↗
PubMed1993

A chronic hypercoagulable state and life-long platelet activation in beta thalassemia major.

Increased frequency of thromboembolic events has been recently observed in patients with thalassemia major (TM), causing hypoxemia and cor pulmonale. Autopsy findings demonstrated "old" and recent pulmonary and renal infarcts as well as premature atherosclerosis. Studies to determine hypercoagulability showed: impaired platelet aggregation, increased circulating platelet aggregates, shortened platelet survival, enhanced excretion of urinary metabolites of thromboxane A2 (TXA2) and prostacyclin and decreased plasma levels of Protein C, Protein S or anti-thrombin III. Erythrocytes from TM patients enhanced thrombin formation in a "prothrombinase" assay (using a chromogenic substrate). Chronic anti-thrombotic therapy may be indicated in thalassemic patients to prevent the cardiac and pulmonary complications.

Blood Platelet Disorders↗
PubMed1993

'Brain-fag' syndrome: manifestation of transculturation in an Ethiopian Jewish immigrant.

All cultures have a cognitive map characterizing their people and comprising a framework of orientation values, knowledge, beliefs, and verbal and nonverbal language. In countries such as Israel, where the population constantly varies due to immigration, the cultural framework continuously shifts as it adapts itself to transculturation. The cultural clash is more conspicuous in the field of health where the therapeutic encounter emphasizes the differences between the therapist and the patient. We present a patient who showed a clinical picture of "brain-fag." Ethiopians refer to the brain-fag syndrome as "overworking of the head" due to the strain of studying. Prince, who first described the syndrome in Nigerian students and characterized its symptoms, emphasized that it stems from a cultural clash between African and Western civilizations. Immigration and acculturation, which Ethiopian Jews face, force them to neglect their social and cultural customs and duties or to synthesize them with the new cultural values. A classification of the different types of suicide attempts according to Durkheim (altruistic, anomic & egoistic) and Hollan (indignant) as well as a description of mourning rites and customs of Ethiopian Jewry, and discussion of the brain-fag syndrome unknown to the local mental health system are presented by means of a case illustration. Understanding the phases of ethnic group rituals and clinical syndromes, such as brain-fag, can smooth the absorption process of Ethiopian Jews in Israel, throw light on difficulties immigrants encounter, and facilitate understanding by the absorbing society.

Acculturation↗
PubMed1993

The criminal liability of the mental patient in Jewish law (Halacha).

The legal status of the mentally impaired has been dealt with in Halachic literature since the third century. This article presents four Halachic viewpoints regarding the exemption of the mentally ill patient from legal responsibility in tort and criminal law: lack of mental awareness; lack of free will; lack of judgment; categorial personal status. Halachic legislations with regard to the liability of the insane predate the criteria as applied by modern psychiatry. The similarities between the Halachic and contemporary medicolegal approaches are presented.

Bible↗
PubMed1993

A look at court appointed psychiatric evaluations in Israel with special reference to criminal liability.

This article presents the data collected from 128 court appointed psychiatric evaluations (CAPEs) and their analysis. Issues addressed are: the link between type of criminal offence and mental disorder; rate of recidivism; efficacy of the early detection and follow-up systems; inherent psychiatric dilemmas; unacceptable lacuna in information recorded in the CAPEs; and the babel of legal and psychiatric terms. We advocate that a combined effort be made by the legal and psychiatric fraternities to create a uniform and standardized CAPE.

Adolescent↗
PubMed1991

Propranolol in the treatment of akathisia caused by antipsychotic drugs.

We have reported the case of a patient with neuroleptic-induced akathisia who had rapid amelioration of his symptoms after treatment with the highly lipophilic beta-blocker propranolol. His symptoms had previously failed to respond to traditional pharmacologic treatment. There is clearly a need for more double-blind studies to assess the efficacy of propranolol and other beta-blockers in the treatment of this troublesome side effect of antipsychotic medications.

Adult↗
PubMed1991

Serum melatonin levels in schizophrenic and schizoaffective hospitalized patients.

Conflicting results on changes of the diurnal melatonin rhythms of patients with affective disorders have been reported in the literature. The heterogeneous data may derive from the great discrepancy in the diagnostic criteria of different authors. A study of 12 schizoaffective and chronic schizophrenic psychotic patients found a constant pattern of an obliterated nocturnal melatonin rise only in the latter group. The presence or absence of the nocturnal melatonin rise was determined in drug-free hospitalized patients and remained unchanged despite 2 months of drug treatment including large doses of neuroleptics. This finding, when confirmed in a larger number of patients, could possibly serve as a marker for the type of mental disorder, drug to be applied and response expected.

Adult↗