Fenfluramine challenge test in obsessive-compulsive disorder--first results

BACKGROUND: The aim of this study is to evaluate the additional diagnostic significance of immunocytochemical staining of thyreoglobulin (TG) in Fine Needle Aspiration Biopsy (FNAB) of neck lymph-nodes, in patients with a previous history of thyroid carcinoma. METHODS: Twenty-five smears performed by ultrasound-guided FNAB on laterocervical nodes with a 21-23 gauge needle were evaluates. All smears were stained according to Papanicolaou and microscopically examined. RESULTS: Of these 25 smears, 15 were diagnostic and 10 were non diagnostic. Of the 15 diagnostic cases, 10 were positive for metastatic lesions from thyroid neoplasm and the other 4 were classified as reactive lymphoadenitis. One smear for each case was selected for the immunohistochemical stain. All the 10 non-diagnostic cases showed no reaction to thyreoglobulin. Neoplastic cells, from 9 out of 11 cytologically positive smears, expressed thyreoglobulin in the cytoplasm. In one case no reaction was evident and the other one was discarded for technical reasons. In 3 of the 4 cases cytologically classified as lymphoadenitis, immunoreactive thyreoglobulin was not found. In the fourth case, blastic-like cells showed a scanty cytoplasmic rime which was immunoreactive for TG and thus was classified as a metastatic tumour. On this basis, it is suggested that FNAB should be performed routinelly in the diagnostic evaluation of neck masses of unknown origin in patients with a previous history of thyroid neoplasm. CONCLUSIONS: If the FNAB is inconclusive, a second aspiration should be performed while immunoperoxidase stain to evidentiate TG may be an adjuntive diagnostic tool in cytologically negative cases.     

The anterior pituitary response to a gonadotropin-releasing hormone challenge test in normal older reproductive-age women

OBJECTIVE: To assess the pituitary responsiveness to GnRH stimulation of premenopausal women relative to age. DESIGN: Older and younger reproductive-age women underwent the GnRH stimulation test in the early follicular phase of the menstrual cycle. SETTING: Female subjects in an academic research environment. PATIENTS: Women aged 21 to 44 years consisting of normal volunteers and infertility patients. INTERVENTIONS: Gonadotropin-releasing hormone was administered intravenously between days 2 and 4 of the menstrual cycle. Blood samples were collected from -20 minutes before to 120 minutes after administration. MAIN OUTCOME MEASURE: Luteinizing hormone, FSH, inhibin, and E2 levels. RESULTS: No significant difference in baseline values existed between older and younger women with regard to LH, inhibin, and E2, but basal FSH levels were higher in older women. A significantly diminished percent of LH and percent FSH change above baseline occurred 30 minutes after GnRH administration in the older women compared with younger women. No change in inhibin or E2 levels could be detected during the sampling period. CONCLUSIONS: The present study demonstrates marked attenuation of the acute pituitary LH response (sensitivity) to GnRH stimulation in older women when compared with a younger cohort.     

Central serotonergic responsiveness in neurocardiogenic syncope: a clomipramine test challenge

BACKGROUND: Central serotonergic mechanisms appear to participate in the pathogenesis of recurrent neurally mediated syncope. The aim of the study was to investigate the responsiveness of the central serotonergic system by measuring the prolactin and cortisol responses to intravenous administration of the serotonin reuptake inhibitor clomipramine. METHODS AND RESULTS: Twenty subjects free of any medical treatment were tested. Twelve had a history of recurrent syncopal attacks and positive tilt test (patient group, mean age 47+/-18 years, 8 men); 8 subjects without syncope and a negative tilt test result served as control subjects (mean age 49+/-10 years, 5 men). Twenty-five milligrams of clomipramine was administered intravenously within 15 minutes, and blood samples were taken at 0, 15, 30, 45, and 60 minutes. Two days later, a tilt test was performed at 60 degrees for 30 minutes and blood samples were taken at 0, 10, 20, and 30 minutes. During the clomipramine challenge, plasma prolactin levels increased in both groups. The levels at 30 minutes were higher in the patient group compared with the control group (17.3+/-7.2 vs 9.3+/-7.6 ng/mL, P=0.05). Similar results were observed for cortisol at 30 minutes (172+/-15 vs 118+/-21 ng/mL P=0. 04) and at 45 minutes (189+/-20 vs 116+/-23 ng/mL, P=0.03). The tilt test was positive in 8 (67%) out of 12 of the patient group and negative in all control subjects. In the samples taken during the tilt test, significant increases in prolactin and cortisol were observed only in the subjects with positive tilt test results. CONCLUSIONS: Patients with a history of neurocardiogenic syncope show a higher responsiveness of the central serotonergic system to clomipramine challenge. The results support the view that central serotonergic mechanisms are involved in the pathophysiology of the syndrome.     

The challenge of change

To succeed in modern life, you must learn to be comfortable with the inevitability of rapid change. The author presents five keys to the successful management of change.     

The challenge of diabetes

The mucosal biopsies morphological investigation of the lower third of esophagus were conducted for Helicobacter pylori detection in 43 patients with reflux-esophagitis. Helicobacter pylori were detected in 66.7%, gastric metaplasia-in 83.3% of patients. Helicobacter pylori plays an important role in reflux-esophagitis pathogenesis. Surgical treatment is indicated if the combined antireflux and antibacterial therapy is ineffective.     

The challenge of space.

"Who publishes in APA journals? Who edits these publications? Do our journals reflect our membership characteristics? Rarely has one of our journals, during its APA existence, been represented by less than 80% academic editors or academic consulting editors. Our journals reflect a heavy preponderance of academic authorship. Nonacademic authors… are being heard more often, but there remains a lengthy distance to traverse before they achieve proportional representation." Tables indicating (1) academic and nonacademic affiliations of APA membership from 4 APA yr. books; (2) affiliations of editors, authors of articles and of total APA membership; and (3) academic and nonacademic authorships by journal between 1925 and 1957 are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Asthma. The states'' challenge

A brief overview of the theory of corrosion and the formation of galvanic couples is presented, followed by a discussion of the metals and alloys used in the fabrication of orthodontic appliances and devices. Attention is paid to the factors that contribute to establishment of corrosion cells in the mouth. Although oral corrosion generally does not cause significant destruction of metal, it can elicit in patients adverse physiological responses such as local irritation and metal hypersensitivity. There are indications that orthodontic treatment may lower the incidence of nickel hypersensitivity. Destructive attack on orthodontic appliances does occur, however, when certain types of denture cleanser are used to clean appliances that contain soldered joints.     

The challenge of sociobiology.

Challenges S. L. Washburn's (see record 1979-12215-001) criticism of the suggestion of E. O. Wilson et al (1976) that sociobiology has important implications for social scientists by arguing that such a focus does not have to mean a recurrence of social Darwinism, eugenics, and racism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The desensitization of oxytocin receptors in human myometrial cells is accompanied by down-regulation of oxytocin receptor messenger RNA

Clinicians providing care to elderly patients must appreciate the subtle clinical manifestations that herald the onset of life-threatening infectious disease. Aged patients with an infection may have neither fever nor leucocytosis, making diagnosis challenging. Often, the early features of infectious disease are nonspecific and may resemble inflammatory or neoplastic processes, or there may be insufficient time to await definitive laboratory confirmation, and empirical antimicrobial treatment must be initiated. Aging involves inevitable deleterious alterations in biological processes and, in many elderly patients, this is most strongly characterised by diminished renal functional capacity. This has a major influence on antimicrobial prescribing in the elderly, because therapeutic efficacy must be achieved while minimising the risk of drug-related toxicity. Before prescribing an antibiotic to an aged patient with an infection, the clinician must be cognisant of the patient's drug allergy history and the other drugs that the patient is taking. Ignorance of potential drug-drug interactions can result in ineffective treatment or enhanced toxicity. The therapy of elderly patients with infections is being expanded. To reduce costs and enhance the efficiency of care, systems have been developed to provide antimicrobial care in the home and in long term care facilities. Home healthcare has burgeoned, and drugs that are well tolerated, have a broad spectrum of activity and are simple to administer (e.g. ceftriaxone and fluoroquinolones) appear to be eminently suitable for this therapeutic role. Physicians must also be informed of the factors responsible for the emergence of resistant bacteria that are contributing to infections in institutional and community settings. Clinicians should strive to curb inappropriate antibiotic use to stem the tide of infections that are caused by multidrug-resistant bacteria.     

Prediction of depressive relapse in remitted bipolar patients using corticotrophin-releasing hormone challenge test

Effects of respiratory tract obstructions on ventilatory mechanics in horses exercising at high speeds were tested with a fibreglass replica of the airways (nares to mainstem bronchi) of an adult horse. Segmental pressures were recorded at six sites along the model at four different unidirectional flows (1300-4100 litre min-1), and the respective resistances (R) to airflow were calculated. The external nares and the larynx made the greatest contributions to the total resistance (RTOT) when no obstruction was present. Modifying the model to simulate severe pharyngeal lymphoid hyperplasia (PLH) had no effect on R at the larynx or at any point in the trachea under these flow conditions. Two 16 litre anaesthetic rebreathing bags were attached to the bronchial end of the model, and tidal ventilation generated by a piston pump. Upper (nares to pharynx) and lower tract R (RU and RL) and RTOT, and dynamic compliance were determined for pump volumes (Vp) of six and 12 litres, at pumping frequencies (fp) of 20-100 min-1 while the airway was clear, and after modifying it to simulate either PLH or partial bronchial obstruction. Model condition had no effect on RU. However, RL and RTOT were higher in the PLH simulated condition when fp > or = 90 and Vp = 12 litres (P < 0.05). This suggested that severe PLH may significantly interfere with airflow distal to the site of the lesions during high frequency high volume ventilation of the type seen in galloping horses. With partial bronchial obstruction RL and RTOT were increased when fp > 34 with each Vp. The applicability of the model was verified by comparing results from the unobstructed state with those from normal horses exercising on a treadmill.     

The filmless hospital--a legal challenge]

Rapid inactivation of voltage-gated K+ (Kv) channels is mediated by an N-terminal domain (inactivating ball domain) which blocks the open channel from the cytoplasmic side. Inactivating ball domains of various Kv channels are also biologically active when synthesized separately and added as a peptide to the solution. Synthetic inactivating ball domains from different Kv channels with hardly any sequence homology mediate quite similar effects even on unrelated Kv channel subtypes whose inactivation domain has been deleted. The solution structure of the inactivating ball peptide from Shaker (Sh-P22) was analyzed with NMR spectroscopy. The NMR data indicate a non-random structure in an aqueous environment. However, while other inactivating ball peptides showed well-defined three-dimensional structures under these conditions, Sh-P22 does not have a unique, compactly folded structure in solution.     

The challenge of managing unstable angina

Neisseria elongata ssp. nitroreducens, a commensal of the human upper respiratory tract, is a newly recognized cause of endocarditis. We report the isolation of the organism from blood cultures of a 30-y-old man with hypertrophic obstructive cardiomyopathy. The patient was successfully treated with benzylpenicillin and netilmicin in combination, followed by ceftriaxone and amoxicillin.     

The challenge of Alzheimer's disease.

Discusses, using the case of a 73-yr-old female with Alzheimer's disease, the complexity of the challenge of Alzheimer's disease (e.g., difficulty of diagnosis, treatment of the patient and his/her family) and the multi-disciplinary effort underway at the National Institute of Mental Health to meet the challenge. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Homosexuality: The ethical challenge.

Suggests that behavior therapists have not attended sufficiently to the factors influencing the desire of some homosexuals to change their sexual orientation. Therapists of all persuasions too often make decisions for their voluntary clients. A perusal of the psychotherapy and behavior therapy literature indicates that therapists generally regard homosexuality as undesirable, if not pathological. Since professionals are unlikely to work on treatment procedures unless they see a problem, it is probable that the very existence of change-of-orientation programs strengthens societal prejudices against homosexuality and contributes to the self-hate and embarrassment that are determinants of the "voluntary" desire by some homosexuals to become heterosexual. A proposal is made that therapists stop offering help to homosexuals to change their sexual orientation and concentrate instead on improving the quality of their interpersonal relationships. Alternatively, more energy could be devoted to sexual enhancement procedures in general, regardless of the adult gender mix. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The nature of receptor binding of oxytocin in myometrial tissue

The dissociation course of the hormone receptor complexes of rat myometrial oxytocin receptors was studied. The dissociation course was biphasic with a major component displaying an almost irreversible binding character (time constant 0.003 min-1). This irreversibility was independent of hormonal status of the myometrium as well as the type of divalent cation present in the medium, and was not caused by endocytosis of the receptor. However, as addition of EDTA caused an immediate dissociation of all receptor binding, the irreversibility must be of a non-covalent character. It is suggested that new analysis methods for receptor kinetics including the possibility of partly irreversible binding mechanisms should be considered.