Clinical aspects of acid-base disorders]

Acid-base disorders are frequently recognized in a wide variety of clinical settings such as severe systemic hospitalized patients. The principal object is to assessment of acid-base equilibrium and to obtain an appropriate guide to therapy. The approach is centered to a systemic analysis of blood gas evaluation. To establish this complex matter is followed. Is an acid-base disorder present? Is the disorder a simple or a mixed abnormality? What is the primary cause? These evaluations should be obtained by accurate history taking, physical examination, and routine laboratory tests. In addition, the supporting analysises such as anion gap (AG) calculation, urine AG assessment, urine chloride concentration and so on are also useful for correct diagnosis. In view of the complexty and difficult expression of acid-base disorders, it is desirable that clinicians must have full knowledges of systemic approach to the blood gas analysis and its evaluation.     

Clinical judgment and affective disorders.

Addresses 3 limitations of previous work on counselor clinical judgment by the 1st author et al (see record 1983-11141-001) and R. F. Haase et al (see record 1983-26503-001). Results of the study of 20 practicing counselors suggest that the judgment process used by experienced counselors to make diagnoses of affective disorders differs depending on the type of diagnostic judgment and that attributions may play a role in at least certain types of judgments. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lithium effects on magnesium, calcium, and phosphate metabolism in rats

Rats were treated with lithium chloride for 8 weeks. At the last day of lithium administration, the animals were given radioactive calcium, magnesium, and phosphate. Electrolyte content and radioactivity were determined in serum, bone, muscle, liver and brain. Lithium led to an increase of inorganic phosphate in muscle and a decrease in serum. Uptake of radioactive phosphate was increased in muscle and liver but reduced in bone. The amount of magnesium in muscle and serum was increased in the lithium-treated rats, whereas the uptake of radioactive magnesium into bone was decreased. Uptake of radioactive calcium into bone was reduced, and radioactive calcium in serum was increased after lithium.     

Clinical epidemiology of endocrine disorders in the elderly

Many epidemiologic studies have examined age-related processes in humans. Some of the difficulties with these studies are noted. Endocrinologic changes of aging often are compensated for by feedback mechanisms and do not cause dysfunction. Common aging changes are reviewed.     

Clinical types of memory disorders and their diagnosis

Three major types of amnesia, i.e. selective deficit of memory formation without disturbance of immediate memory have been recognized clinically. The hippocampal type is characterized by relatively short retrograde amnesia and preserved insight into his own amnesic trouble. Persistent amnesia is always associated with bilateral lesion. The diencephalon type usually shows longer retrograde amnesia and poor insight. Unilateral lesion is usually modal in deficit, i.e. verbal in the left and non-verbal in the right, and lacks clear evidence of retrograde amnesia. Responsible locus within the thalamus is still controversial. Our experience point to the mammilothalamic tract. The basal forebrain type is characterized by disorganized and confused recollection of the memorized items. Cued recall is fair compared to voluntary recall. Two special types of amnesic syndrome, i.e. transient global amnesia and isolated focal retrograde amnesia are also important clinical entities, although their etiologies and responsible lesions are not clear yet.     

Secondary disorders of lipid metabolism, metabolic syndrome and familial combined hyperlipidemia

Secondary hyperlipoproteinemias are found in connection with other primary organic diseases. Typical examples are those seen with diabetes mellitus, liver and kidney diseases. In addition there are changes induced by hormonal dysfunctions such as hypothyroidism, by the use of oral contraceptives or in postmenopausal women. During pregnancy there is a physiological transient increase in lipoproteins. In addition to primary organic diseases there are a number of exogenous factors such as obesity, malnutrition and alcohol abuse causing hyperlipidemia. The relation between hypertension and hyperlipidemia described as familial dyslipidemic hypertension is less well known. Obesity, hypertension, dyslipidemia, hyperuricemia and impaired glucose tolerance are the basic conditions of the metabolic syndrome. Familial combined hyperlipidemia is a genetically determined, dyslipidemic syndrome with a high prevalence among patients with coronary artery disease and stroke. As there are some links between familial combined hyperlipidemia and secondary hyperlipoproteinemias, this disease entity is discussed together in this paper. Familial combined hyperlipidemia is metabolically, genetically and by this on a molecular level closely linked to familial dyslipidemic hypertension as well as the metabolic syndrome. The exact mechanism of this disease is currently unknown.     

Clinical applications of hypnosis to three psychosomatic disorders.

Reviews outcomes and methodological soundness of studies of hypnosis in the treatment of skin disorders, headaches, and asthma. Some studies focused on changing physiological functions, others on increasing insight in their patients, and others on altering patients' perceptions of their symptoms. Methodological weaknesses included lack of control groups, nonrandom assignment of patients to treatment conditions, and confounding of treatment effects or lack of control for placebo effects. Additional weaknesses centered around the use of single outcome measures and the failure to assess the specific roles of mediating variables. Most studies showed positive treatment effects. However, there was equivocal evidence that hypnosis can directly influence autonomic functioning. Hypnosis may be valuable in facilitating one's capacity to gain insight into how one's symptoms developed and are maintained. In addition, hypnotic procedures have resulted in some success when used to indirectly alleviate symptoms by altering how individuals perceive their disorders and how these disorders affect their lives. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical patterns of neuronal migrational disorders and parental consanguinity

The primary metabolite of morphine, morphine-6-beta-glucuronide (M-6-G), is reported to contribute to the effects of morphine. The authors investigated the effects of M-6-G on the central nervous system (CNS) after short-term intravenous (i.v.) administration by employing both electroencephalograph (EEG) power spectra analyses and clinical signs as indicators of opioid effects. Three dosages of M-6-G, one dosage of morphine (bolus 10 mg/70 kg and 3.5 mg/70 kg/hour for 4 hours), a combination of morphine and M-6-G, and placebo were administered to 20 healthy volunteers as i.v. bolus plus i.v. infusion for 4 hours. M-6-G was dosed to produce steady state plasma concentrations that were either identical, 2 times, or 3 times higher than the M-6-G plasma concentrations observed after administration of morphine. The EEG background activity and clinical effects were recorded 3.5 hours after the infusion started. M-6-G failed to produce effects on any of the investigated EEG or clinical parameters at the doses tested. In contrast, morphine produced a significant increase in the alpha 1 and delta power of the EEG. In addition, morphine increased the subjects' ratings of tiredness, sickness, vertigo, and drowsiness, and decreased their level of performance in a tracking task. It was concluded that after short-term i.v. administration, M-6-G does not affect the CNS at the doses tested. Therefore, its contribution to clinical effects of morphine after short-term administration is questionable. The missing CNS effects were probably caused by the slow brain permeability of M-6-G, which in short-term treatment might not attain effective CNS concentrations.