Inhaled nitric oxide, right ventricular efficiency, and pulmonary vascular mechanics: selective vasodilation of small pulmonary vessels during hypoxic pulmonary vasoconstriction

OBJECTIVE: In the setting of acute pulmonary artery hypertension, techniques to reduce right ventricular energy requirements may ameliorate cardiac failure and reduce morbidity and mortality. Inhaled nitric oxide, a selective pulmonary vasodilator, may be effective in the treatment of pulmonary artery hypertension, but its effects on cardiopulmonary interactions are poorly understood. METHODS: We therefore developed a model of hypoxic pulmonary vasoconstriction that mimics the clinical syndrome of acute pulmonary hypertension. Inhaled nitric oxide was administered in concentrations of 20, 40, and 80 ppm. RESULTS: During hypoxic pulmonary vasoconstriction, the administration of nitric oxide resulted in a significant improvement in pulmonary vascular mechanics and a reduction in right ventricular afterload. These improvements were a result of selective vasodilation of small pulmonary vessels and more efficient blood flow through the pulmonary vascular bed (improved transpulmonary vascular efficiency). The right ventricular total power output diminished during the inhalation of nitric oxide, indicating a reduction in right ventricular energy requirements. The net result of nitric oxide administration was an increase in right ventricular efficiency. CONCLUSION: These data suggest that nitric oxide may be beneficial to the failing right ventricle by improving pulmonary vascular mechanics and right ventricular efficiency.     

Psychologists in medical schools.

Describes developments at a medical school on which H. A. Witkin et al (1972) based their article on approaches to the problem of autonomous organization and function of psychologists in medical schools. The Rush-Presbyterian-St. Luke's Medical Center established the Department of Psychology and Sciences of Society. The Department is independent and autonomous; it embraces all psychologists and social scientists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of mental health services provided by HMOs.

Surveyed 145 US health maintenance organizations (HMOs) to determine outpatient mental health services offered, psychologists and other providers used, and practices followed in offering such services. Results show that basic assessment and intervention modalities were available to almost all HMO members. Health education programs (weight control, smoking control, and stress adaptation) were not as broadly available as were the more traditional mental health efforts. Almost all HMOs utilized psychologists as providers, either as employees or consultants; subdoctoral qualifications for employment were accepted by one-fifth of the plans. In most plans, physicians referred patients for psychological services. HMOs based on individual practice association models offered fewer services than either group or staff models. The level of mental health service required for federal qualification is exceeded by plans enrolling 82% of all members. Data did not support the argument that requiring mental health services results in forcing both services and costs upward. It is concluded that the current rate of HMO growth will not provide large numbers of additional jobs for psychologists. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In vitro and in vivo analysis of antide delivery from multi-phase microspheres fabricated via solvent removal

Antide, a gonadotropin releasing hormone (GnRH) antagonist, has been studied as a new drug for treatment of various gonadotropin-dependent disorders, including hormone-dependent prostate and breast cancer. Antide was encapsulated into multi-phase microspheres composed of poly(l-lactic)acid (PLLA) and poly(fumaric-co-sebacic)anhydride (P(FA:SA)) fabricated via solvent removal and loaded at 5% and 20% (w/w). In vitro release kinetics and the in vivo therapeutic effect (changes in the testosterone levels) were evaluated. In vivo studies were conducted in male rats at a dose of 12.5 mg antide/kg for both the 5% and 20% loaded particles as well as 31.5 mg antide/kg for the 20% loaded particles. The 5% loaded particles achieved a decrease in testosterone levels below the castration level (0.5 ng/mL) over the course of 11 weeks. The 20% loaded particles resulted in testosterone levels below the castration level for 7 weeks. The results of these studies demonstrate that it is possible to encapsulate antide into a controlled delivery system for more than 2 months. Furthermore, we were able to achieve a therapeutic response in vivo indicated by serum testosterone levels below the castration level of 0.5 ng/mL for at least 11 weeks.     

Mental health services in health maintenance organizations: Implications for psychology.

Contends that roles for psychologists in health maintenance organizations (HMOs) are affected by the nature of HMOs, economic considerations, standards set by federal legislation, claims for the cost-effectiveness of mental health services, and the federal administration's goal of removing mental health services from those required in law. Legislation is not precise concerning the nature or extent of mandated mental health services, and administrative interpretation of this legislation encourages considerable latitude in services provided. Studies do not support arguments for mental health services on the basis of their claimed cost-offset effects as strongly as one might wish. It is concluded that if psychologists are to establish areas of unique worth to HMOs, they may have to do so by adding contributions other than traditional clinical services to meet the need structure of HMOs. Possible ways of doing this are discussed, drawing on contributions that are developing in the field of behavioral health and relating these contributions to the prime purposes of HMOs. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comment on "Bender Gestalt Discernment of organic pathology."

Bender Gestalt (BG) literature, reviewed by Billingslea (1963), leads to ambiguity concerning the usefulness of BG in discerning organic brain pathology. Some ambiguity seems to stem from inadequate realization by many authors of the importance of locus of brain pathology in selecting Ss and interpreting results. Also, much BG work involving recall seems unrealistically simplified in its view of memory, leading to faulty design and contradictory results. This note reviews knowledge of parietal lobe function necessary to thoughtful BG study and cites findings which cast doubt on some assumptions underlying recall methods used in BG studies. Implications bearing on diagnostic interpretations of BG results are discussed. (27 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)