Recruitment of institutional psychiatrists for the 50 states

We studied institutional recruitment of non-federal psychiatrists in 1979 as measured by national advertisements. Vacant positions in state mental hospitals and CMHCs are over-represented in the adverts compared to the current institutional distribution of physicians practicing psychiatry. States' per capita recruitment rates vary widely, but do not decrease linearly or exponentially with increasing abundance of psychiatrists. The percentage increase sought in institutional psychiatrists (‘recruitment intensity’), however, does decrease exponentially as institutional psychiatrists/100,000 population increase. Recruitment rates and recruitment intensity are not highly correlated with states' sociodemographic characteristics or with characteristics of their health care systems. Private sector recruitment, however, is significantly higher in states that have mandated psychiatric benefit packages in private insurance. Studies relating institutional recruitment or vacancy rates to measures of local demand for psychiatric services are needed, as well as comparisons of successful versus unsuccessful institutions. Institutional vacancies are undoubtedly affecting the quality of care, compliance with standards for reimbursement and ability to generate third-party revenues. Greater understanding of institutional recruitment is needed.     

The lateral cerebral ventricle in early second trimester

In routine imaging of normal early second trimester pregnancies, one will not infrequently encounter potentially confusing cases which may raise the question of fetal hydrocephalus. In a retrospective analysis of 100 cases, this appearance occurred in 10. The anatomic origins of this potential error are discussed, and an imaging technique is described which can be used to exclude fetal hydrocephalus in confusing cases. Close apposition of the normally large choroid plexus with the medial and lateral walls of the ventricular body and atrium indicates normalcy.     

Potassium prorenoate: a new steroidal aldosterone antagonist.

Potassium prorenoate (SC-23992) is a water-soluble steroidal compound with the ability to antagonize the sodium-retaining and, when apparent, the potassium-dissipating effects of mineralocorticoids. A significant natriuretic response was obtained at dosages of 1 mg/kg and approximately 1.8 mg/kg in the dog and rat, respectively. Based upon an elevation in the previously depressed urinary log Na/K ratio, prorenoate possesses an oral potency of 4.6 and 8.1 times that of spironolactone (S), respectively, in the aldosterone and deoxycorticosterone acetate-treated adrenalectomized rat. In the aldosterone-treated dog, the compound had 3.0 times the potency of S and 2.2 times that of a related steroid, potassium canrenoate (SC-14266). Prorenoate and S are relatively inactive at the renal level in adrenalectomized rats without mineralocorticoid replacement. Prorenoate possesses no more than 2% of the natriuretic activity of hydrochlorothiazide in the intact animal. Clearance studies in dogs indicate a direct renal tubular site of interaction between prorenoate and aldosterone independent of changes in renal hemodynamics. The natriuretic response occurred within 100 minutes after a single oral dose and was sustained for at least 7 hours. Prorenoate possesses the pharmacological characteristics of an aldosterone antagonist, in common with those of S.     

Comparison of magnetic resonance imaging with neuropathological findings in the diagnosis of HIV and CMV associated CNS disease in AIDS.

OBJECTIVES: To compare the results of clinical assessment and MRI with neuropathological findings in the diagnosis of HIV and cytomegalovirus (CMV) associated CNS disease. METHODS: A retrospective study of 35 patients infected with HIV who were examined at necropsy between four and 70 (median 20) days after neurological assessment and MRI. RESULTS: Of the 35 patients, 19 had diffuse white matter hyperintensity on T2 weighted MRI, six of whom also had focal lesions. Nine other patients had focal white matter lesions and seven had changes in cortical atrophy only. Necropsy in the 19 with diffuse white matter hyperintensity showed HIV leukoencephalopathy (HIVLEP) with encephalitis in 10, CMV encephalitis in three, both HIVLEP/HIV encephalitis and CMV encephalitis in one, lymphoma in three, and non-specific inflammation in two. Necropsy in the 16 other patients without diffuse white matter hyperintensity showed CMV encephalitis in six, HIV encephalitis (without HIVLEP) in two, CMV encephalitis and HIVLEP/HIV encephalitis in one, non-HIV associated abnormalities in five, herpes simplex encephalitis in one, and lymphoma in one. CMV DNA was detected in CSF of five of seven patients with CMV encephalitis and in two of two with CMV associated polyradiculopathy but without CMV encephalitis. Diffuse white matter hyperintensity on MRI had a sensitivity of 100%, a specificity of 66.6%, and a positive predictive value of 58% for diagnosis of HIVLEP. CONCLUSION: Diffuse white matter hyperintensity on MRI can be due to either HIV or CMV associated pathology or non-specific abnormalities.     

Pancreas transplantation

Clinical pancreas transplantation is a procedure being applied with increasing effectiveness for the treatment of diabetes. The authors examine, through the Pancreas Transplant Registry, all known cases of islet transplantation since 1970 and all pancreas transplantation since 1977 and then summarize their own work on pancreas transplants at the University of Minnesota.     

Activity of 5-fluorouracil, mitomycin C, and methyl CCNU in inoperable adenocarcinoma of pancreas

Twenty-two patients with inoperable adenocarcinoma of the pancreas were treated with 5-fluorouracil (5-FU), mitomycin C (Mito-C), and 1(-2-chloroethyl)-3-(4-methylcyclohexyl)-1-nitrosourea (MeCCNU). Fifteen were evaluable by completing 2 months of therapy. Two patients achieved a complete remission with the above combination. A partial remission seen in four other patients, which produced a response rate of 40% of evaluable, and 27% of entered, patients. Three had stable disease. The average time to progression in this study was 8 months. This combination was well tolerated and no deaths were secondary to drug therapy. Mucositis, leukopenia, thrombocytopenia, and hyperpigmentation were the significant toxicities seen in this study. These observations are worthy of further investigation.     

Clinical pancreas and islet transplantation. Part 2: pancreas transplantation at the University of Minnesota

The results of pancreas transplantation at the University of Minnesota according to technique, donor source, and immunosuppressive therapy are discussed. Preliminary evidence suggests that not only prevention but reversal of lesions resulting from diabetes may be possible with pancreas transplantation.