Behavioral family treatment for patients with bipolar affective disorder

Techniques of behavioral family management (BFM), which have been found to be highly effective in delaying relapse for schizophrenic patients when used as adjuncts to medication maintenance, are also applicable in the outpatient treatment of recently hospitalized bipolar, manic patients. The authors describe their adaptation of the educational, communication skills training, and problem-solving skills training modules of BFM to families containing a bipolar member. The observations that families of bipolar patients are often high functioning, and that these families seem to enjoy interchanges that are highly affective and spontaneous, led to certain modifications in the original BFM approach. The authors found it necessary to be (a) more flexible and less didactic, (b) more oriented toward dealing with affect and resistance to change, and (c) more focused on the patient's and family members' feelings about labeling, stigmatization, and medication usage. Research issues relevant to testing the efficacy of this approach are also discussed.     

Socioeconomic concerns in vascular surgery: a survey of the role of age, resource consumption, and outcome in treatment cost

Surgical hospital payment issues and socioeconomic concerns are likely to attract more attention in the future, especially regarding access and the quality of surgical care. We analyzed all peripheral vascular surgical admissions (n = 1240) by age treated at the Long Island Jewish Medical Center from 1985 to 1987. Hospital cost and length of stay per patient increased with age, as did losses under diagnostic related group (DRG) prospective hospital payment. Hospital cost by hospital service showed considerable variation by age category; outliers, mortality, and the number of diagnoses and procedures generally rose with age. Use of hospital resources, such as emergency or surgical intensive care unit admission, or the need for blood or plasma products was high in general for patients undergoing peripheral vascular surgery. This study demonstrates a number of findings regarding the socioeconomic factors for hospitalized patients undergoing peripheral vascular surgery. Surgical health policy analysis of this specialty vis-a-vis current changes proposed to the federal medicare DRG system in the U.S. Congress and Health Care Financing Administration suggests a relatively greater impact on the specialty of peripheral vascular surgery demonstrated in this study by the use of higher resources of the same.     

Possible relation between viruses and oromaxillofacial tumors. III. Demonstration of the SV40 antigen and anti-SV40 antibodies in patients with tumors of the parotid gland

SV40 antigen was detected in 7 of 13 malignant tumors developed in the head and neck region. Specific complement fixing antibodies were found in all the patients with the SV40 antigen present in the parotid gland tumoral cells. Incidence of the anti-SV40 complement fixing antibodies in parotid gland tumor bearing patients was of 69.6%.     

An unusual presentation of a congenital benign apocrine hamartoma

A case of an unusual benign apocrine hamartoma was studied by light microscopic, immunohistochemical, and electron microscopic methods. This tumor clinically showed a linear configuration and was located on the midline chest of a pubescent male. Microscopic studies revealed features of both a tubular apocrine adenoma and a syringocystadenoma papilliferum.     

Thymopoietin, a potent antagonist at nicotinic receptors in C2 muscle cell cultures

Recent work has shown that thymopoietin, a polypeptide with actions in the immune and nervous systems, potently binds to the alpha-bungarotoxin (alpha-BGT) receptor. The present study was done to characterize the interaction of thymopoietin at the nicotinic alpha-BGT binding site in cultured muscle cells and to correlate these findings with the effects of the polypeptide on nicotinic receptor-mediated function. Inhibition studies showed that thymopoietin potently inhibited 125I-alpha-BGT binding in C2 muscle cells in culture, with an IC50 of 1.1 nM, a value similar to that for alpha-BGT. Thymopoietin bound to the alpha-BGT receptor in the cells in culture relatively slowly; at 10(-8) M thymopoietin, maximal inhibition occurred after 45 to 75 min of exposure to the polypeptide. Dissociation of thymopoietin from the receptor exhibited a much longer time course; recovery of alpha-BGT binding to control values after exposure to 10(-8) M thymopoietin occurred approximately 16 hr after removal of the polypeptide. The effects of thymopoietin on 125I-alpha-BGT binding correlated well with those on nicotinic function. Thymopoietin potently inhibited nicotinic receptor-mediated 22Na uptake in muscle cells in culture, with an IC50 of 2 nM. This effect was dependent on the length of the preincubation period with thymopoietin, with maximal inhibition occurring after 60 min of exposure to the polypeptide. Recovery of the functional response after thymopoietin (10(-8) M) exposure required about 16 hr. The mode of inhibition of receptor-mediated ion flux by thymopoietin was similar to that observed with alpha-BGT but distinct from that obtained with d-tubocurarine and gallamine. To conclude, thymopoietin, a thymic polypeptide associated with the immune system, potently inhibited both 125I-alpha-BGT binding and nicotinic receptor-mediated function in C2 muscle cells. These findings may have implications for myasthenia gravis and/or other neuromuscular disorders.     

High-functioning autism and schizophrenia: a comparison of an early and late onset neurodevelopmental disorder.

Autism and schizophrenia are separate neurodevelopmental disorders that share a number of interpersonal and cognitive deficits. The symptoms of autism first appear during early life while schizophrenic symptoms do not typically appear until adolescence at the earliest. Efforts have been made to characterize the pattern of cognitive function in both disorders, and certain resemblances have become apparent such as deficits in abstract reasoning and the more complex aspects of memory and language. The present study provided a comparison of cognitive function between the two disorders. The autistic sample consisted of well-diagnosed individuals with high-functioning autism (IQ> or =70). The schizophrenic sample was divided into four subgroups using Ward's method of cluster analysis. Participants received the Wechsler Adult Intelligence Scale-Revised (WAIS-R), the Halstead Category Test, the Trail Making test, and the Wisconsin Card Sorting test (WCST). The profile of the autism sample was compared with the four schizophrenia cluster profiles. The autism group resembled only one of the schizophrenia clusters, with both showing elevations on the WAIS-R Information and Block Design subtests and depressions on Comprehension and Digit Symbol. It was concluded that individuals with high-functioning autism have a cognitive profile that resembles that of an empirically derived subgroup of schizophrenia patients but that does not resemble profiles found in other schizophrenia subgroups. The pattern itself, marked by a relatively depressed score on the Comprehension subtest among the Verbal subtests and a relatively elevated score on Block Design among the Performance subtests, has been characterized in the past as a prototypic profile for high-functioning autism.     

Affinity sensor: a new technique for developing implantable sensors for glucose and other metabolites

We describe affinity sensors for monitoring various metabolites in blood plasma by optical means. The principle of detection is similar to that used in radioimmunoassays and is based on the competitive binding of a particular metabolite and a fluorescein-labeled analogue with receptor sites specific for the metabolite and the labeled ligand. This concept has been directed toward the development of an affinity sensor for glucose. Concanavalin A, a protein with specific binding character for glucose, was immobilized on the inside surface of a hollow dialysis fiber. Fluorescein-labeled dextran was selected as the competitive labeled ligand. The molecular weight cutoff of the dialysis fiber is low enough to completely retain the 70,000 MW dextran within the fiber lumen while glucose can freely pass through the dialysis membrane. The sensor is completed by inserting a single optical fiber in the lumen of the dialysis fiber, thus allowing measurement of the unbound FITC-dextran. Preliminary tests of the sensor indicated the feasibility of the approach. Sensitivity to glucose in the physiologic range was obtained, but further work will be required to optimize the sensitivity and response time of the sensor.     

Cefoperazone therapy of complicated urinary tract infections: pharmacokinetics in renal transplant recipients

Cefoperazone was used to treat patients with complicated urinary tract infections due to multiple antibiotic-resistant gram-negative rods who had failed prior courses of intravenous antibiotic therapy. Cure was achieved in 44% (4/9) of cases; 44% of patients improved but relapsed and 11% (1/9) of patients were reinfected. Relapse and reinfection were associated with Pseudomonas aeruginosa and/or with conditions not normally responsive to medical therapy alone including prostatitis, reflux and chronic indwelling Foley catheters. The pharmacokinetics of cefoperazone were studied in renal transplant recipients. Peak serum concentrations (range 146-241 micrograms/ml) and 2-hour noncumulative urine concentrations (range 161-291 micrograms/ml) exceeded the minimal inhibitory concentrations of the bacteria in all cases. There was no accumulation of cefoperazone despite the presence of impaired renal function.