Sub-acute effects of MDMA (±3,4-methylenedioxymethamphetamine, "ecstasy") on mood: evidence of gender differences

RATIONALE: Research with animals suggests that central 5-hydroxytryptamine (5-HT) function may be attenuated for a period following a single dose of +/-3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy'). If the same is true in humans, then functions thought to be modulated by 5-HT may differ in MDMA users compared with non-users a few days after the drug is taken. AIMS: The present study therefore investigated both acute and sub-acute effects of MDMA on mood of recreational users. A second aim was to determine whether these effects differ for females and males. DESIGN: A parallel group design was used to compare 40 participants who reported taking MDMA with 40 participants who reported using illicit substances excluding MDMA (polydrug controls). Participants were assessed on the night of drug use (day 0) and again 4 days later. RESULTS: Female MDMA users showed higher depression scores mid-week than male users or male or female controls. Mid-week depression in female users was correlated with the amount of MDMA taken on day 0. MDMA users rated lower levels of aggression than controls on the night of drug use but significantly higher levels of aggression mid-week, and in males change in aggression correlated with the amount of MDMA taken on the weekend. There was no association between mood and measures of long-term use of MDMA (e.g. years of use). CONCLUSION: Women are more susceptible than men to mid-week low mood following weekend use of MDMA; however, both men and women show increased self-rated aggression. These results are interpreted in terms of an attenuation of 5-HT function for a period following acute use of MDMA.     

Radiologically guided balloon dilation of gastrointestinal strictures. Part I. Technique and factors influencing procedural success

Radiologically guided balloon catheters were used to dilate 94 gastrointestinal strictures in 92 patients over a 6-year period. Fifty strictures were esophageal and 44 nonesophageal (22 gastroenterostomies, 11 antral-pyloric strictures, four colorectal strictures, four enteroenterostomies, and three miscellaneous strictures). Factors influencing the success of stricture intubation included patient age, stricture location (esophageal vs. nonesophageal and proximal vs. distal esophageal), and association with a surgical anastomosis. Malignancy was associated with greater postdilation irregularity and a smaller increase in stricture diameter, as measured radiographically. Procedural failures occurred in 8% of cases (2% of esophageal and 30% of nonesophageal lesions). Two small, asymptomatic mucosal tears were seen after dilation (one esophageal and one colonic); no other procedural complications occurred. Following successful dilation, 16 patients (17%; six with esophageal and ten with non-esophageal strictures) had recurrence of symptoms during short-term (30-day) follow-up.     

Noncosmetic operations for benign breast disease

The operation of excision of the major duct system of the breast has remained unchanged since it was first designed by Adair and described by Hadfield [1–4], Urban [5], and recently by Preece [6] from Professor Hughes' unit in Cardiff.Operations for diseases for a single major duct or the whole major duct system, namely subareolar excision of the major ducts of the breast, are discussed. Technical problems are discussed and suggestions are made on ways to avoid these problems. An adequately performed operation should render the patient free from her disease with a good cosmetic result.Operations for excision of palpable and radiologically detected lesions are described. Since a histological examination is the final arbiter; methods ensuring that the whole lesion is demonstrated, excised, and fully examined are discussed. The medico-legal aspect of this is of obvious importance.

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Resumen La operación para resecar el sistema ductal principal del seno ha permanecido inmodificada desde su diseño original por Adair y su descripción por Hadfield [1–4], Urban [5], y, más recientemente, por Preece [6] del Servicio del Profesor Hughes en Cardiff.Las operaciones para el manejo de enfermedades que afectan a un ducto único o a la totalidad del sistema ductal principal, consistentes en la resección subareolar de los principales ductos o canalículos mamarios son analizadas. Se discuten los problemas técnicos y se hacen sugerencias sobre la manera de evitarlos. Una operación bien realizada debe dejar a la paciente libre de su enfermedad y con un buen resultado estético.Se describen las operaciones para resección de lesiones palpables o detectadas mediante radiología; el examen histológico representa el arbitraje final; se discuten los métodos que aseguran que la totalidad de la lesión ha sido demostrada, resecada, y completamente examinada. Los aspectos medicolegales pertinentes son de obvia importancia.

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Résumé La technique d'excision du système canalaire majeur du sein n'a guère changé depuis qu'elle a été imaginée pour la première fois par Adair et décrite successivement par Hadfield [1–4], Urban [5], et Preece [6] de Cardiff.Les interventions utilisées pour les maladies d'un canal galactophore majeur ou du système entier, c'est-à-dire l'excision sous aréolaire des canaux galactophores, sont exposées. Les écueils de la technique sont discutés et des suggestions sont formulées pour les éviter. Une intervention bien menée devrait libérer la patiente de sa maladie avec un bon résultat esthétique.On décrit ensuite des interventions pour excision des lésions détectables par la palpation et la radiologie. Comme finalement c'est l'examen histologique qui importe, des méthodes garantissant l'excision et l'examen de la pièce entière sont exposées et discutées. L'aspect médicolégal de ce détail est évident.

     

Keine Doppelzulassung als Facharzt für Allgemeinmedizin und Anästhesiologie

Ohne Zusammenfassung     

Tongue and oropharynx: findings on MR imaging

Ten healthy subjects and 44 patients with diseases of the tongue or oropharynx were studied with magnetic resonance (MR) imaging. Axial, coronal, and sagittal images with a thickness of 4 mm were obtained with a pixel size of 0.75 X 0.75 mm on a 256 matrix. Nineteen of the patients underwent computed tomography (CT). Nine of those patients later had surgery, and the specimens were obtained for organ sectioning. These three studies as well as clinical history and physical examination findings were correlated. MR imaging was equal to or better than CT in those patients having both examinations. However, neither CT nor MR allowed recognition of histologic features or detection of microscopic spread of disease. Direct coronal and sagittal imaging planes on MR imaging allowed visualization of intrinsic tongue musculature, not possible with CT; this was important in recognizing subtle tumor extension. For these reasons, MR is the imaging method of choice for studying diseases of the tongue and oropharynx.     

Parkinsonism and extraocular motor abnormalities with unusual neuropathological findings

Parkinsonian patients with ocular motility abnormalities are usually considered to have progressive supranuclear palsy. However, a number of other conditions have been noted to have the combination of parkinsonism and ocular problems. We report a case of rigid akinetic parkinsonism, oculomotor palsy, and eyelid apraxia with postmortem examination. Our findings are unusual in that there was marked gliosis of the substantia nigra with a large amount of free extracellular neuromelanin despite a 3-year clinical course. Only rare hyaline inclusion bodies and no neurofibrillary tangles were seen in the brainstem. Excessive calcification of the vessels of the globus pallidus were also noted. This case represents another example of the diversity of conditions producing parkinsonism with extraocular motor abnormalities.     

NOD鼠腹腔巨噬细胞肿瘤坏死因子α和白细胞介素水平变化与吡格列酮的干预效应

目的:观察含0.02%吡格列酮的饲料对NOD鼠糖尿病发病率的影响,分析巨噬细胞在吡格列酮预防NOD鼠糖尿病中的作用。方法:实验于2003-01/2005-01在中南大学湘雅二医院动物实验室及中心实验室完成。4周龄NOD雌鼠56只,随机数字表法分为吡格列酮组(n=25)和对照组(n=26),分别摄食含0.02%吡格列酮的混合饲料和普通营养饲料。自10周龄开始,每周测尿糖1次,尿糖阳性后用血糖仪测血糖,连续两次血糖≥16.7mmol/L即诊断为糖尿病。两组各取12周龄NOD雌鼠15只,处死前4d腹腔注射30g/L的硫代乙醇酸钠2mL,麻醉后摘除眼球法处死小鼠后腹腔灌洗收集巨噬细胞,加入脂多糖共同培养24d后收集上清,ELISA法测细胞因子肿瘤坏死因子α、白细胞介素6水平。结果:小鼠56只全部进入糖尿病发病率分析;进入腹腔巨噬细胞肿瘤坏死因子α、白细胞介素6的水平结果分析20只。①30周龄时,对照组25只小鼠有20只发生了糖尿病,发病率80.0%,平均发病时间为(139.2±38.2)d;吡格列酮组26只中有14只发生了糖尿病,发病率为53.8%,平均发病时间为(153.0±28.1)d,与对照组相比,吡格列酮组发病率明显降低(P<0.05)。②12周龄时对照组NOD鼠腹腔巨噬细胞肿瘤坏死因子α、白细胞介素6水平与吡格列酮组差异无显著性意义[(537.4±112.49),(448.9±92.18)ng/L;(551.2±108.23),(461.7±80.49)ng/L,P>0.05]。结论:吡格列酮在一定程度上预防和延缓NOD鼠糖尿病的发生;吡格列酮对NOD鼠糖尿病和胰岛炎的预防作用可能与巨噬细胞无明显关系。     

Quantitation of CD62, soluble CD62, and lysosome-associated membrane proteins 1 and 2 for evaluation of the quality of stored platelet concentrates

BACKGROUND: Platelets become activated during storage, which results in secretion of granules, vesiculation of microparticles, secretion of protein, and a number of other biochemical and morphologic processes that decrease the utility of platelet concentrates stored for transfusion. STUDY DESIGN AND METHODS: To evaluate the quality of stored platelet concentrates, the cell surface expression of specific activation-dependent antigens (CD62 and lysosome-associated membrane proteins 1 and 2 [LAMP-1, LAMP-2]) on platelets stored in a hospital blood bank over a 7-day period was examined. Relative microparticle counts and the expression of CD62 by microparticles, as well as platelet concentrate supernatant levels of soluble CD62, were determined. RESULTS: The percentage of platelets expressing CD62 increased significantly from Day 1 to Day 5 (p < 0.05) of storage; the mean fluorescence values for CD62 did not. In contrast, the mean fluorescence values of LAMP-1 and LAMP-2 rose significantly (p < 0.01 and p < 0.05, respectively) between Days 1 and 5. Significant declines in CD62, LAMP-1, and LAMP-2 percent expression and mean fluorescence were seen on Day 6 of storage (p < 0.001). Microparticle numbers increased significantly during storage and correlated with levels of CD62 protein (free and membrane-bound) (r = 0.95 vs. Day 2, p < 0.05; r = 0.88 vs. Day 5, p < 0.05). CONCLUSION: Flow cytometric evaluations of the expression of cell surface CD62, LAMP-1, and LAMP-2 are complementary tests that, especially when used in conjunction with the quantitation of CD62 protein, provided a simple and effective means of evaluating the quality of platelet concentrates stored for transfusion.