125I]thienylphencyclidine, a novel ligand for the NMDA receptor.

We have monitored the binding of [125I]thienylphencyclidine ([125I]TCP), a novel high affinity radioiodinated ligand that specifically recognizes the NMDA (N-methyl-D-aspartate) receptor in rat brain membranes. [125I]TCP binds with an affinity of about 30 nM, and recognizes a similar number of binding sites to previously employed ligands for this receptor. [125I]TCP binding is characterized by slow association and dissociation rates, and the latter can be modified by the addition of Mg2+ or Zn2+, as previously described for [3H]dizocilpine ([3H]MK801). Other phencyclidine-like ligands displaced [125I]TCP binding with the order of potency dizocilpine greater than thienylphencyclidine greater than ITCP greater than phencyclidine greater than ketamine. The binding of [125I]TCP was also increased by NMDA and glycine-site agonists and inhibited by antagonists of these sites. Surprisingly, however, the polyamines spermidine and spermine did not increase [125I]TCP, even though the polyamine antagonist arcaine was an effective inhibitor of binding. These results show that [125I]TCP is a useful ligand for the NMDA receptor complex that binds to the receptor in a manner that is qualitatively distinct from previously described ligands.     

Full protein alimentation and nitrogen equilibrium in a renal failure patient treated with continuous hemodiafiltration: a case report of 67 days of continuous hemodiafiltration.

Standard care for patients with renal failure while in an intensive care unit involves traditional hemodialysis or peritoneal dialysis and protein restriction. We present a case of a patient with renal failure supported with continuous arteriovenous hemofiltration with dialysis (CAVH-D) who was given full protein alimentation. Total daily urea clearance was measured from the CAVH-D output. Protein load was 196 +/- 34 g/day while receiving total parenteral nutrition and 164 +/- 30 g/day while receiving enteral alimentation. Serum blood urea nitrogen was controlled between 40 and 75 mg/dL, except during septic episodes. Nitrogen balance was estimated based upon known alimentation protein load and measurable and estimated nitrogenous losses. The patient was potentially in nitrogen equilibrium during most of the dialysis period. The cumulative nitrogen balance was positive by 5.2 g after 67 days of dialysis. Volume of alimentation was 3.49 +/- 0.7 liters/day. With CAVH-D, the renal failure patient can receive full alimentation without volume or protein load limitations. Furthermore, nitrogen balances can be estimated easily while the patient is on CAVH-D.     

The balance of positive and negative affects in major depression: a further test of the States of Mind model.

The States of Mind (SOM) model provided a framework for assessing the balance between self-reported positive and negative affects in a sample of 39 outpatients with major depression and 43 healthy control subjects. The SOM model proposes that healthy functioning is characterized by an optimal balance of positive (P) and negative (N) cognitions or affects (P/(P + N) approximately 0.63), and that psychopathology is marked by deviations from the optimal balance. Research thus far has focused on the functional significance of cognitive rather than affective balance. Within this framework, we hypothesized that patients in untreated episodes of major depression would balance their positive and negative affects at the same level where depressed patients in other studies have balanced their positive and negative cognitions--namely, at P/(P + N) approximately 0.37. Points and confidence interval (CI) estimation procedures yielded results (mean = 0.35, 95% CI = 0.30 - 0.40) consistent with this hypothesis in a sample of 39 depressed male outpatients. Correlational analysis indicated that affect balance is inversely related to symptom severity as measured by self-report (Beck) and clinician-rating (Hamilton) scales.     

Combined neurosurgical-otolaryngologic operative approach to a massive nasoethmoidal encephalomeningocele

Frontal encephaloceles are uncommon yet challenging therapeutic problems that require careful planning and cooperation between the disciplines of neurosurgery and head and neck surgery. A case presentation is discussed together with the embryology, differential diagnosis, and surgical approach to the problem.     

The influence of epidural administration of fentanyl infusion on gastric emptying in labour

The effect of epidural infusions containing fentanyl on maternal gastric emptying in labour was examined using the rate of paracetamol absorption. Women were randomly allocated to receive one of two epidural infusions, bupivacaine 0.125% alone or bupivacaine 0.0625% with fentanyl 2.5 μgml⁻¹ at a rate of 10–12 mlh⁻¹. Paracetamol 1.5 g was given orally to women after either 30 ml of the infusion solution had been given (mean time 2.5 h, study A) or 40–50 ml (mean time 4.5 h, study B). Six venous blood samples were taken over the next 90 min for measurement of plasma paracetamol concentration. There were no significant differences in maximum plasma paracetamol concentration, time to maximum paracetamol concentration and area under the concentration–time curve between the two groups for study A. In study B the time to maximum plasma paracetamol concentration was significantly delayed in women receiving > 100 μg fentanyl compared with controls (p < 0.05). We conclude that the dose of fentanyl that may delay gastric emptying when given by epidural infusion is greater than 100 μg.     

Personality and sexual anomalies

Test properties of the Millon Clinical Multiaxial Inventory (MCMI) were examined in a sample of 419 sex offenders and controls in three different settings. The offender group included sexual aggressives, pedophiles, incest perpetrators and miscellaneous cases. Nineteen of the 20 scales of the MCMI had alpha reliability over 0.60 and for 13 scales it was over 0.80. The scales showed satisfactory discriminant validity from age but 9 scales showed a moderate influence of intelligence scores and education. Criminal history did not influence scale results. The scales unfortunately did show significant correlations with MMPI validity scales. Although the scales were not susceptible to naive lying, they were influenced by social desirability especially. Four factors were extracted in principal axes factor analysis that accounted for 91.2% of the total variance. The first factor explained 58.2% of the variance and was labeled general psychopathology. The other three factors suggested psychotic tendencies, extraversion and the bipolar dependency-antisocial tendencies. When the groups were compared, almost all scales significantly differentiated them. When the MMPI F-K Scale was forced to enter a stepwise discriminant analysis first, five scales still were significant; Narcissistic, Schizoid-Asocial, Alcohol Abuse, Paranoid, & Dependent-Submissive scales. The MCMI taps important dimensions in sex offenders but suffers from validity problems.     

Substance Misuse Among Women Attending Family Planning Clinics in a Rural Area in Britain: prevalence and associated problems

Objectives: Little research has been carried out focusing on women who misuse substances, although existing evidence suggests that they represent a distinctive group. The aims of the current study are to determine prevalence of tobacco, alcohol and other drug use in women attending family planning services in a rural area and to investigate preferred sources of help-seeking. Methods: A prospective study using a self-completed questionnaire assessing use of tobacco, alcohol, other drugs, associated problems and sources of help-seeking. The sample included women attending family planning clinics in a rural area of southern England. Results: Fifty-three percent were current smokers,thirty-five percent misused alcohol and fourteen and a half percent had used other drugs in the last year. Those using each of the substances were significantly more likely to be 21 years or under. Not all those using substances indicated problems and sources of help varied with the presence of problems. Conclusions: Women attending family planing clinics are a self-selected group with a high level of substance use compared to the general population. This suggests that they may have a lifestyle incorporating more risky behaviours, including unsafe sexual behaviour. Once problems have occurred due to substance use, help needs to be more accessible.