An examination of suicidal intent in patients with multiple sclerosis

OBJECTIVE: To examine neurologic and psychiatric correlates of suicidal intent in a community sample of 140 patients with MS. METHODS: Patients with (28.6%) and without lifetime suicidal intent were compared across MS disease-related and psychiatric variables. All subjects were interviewed with 1) the Structured Clinical Interview for DSM-IV Axis 1 disorders (SCID-IV) to determine lifetime prevalence of major depression and anxiety disorders; and 2) the Social Stress and Support Interview to assess psychological stressors. Suicidal intent was documented with questions from the SCID-IV and Beck Suicide Scale. Patients also completed the Hospital Anxiety and Depression Scale and cognitive testing. RESULTS: Suicidal patients were significantly more likely to live alone, have a family history of mental illness, report more social stress, and have lifetime diagnoses of major depression, anxiety disorder, comorbid depression-anxiety disorder, and alcohol abuse disorder. By logistic regression analysis, the severity of major depression, alcohol abuse, and living alone had an 85% predictive accuracy for suicidal intent. A third of suicidal patients had not received psychological help. Two-thirds of subjects with current major depression, all suicidal, had not received antidepressant medication. CONCLUSIONS: Suicidal intent, a potential harbinger for suicide, is common in MS and is strongly associated with major depression, alcohol abuse, and social isolation. Suicidal intent is a potentially treatable cause of morbidity and mortality in MS.     

Unusual presentation of perirenal lung metastases

Lung cancer is not commonly known to metastasise to the perirenal space, with only five such cases previously published. We present an unusual case of perirenal lung metastases manifesting as diffuse perinephric stranding which to our knowledge has not been described before.     

Disseminated intravascular coagulopathy in pregnancy: thorough comprehension of etiology and management reduces obstetricians’ stress

In pregnancy and puerperium disseminated intravascular coagulopathy may accompany abruptio placenta, intrauterine fetal demise with retained dead fetus, amniotic fluid embolism, endotoxin sepsis, preecalampsia with HELLP and massive transfusion. Clinical signs and symptoms of DIC can include oozing from venupuncture sites and/or mucous membranes, red cell lysis from activation of the complement system, hemorrhage from coagulopathy and possible uterine atony, hypotension from hemorrhage and/or bradykinin release, and oliguria from end-organ insult and hypovolemia/hypotension. Treatment of DIC consists of replacement of volume, blood products, and coagulation components and cardiovascular and respiratory support with elimination of underlying triggering mechanism. Received: August 1998 / Accepted: 10 May 1999     

Noonan's and DiGeorge syndromes with monosomy 22q11

A boy with the dysmorphic features of Noonan's syndrome and pulmonary valve stenosis who had evidence of hypoparathyroidism and abnormal T lymphocyte numbers in the neonatal period is reported. He had a normal karyotype but molecular analysis revealed a submicroscopic deletion within chromosome 22q11, the region deleted in DiGeorge syndrome. Thus this child has both Noonan's syndrome and DiGeorge syndrome; 22q11 is a candidate region for a gene defective in Noonan's syndrome.     

Glial fibrillary acidic protein mRNA isotypes: Expression in vitro and in vivo

Glial fibrillary acidic protein (GFAP) and its mRNA, primarily expressed in astrocytes, are also expressed in peripheral nervous system Schwann cells as well as in certain non-neural tissues. Schwann cells express a GFAP mRNA (GFAP-β) which differs from the CNStype mRNA (GFAP-β) by the presence of an extended 5′ untranslated region. We have developed a polymerase chain reaction assay which allows distinction of these two GFAP mRNAs, as well as quantitative analysis of their levels. In the cultured rat Schwannoma cell line RT4-D6, GFAP-b? was the major GFAP mRNA species, accounting for at least 75% of total GFAP (α+β) mRNA. GFAP-b? was also detected in primary rat astrocyte cultures, where it constituted approximately 5% of the total GFAP mRNA, as well as in RNA samples prepared from normal rat cerebral cortex, and from hamster and human brain. In rat cortex, the temporal expression of GFAP-β mRNA paralleled that of total GFAP mRNA, with plateau levels reached between postnatal days 15 and 20. In astrocyte cultures, the relative levels of GFAP-α and -β mRNAs were differentially regulated by exposure to interferon-γ (10 to 25 units/ml), which caused an increase in GFAP-β levels while at the same time no change or a small decrease in total GFAP levels. In rat brain cortical slices, 4 hr exposure to 25 units/ml interferon-γ decreased total GFAP mRNA levels over tenfold, while GFAP-b? levels were unaffected. These data indicate that a second form of the GF AP mRNA is expressed in astrocytes both in vivo and in vitro and provide evidence for independent regulation of these two GFAP mRNA species. © 1995 Wiley-Liss, Inc.     

Weekly Griseofulvin Therapy for Tinea Capitis

Fünf arabische Dörfer und ein jüdisches Dorf wurden auf Pilzkrankheiten untersucht. Die Bevölkerung dieser sechs Dörfer betrug insgesamt 27 735 Personen. Mit Hilfe klini-scher und mykologische Methoden fanden sich 832 Fälle von Tinea capitis (776 Fälle durch T. violaceum, 50 Fälle durch T. glabrum, 5 Fälle durch T. Schönleinii und 1 Fall durch T. tonsurans). Die Behandlung erfolgte mit feinkörnigem Griseofulvin. Die Dosis betrug 25 mg/kg Körpergewicht (das Doppelte der üblichen Dosis) einmal die Woche 9 Wochen hindurdi unter strenger Überwachung und ohne jede Lokaltherapie. Bei den nachfolgenden Untersuchungen, unmittelbar nach Beendigung der Behandlung und 2 Monate später, waren alle 832 Fälle geheilt. Bei einer späteren Untersuchung 6 Monate nach Beendigung der Behandlung wurden 3 positive Fälle gefunden, wahrscheinlich durch Re-Infektion bedingt. Während der Behandlung wurden keine Nebenwirkungen beob-achtet, der Leukozytenspiegel blieb ziemlich konstant. Der Behandlungserfolg (100 %ige Heilung) war ausgezeichnet.