Friendships and Suicidality Among Mexican American Adolescent Girls and Boys

Although the fields of bereavement and traumatology regarding childhood physical and sexual abuse have developed simultaneously, little information exists regarding the issues of bereavement for a sexual abuse survivor when the decedent was the abuser. This article is a case study that examines the reactions, themes, and attributions that individuals experience regarding the loss of a relative who was sexually abusive to them during childhood and discusses the impact of that abuse on the bereavement process.     

Early Afterdepolarization Formation in Cardiac Myocyte:

Early Afterdepolarization Formation, introduction: Early afterdepolarizations (EADs) are among the mechanisms proposed to underlie ventricular arrhythmias. Sea anemone toxin, ATXII, known to delay Na inactivation and to induce plateau level voltage oscillations, was used to study the formation of EADs. Methods and Results: Action potential and membrane currents were studied in rat ventricular myocytes using whole cell current and voltage clamp techniques. Phase plane trajectories were generated by plotting membrane potential (V) versus the first time derivative of membrane potential (dV/dt). Under current clamp conditions, ATXII (40 nM) consistently prolonged the action potential and induced EADs. The EADs developed at a plateau voltage between -10 and -40 mV. Calcium channel blockers, verapamil 10 μM and cobalt 4 μM, and the sarcoplasmic reticulum modulator, ryanodine (1 μM) did not antagonize ATXII effects on the action potential and EADs. However, Na channel blockers, tetrodotoxin 0.3μM and lidocaine 40μM. and rapid stimulation consistently shortened the prolonged action potential and suppressed EADs. Under voltage clamp conditions in the presence of ATXII, a slowly decaying inward current followed the fast inward current during depolarizing pulses. Membrane currents flowing at or later than 100 msec after the test pulse were analyzed. The control isochronal current-voltage (I-V) curves showed no late inward currents. In the presence of ATXII, all the isochronal I-V curves showed an inward current that was more prominent between -40 and 0 mV. The ATXII-induced current at the 100-msec isochronc activated at a potential of approximately -60 mV, peaked at about -20 mV, and reversed at +40 mV consistent with the Na current I-V curve. The isochronal I-V curves obtained after lidocaine superfusion resembled those of the control. The phase plane trajectory of the action potential obtained with ATXII showed an oscillatory behavior corresponding to the t AD range of potential; within this voltage range, the isochronal I-V curves were shown to cross the abscissa three times instead of once. Conclusion: These results suggest that, in this experimental model, neither sarcolemmal L-type Ca current nor sarcoplasmic reticulum Ca release plays a significant role in the genesis of ATXII-induced EADs. EADs are generated by a voltage-dependent balance between a markedly prolonged Na inward current and K outward currents within the voltage plateau range of the action potential hut not by Ca current reactivation and inactivation.     

Dizocilpine-like Discriminative Stimulus Effects of Low-affinity Uncompetitive NMDA Antagonists

The dizocilpine-like discriminative stimulus effects of a variety of channel blocking (uncompetitive) N-methyl- -aspartate (NMDA) receptor antagonists were examined in rats trained to discriminate dizocilpine (0.17 mg/kg, i.p) from saline in a two-lever operant procedure. The dissociative anesthetic-type NMDA antagonists dizocilpine ( ₅₀ 0.05 mg/kg), phencyclidine ( ₅₀ 3.4 mg/kg) and ketamine ( ₅₀ 14 mg/kg) showed complete substitution without producing significant decreases in response rates, whereas dexoxadrol ( ₅₀ 4.3 mg/kg) also produced complete substitution with a concomitant decrease (35%) in response rate. Similarly, the low-affinity antagonist memantine resulted in complete substitution ( ₅₀ 9.7 mg/kg) at doses that significantly reduced (68%) the response rate. All other low-affinity antagonists resulted in either partial or no substitution for the discriminative stimulus effects of dizocilpine at doses that significantly decreased average response rates. These include ( ₅₀ values in parentheses) remacemide (29 mg/kg), the remacemide metabolite 1,2-diphenyl-2-propylamine (ARL 12495)(14 mg/kg), phencylcyclopentylamine (25 mg/kg), dextromethorphan (46 mg/kg), (±)-5-aminocarbonyl-10,11-dihydro-5H-dibenzo- [a,d]cyclohepten-5,10-imine (ADCI; no substitution) and levoxadrol (no substitution). We conclude that low-affinity uncompetitive NMDA antagonists have discriminative stimulus properties distinct from dissociative anesthetic-type uncompetitive NMDA antagonists. The lowest-affinity antagonists show virtually no substitution for dizocilpine, whereas the relatively more potent low-affinity antagonists (such as memantine) exhibit greater substitution, but complete substitution is obtained only at rate-reducing doses. © 1997 Elsevier Science Ltd. All rights reserved.     

Nursing in Child Psychiatric Milieus

Because of the reduced length of inpatient hospitalization and the increasing emphasis on biopsychiatric treatments, milieu psychiatry is in decline. However, certain aspects of the therapeutic milieu are essential to the operation of child inpatient units. Children with acute psychiatric illness need a safe, structured, and supportive environment. Nurses are the professional group responsible for instituting and maintaining this type of environment, yet their specific functions are vaguely stated and often intuitively derived. A useful way to delineate and describe what nurses do is to organize nursing behaviors into five therapeutic processes: (a) safety, (b) structure, (c) support, (d) involvement, and (e) validation. By delineating essential milieu dimensions in this way, the form and purpose of nursing interventions are clarified.     

Isobutyl-2-cyanoacrylate pulmonary emboli associated with occlusive embolotherapy of cerebral arteriovenous malformations

Three patients had cerebral arteriovenous malformations (AVM) treated by occlusive embolotherapy using isobutyl-2-cyanoacrylate (IBC). At necropsy two had asymptomatic IBC pulmonary emboli. The numbers of emboli and the size of pulmonary vessels occluded correlated roughly with an increasing frequency and volume of injectate made in the cerebral tissue. The extent of pulmonary vascular occlusion in one case suggests that pulmonary vascular hypertension could develop as a complication of this form of treatment.     

Is portal hypertension associated with protein-losing enteropathy?

Background and Aim:  Hypoalbuminemia in patients with decompensated cirrhosis has traditionally been assumed to be a result of to impaired liver synthesis; however, protein-losing enteropathy (PLE) may also contribute. The aim of this study was to assess whether hypoalbuminemic cirrhotic patients with portal hypertension had evidence of PLE.
Methods:  Sixteen patients with alcoholic cirrhosis, hypoalbuminemia and portal hypertension underwent whole gut lavage with polyethylene glycol solution. The effluent obtained was analyzed for albumin, immunoglobulin (Ig)G and α1-antitrypsin (α1-AT). Serum C-reactive protein (CRP) was also measured to assess the systemic inflammatory response.
Results:  Twelve of the 16 enrolled patients had a persistently low albumin concentration at the time of lavage. Only one patient (who was subsequently found to have celiac disease) had elevated concentrations of lavage albumin, α1-AT and IgG levels. There was a significant correlation between lavage albumin and α1-AT ( r  = 0.671, P  = 0.024), and between lavage albumin and IgG ( r  = 0.614, P  = 0.045). There was no correlation between serum albumin and lavage proteins. Six patients had elevated serum CRP levels, but serum albumin or lavage protein concentrations did not correlate with serum CRP.
Conclusion:  There is no evidence of a significant PLE in patients with alcoholic cirrhosis, hypoalbuminemia and portal hypertension.     

SPONTANEOUS ONSET OF CILIARY BLOCK GLAUCOMA IN ACUTE HYDROPS IN DOWN'S SYNDROME

A flat anterior chamber and raised intraocular pressure are unusual complications of acute hydrops. We report a case in which a patient with Down's Syndrome developed a flat anterior chamber, together with raised intraocular pressure, several weeks after the onset of acute hydrops.