Early separation and suicidal behaviour in the parental homes of 40 consecutive suicide attempters

Forty suicide-attempt patients who were consecutively admitted to an intensive-care unit, their significant others and treatment personnel were investigated by semistructured interviews. The patients were divided into neurosis (n = 14), abuse (n = 19) and psychosis (n = 7) groups. Twenty-one of the patients (52%) had lost contact with one or both parents before the age of 18, in 25% of cases owing to death and in 27% because of the parents' divorce or separation. Parents and/or siblings of 19 patients (47%) had shown suicidal behaviour in the form of attempted suicide and/or suicide. Differences between the groups were not significant. Alcohol abuse in the parental home was overrepresented in the abuse group compared with the other groups. The role of identification with the dead and suicidal parent in prompting suicidal actions in adulthood is discussed, as well as that of the impeded evolution of stable external object relations owing to parental losses.     

Passive euthanasia in response to attempted suicide: one form of aggressiveness by relatives

A total of 88 interviews were conducted with 40 people attempting suicide who were receiving care in an intensive-care unit, and 129 interviews were carried out with their relatives and friends. The subjects were divided into 3 diagnostic groups: neurosis (n = 14), abuse (n = 19) and psychosis (n = 7). The incidence of relatives' failure to provide care after the suicide attempt--turning-away reactions as well as do not resuscitate orders, a form of passive euthanasia--was investigated. In 8 cases, partners of patients in the abuse and neurosis groups showed turning-away reactions. In 2 cases, relatives of elderly patients in the neurosis group said to the doctor that life-preserving measures should not be taken. Relatives explained their behaviour by saying that they had the best interests of the suicidal individual at heart. In-depth interviews, however, revealed that these reactions were a manifestation of the relatives own psychic conflicts, brought forth by the confrontation with the depressed and suicidal patient. Turning-away reactions and do not resuscitate orders might be interpreted as expressing the relatives' aggressiveness towards the suicidal individual and attempts to escape from a difficult situation. It is important that doctors stand up for the interests of suicidal people, which at times may conflict with relatives' interests, and help the relatives to sort out their problems and wishes with respect to the problem areas of passive euthanasia.     

Lead exposure and intelligence in 7-year-old children: the Yugoslavia Prospective Study.

For a prospective study of lead exposure and early development, we recruited pregnant women from a lead smelter town and from an unexposed town in Yugoslavia and followed their children through 7 years of age. In this paper we consider associations between lifetime lead exposure, estimated by the area under the blood lead (BPb) versus time curve (AUC7), and intelligence, with particular concern for identifying lead's behavioral signature. The Wechsler Intelligence Scales for Children-Version III (WISC-III) was administered to 309 7-year-old children, 261 of whom had complete data on intelligence, blood lead, and relevant sociodemographic covariates (i.e., Home Observation for the Measurement of the Environment (HOME), birth weight, gender, sibship size, and maternal age, ethnicity, intelligence, and education). These showed anticipated associations with 7-year intelligence, explaining 41-4% of the variance in Full Scale, Performance, and Verbal IQ. Before covariate adjustment, AUC7 was unrelated to intelligence; after adjustment, AUC7 explained a significant 2.8%-4.2% of the variance in IQ. After adjustment, a change in lifetime BPb from 10 to 30 micro/dl related to an estimated decrease of 4.3 Full Scale IQ points; estimated decreases for Verbal and Performance IQ were 3.4 and 4.5 points, respectively. AUC7 was significantly and negatively related to three WISC-III factor scores: Freedom from Distractibility, Perceptual Organization, and Verbal Comprehension; the association with Perceptual Organization was the strongest. Consistent with previous studies, the IQ/lead association is small relative to more powerful social factors. Findings offer support for lead's behavioral signature; perceptual-motor skills are significantly more sensitive to lead exposure than are the language-related aspects of intelligence.     

库欣综合征低钾血症发生与氢化可的松关系的探讨

①目的　探讨库欣综合征病人低钾血症的发生与氢化可的松的关系。②方法　采用放免法测定 6 4例库欣综合征病人 2 4h尿游离氢化可的松 (UFC) ,血清氢化可的松 (SC)及血浆促皮质素 (ACTH)水平 ,比较增生型与腺瘤型病人中低钾血症组与非低钾血症组之间UFC ,SC和ACTH等指标的差异。③结果　库欣综合征中增生型及腺瘤型病人低钾血症的发生率均较高 ,分别为 30 .4 3%及 33.33% .增生型中低钾血症者UFC ,SC(2 4 :0 0 ,8:0 0 ) ,血浆ACTH(8:0 0 )含量显著高于无低钾血症者 ,差异有显著性 (t=2 .10～ 3.0 2 ,P <0 .0 5 ) ;腺瘤型中有低钾血症者仅UFC含量显著高于无低钾血症者 (t=3.2 7,P <0 .0 5 )。直线相关分析表明 ,低钾血症的发生与UFC含量呈正相关 (r=0 .32 5 ,P <0 .0 5 )。④结论　库欣综合征病人低钾血症的发生与体内氢化可的松水平有关 ,UFC水平可作为预测低钾血症是否发生的一个重要指标     

外伤后癫痫大鼠模型脑内铁蛋白与转铁蛋白含量的动态变化研究

目的:从脑内铁代谢的角度研究铁在外伤后癫(PTE)发病机制中的可能作用。方法:用ELISA方法检测PTE大鼠模型脑组织内铁蛋白(Ft)和转铁蛋白(Tf)的动态含量。结果:早期Ft在整个脑组织内呈现为即刻反应性升高,15d后其含量在实验对侧脑组织内恢复至正常范围,而在实验侧脑组织内呈现继续升高的趋势;Tf含量只在实验侧脑组织内升高,且呈现随时间继续升高趋势。结论:PTE大鼠模型中的铁代谢过程十分复杂,相关蛋白尤其是Tf含量的增加提示铁可能是外伤后癫灶形成机制的一部分。     

Ureteral pseudodiverticulosis associated with carcinoma of renal pelvis

We describe a patient with bilateral ureteral pseudodiverticulosis of 10 years’ duration before developing transitional carcinoma of the pelvis.     

Dynamic and steady-state ventilatory and gas exchange responses to arm exercise.

Previous studies have suggested that, for the same power output, arm exercise requires higher oxygen uptake (VO2), carbon dioxide output (VCO2), and ventilation (VE) than leg exercise and that response kinetics are slower. To evaluate these differences, four healthy subjects performed a total of 95 arm cranking tests. Each subject performed several tests at each of three or four power outputs spaced evenly below the maximum the subject could sustain (average = 53 W). Breath-by-breath responses to identical stimuli were averaged. End-exercise blood lactate was determined at each power output. Responses were compared to leg exercise responses in these subjects (J. Appl. Physiol. 67:547-555, 1989). For power outputs unassociated with lactic acidosis, differences between steady-state VO2, VCO2, and VE responses for arm and leg exercise were not significant. At higher power outputs, the higher VO2, VCO2, and VE during arm exercise were well correlated with higher lactate. For power outputs not engendering lactic acidosis, the time constants (tau) for VO2, VCO2 and VE were not greatly different for arm than for leg exercise. For each variable, at higher power outputs tau became longer by an amount correlated with higher lactate level. Like leg exercise, the slower kinetics of VO2 and VE (but not VCO2) at higher power outputs were well described as a superimposed slower component. We conclude that both dynamic and steady-state responses of VE and gas exchange to arm exercise do not differ substantially from those to leg exercise so long as the power output does not elevate blood lactate.     

生长抑素受体亚型在人鼻咽癌细胞株CNE2中表达

背景与目的：生长抑素受体（somatostatin receptor SSTR）在许多肿瘤组织均有表达，为生长抑素类似物如奥曲肽用于这些肿瘤的治疗提供了生物学基础，但对生长抑素受体在鼻咽癌中表达情况的研究甚少。本研究旨在了解生长抑素受体基因在鼻咽癌细胞中的表达情况，为生长抑素类似物用于鼻咽癌治疗的进一步研究提供试验基础。方法：采用RT—PCR法和SP免疫组化法联合检测体外培养的人鼻咽癌细胞株CNE2的SSTRs表达，并对PCR mRNA产物测序以鉴定结果。结果：RT—PCR提示人鼻咽癌细胞株CNE2分别表达生长抑素受体亚型SSTR1、SSTR2、SSTR4；免疫组化结果：人鼻咽癌细胞株CNE2表达SSTR1、SSTR2A为强阳性（〉60％），表达SSTR4为弱阳性、SSTR2介于两者之间、SSTR3和SSTR5则无表达。结论：我们的研究证实人鼻咽癌细胞株CNE2有多种生长抑素受体亚型基因表达，且以表达SSTR1、SSTR2较多。     

Male suicides and alcohol consumption in the former USSR

A significant decline (34.5%) in the suicide rate occurred in 1984–1988 throughout the USSR. The decline was observed shortly after the introduction of strict restrictions on the sale of alcohol. We tested the hypothesis that the restrictive alcohol policy in the first years of perestroika (June 1985) caused the fall in suicide rates in the former USSR. Data on alcohol consumption, violent death caused by external injury and poisoning (n= 916,315), death due to accidental alcohol poisoning (n= 77,837), suicide (n= 192,305) and death undetermined whether accidentally or purposely (n= 54,253) were analyzed for all former Soviet republics for 1984, 1986, 1988 and 1990. Men were chosen for the analysis, since men are more prone to abuse alcohol than women. Regression analysis with alcohol consumption as the independent variable and suicide rates and violent death rates as dependent variables shows that suicide and alcohol consumption were positively correlated as were violent death and alcohol consumption. In the republics with high alcohol consumption (Slavic and Baltic), suicide rates were also high. In the Caucasian republics, low alcohol consumption was associated with low suicide rates. For most republics, alcohol seems to explain more than 50% of suicides. Alcohol also has considerable explanatory value for violent death. Thus, a restrictive alcohol policy might be a way to reduce suicide and violent death.     

重型肝炎急性肝衰竭肝移植手术指征探讨

目的总结重型肝炎实施急诊肝移植的经验,探讨其手术指征。方法回顾性分析34例拟行急诊肝移植治疗的重型肝炎并急性肝衰竭患者的临床资料,其中11例实施急诊肝移植手术。结果34例患者中,14例在等待供体中死亡,另9例在转入我科时已丧失手术机会,于3d内死亡。11例急诊肝移植均采用改良背驮式肝移植,其中1例术后7d死于肺部感染、急性呼吸窘迫综合征(ARDS),1例术后20d死于原发性移植肝功能不良合并肾功能衰竭,其他9例术后均恢复顺利。随访6~29个月,1例于术后12个月死于慢性排斥反应,余8例情况良好。结论急诊肝移植是治疗重型肝炎合并急性肝功能衰竭移植的有效方法,其指征为:(1)Ⅱ级及Ⅱ级以上的进行性脑病;(2)PT延长15 s以上(或凝血酶原活动度<30%);(3)血清TBIL(300μmol/L(17.5mg/dl)或TBIL进行性升高(每天>17.1μmol/L)。