Cerebral embolization and coma after hysterosalpingography with oil-soluble contrast medium

A case of coma due to embolization after HSG, using oil-soluble contrast medium is presented. The patient was in a comatose state 11 days and then spontaneously regained full consciousness. The safety of oil-contrast medium for HSG is questionable.     

Defective oocytes: a new subgroup of unexplained infertility.

OBJECTIVE: To define a new category of unexplained infertility and its potential treatment. DESIGN: Normal infertile couples underwent prospectively, cross-fertilization attempts in which the wife's oocytes were inseminated by the husband and donor semen. After recurrent failure of fertilization, cross insemination of donor oocytes was attempted with the husband sperm. SETTING: In vitro fertilization unit at a teaching hospital. PATIENTS: Three couples who were diagnosed as suffering of unexplained infertility and treated by in vitro fertilization (IVF). RESULTS: The female partner of these couples produced morphologically normal oocytes that were demonstrated to be functionally defective and failed to fertilize in vitro with both husband and donor sperm. Donated oocytes inseminated by the husband's sperm were fertilized in all patients, demonstrating the normal fertilizing ability of the husbands' semen. One patient conceived and delivered after an oocyte donation. CONCLUSIONS: Conclusive diagnosis of defective oocytes as a cause of infertility may be made only after IVF and oocyte donation.     

Clinical characteristics, 4-year course, and DSM-IV classification of patients with nonaffective acute remitting psychosis

OBJECTIVE: The authors examined the clinical characteristics and 48-month illness course of cases of nonaffective acute remitting psychosis and described the classification of these cases in the DSM-IV system. METHOD: The data were derived from the Suffolk County (N.Y.) Mental Health Project, a study of first-admission patients with psychotic disorders admitted to psychiatric facilities between September 1989 and December 1995. The authors compared the demographic and clinical characteristics, 48-month course, and longitudinal research diagnoses of 16 patients with nonaffective acute remitting psychosis, defined by onset in 2 weeks or less and duration of less than 6 months, to those of 26 patients with other nonaffective remitting psychoses. RESULTS: Nonaffective acute remitting psychosis had a distinctly benign course-46% of the patients remained in full remission throughout the 48-month follow-up, compared with 14% of patients with other remitting psychoses. Nonaffective acute remitting psychosis was also associated with fewer negative symptoms than other remitting psychoses. By 24-month follow-up, only 6% of the patients with nonaffective acute remitting psychosis, compared with 77% of the patients with other remitting psychoses, received a research diagnosis of schizophrenia or schizoaffective disorder, whereas 44% of patients with nonaffective acute remitting psychosis, compared with 12% of patients with other remitting psychoses, were given the residual diagnosis of psychotic disorder not otherwise specified. CONCLUSIONS: Nonaffective acute remitting psychosis is a highly distinctive yet not adequately classified condition. Better delineation of nonaffective acute remitting psychosis in current diagnostic systems could lead to better understanding of this condition and improve the applicability of diagnostic systems in developing countries, where these conditions are more common than in industrialized countries.     

The roles of behavioral health professionals in class action litigation

Class action suits frequently have been used as a strategy for improving the quality of mental health care. Psychiatrists, psychologists, and professionals from related disciplines have been involved in these suits in different roles. This article presents and discusses case examples of these roles, which include the expert witness, court-appointed expert, consulting expert, monitor, special master, receiver, advocate, amicus curiae, plaintiff, and defendant. The authors caution against assuming dual roles and argue that professionals, before beginning to participate in this complex arena, should clarify their functional responsibilities, the legal basis of their involvement, and the ethics principles that will guide their actions.     

Perthes-like changes in geleophysic dysplasia

Geleophysic dysplasia is a rare skeletal dysplasia characterised by 'happy natured' facies, short stature with short limbs, brachydactyly, and joint contractures. This report describes a case of a patient with unilateral Legg-Calvé-Perthes-like changes associated with dysplastic proximal capital femoral epiphysis, typical to geleophysic dysplasia.     

Tetrahydrobiopterin protects against guanabenz-mediated inhibition of neuronal nitric-oxide synthase in vitro and in vivo.

It is established that guanabenz inhibits neuronal nitric-oxide (NO) synthase (nNOS) and causes the enhanced proteasomal degradation of nNOS in vivo. Although the time- and NADPH-dependent inhibition of nNOS has been reported in studies where guanabenz was incubated with crude cytosolic preparations of nNOS, the exact mechanism for inhibition is not known. Moreover, even less is known about how the inhibition of nNOS triggers its proteasomal degradation. In the current study, we show, with the use of purified nNOS, that guanabenz treatment leads to the oxidation of tetrahydrobiopterin and formation of a pterin-depleted nNOS, which is not able to form NO. With the use of 14C-labeled guanabenz, we were unable to detect any guanabenz metabolites or guanabenz-nNOS adducts, indicating that reactive intermediates of guanabenz probably do not play a role in the inhibition. Superoxide dismutase, however, prevents the guanabenz-mediated oxidation of tetrahydrobiopterin and inhibition of nNOS, suggesting the role of superoxide as an intermediate. Studies in rats show that administration of tetrahydrobiopterin prevents the inhibition and loss of penile nNOS due to guanabenz, indicating that the loss of tetrahydrobiopterin plays a major role in the effects of guanabenz in vivo. Our findings are consistent with the destabilization and enhanced degradation of nNOS found after tetrahydrobiopterin depletion. These studies suggest that drug-mediated destabilization and subsequent enhanced degradation of protein targets will likely be an important toxicological consideration.     

Constancy of relative body weight in children

The height and weight records of 404 schoolchildren at age 6 to 7 and at age 13 to 14 were analysed. Relative weight (i.e.% of ideal weight for height) of a child tended to change little over this period of 7 to 8 years of rapid growth. The correlation coefficient of relative weight for the group at the two ages was 0·81. In only 6% of the children did relative weight change more than 20% in either direction.This stability of relative body weight, despite the variations in environmental factors during school years, emphasizes the dominant role of genetic factors in the monitoring of body weight.