Milk composition of insulin-dependent diabetic women

The macronutrient, trace mineral, and immunological contents of milk of five moderately controlled, insulin-dependent diabetic women were studied at 3 months postpartum. Concentrations of total nitrogen, lactose, fat, and energy were not distinguishable from those in milk of nondiabetic women. Glucose concentrations in milk from diabetic women were significantly higher (p less than 0.001) and more variable. The macro- and trace minerals (Ca, P, Mg, K, Zn, Cu, and Fe) were within normal ranges with the exception of Na which was higher in milk from the diabetic women (p less than 0.05). The concentrations of lactoferrin and secretory IgA were not statistically different from reference norms. Milk composition of five insulin-dependent diabetic women was not distinguishable from that of the reference population, with the exceptions of Na and glucose concentrations, which were slightly elevated.     

A polymorphism in the dopamine β-hydroxylase gene is associated with “paranoid ideation” in patients with major depression

Background: Increased dopaminergic activity may play a primary role in psychotic depression. Dopamine β-hydroxylase (DβH) catalyses the key step in biosynthesis of the neurotransmitter noradrenaline from dopamine, and low DβH activity is a possible risk factor for developing psychotic depression. An exon 2 polymorphism (DBH∗444 g/a) of the DβH gene (DBH) is significantly associated with both serum and cerebrospinal fluid levels of DβH.Methods: We determined the genotype of the DBH∗444g/a polymorphism in a cohort of 164 patients with major depression and examined the association of this polymorphism with paranoid ideation, interpersonal sensitivity, and psychoticism on the Hopkins Symptom Checklist.Results: Patients who possessed the A allele were significantly more likely to have higher scores for interpersonal sensitivity and paranoia than patients without the A allele (p = .004 and p = .048, respectively), suggesting that this allele may predispose patients to paranoia in major depression. In addition, we found an association between prolactin levels in men and DBH∗444 g/a genotype such that homozygous G individuals displayed significantly higher levels than homozygous A or heterozygote individuals.Conclusions: Depressed patients with the GG genotype of DβH have lower scores for interpersonal sensitivity and paranoid ideation. The GG genotype may be protective against the development of psychosis in the presence of a major depressive episode.     

Hypoxic cells as specific drug targets for chemotherapy

Hypoxic cells exist in solid tumors in regions of poor vascularity and are likely to be exposed to insufficient concentrations of chemotherapeutic agents. Furthermore, because these cells may be cycling very slowly or may be quiescent, they may not be sensitive to agents which are most active in proliferating cells. Under conditions of reoxygenation, hypoxic cells which have survived therapy may re-enter the cell cycle and repopulate a tumor which had shown responsiveness. Three classes of agents have recently been shown to be selectively toxic to hypoxic cells in vitro. For some of these agents, combinations of hypoxic cell-selective drugs and agents with selectivity for well oxygenated cells have demonstrated improved tumor cell kill in solid transplantable rodent tumor systems. The selectivity of these classes of drugs apparently stems from enhanced activation of the drug under hypoxic conditions. Although all of these drugs exhibit selectivity, the wide divergence in the therapeutic ratios for the individual agents suggests that it may be possible to develop newer agents that are highly toxic to hypoxic cells with little toxicity for normal tissues.     

Primary small cell carcinoma of the larynx: analysis of treatment

Primary small cell carcinoma of the larynx continues to pose problems in its treatment. Four patients with this neoplasm were seen in a seven-year period at our institution and 49 patients were reviewed from the world literature. The only variables which significantly affected survival were the presence of metastases at initial examination and treatment modality. Those patients treated with chemotherapy and radiation therapy had an increased length of survival and increased chance of survival as compared to patients subjected to other treatment modalities. Because of the small number of patients reported in the world literature and lack of controlled studies, the treatment of small cell carcinoma of the larynx remains controversial; this retrospective analysis suggests that combination chemotherapy plus radiation offers the best chance for cure.     

Erotomania revisited: clinical course and treatment.

Erotomania is a rare disorder in which an individual has a delusional belief that a person of higher social status falls in love and makes amorous advances towards him/her. Little is known about the background, classification, treatment, or outcome of individuals with this disorder. The purpose of this study was to evaluate current criteria for diagnosing and classifying primary and secondary erotomania in addition to examining course, outcome, and impact on victims of erotomania. Semistructured interviews covering personal and family details in addition to treatment and outcome to date were performed on a series of erotomanic patients identified in a defined area. Evaluation of diagnosis used DSM-IV and other criteria. Fifteen erotomanic subjects (11 female, four male) were identified. Most were isolated, without a partner or full-time occupation. Forty percent had a first-degree relative with a psychiatric history and of those half had a first-degree relative with a mono-delusional disorder. Less than half of the objects of their affection, mainly noncelebrities, were subject to harassment. Subjects with primary erotomania and erotomania secondary to other psychiatric diagnoses were identified using DSM-IV criteria. Ellis and Mellsop's criteria were found to be useful in assessing erotomania but we could not replicate Seeman's fixed and recurrent groups. Treatment and outcome was better than expected particularly for those with primary erotomania and erotomanics with a diagnosis of bipolar affective disorder. In this series, erotomanic symptoms largely occurred in the context of other psychiatric disorders, although subjects with pure erotomanic symptoms were seen. Subjects were less dangerous and engaged in less harassment of victims than the literature suggests. Subjects were often isolated, unemployed, and with few social contacts. Strong family psychiatric histories were seen particularly with regard to mono-delusional disorders raising the possibility of genetic inheritance. An adaptation of Ellis and Mellsop's criteria was suggested for the diagnosis of primary and secondary erotomania. Response to treatment and prognosis was good, particularly for primary erotomania and erotomania secondary to bipolar affective disorder.     

Reversible tetraplegia due to polyneuropathy in a diabetic patient with hyperosmolar non-ketotic coma

Critical illness polyneuromypathy has not previously been reported as a complication of diabetic coma. We describe a patient with hyperosmolar non-ketotic coma (HONK) complicating gram-negative sepsis in whom persistent coma and profound tetraplegia caused considerable concern. Although, initially, it was feared that the patient had suffered a central neurological complication such as stroke or cerebral oedema, a diagnosis of critical illness motor syndrome (CIMS) was subsequently confirmed neurophysiologically. Profound limb weakness associated with HONK is not necessarily due to a catastrophic cerebral event, rather it may be a result of CIMS, which has an excellent prognosis for full neurological recovery. Received: 4 June 1999 Accepted: 22 September 1999