The Syndrome of Self-Induced Water Intoxication in Psychiatric Patients

Abstract: This is a report on six psychiatric patients who indulged in excessive ingestion of water and subsequently developed tonic-clonic seizures in the course of the underlying mental disorders. On the basis of the DSM-III criteria, they were diagnosed as follows: schizophrenic disorder, 4; schizoaffective disorder, 1; borderline personality disorder, 1. The levels of serum electrolytes were estimated during five episodes of seizures in three patients. Hyponatremia was a consistent finding (serum sodium: mean = 120.6 mEq/liter). Plasma osmolality and plasma levels of arginine vasopressin (AVP) were determined during two episodes in two patients. The inappropriately high circulating levels of AVP relative to plasma hypoosmolality were documented. However, the response to the overnight fluid deprivation and acute water load during the period of no seizures in two patients revealed no evidence of the persistent SIADH, suggesting the temporal association of hyponatremic encephalopathy with inappropriate AVP secretion. It is not conclusive whether the transient SIADH is the cause or the consequence of hyponatremic encephalopathy, although a delusion or an auditory hallucination could play a critical role in drinking water excessively in three patients.     

Blood status and serum free amino acids in Papua New Guinea highlanders

Hematological values and serum amino-acid concentrations were measured in 17 healthy male adult Papua New Guinea highlanders who live on a sweet-potato staple diet. Hematological values were within the normal range, except for a low serum urea concentration. The concentrations of serum threonine, valine, isoleucine, leucine and tyrosine were significantly lower, and those of arginine, glutamate, glycine and alanine were significantly higher, than in Japanese controls. These amino acid patterns in the serum of Papua New Guinea highlanders are an indication of low protein nutrition and adequate energy supply. Some essential amino acid and urea concentrations in the serum of nine Papua New Guinea subjects fed on an adequate protein diet (1.3 g/kg body weight, about twice their habitual diet) for 13 days were significantly increased but were still significantly lower than those of Japanese subjects. Serum alanine decreased on an adequate protein diet. These results show that amino acid uptake and utilization by peripheral tissues may be accelerated on an adequate protein diet. Blood status and serum amino acid concentrations did not show any change except for urea and some amino acids, when five Papua New Guinea highlanders were fed on a low protein diet (0.6 g/kg) consecutively for 13 days.     

Adrenal tumors discovered incidentally on ultrasonography: three case reports

A series of three adrenal tumors is reported. They were discovered incidentally on ultrasonography for screening. One case was a benign pheochromocytoma and the others were non-functioning adrenocortical adenomas. They were hypoechoic on ultrasonography and were 4.5 x 3.5 x 4.0, 3.0 x 2.5 x 2.5 and 3.5 x 2.5 x 2.0 cm. Non-functioning adrenal tumors of a diameter smaller than 3.0 cm generally tended not to require surgery. Ultrasonography is useful for screening and evaluating patients with an adrenal mass without surgery as well as is computed tomographic scan.     

Choleretic effects of taurine on experimentally-induced intrahepatic cholestasis]

When a lymphokine, the cholestatic factor, is intravenously injected into rats through a mesenteric vein, remarkable reductions in bile flow and bile acid excretion are observed. However when taurine was injected with the cholestatic factor, the reduction in bile flow and bile acid excretion were significantly suppressed. Moreover, injection of taurine with cholestatic factor resulted in the decreases of both bile acid-dependent bile flow and vesicular transport but not bile acid-independent bile flow. Not significant choleretic effects were noted when taurine alone was administered to normal rats.     

MR of the base of the pons in Wilson disease.

The authors describe unusual MR findings in three patients with Wilson disease, eg, white matter changes in the base of the pons, and speculate whether the changes are caused by Wilson disease or by concomitant disease, and whether the pontine lesions they observed are primary or related to lesions located more rostrally.     

Cell-free translation of immunoglobulin G polypeptides by chicken bursal RNA.

The acquisition of messenger RNA controlling the translation of immunoglobulin G was studied in the chicken bursa of Fabricius, using the cell-free translation system of wheat germ lysate. Total cellular RNA extracted by phenol-1% sodium dodecylsulphate (pH 5.0 at 50 degrees) incorporated [3H]-leucine maximally. Sodium dodecylsulphate polyacrylamide gel electrophoresis of the immune precipitates of cell-free products with anti-chick IgG showed that polypeptides of gamma- and light chains were synthesized by bursal RNA from 20-day embryos and one-week-old chicks; in addition, a polypeptide with a molecular size of about 4 x 10(4) was synthesized. No appreciable synthesis of gamma- and light chains by bursal RNA from 12-day embryos was found.     

Binding of thyroid hormone receptor-associated factors to rGH gene 5' flanking sequences

Binding of semi-purified rat liver triiodothyronine (T3) nuclear receptor (T3-nR) to sequences in the 5' flanking DNA of rat growth hormone (rGH) has been evaluated by the DNAse-footprinting technique. T3-nR was obtained by extraction in 0.3 M KCl and partially purified by column chromatography to 80 pmol/mg T3 maximal binding capacity (MBC). The T3-nR preparation protects the sequence -330 to -314 (5'-CAGTGAACAAACGATG-3') which may represent a repressor element, the sequence -224 to -192 (5'-CATTGCCCATAAACCTGAGC-3') which is thought to involve positive T3 regulation, the sequence -98 to -78 (5'-GCTCCAGCCATGAATAAATG-3') which may regulate basal expression, and the TATA box area. Although the DNAse footprints occur only with preparations containing functional T3-nR, it is uncertain whether each protected zone is due to binding of T3-nR or associated proteins. Protection is associated with enhanced DNAse digestion around the protected sites, involves both strands, and does not appear to require T3 occupancy of the receptor. Only the areas described are protected in the studies, and non-specific proteins such as albumin, core histones, and nuclear extracts without receptor activity, have no effect. A putative consensus enhancer sequence -CCAGAGCCAAGG- conveying T3 responsivity is suggested on the basis of comparison to sequences in four T3 responsive genes.     

Diaphragmatic reconstruction using a latissimus dorsi muscle flap following wide resection of the diaphragm combined with esophago-gastrectomy for cardial cancer

In three patients with cardial cancer invading the esophagus and the diaphragm, wide resection of the left diaphragm and its reconstruction using a latissimus dorsi muscle flap were performed during radical esophago-gastrectomy. More than two thirds of the diaphragm could be resected because the muscle flap was large enough to be brought into the thoracic cavity without difficulty, to repair the diaphragmatic defect. The postoperative respiratory function of these patients was adequately maintained. A technique for diaphragmatic reconstruction by means of the latissimus dorsi muscle flap is described in this report.