Contraction of the fetal ductus arteriosus induced by diclofenac. Case report

The ductus arteriosus in the fetus may contract after administration of nonsteroidal anti-inflammatory drugs such as indomethacin and aspirin. We report a similar effect observed after a 36-week pregnant women was given diclofenac against flank pains. The ductus of this fetus was vasoconstricted with evidence of right ventricular hypertension. It resolved after cessation of the drug. Diclofenac is a cyclo-oxygenase inhibitor and thus carries the pharmacodynamic properties of other nonsteroidal anti-inflammatory drugs with inhibition of prostaglandin synthesis, resulting in vasoconstriction of the ductus arteriosus. We suggest monitoring of the fetal ductus state and velocities by fetal echocardiography in women treated with diclofenac.     

Perceptions of medical errors by internal medicine residents: development and validation of a new scale

Efforts to identify the underlying structure of 40 survey items dealing with perceptions of medical errors are reported on the basis of responses from 195 medical residents. Factor analysis revealed that the medical errors perceptions were represented by a 10-factor solution. The external validity of these factors was examined relative to perceptions about the cost of medical errors, the cost of errors to health care, and the need for education and interventions to address errors. Results indicated that 13.9% of the variation in the perceived cost of medical errors and 17.1% of the variation in the perceived need for additional physician education was explained by the factor structure.     

Differential responses of visceral and subcutaneous fat depots to nutrients

Increased visceral adiposity is a pivotal component of the metabolic syndrome. Differential gene expression patterns of fat-derived peptides (FDPs) in visceral fat and subcutaneous fat have been characterized in the fasting state. Here we examined whether delivery of nutrients differentially affects the expression of FDPs in visceral fat versus subcutaneous fat (in the fed state). We increased the rate of glucose flux into adipose tissue of normal rats (n = 16) by hyperglycemia or hyperinsulinemia using the clamp technique. Glucose uptake was associated with increased expression of FDPs, including resistin ( approximately 5-fold), adiponectin ( approximately 2-fold), leptin ( approximately 15-fold), plasminogen activating inhibitor-1 ( approximately 10-fold), and angiotensinogen ( approximately 4-fold) in visceral fat, but markedly less in subcutaneous fat. Cytokine expression derived mainly from vascular/stromal/macrophage components of adipose tissue was less dramatically increased. Infusion of glucosamine amplified the results obtained by increasing glucose uptake into adipose tissue, suggesting that flux through the hexosamine biosynthetic pathway may serve as a mechanism for "nutrient sensing." Nutrient-dependent expression of FDPs in visceral fat was also associated with increased plasma levels of several FDPs. Because a biologic sensing pathway can dynamically couple daily food intake to abnormal plasma levels of important FDPs, we challenge the practice of obtaining plasma levels after fasting to assess risk factors for metabolic syndrome.     

Correlation between radionuclides uptake and ultrastructural features of tight junctions in the capillary wall of meningiomas.

The uptake of Tc-99m pertechnetate and Co-57 bleomycin and the ultrastructure of small blood vessels were studied in 10 cases of meningioma. When thin sections of 120 contact areas between adjacent endothelial cells were examined, 92% of the intercellular contacts contained one to three punctate tight junctions. Freeze fracture preparations revealed fascia occludens with one to four sealing strands. These findings are consistent with the high permeability the meningiomas displayed for both of the radiopharmaceuticals.     

The unmotivated patient syndrome: survey of therapeutic interventions.

The authors describe five groups of patients who have been found to respond poorly to psychiatric treatment--people from lower socioeconomic groups, juvenile delinquents, drug-addicted individuals, alcoholics and military psychiatric patients. Although these groups of patients represent different etiologies and symptom-specific pathologies, many of their members have in common a lack of motivation for change. The authors discuss the reasons for this lack of motivation, suggesting that focusing on this factor would promote a better understanding of the unmotivated patient syndrome and lead to the development of more effective psychotherapeutic efforts.     

The pineal and endocrine changes in heat exposed male hamsters

Summary Decreased testicular weight with damaged seminiferous tubules were observed in hamsters pinealectomized and exposed continuously to high ambient temperature. In hamsters with intact pineals, exposure to heat resulted in reduced testicular weight without recognizable histological damage. In both groups, serum testosterone levels were elevated, evidently through a compensatory mechanism in the interstitial cells, which did not appear to be damaged. Concomitantly with these findings, reduced serum LH, and pituitary LH and proclactin concentrations were encountered in the heat-exposed pinealectomized hamsters, compared to those of their heat-exposed sham-operated counterparts.These results in hamsters reaffirm a previous postulation of a moderating, protective role for the pineal, against adverse effects of prolonged exposure to heat, in rodents.     

Preparation of an infectious ribonucleic acid derived from mouse brains infected with Israel turkey meningo-encephalitis virus

Summary An infectious RNA preparation was obtained from mouse brains infected with the hitherto little known Israel turkey meningo-encephalitis virus isolated from diseased turkeys in 1958. The procedure adopted was based on the use of saturated aqueous phenol and bentonite. The infectiousness of the preparation was demonstrated in vivo and in vitro, and the identity of the virus derived thereof was proved by neutralization and fluorescent antibody techniques. The yields of infectivity was of a low order, approximately 0.001 per cent.