A mental health center's influence in a county jail.

A case study that describes the process of establishing mental health services in the medium-sized Howard County (Maryland) jail is presented. Built in 1878, the county jail provided virtually no rehabilitative services to its inmates until 1972. At that time, personnel from the Howard County Bureau of Mental Health began to gain access to the jail, establish rapport with the jail staff, assess the mental health needs of the inmates, and implement various programs to meet these needs. Implementation and development of services are described for the 12-year span between 1972 and 1984. The concept of providing community-based services has been accepted and incorporated into the value system and structure of the jail. It is concluded that the viability of programs depended upon interactions among continuation of strong leadership for each component of the rehabilitation program, acceptance of the value of these services by the jail administration and staff, and availability of community resources. The linkage between the jail and community agencies is discussed.     

Handling antineoplastic-drug admixtures at cancer centers: practices and pharmacist attitudes

Results of a 1986 national survey of handling practices for antineoplastic drugs at cancer centers and pharmacists' attitudes toward the importance of recommended practices are reported. A sample of 323 hospitals representing the 27 comprehensive cancer centers (CCCs) and 296 member institutions of the Association of Community Cancer Centers (ACCC) was selected for participation in the survey. Respondents were asked to rate the importance of a recommendation using a five-point scale. Data were analyzed according to hospital bed capacity (small, medium, and large). A total of 175 usable questionnaires were returned, yielding a response rate of 54%. Overall, 99.6% and 94.7% of CCCs and ACCC member institutions, respectively, used vertical-laminar-airflow containment h oods. Personnel used in antineoplastic-drug preparation varied according to hospital size, with CCCs using technicians more frequently than ACCC members. Training methods for personnel were similar among hospitals, although CCCs reported using written testing during training more often than ACCC members. Concern about the safety of the pregnant or breast-feeding woman and of the fetus or infant has led to precautionary policies and procedures in many hospitals. Most hospitals handled antineoplastic waste separately from other waste and regarded this as extremely important. Incineration of antineoplastic waste was used by most hospitals. Antineoplastic-drug-handling precautions taken at CCCs and ACCC member institutions have improved during recent years; pharmacists' perceptions of the importance of various recommendations for handling antineoplastic agents may be helpful in analyzing and developing relevant guidelines.     

Differential Effects of Serotonin and Raphe Grafts in the Hippocampus and Hypothalamus: A Combined Behavioural and Anatomical Study in the Rat

Combined with a partial cholinergic deficiency, serotonergic lesions induce severe spatial learning deficits. Serotonergic lesions, however, have additional effects, such as reduced body weight and disruption of thermoregulation, which may be the cause of the observed learning deficits. Restoration of the serotonergic innervation of the hippocampus by raphe grafts reduces these learning deficits. The effects of the grafts may result from a direct support of spatial learning but may also be an indirect result of preventing some of the other effects of serotonergic lesions. In the present study we used raphe grafts to examine the selectivity and specificity of the effects of serotonergic lesions in the rat, and used the behavioural effects as an indication of successful transplantation in order to examine the fine details of such grafts. Raphe grafts in the hippocampus did not prevent the effects of the lesions on body weight, thermoregulation and exploratory behaviour but did minimize the effects of the lesions on spatial learning. In contrast, raphe grafts in the hypothalamus reduced the effects of the lesions on thermoregulation but failed to support learning. The grafted fibres showed termination specificity with the interneurons, which is typical of the serotonergic innervation of the normal hippocampus. The results indicate that the serotonergic innervation of the hippocampus functions locally to support spatial learning. This role of serotonin is independent of its involvement in modulation of body weight, thermoregulation or exploratory behaviour. The results confirm that the modes of serotonergic action in the hippocampus include the selective innervation of specific interneuron subpopulations.     

Predictive Value of Balloon Test Occlusion of the Internal Carotid Artery

Balloon test occlusion (BTO) of the internal carotid artery (ICA) is used in conjunction with single-photon emission computed tomography (SPECT) imaging to assess the cerebrovascular collateral reserve prior to surgical manipulation of the artery. The present report reviews 56 consecutive patients with tumors or vascular lesions at the base of the skull who underwent BTO and subsequent treatment on that basis within a 3-year period. Four patients underwent carotid sacrifice, since they tolerated the BTO and had normal SPECT imaging. Postoperatively, one patient had patchy infarcts in the frontal lobe, another a middle cerebral artery territory infarction, a third had a lacunar infarct, and the fourth had an impending stroke and was treated with an emergent revascularization procedure. There were 15 patients who underwent saphenous vein bypass grafting, of these there were three graft occlusions, one of which resulted in an infarction. There were two other infarctions due to technical difficulties, one being related to the revascularization procedure. Based on these results, we suggest that passing BTO with a normal SPECT study does not necessarily indicate that the patient is immune to stroke following carotid sacrifice. Revascularization should be considered, when ICA sacrifice is deemed necessary to treat the pathologic condition adequately, to minimize the likelihood of a stroke.     

Clinical Review of Adult Granulosa Cell Tumors of the Ovary

Granulosa cell tumors are uncommon neoplasms that are characterized by their long natural history and for their tendency to recur years after an apparent clinical cure. As such they are difficult tumors to study. In the majority of cases, the initial therapy is surgical although the extent of the necessary procedure remains controversial. The role for any adjuvant therapy after complete resection remains to be established. In patients with advanced disease, combination chemotherapy consisting of cisplatinum/vinblastine/bleomycin has the highest identified response rates. In patients with recurrent or metastatic disease therapy is palliative and has not yet been standardized. Treatments therefore need to be individualized.     

Evaluation of reduced activity galactose-1-phosphate uridyl transferase by combined radioisotopic assay and high-resolution isoelectric focusing

Fifty-nine patients referred for testing of galactose-1-phosphate uridyl transferase (GALT) activity were evaluated by a combination of radioisotopic assay and an improved high-resolution isoelectric focusing (IEF) method for determination of individual genotypes. The majority of evaluations (43 of 59) were undertaken because of an abnormal fluorometric GALT screening assay conducted as part of a state newborn galactosemia screening program or as a diagnostic test for an infant with one or more clinical signs of galactosemia. Only 12 of the 43 patients with an abnormal fluorometric screening test were found to have less than 3% GALT activity by quantitative assay, no GALT-staining by IEF, and a clinical history consistent with classical galactosemia. The majority of the remainder (24 of 43) were found to be heterozygotes for galactosemia, the Duarte variant, or both. IEF was found to be a fast and accurate technique for assignment of GALT genotypes in conjunction with quantitative enzymatic assay.     

The efficacy of excimer laser (308 nm) for vitiligo at different body sites

BACKGROUND: The treatment with XeCl-excimer laser generated 308-nm UVB radiation has shown promising results in patients with vitiligo. OBJECTIVE: In this controlled, prospective trial we studied the primary efficacy (start and grade of repigmentation) and patient's satisfaction of XeCl-excimer laser for treatment of vitiligo patches at different body sites and re-evaluated the achieved repigmentation 12 months after the end of therapy. METHODS: Twenty-five patients with generalized or localized vitiligo with a total of 85 lesions at different body sites were enrolled in this study. Vitiligo patches were treated with 308-nm XeCl-excimer laser 3 times a week for 6 to 10 weeks. The overall repigmentation grade of each treated lesion was evaluated once a week on a 5 point scale rating from 0 (no repigmentation), 1 (1-5%), 2 (6-25%), 3 (26-50%), 4 (51-75%), to 5 (76-100%). RESULTS: Twenty-four patients completed the study. Within 6 to 10 weeks of treatment 67% of the patients (16/24) developed follicular repigmentation of at least one of their vitiligo lesions. Lesion repigmentation started after a mean of 13 treatments in lesions located on the face, trunk, arm, and/or leg (high-responder location), and after a mean of 22 treatments in lesions located on the elbow, wrist, dorsum of the hand, knee, and/or dorsum of the foot (low-responder location). Untreated control lesions and lesions located on the fingers did not achieve any repigmentation. After 10 weeks of treatment repigmentation of more than 75% was found in 25% (7/28) of lesions of the high-responder location group versus 2% (1/43) of lesions of the low-responder location group. In most cases, laser-induced repigmentation was persistent, as determined 12 months after the end of treatment. CONCLUSIONS: 308-nm excimer laser is an effective modality for the treatment of vitiligo. However, similar to other non-surgical treatment modalities, the therapeutic effect is mainly dependent on the location of vitiligo lesions.     

Phenylethylamine, norepinephrine and mounting behavior in the male rat

Phenylethylamine, which induces mounting behavior in naive adult male rats when administered chronically, was shown to selectively raise brain norepinephrine levels in the medial preoptic nucleus, a region known to be implicated in the regulation of sexual behaviors. It is suggested that the catecholamine alteration is a secondary response to the primary influence of phenylethylamine on the preoptic nucleus.     

Spatial performance is severely impaired in rats with combined reduction of serotonergic and cholinergic transmission

A possible interaction between serotonergic and cholinergic neurotransmission was examined in relation to the performance of a spatial memory task. Blockade of cholinergic transmission with a high dose of atropine was sufficient to impair performance of a water maze task. A partial reduction of cholinergic transmission using a low dose of atropine had no effect on this performance. Reducing serotonin synthesis, using a specific inhibitor of tryptophane hydroxylase p-chlorophenylalanine (PCPA) also had no effect on performance of such a task. However, a combined treatment with a low dose of atropine and PCPA severely impaired the performance of rats in the water maze. The rats were impaired in both acquisition of the initial spatial task and in reacquisition of a new spatial position (= working memory). These findings suggest an interaction between cholinergic and serotonergic transmission in acquisition and retention of spatial information. Furthermore they propose that deficits in cognitive abilities, observed in aging or Alzheimer's disease, may result from the combined reduction in cholinergic and serotonergic transmission.