AN UNUSUAL CAUSE OF RECTOVAGINAL FISTULA

An unusual case of rectovaginal fistula is reported. An 81 year old woman presented to the geriatric team with a request to review her faecal incontinence. It was discovered that she had a predilection for placing foreign objects in her vagina. In this instance a carbonated drink top had formed a rectovaginal fistula.     

Abnormal biochemical and cellular parameters in the blood of patients with Raynauds phenomenon

Finger blood flow is decreased in Raynauds Phenomenon (RP). This may be due not only to vasospasm, but also to blood abnormalities. 40 patients with Raynauds Disease (RD), 28 with suspected RP (SS) and 42 with secondary Raynauds syndrome (RS) were enrolled and compared to 50 controls. Results from base-line samples show that those with RP have abnormal haemostasis and rheology whereas those with mild Raynauds, RD do not. Blood sampled after cold challenge in 15 RS patients and 15 controls show that both groups exhibit platelet activation after emersion. The degree of activation however was much more marked in the RS patients. We have shown that abnormalities of haemostasis and rheology are found in patients likely to have endothelial damage (RS). These changes are probably a consequence rather than a cause of the disease. After cold challenge the results become more abnormal and correlate with severity of disease.     

Measurement of maximum variability within event related potentials in schizophrenia.

One limitation of averaging individual late component event related potential (ERP) responses is that a single average ERP cannot reflect the variability of responses from epoch to epoch. In this article, we describe a method to quantify this variability and determine if any part of the overall ERP reflects a maximum variance through the use of response variance curves. We then apply this method to one disorder, schizophrenia, in which variability of information processing is hypothesized to underlie aspects of the symptomatology. Response variance curves in a group of unmedicated schizophrenic patients reveal systematic differences, maximal between 190 and 250 ms, compared with those in a group of medicated schizophrenic patients and normal control subjects.     

Longterm neurological complications of chronic, habitual cocaine abuse.

We review and expand the results of several previously published studies on computed tomographic and electroencephalographic correlates of chronic, habitual cocaine abuse in order to present a complete spectrum of the longterm neurological complications of cocaine abuse. We argue that prolonged and frequent cocaine abuse leads to biochemical and vascular cerebral insults that eventually may cause functional and structural abnormalities affecting predominantly the fronto-temporal areas.     

Chiari II malformation: MR imaging evaluation

The purpose of this study was to explore the value of high-detail MR imaging in the diagnosis of the Chiari II malformation. Twenty-four patients with known Chiari II malformation as diagnosed by CT scanning were evaluated with cranial MR scans. Two patients also had spine scans. The sagittal-plane images were the most informative, and abnormalities of the telencephalon, diencephalon, mesencephalon, rhomboencephalon, upper spinal cord, and mesencephalon were shown extremely well. We found MR to be an easy and accurate method for demonstrating the abnormalities of the Chiari II malformation, and it is our procedure of choice.     

Altered turnover and synthesis rates of lung surfactant following thoracic irradiation

Between 2-6 weeks after thoracic irradiation with 10 Gy X rays, when levels of surfactant in the alveoli show the greatest increase, there is a reduction in the rate of radioactivity loss from 3H-choline labeled disaturated phosphatidylcholine from the lung. This indicates a reduced turnover of surfactant. Discrepancies between the halving times for specific activity and for total radioactivity of the disaturated phospholipids suggest that at between 2 and 3 weeks post-irradiation, removal and degradation of surfactant almost ceases, but that synthesis continues normally. However, by 3 weeks post-irradiation, choline-3H incorporation into disaturated phosphatidylcholine suggests that surfactant synthesis is increased about two-fold. The reduced number of macrophages recovered from alveolar lavage between about 2 and 6 weeks post-irradiation may indicate a reason for the lengthened turnover times of surfactant over this period. Nevertheless the stimulated surfactant production that takes place from about 3 weeks onward suggests an additional active response to radiation or to radiation damage by the type II pneumonocytes. These studies confirm that the maximum levels of alveolar surfactant seen at 3 weeks post-irradiation result from a different lung response than that responsible for the increase in surfactant, which occurs within hours of irradiation.     

Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. I. One-year effects of a controlled study on relapse and expressed emotion

Relapse rates averaging 41% in the first year after discharge among schizophrenic patients receiving maintenance neuroleptic treatment led to the development of two disorder-relevant treatments: a patient-centered behavioral treatment and a psychoeducational family treatment. Following hospital admission, 103 patients residing in high expressed emotion (EE) households who met Research Diagnostic Criteria for schizophrenia or schizoaffective disorder were randomly assigned to a two-year aftercare study of family treatment and medication, social skills training and medication, their combination, or a drug-treated condition. First-year relapse rates among those exposed to treatment demonstrate a main effect for family treatment (19%), a main effect for social skills training (20%), and an additive effect for the combined conditions (0%) relative to controls (41%). Effects are explained, in part, by the absence of relapse in any household that changed from high to low EE. Only the combination of treatment sustains a remission in households that remain high in EE. Continuing study, however, suggests a delay of relapse rather than prevention.