Delusions of disfigurement in a woman with acne rosacea.

A 36-year-old woman with newly diagnosed acne rosacea is presented. Her skin changes were noticeable only under closest scrutiny, but she quit her job, became despondent about her acne, and developed suicidal ideation. The diagnosis and treatment of this patient allow a broader discussion of the somatically focused patient whose ideation reaches delusional intensity.     

Safer, more expensive iodinated contrast agents: how do we decide?

The advantages of the new, safer, but more expensive iodinated contrast agents are discussed, and opinions on which patient groups should receive the agents are presented.     

Kohl: a hazardous eyeliner

Kohl is a widely used traditional cosmetic. It is mainly worn around the eyes in the Middle East, Asia and Africa. The elemental composition of twenty-one kohl specimens originating from various parts of Saudi Arabia, India and the Middle East was determined by energy dispersive X-ray analysis (EDAX). The data indicates the presence of significant lead levels in two thirds (14/21) of the kohl specimens ranging from 2.9–100 (mean 48.5). Other less frequent elements present in kohl preparations include aluminum, carbon, iron, titanium, calcium, magnesium, oxygen, silver silicon, sulfur and antimony. Seven kohl specimens were totally lead-free, four had a lead content in the range of 2.9–34.1 and ten had lead levels in excess of 84. Carbon levels in excess of 60 were detected in six kohl samples. Antimony was present in only one kohl specimen at a concentration of 7.8.Five western made eyeliner pencils analyzed for comparative purposes consistently revealed iron as a common constituent (mean 46) but no lead or carbon were detected in these specimens.The findings of this study indicate that modern kohl preparations contain a number of metals derived from natural sources in addition to carbon. The predominance of lead in the kohl preparations tested is of major concern due to the documented adverse effects in humans and the increased susceptibility of children to lead intoxication. Application of lead-containing kohl needs to be considered as a source of lead in evaluating patients with symptoms of lead intoxication in regions where this tradition prevails. The documented toxic effects of lead in humans and the increased sensitivity of children to lead exposure serve to emphasize potential health risks of using traditional lead containing kohl preparations and the need for increased surveillance and regulation of the manufacture of kohl.The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of the Army or Department of Defense.     

抗胆碱药3-(2-苯基-2-环戊基-2-羟基-乙氧基)奎宁环烷的立体化学和构效关系

研究了强效抗胆碱药dl-3-(2-苯基-2-环戊基-2-羟基-乙氧基)-奎宁环烷的四个光学异构体的两种不对称合成方法,用HPLC检测了异构体含量,讨论了构效关系。     

Pulmonary artery catheterization: a modified technique

A modified technique for catheterization of the pulmonary artery was developed. It involves the passage of a tapered, movable-core, J-tipped guide wire across the right ventricle into the pulmonary artery followed by the advancement of a straightened Grollman pigtail catheter. The technique was successful in 34 of 34 pulmonary artery catheterizations. The method avoids prolonged catheter manipulation within the right ventricle. In addition, since the catheter does not cross the tricuspid valve until the guide wire has been advanced, the occasional complication of the pigtail "hooking" on a tricuspid valve leaflet or chordae tendineae during catheter withdrawal and manipulation is prevented.