The neurologic examination in geriatric psychiatry

The need to distinguish functional mental disorders from organic brain dysfunction has become increasingly important with the growing number of elderly patients who present with behavioral disturbances. As part of the evaluation of these patients, the psychiatrist or other physician should perform a basic neurologic examination. The author describes an examination for geriatric patients that includes methods for taking a neurologic history, for clinically measuring psychological functions, for evaluating primitive reflexes, and for interpreting peripheral neurologic responses.     

Recognizing the CT Manifestations of Gynecologic Conditions Encountered in the Emergency Department

Women commonly present to the emergency room with subacute or acute symptoms of gynecologic origin. Although a pelvic exam and ultrasound (US) are the preferred initial diagnostic tools for gynecologic entities, a CT is often the first line imaging modality in the emergency department. We will provide a review of normal uterine enhancement and normal pregnancy related findings, and then familiarize radiologists with the CT appearances of gynecologic entities classically described on ultrasound that may present to the emergency department.     

Effect of estradiol and progesterone on human chorionic gonadotropin secretion in vitro

Many of the substances known to control the secretion of pituitary gonadotropins also modulate the secretion of human chorionic gonadotropin (hCG) by the placenta. In order to study the effect of estrogens and progestins on hCG secretion, term placental explants were cultured in culture media for 144 hours. During the culture period, hCG secretion increased after 48 hours, and a fortyfold increase was observed after 144 hours (p less than 0.001). Compared to concentrations of hCG in control cultures, secretion of hCG was markedly suppressed in the presence of progesterone 2.25 X 10(-5)M (p less than 0.001), a concentration similar to that found in term placental tissue (1.7 +/- 0.2 micrograms/gm of tissue). Suppression of hCG by progesterone occurred in a dose-response manner (r = -0.9100, p less than 0.01). Estradiol, an important steroid modulator of pituitary gonadotropins, did not significantly suppress the secretion of hCG, except in pharmacologic concentrations (10(-4)M), and physiologic concentrations of estradiol had no effect on the suppression of hCG by progesterone. These results suggest that the mechanism by which progesterone suppresses the secretion of hCG differs from the manner in which steroids modulate the secretion of pituitary gonadotropins.     

Diagnosis and management of scrofula in children

Atypical myobacterial infection in humans appears to be of low virulence and is acquired from the environment with no evidence of transmission ever from human contact. The majority of infected patients are never symptomatic and the disease is self-limited. When symptomatic disease does occur, it is usually in children. Treatment should be confined to patients with symptomatic cervical adenitis; surgical excision of the subcutaneous abscess and of the offending caseous lymph node is sufficient. Adjacent hyperplastic nodes should not be excised, and chemotherapy is not indicated.