PSYCHOPHYSIOLOGY AND MEDICINE

Psychophysiology is just as closely related to internal medicine as it is to psychiatry. “Psychological variable” has two distinct meanings: a) an external sensory stimulus, or b) an organismic state described in psychological language. “Psychological” and “Physical” are names of two different languages. There is no such thing as a non-physical illness. Asking whether emotions cause diseases, or diseases cause emotions, leads to many difficulties and is unprofitable. It is far more useful to ask about stimulus-response relationships. There are more kinds of specificity relations in psychophysiology and psychosomatic medicine than are usually recognized, and the usual specificity statements in psychosomatic medicine are not concerned with I-R or S-R specificity. There are many problems in medicine which psychophysiology could help to solve.     

Magnesium metabolism in blood and the whole body in man using 28magnesium.

Studies of magnesium kinetics in plasma, red cells, and the whole-body with ²⁸Mg are described. The observations in plasma were analyzed with a three-compartment model and those in red cells with a two-compartment model. An integral approach, using the occupancy principle, was used in the analysis of the whole-body observations. At 120 hr after intravenous administration of ²⁸Mg, exchangeable magnesium calculated by the dilution principle was only 23% of total body magnesium. There was good agreement between the estimates of exchangeable magnesium based on plasma and “spot” urine ²⁸Mg activity. Exchangeable magnesium, as estimated by compartmental analysis and the occupancy principle, was only 12.5%–15% of total body magnesium. These results suggest the existence of magnesium compartments in the body with turnover half-periods of at least 63–181 days that cannot be investigated adequately with the short-lived tracer, ²⁸Mg. A possible mechanism for the observed pattern of red cell uptake of ²⁸Mg in vivo is suggested in which magnesium enters these cells only during erythropoiesis and is then lost progressively from circulating red cells during the aging process. Present results suggest that the concentration of magnesium in reticulocytes may be 3.9 times greater than the mean red cell concentration. Magnesium may leave red cells exponentially with age; a half-period of 22.4 days is suggested.     

Objective perimetry in glaucoma

PURPOSE: Objective perimetry in glaucoma is described using the multifocal pattern visually evoked potential (VEP). A multichannel recording technique was used to improve signal detection in healthy volunteers and assess its ability to detect glaucoma and early changes in patients with suspected glaucoma. DESIGN: Prospective, case-control study. PARTICIPANTS: Thirty healthy volunteers, 30 patients with suspected glaucoma, and 30 patients with glaucomatous visual field defects were tested. METHOD: The VEP was recorded using cortically scaled, multifocal, pseudorandomly alternated pattern stimuli with the VERIS system (Electro-Diagnostic Imaging, Inc., San Francisco, CA). An array of four bipolar occipital electrodes provided four differently oriented channels for simultaneous recording. Signals were compared for different locations within the field up to 26 degrees of eccentricity. Healthy volunteers, patients with suspected glaucoma, and glaucoma patients with established visual field defects were tested, and results were compared with Humphrey visual fields (Humphrey Systems, Dublin, CA) performed on the same day. For reproducibility, five healthy volunteers were each tested on four separate days. The patients with suspected glaucoma and the established glaucoma patients were analyzed for intereye asymmetry of signals, and these data were compared with the asymmetry values of the healthy volunteers. RESULTS: Multiple recording channels significantly enhanced the recording of signals from parts of the visual field not reliably sampled with a single channel technique in all healthy volunteers, particularly along the horizontal meridian (P: < 0.001). Signal amplitude did not decline with age in healthy volunteers. Recordings showed good reproducibility within individuals. In all 30 glaucoma patients, the Humphrey visual field defects were well demonstrated by the VEP, and topographic location was strongly correlated (r(s) = 0.79). Despite large interindividual variations in amplitude, scotomas were well demonstrated when compared with normal values. In the patients with suspected glaucoma, smaller changes in signal amplitude could be identified in parts of the field still normal on perimetry using intereye asymmetry analysis. CONCLUSIONS: The multifocal, multichannel VEP can objectively detect glaucomatous visual field defects. The nasal step region can be more reliably tested using multiple channels. Asymmetry analysis has the potential to detect early defects. This technique represents a significant step toward the clinical application of objective perimetry in glaucoma.     

Graham Little–Piccardi–Lassueur syndrome associated with androgen insensitivity syndrome (testicular feminization)

Graham Little–Piccardi–Lassueur syndrome is characterized by the presence of cicatricial alopecia on the scalp, keratosis pilaris in the skin of trunk and extremities, and non‐cicatricial hair loss in pubis and axillae. A frequent form of male pseudohermaphroditism is complete androgen insensitivity syndrome (CAIS), also known as testicular feminization syndrome. It refers to genetic males with XY karyotype who, owing to a lack of sensitivity in the peripheral androgenic receptors, develop a female phenotype. Axillary and pubic hair is typically scarce or absent. To our knowledge, this is the first case describing the association of the two processes. The presence of both processes in the same patient furthers our understanding of Graham Little–Piccardi–Lassueur syndrome as it rejects the influence of androgens in the alopecias accompanying this syndrome. The coincidence of non‐cicatricial alopecia in axillary and pubic hair in both processes is also remarkable.     

Strong lymphoproliferative suppressive function of PLT clones specific for SB-like antigens

From a total of 37 different priming combinations between donors matched for HLA-A,B, and/or Dw/DR, but mismatched for SB, antigens, T cell clones strongly restimulated with concordance for SB specificities were isolated from only two. Most of the alloproliferative (PLT) clones obtained were restimulated by determinants not correlated with any currently known HLA product. Nonetheless, their stimulation was inhibited by a monoclonal antibody TU 39, which preferentially blocks stimulation by SB-, rather than by Dw/DR-associated determinants. Despite having an OKT4+, OKT-, Leu8- phenotype, and secreting Interleukin-2 after contact with stimulatory cells, these clones strongly suppressed proliferative responses of cloned PLT reagents as well as unprimed lymphocytes in mixed leukocyte cultures. They may thus represent a novel type of immunoregulatory T cell, stimulated by SB-related antigens, which despite their "helper/inducer" phenotype are able directly to suppress lymphoproliferative responses.     

Use of droperidol-fentanyl sedation for cardiac catheterization in children

Droperidol-fentanyl sedation for cardiac catheterization was evaluated in 106 consecutive children ≥ two years of age. The dose of 0.025 c.c. per kilogram of body weight (maximum 1 c.c.) produced adequate sedation in all but two patients without producing significant hypoventilation or heart rate changes. In patients without left heart volume overload or myocardial disease, left ventricular volume studies and pressurevelocity indices of contractile state were normal. Side effects were rarely encountered and easily controlled or reversed with diphenhydramine. Although we recommend this combination for cardiac catheterization sedation, we would not recommend exceeding our dosage schedule.     

Laparoscopic repair of perforated duodenal ulcers: the“three-stitch” Graham patch technique

Background “Three-stitch” laparoscopic Graham patch repair (LGPR) for perforated duodenal ulcer enjoyed the same advantage as open Graham patch repair. However, it was not a popular approach because it had problems of suture entanglement and difficult laparoscopic suturing and knotting. The authors describe their technique and results. Methods A prospective series from January 2000 to September 2004 was examined. In this study, 35 LGPRs were performed for 32 males and 3 females with a median age of 47 years (range, 18–76 years). Results No conversion occurred for any of the 35 LGPRs attempted. The median perforation size was 5 mm (3–10 mm), and the median operative time was 86 min (range, 55–163 min). The median time for ambulation was day 2, and the median time for discharge was day 4. Morbidity was 11%, involving one chest infection, one retention of urine, one pelvic collection, and one pyloric stenosis. There was no reoperation, leakage, or mortality. Conclusion The authors’ LGPR technique was safe and efficient, and might be the choice for laparoscopic repair of relatively large perforations.