Cytogenetic studies on a patient with prepubertal breast cancer: a case report.

Cytogenetic studies were carried in a 10 year old girl with prepubertal breast cancer for assessing inherited genetic susceptibility to chromosome breakage. The girl presented with a tumour in the left breast. Histologically it was diagnosed as secretory carcinoma (SC). Chromosome anomalies observed in phytohemagglutinin (PHA-P) stimulated lymphocytes were del(2)(q33), del(3)(p24), del(7)(q22) and dup(12)(p11p12). The regions involved have been reported in breast tumors. These loci, detected in peripheral blood lymphocytes (PBL), could be the sites susceptible to breakage, its subsequent effect being manifested in the target (breast) tissue.

A controlled trial of home-based acute psychiatric services. I: Clinical and social outcome.

While research has shown community-based psychiatric care to be as good as, or better than, hospital-based care, generalisation to clinical practice has been difficult. This prospective, randomised controlled study examined a community-based approach feasible within NHS conditions. Ninety-four patients were randomly allocated to experimental and 78 to control treatments and followed for one year. The groups were well matched apart from an excess of psychotic control patients. No differences in clinical or social functioning outcome were found. Both groups improved substantially on clinical measures in the first six weeks, with some slow consolidation thereafter. There were three suicides in the control group and one in the experimental group. Access to care was better in the experimental group (93% attended assessment) than in the control group (75% attended assessment).

The clinical features of late onset anorexia nervosa.

This study examines clinical features of late onset anorexia nervosa. This involved the scrutiny of a large database of patients with anorexia nervosa comprising data gathered at standardized initial assessments over the period 1960-1990. Patients with a late onset were compared to other selected patient samples. The population comprised 12 patients with a first onset of anorexia nervosa at or after the age of 30, 415 patients with an onset after 15 but before 20 and 9 patients with an onset after 15 but before 20 and matched for age at presentation with the late onset group. Features studied included age at menarche, age at onset of anorexia nervosa, age at presentation, duration of illness, weight at presentation, lowest adult weight, highest weight, weight at onset of illness, marital status and parity. Patients with an onset of anorexia nervosa after the age 30 comprised 2% of the total female patient sample. Though such patients were rare, their clinical features were very similar to those of typical patients with adolescent onset. Notably, young and late onset patients had similar durations of illness prior to presentation, and similar proportions had bulimia and defensive vomiting. Feared sexuality, no longer necessary for childbearing, emerged as being of apparent aetiological significance in the late onset group, with the disorder embodying its rejection, as often also seems to be the case with earlier onset. The late onset cases were hard to diagnose and had a poor outcome. The study underlines the importance of considering the diagnosis of anorexia nervosa in older patients, even if there is no earlier history of anorexia nervosa. Such patients are likely to find it easier to conceal the psychological origins of their problem behind the possibility of a primary physical illness, or behind psychiatric diagnoses such as depression, the treatment of which may not threaten their avoidance of normal body weight.

Bulimia nervosa: family size, sibling sex and birth order. A catchment-area study.

Family size, sex of siblings and birth order were examined in 225 bulimic patients of normal weight, all stemming from the same circumscribed catchment area. Although bulimia can occur in any size family, all-female sibships were significantly over-represented. In small families at least, the bulimic patient was highly likely to be the only or eldest daughter. In small sibships, a bulimic who was first-born was significantly more likely to have a younger sister; if second-born she was more likely to have an elder brother. Despite the very large sample size, no final conclusion can be made on birth order.

A comparison between women seeking self-help and psychiatric treatment in anorexia nervosa and bulimia.

Thirty new members of a branch of Anorexic Aid were interviewed to determine their characteristics and compared with women seeking psychiatric treatment for anorexia nervosa and normal-weight bulimia. It was expected that the two samples would be similar and that the women in the self-help group would have also had professional treatment. Over half (53 per cent, 16) of the Anorexic Aid sample were anorectic, 40 per cent (12) were normal-weight bulimics and 7 per cent (2) could not be classified and were excluded. Demographic characteristics were similar, with both samples being mainly British, single and from social classes I-III, but the Anorexic Aid sample was significantly older. Clinical features were also similar, although there was a trend towards the Anorexic Aid anorectics being less severely ill at presentation. Nearly 90 per cent (25) of the Anorexic Aid sample had had professional treatment. The hypotheses are partially confirmed. Reasons for the differences in age and severity are discussed.

In-patient treatment for drug abuse.

During 1984 there were 253 admissions to the in-patient drug dependence treatment unit at Tooting Bec Hospital. Of the 198 patients responsible for these admissions, 60% were male and 43% were over the age of 30 years. There were 151 patients admitted for opiate detoxification, and 75% completed the withdrawal schedule. However, only 15 out of 25 patients admitted for benzodiazepine withdrawals were found to be physically dependent. Other reasons for admission included stabilisation of the dose of opiate (24%) and the treatment of physical complications of addiction.

Primary anorexia nervosa in the male and female: a comparison of clinical features and prognosis.

The clinical characteristics of a consecutive series of 36 male anorectics were compared with those of a similar series of 100 female cases. Social class background and mean age of onset were found to be similar as were the majority of clinical features at presentation. Anorexia nervosa was associated with diminished differences between the sexes in terms of physical, experiential and behavioural characteristics directly related to the condition, and in terms of general psychoneurotic characteristics. The condition is one within which the individual is sadly reduced to an existence rooted in the experience, behaviour and impulses of starvation including the impulse to ingest and the consequent defences against this latter propensity and its implication of weight gain. Only the 'choice' of defence relates to premorbid 'personality' characteristics and thereby continues to characterize the individual. Overall the same background and presentation factors in both sexes predict similar outcomes, though a vomiting defence at presentation predicts good outcome for males and poor outcome for females. The condition is very rare in the male and such presentations may help to shed light on its overall nature.

The relationship between nocturnal motility and the enuresis alarm device.

The mode of action of the enuresis alarm is not clear. Earlier work suggested that the wire mesh itself may alter sleep and in this way affect nocturnal enuresis. Seven healthy males have been studied within a two-period cross-over design in which their nocturnal motility, on and off an enuresis wire mesh, was recorded using a motility bed. There were no order, treatment or day effects in any of the variables studied. However, the mean hourly motility for each subject averaged over the three nights shows a substantial trend towards increased motility on the mesh. This lends some support to the hypothesis and merits further study.

Attitudes of health care professionals towards patients who take overdoses.

The attitudes of health care professionals in Malta towards patients who take drug overdoses were studied. It was found that the intention of the overdose had a marked effect on the attitude of the health care professional towards the patients. Differences between different professionals were noted and the Maltese results were compared with those of a similar study in London.

Cerebral hemisphere function and laterality of migraine.

We report preliminary findings of a study exploring the hypothesis that migraine is the experience of a protective cerebrovascular mechanism arising in response to unilateral cerebral information overload. The necessary population to be studied, namely those with exclusive one-sided migraine, proved to be rare. The measures of cerebral hemisphere function were the verbal and non-verbal scales of Wechsler's Adult Intelligence Scale. Preliminary results suggest that it is worthwhile continuing to explore the notion using additional and more sophisticated measures.

Why do some anorexics steal? Personal, social and illness factors.

There is a recognised association between anorexia nervosa and stealing. Anorexics who steal are usually also bulimic. However, not all bulimic anorexics steal. The question of why some do and others do not is explored with respect to features of the illness and personal and social variables. Bulimic anorexics who stole differed from their non-stealing counterparts in older age at presentation and in terms of greater sexual activity. These and other findings are discussed with reference to clinical understanding and aetiological theories of other aberrant behavior displayed by the adolescent female.

A double-blind comparison of fluvoxamine, imipramine and placebo in depressed patients.

In a placebo-controlled, double-blind study of 91 out-patient depressives, the anti-depressant effect of fluvoxamine, a selective serotonin uptake inhibitor was compared to that of imipramine. Overall drug effects were relatively weak but analyses in selected sub-groups showed both active drugs superior to placebo. Effects of fluvoxamine were more marked in non-situational depressives and it did not improve sleep while effects of imipramine were more marked in retarded depressives and on retardation ratings, suggesting that fluvoxamine may have a different pattern of clinical effects. Side effects of Fluvoxamine were predominantly gastrointestinal and it did not produce postural hypotension or anticholinergic side-effects.

Responses to phenelzine and amitriptyline absence of differential predictors by multiple regression analysis.

Multiple regression analyses using initial symptoms to predict outcome were carried out on data from an outpatient controlled comparison of amitriptyline, phenelzine and placebo. Separate analyses were carried out in the three treatment groups and regression equations were compared. Significant prediction was obtained only for phenelzine. On only one of three outcome measures analysed, however were there significant differences between treatment groups in regressions. Individual predictors were not easily interpretable. There was little evidence for different clinical predictors or response to phenelzine and amitriptyline in this sample.

Comparison of biochemical characterisation of ICRC bacilli with M. leprae: effect of substrate alteration in the medium.

ICRC-bacilli strain C-44 when grown in Dubos medium of its equivalent, express M. avium taxonomic biochemical characters. Assuming that difference in characters of M. leprae and ICRC bacilli, could be due to 'in vivo' and 'in vitro' milieu, we altered the substrates in the medium. The bacilli grow well in the new medium containing selenium, ferric nitrate, magnesium chloride and deleting Tween 80. The ICRC strain C-44 grown in new medium expressed characters: 9/10 similarity with M. leprae. The 10 day tween hydrolysis reaction in weak but positive. It is probable that 'M. leprae culture isolate', may have acquired 'in vitro' growth potential by recombination with M. avium, an ubiquitous mycobacterium. The M. leprae culture isolate thus may express some characters of both M. leprae and M. avium.

Psycho-social stress, insomnia and temazepam: a sleep laboratory evaluation in a "general practice" sample.

Taking a population of women most of whom were about to seek medication from their general practitioner for stress-induced insomnia, this sleep laboratory study examined--both electro -physiologically and psychologically--the immediate impact of temazepam, at normal prescribed dosage, on sleep. The study was double-blind, controlled with random allocation. Temazepam 20 mg, prepared as a liquid in a soft gelatin capsule, reduced sleep latency and prolonged total sleep time. A reduction in stage shifts to Stages I and II and a reduction in time spent in Stages 0 + I suggest more restful sleep. The sleep "architecture" (including REM/NREM cycling, total SWS and REM time) was relatively undisturbed. Temazepam would seem to be effective as a first-line hypnotic for short-term use in stressed patients.

Dopa-oxidase activity on ICRC bacilli.

Presence of O-phenoloxidase is regarded as M. leprae specific character. This enzyme activity was found to be present in ICRC bacilli, Strain C-44. Though this strain is cultivable 'in vitro', the expression of DOPA-Oxidase activity strongly suggests that it carries M. leprae genome. The ICRC bacilli, therefore, may thus from a group of M. leprae culture isolates, distinct from other known cultivable mycobacteria which do not possess this enzyme activity.

The neuro-endocrine impact of 3-hydroxy-diazepam (temazepam) in women.

The benzodiazepines have been considered largely free of neuro-endocrine effect. However, in a double-blind, random assignment, placebo controlled study of six young women in the first half of their menstrual cycle oral temazepam (20 mg) was found to significantly lower plasma cortisol and raise plasma prolactin. The impact on cortisol was significant at 40 min and persisted for 3 h (P less than 0.01) after oral ingestion. Prolactin was significantly raised at 1 h after ingestion only (P less than 0.05). No impact on FSH or LH was noted. These findings are compatible with recent reports of gamma-aminobutyric acid and benzodiazepine binding sites in human pituitary tissue. The positive and negative aspects of these findings for the clinician are discussed. This research has important implications for biological studies such as the dexamethasone suppression test, since the patients involved are commonly allowed benzodiazepine treatment.