Recurrent cerebral venous thrombosis associated with heterozygote methylenetetrahydrofolate reductase C677T mutation and sickle cell trait without homocysteinemia: an autopsy case report and review of literature.

Elevated blood homocysteine concentration and certain genetic mutations have been associated with increased risk for developing arterial and venous thrombosis. A common mutation of methylenetetrahydrofolate reductase, MTHFR C677T, has been associated with elevated homocysteine concentration and increased risk for developing thrombosis in homozygote carriers. Heterozygote carriers for this gene mutation, if associated with other major or minor risk factors for thrombophilia, appear to be prone to develop thrombosis. A postmortem genetic testing for common mutations resulting in thrombophilia should be performed in all individuals who die as a result of thrombosis, regardless of predisposing risk factors, to determine the true prevalence of mutations in these individuals, and to assess the true role of a certain mutation, such as heterozygote MTHFR C677T, in the pathogenesis of thrombosis. Postmortem genetic testing for common mutations associated with thrombophilia in selected cases has potentially life-saving importance to surviving family members. We report a case of recurrent cerebral venous thrombosis in a 19 year old male with history of sickle cell trait, obesity, and high normal blood homocysteine, who was heterozygote for MTHFR C677T mutation.

Trichinella surveillance in black bears (Ursus americanus) from Oregon, USA.

We used serology and muscle digestion to test black bears (Ursus americanus) from western Oregon, USA, for Trichinella. Results indicate black bears in Oregon are not part of a sylvatic cycle for Trichinella, and risk of human exposure to Trichinella larvae from eating black bear meat from Oregon appears low.

Neuropathology of preclinical and clinical late-onset Alzheimer's disease.

We report on the neuropathological examinations of a 74-year-old woman with Alzheimer's disease (AD) and of her 47-year-old nondemented daughter. The brain of the mother showed fully developed pathological changes of AD. By contrast, the brain of the daughter revealed only perineuronal deposition of diffuse amyloid in cerebral cortex and striking abnormalities of the endosomal-lysosomal system, without neurofibrillary, glial, or microglial changes. These observations suggest that amyloid deposition and endosomal-lysosomal changes are early events in late-onset AD and that they may precede the onset of dementia by several decades.

Suicide risk factors among veterans: risk management in the changing culture of the Department of Veterans Affairs.

Suicide risk management in the Department of Veterans Affairs (VA) health care system is particularly challenging because of both patient characteristics and aspects of the delivery system. The prototypical suicide-prone person is an older white male with alcoholism, depression, physical problems, and poor psychosocial support. This describes a large portion of the veteran patient population. Suicide risk factors that are common in VA patients include male gender, older age, diminished social environment support (exemplified by homelessness and unmarried status), availability and knowledge of firearms, and the prevalence of medical and psychiatric conditions associated with suicide. A variety of characteristics of the VA system complicate suicide management. Efforts under way to emphasize ambulatory care and decrease the VA culture of reliance on inpatient treatment heighten the importance of accurate suicide assessment. The authors recommend several strategies that VA administrators can consider for improving the assessment and management of veterans with long-term suicide risk factors.

Malignant Post-Vietnam Stress Syndrome revisited.

Malignant Post-Vietnam Stress Syndrome describes a severe form of combat-related posttraumatic stress disorder. We update the concept of Malignant Post-Vietnam Stress Syndrome, considering the effects of repeated severe traumatization, exposure to atrocities, and a variety of comorbid conditions. An illustrative case report demonstrates an interdisciplinary treatment approach, combining case management, brief hospitalizations, symptom-directed use of medications, and supportive psychotherapy.

Psychiatric education at a veterans affairs medical center.

The authors describe how a small and relatively low-functioning psychiatric teaching program at a Department of Veterans Affairs (VA) medical center was transformed over a 6-year period into an active and well-functioning program for both medical students and residents. Steps were taken to address trainees' negative perceptions about VA patients and faculty, recruit and support an education-oriented staff, and improve the "user-friendliness" of the system. Efforts were made to integrate education into the missions of a variety of clinical and research programs while emphasizing the convergence of trends in the field of psychiatry with the VA experience. Data are presented indicating improvements in student and resident evaluations. Training was significantly expanded on inpatient units, chemical dependence units, a research unit, and an outpatient clinic. The authors offer suggestions that may be helpful to those developing psychiatric education at other academically affiliated VA medical centers.

Safety of gadoteridol injection: U.S. clinical trial experience.

As part of the clinical evaluation of gadoteridol injection, intravenous doses ranging from 0.05 to 0.3 mmol/kg were administered to 1,709 patients and volunteers. Safety monitoring included pre- and postdose physical examinations, vital signs, and clinical laboratory values. Adverse event recording included occurrence, duration, severity, relationship to injection, and clinical importance. No clinically important changes in physical examination results, electrocardiograms, or vital signs were attributed to gadoteridol injection except for one case of hypotension. Four clinically important changes in laboratory values possibly or definitely related to the contrast agent were noted in two patients (0.1%). Adverse events were recorded in 118 subjects (6.9%), including nausea in 24 subjects (1.4%) and taste perversion in 22 subjects (1.3%). All other adverse events occurred with a frequency of less than 1%. Adverse events related to contrast agent administration occurred in 79 subjects (4.6%). Gadoteridol injection demonstrated excellent clinical safety and patient tolerance at various doses and injection rates.

Phase I clinical evaluation of a new iron oxide MR contrast agent.

The safety and magnetic resonance (MR) imaging potential of BMS 180549, a new superparamagnetic iron oxide contrast agent, were evaluated in a phase I, open-label, placebo-controlled study involving 41 healthy subjects. No clinically significant postdose changes in physical examination findings, vital signs, or electrocardiogram results were reported for any of the subjects evaluated. No clinically significant changes in clinical laboratory values were noted by the investigators. Fourteen adverse events considered not serious and considered possibly or definitely related to the drug were reported, three of which required minor treatment. Relaxation time measurements in plasma samples showed a strong, dose-dependent, and persistent decrease in T1 and T2 values. Significant changes in MR signal intensity of the blood pool and well-perfused organs (liver and spleen) were noted on both T1- and T2-weighted images. Changes in signal intensity of cervical lymph nodes were also observed at the higher doses and late postdose imaging times.

Intra-cellular and extra-cellular growth of L. monocytogenes in chick embryo fibroblast cell culture.

The growth of L. monocytogenes in isolated chick embryo fibroblast cell culture was studied. Hanks balanced salt solution and Eagles minimal essential medium were shown to support a limited growth of L. monocytogenes. Extra-cellular growth on the maintenance medium occurs for 48 h prior to the establishment of intra-cellular organisms. As the uptake of the parasite by the cell culture takes place, intra-cellular replication begins with subsequent release of the organisms into the surrounding medium. The organism continues to replicate intra-cellularly until all the cell culture is destroyed.

The effect of progesterone on the growth and virulence of Listeria monocytogenes.

Progesterone was examined for action on the virulence of Listeria monocytogenes and the toxicity of its haemolysin. Progesterone at concentrations between 5 and 20 micrograms/ml reduced the numbers of L. monocytogenes over the first two hours of growth. Virulence and haemolysin toxicity were assessed using the allantoic sac route of inoculation into embryonated hens eggs. Increasing the concentrations of progesterone in the culture medium resulted in a decrease in the mortality of chick embryos inoculated with either organisms, or cell-free extracts or purified haemolysin. Progesterone had no effect on the lethality of pre-formed haemolysin.

Role of haemolysin and temperature in the pathogenesis of Listeria monocytogenes in fertile hens' eggs.

The haemolysin produced by Listeria monocytogenes at 37 degrees C and 4 degrees C was examined in fertile hens' eggs. Organisms, cell free extracts and purified haemolysin derived from broth cultures grown at the lower temperature were more pathogenic for chick embryos, induced higher mortality with toxic changes in the embryos. These effects were most pronounced with the purified haemolysin as shown by LD50 determinations and following inoculation of constant haemolytic doses. Pathological changes induced by the haemolysin included sub-cutaneous haemorrhage due to endothelial damage, hepatosplenomegaly with macroscopic and histological lesions in heart, spleen and liver in the absence of an inflammatory response. At the cellular level, the myocardial tissue, and hepatocyte structure were destroyed with intravascular haemolysis, fatty degeneration of mitochondria, dilation of endoplasmic reticulum and distortion of liver cell nuclear membranes evident. The mortality and morphological data showed an increase in virulence for Listeria after culture at 4 degrees C compared with 37 degrees C and suggested a more cytotoxic component of the haemolysin which was activated at lower temperatures.

Role of lipid in butylatedhydroxyanisole (BHA) resistance of Listeria monocytogenes.

The lipid content of Listeria monocytogenes 5214m was increased by successive subculturing in a glycerol medium. Fattened cells showed considerably greater resistance to Butylatedhydroxyanisole (BHA). Polar lipids and fatty acid composition of four cultures with different BHA sensitivity were analysed. They are basically similar but the resistant cultures had a lower percentage of unsaturated and anteiso to saturated and iso fatty acids.

Pathogenesis and growth of Listeria monocytogenes in fertile hens' eggs.

The LD50 for 15-day old chicken embryos inoculated with Listeria monocytogenes into the allantoic sac was determined. The growth cycle of the organism was investigated in different tissues and fluids derived from embryonated eggs following inoculation with a suspension of L. monocytogenes equivalent to the LD50. Eggs receiving doses of 100 and 1000 times the LD50 were used to examine the effect of high doses on the pathogenesis and growth of Listeria in ovo. The pattern of growth of the organism in embryonic blood showed two distinct peaks and correlated with these was the development of large and small pock lesions on the chorioallantoic membrane. Bacterial growth in the internal organs exhibited a single peak. Histological and electron microscopic evidence indicated that the primary cellular damage was due to a soluble haemolysin present prior to the establishment of the organism within the tissues.

Pathogenicity of natural and experimental listeriosis in newly hatched chicks.

The pathogenicity of Listeria monocytogenes for newly hatched chickens exposed to natural infection was examined. Organisms entered through the alimentary tract and dissemination followed bacteraemia. Among a number of symptoms recorded were unilateral and bilateral toe paralysis. In addition to gross abnormalities in the following tissues, histological lesions were seen in the liver, spleen, heart and kidneys of all infected chicks but brain lesions were observed only in birds with central nervous system involvement. The organism was recovered from some tissues derived from apparently healthy chicks as well as those with listeriosis. The use of trypsin in the isolation process increased the probability of a positive result from tissues, reduced the storage time needed and had no adverse effect on the rate of organism growth.

Validation of a problem-focused nomenclature.

To test the value of a problem-focused nomenclature, problems were compared with DSM-II diagnoses as predictors of treatment and outcome. Patient problems, diagnoses, and treatment plans were coded from the medical records of 779 psychiatric inpatients. Problems were found to predict treatment plans better than did diagnoses. The combination of problems and diagnoses, however, was the best predictor of treatment with psychotropic medications. Problems of over 300 patients were compared with diagnoses as predictors of patient outcomes in overall functioning, subjective well-being, family functioning and mental status. At two months, problems and diagnoses predicted outcome equally well while the two in combination afforded the best prediction. At one year, however, the variance in outcomes explained by diagnosis was one third less than that explained by problems.

The psychiatrist and health insurance claims review.

Expanded health insurance benefits for the treatment of mental illness have obliged psychiatrists to devote more time to justifying psychiatric treatment to claims reviewers. The author, drawing from experience in utilization review and peer review, summarizes factors contributing to the denial of payment for psychiatric services by health insurers, and gives practical advice on protecting against claims denials and on the process of appealing denials. Psychiatrists should make greater use of peer review committees to justify legitimate treatment services in the face of claims denials. Greater coverage for psychiatric treatment under national health insurance will increase the psychiatrist's responsibility for public accountability. This accountability will require better communication between psychiatrists and claims reviewers.

Psychiatric hospitalization. I. Comparison of public and private delivery systems.

The effect of financial requirements for admission on the delivery of psychiatric treatment services was studied by comparing all patients admitted to the psychiatric services of a public and a private general hospital, serving geographically similar areas. Patients admitted to these two services (both staffed by the same Department of Psychiatry) were compared in a variety of factors relating to admission determinants, diagnosis, length of hospitalization, and type of treatment. The two patient groups differed in a number offactors, including presenting problems, diagnoses, and.psychological concept of their illnesses. The public hospital patients were less likely to receive somatic treatments (especially psychotropic drugs) and more likely to be hospitalized for longer periods than were the private hospital patients. These findings, although inconclusive because of social class, age, and sex variables, suggest that financial requirements for admission affect the intensity and expeditiousness of the treatment.