Oestradiol-induced synapse formation in the female hippocampus: roles of oestrogen receptor subtypes.

During the oestrus cycle, varying spine synapse density correlates positively with varying local synthesis of oestradiol in the hippocampus. In this context, the roles of the oestrogen receptor (ER) subtypes ERα and ß are not fully understood. In the present study, we used neonatal hippocampal slice cultures from female rats because these cultures synthesise oestradiol and express both receptor subtypes, and inhibition of oestradiol synthesis in these cultures results in spine synapse loss. Using electron microscopy, we tested the effects on spine synapse density in response to agonists of both ERα and ERß. Application of agonists to the cultures had no effect. After inhibition of oestradiol synthesis, however, agonists of ERα induced spine synapse formation, whereas ERß agonists led to a reduction in spine synapse density in the CA1 region of these cultures. Consistently, up-regulation of ERß in the hippocampus of adult female aromatase-deficient mice is paralleled by hippocampus-specific spine synapse loss in this mutant. Finally, we found an increase in spine synapses in the adult female ERß knockout mouse, but no effect in the adult female ERα knockout mouse. Our data suggest antagonistic roles of ERß and ERα in spine synapse formation in the female hippocampus, which may contribute to oestrus cyclicity of spine synapse density in the hippocampus.

[High prevalence of subclinical thyroidal disease among individuals attended in health control]. / Alta prevalencia de enfermedad tiroidea subclínica en sujetos que concurren a control de salud.

BACKGROUND: There is no information about the prevalence of thyroidal diseases in the general Chilean population. AIM: To assess the prevalence of thyroidal diseases in individuals attended in occupational health examinations. SUBJECTS AND METHODS: Four hundred seventy two individuals were examined between 1998 and 1999. In all, serum levels of thyroid hormones, TSH and anti thyroidal antibodies (anti microsomal, anti thyroid peroxidase and anti thyroglobulin) were measured. RESULTS: Forty four subjects were excluded from the study due to an incomplete medical record and 18 due to a personal history of thyroidal disease. Abnormal serum levels of thyroid hormones or TSH were detected in 28 subjects (6.8%). Four (1%) had hypothyroidism, 23 a subclinical hypothyroidism (5.6%) and one (0.2%) had hyperthyroidism. In 87 subjects (21.2%) at least one of the antibodies was positive. Positive anti thyroid antibodies were found in 14 of 28 subjects (50%) with abnormal thyroid hormone levels, compared with 73 of 382 subjects (19.1%) with normal thyroid hormone levels. Thyroid dysfunction was twice as frequent in women than in men. CONCLUSIONS: In this sample, a 6.8% prevalence of abnormal thyroid function tests was detected.

[Panic disorder and hyperthyroidism. Report of 2 cases]. / Trastorno de pánico e hipertiroidismo: curso clínico en dos pacientes.

In two females aged 27 and 32 years old, an aggravation of their panic disorder coincided with the appearance of clinical signs of hyperthyroidism. The clinical diagnosis was confirmed with the finding of raised thyroid hormone levels and undetectable TSH levels. These two cases highlight the importance of routine thyroid function assessment in patients with panic disorder, mainly in those with partial response to medications or when symptoms aggravate, despite an adequate treatment.

High prevalence of thyroid abnormalities in a Chilean psychiatric outpatient population.

The aim of the present study was to establish the prevalence of thyroid disturbances in patients consulting for panic and mood disorders. These data may be relevant because thyroid functional alterations affect the success of treatment in these pathologies. We studied prospectively 268 psychiatric outpatients (204 females and 64 males) diagnosed by DSM-IV criteria. We excluded patients with addictive disorders and major medical disease. We measured TSH, Free T4 (FT4) and antimicrosomal antibodies (AMA). We diagnosed classical hypothyroidism when the TSH value was >10 microUI/ml (NV=0.25-4.3) and subclinical hypothyroidism when the TSH value was between 5-10 microUI/ml. Hyperthyroidism was diagnosed when FT4 >1.4 (NV=0.8-1.4), the TSH suppressed and the radioiodine uptake >20% (NV=5-15). Positive antimicrosomal antibodies (AMA) titres were >1:100 dilution. Hypothyroidism was diagnosed in 26/268 patients (9.7%); 10 cases corresponded to the classical form (38.5%) and 16 cases to the subclinical form (61.5%). Hyperthyroidism was found in 6/268 patients (2.2%). Normal thyroid function with positive AMA was found in 28/268 patients (10.4%). Hypothyroidism was more common in patients with mood disorders, and hyperthyroidism in patients with panic disorders. Patients with panic disorder had significant higher levels of FT4. The prevalence of positive AMA, hypothyroidism and hyperthyroidism was higher in women than men. We found a high frequency of thyroid abnormalities in a psychiatric outpatient population. These data suggests that routine evaluation of thyroid function should be considered in patients consulting for mood and panic disorders.

Subacute liver failure induced by phenprocoumon treatment.

We report on a 39-year-old woman suffering from deep venous thrombosis due to a heterozygous factor-V-Leiden mutation with resistance to activated protein C. Four months after beginning oral anticoagulation, generalized jaundice appeared. Subsequently, subacute liver failure developed necessitating an orthotopic liver transplantation. Histopathology showed features of extensive liver cell necrosis without evidence of a substantial inflammatory infiltrate. Based on histopathology and exclusion of other liver diseases, phenprocoumon-induced liver failure was diagnosed. Five months after transplantation the patient is well with normal liver function tests. Because of the widespread use of oral anticoagulants, not only bleeding complications but also hepatotoxicity should be considered in therapy supervision.

[Immune response reduced by intense intellectual stress: changes in lymphocyte proliferation in medical students]. / Respuesta inmune disminuida por estrés académico intenso: cambios de la proliferación linfocitaria en estudiantes de medicina.

BACKGROUND: There is a relationship between stressful situations and the susceptibility towards certain diseases, probably mediated by immune system modifications. AIM: To study T lymphocyte proliferation in medical students during periods of differing academic stress. SUBJECTS AND METHODS: Blood samples were obtained from 42 medical students during a period of moderate academic stress, immediately before a final examination and after their summer vacations. T lymphocyte proliferation in response to 5, 10 and 20 mg/ml phytohemagglutinin was measured by the incorporation of 3H-thymidine, and plasma cortisol was measured by RIA. RESULTS: T lymphocyte stimulation index in response to all phytohemagglutinin concentrations was significatively lower in the period before examination than in the other two periods. There were no differences in the index between the period of moderate stress and after summer vacations. Plasma cortisol levels were 15.6 +/- 4.3, 18.6 +/- 5.8 and 16.7 +/- 5.1 mg/dl during the periods of moderate stress, before the examination and after vacations, respectively (p < 0.05 for the difference between examination and the other two periods). CONCLUSIONS: There is a decrease in lymphocyte proliferation and an increase in cortisol levels during a period of acute academic stress in medical students, suggesting that, the exposure of the healthy subjects to common stressful stimuli, may affect their immunocompetance.

[Relevance of the thyroid function assessment in psychiatric patients]. / Relevancia del estudio tiroideo en pacientes con trastornos psiquiátricos.

BACKGROUND: Thyroid dysfunction is frequent in psychiatric outpatients and the correction of their endocrine abnormalities seems to improve the response to psychopharmacologic treatment. AIM: To retrospectively explore the frequency of thyroid abnormalities in psychiatric outpatients. MATERIAL AND METHODS: Clinical charts and thyroid assessment of 102 psychiatric patients aged 40.8 +/- 15 years old (28 male) seen between April 1995 and September 1996 were reviewed. Endocrine diagnosis was made according to international criteria and psychiatric diagnosis was made by a single psychiatrist following DSM IV criteria. RESULTS: Forty patients (39.2%) had thyroid abnormalities. Thirteen (12.7%) had a diagnosis of thyroid problems and were in treatment before they came to the psychiatric clinic. Sixteen patients had hypothyroidism (40%), seven had subclinical hypothyroidism (17.5%), 12 were euthyroid but had goiter or positive thyroid antibodies (30%) and 5 individuals had hyperthyroidism (12.5%). The most frequent thyroid abnormality was the presence of positive thyroid antibodies in 16 cases (15.7%). No specific association was found between psychiatric and endocrine diagnoses. CONCLUSIONS: The design of this study prevents to draw conclusions about prevalence of thyroid alterations in psychiatric patients. Nevertheless results support the need for routine thyroid assessment in this specific population.

Computer-assisted 3D reconstruction of the terminal branches of the cerebral arteries. III. Posterior cerebral artery and circle of Willis.

We present a three-dimensional anatomical computer model of the terminal branches of the posterior cerebral artery and circle of Willis, acquired from equidistant serial anatomical slices of three brains. The reconstructions provide a clear picture from all angles of the complicated course of the terminal branches of the cerebral arteries. This can help to identify the arteries in conventional and magnetic resonance angiography. Our rendition of the cerebral arteries can be matched with CT, MR und PET images to indicate the areas of extension of the individual branches, allowing neuromorphological and functional correlations.

Computer-assisted 3D reconstruction of the terminal branches of the cerebral arteries. I. Anterior cerebral artery.

We present a three-dimensional anatomical computer model of the terminal branches of the anterior cerebral artery, acquired from equidistant serial anatomical slices of three brains. The reconstructions provide a clear picture from all angles of the complicated course of the terminal branches of the cerebral arteries, which can help to identify them on conventional and magnetic resonance angiography. Our rendition of the cerebral arteries can also be matched with CT, MR or PET images to indicate the areas of extension of individual branches, allowing neuromorphological and functional correlations.

Computer-assisted 3D reconstruction of the terminal branches of the cerebral arteries. II. Middle cerebral artery.

We present a three-dimensional anatomical computer model of the terminal branches of the middle cerebral artery, acquired from equidistant serial anatomical slices of three brains. The reconstructions provide a clear picture from all angles of the complicated course of the terminal branches of the cerebral arteries, which can help to identify them on conventional angiography and magnetic resonance angiography. The arteries can also be matched with CT, MR or PET images to indicate the areas of extension of individual branches, allowing neuromorphological and functional correlations.

Panic attacks and agoraphobia: low dose clomipramine treatment.

Seventeen outpatients with panic anxiety and agoraphobia were treated with a low, flexible dose of clomipramine in an 8-week open trial. Panic attacks ceased completely in 13 patients and markedly decreased in the other four without additional therapeutic measures. Avoidance behavior disappeared in five of the seven agoraphobic patients. Overall mean dosage was 45 mg/day, with eight patients receiving clomipramine 25 mg or less. Higher doses were needed when agoraphobia was present. These results are discussed in conjunction with previous findings and lend support to serotonergic involvement in panic anxiety. Further double-blind studies are needed to confirm these results.

Clomipramine treatment for panic attacks in patients with mitral valve prolapse.

Clomipramine (25-150 mg/day) was given in a 2-month open clinical trial to patients with DSM-III defined panic disorder (N = 8) or agoraphobia with panic attacks (N = 12); 6 of these patients were found to have MVP. Substantial improvement was seen in all of the patients with MVP and 11 of 14 without MVP. Response was not affected by age, sex, or agoraphobic vs panic disorder diagnosis. Thus, clomipramine appears effective in the treatment of spontaneous panic attacks with or without mitral valve prolapse.

Prolactin response to the cold pressor test in patients with panic attacks.

Recent advances in psychiatric nosology have provided a clearer clinical description of panic disorder and agoraphobia with panic attacks. This clinical improvement has yet to result in a better understanding of the basic mechanisms involved in these conditions. The present study compares the effects of the cold pressor test on blood pressure changes and prolactin levels in patients with panic disorder and agoraphobia with panic attacks to its effects in normal controls. Because the effects of the cold pressor test were similar in patients and normal controls, it appears that alpha-adrenergic function is normal in the patient group. The results also suggest that prolactin hypersecretion does not occur in pathological anxiety states.

Clasificacion y patogenia de los cuadros angustiosos. / Classification and pathogeny of anxiety

La angustia como emocion humana basica ha sido motivo central del pensar psiquiatrico por mas de un siglo: desde las descripciones iniciales de Da Costa orientadas hacia los sintomas somaticos, el aporte de Freud como factor central de la psicopatologia, las investigaciones fisiologicas clasicas de Cannon y Selye, hasta los recientes avances en la reconceptualizacion y clasificacion de cuadros clinicos nuevos como el Desorden de Panico. Este articulo revisa el tema de la angustia, define el concepto, se refiere a los aspectos epidemiologicos resaltando su elevada prevalencia, revisa los aspectos historicos, los aportes de las recientes clasificaciones, discute la etiopatogenia dando enfasis a las teorias dinamica-analiticas, describe los conocimientos sobre mecanismos fisiopatologicos, aporta una detallada descripcion de los cuadros con especial enfasis en el desorden de panico. Finalmente se discuten los antecedentes aportados a la luz en la bibliografia recientemente publicada resaltando aspectos concepctuales y de orden terapeutico, asi como la asociacion de los cuadros angustiosos con desordenes cardiovasculares

Mitral valve prolapse and panic attacks.

Patients complaining of recurrent spontaneous panic attacks (RSPA) are frequently seen in emergency rooms and psychiatric outpatient services. The symptomatology of RSPA suggests some underlying cardiac pathology. Recent publications in the psychiatric literature have reported a high incidence of mitral valve prolapse (MVP) in patients complaining of RSPA. In our study we report a 39% incidence of MVP in a psychiatric population with RSPA. The importance of this finding is yet to be determined.

Panic attacks. A review of treatments and pathogenesis.

In the psychiatric literature, panic attacks have been considered as part of the clinical manifestations of anxiety neurosis, agoraphobia, functional cardiovascular disturbances, and the phobic depersonalization syndrome. Even though recurrent spontaneous panic attacks are described in these entities, the importance ascribed to them has been minor one. Therefore, panic attacks are poorly understood from a psycho-physio pathological point of view. In the past years, new trends in the nosology of psychiatric disorders have grouped the recurrent spontaneous panic attacks under the heading "panic disorder and agoraphobia with panic attacks." In this view, we present the results of the controlled pharmacological trials on patients complaining of panic attacks. Some relationships between panic attacks, panic disorder, and agoraphobia are discussed.

Treatment of spontaneous panic attacks with chlomipramine.

Recurrent spontaneous panic attacks are psychophysiological symptoms present in panic disorder and agoraphobia with panic attacks. Effective pharmacological treatment for panic attacks is essential to any treatment plan for these conditions. The authors administered chlomipramine to 20 patients who had panic disorder or agoraphobia with panic attacks, and after 8 weeks of treatment 75% of the patients with each diagnosis were asymptomatic. These results support the claim that chlomipramine is highly effective in preventing recurrence of panic attacks.