Brain correlates of memory dysfunction in alcoholic Korsakoff's syndrome.

OBJECTIVES: To investigate the relation between anterograde amnesia and atrophy of brain structures involved in memory processing in alcoholic Korsakoff's syndrome. METHODS: The volume of brain structures involved in memory processing was measured with MRI from 13 subjects with Korsakoff's syndrome, 13 subjects with chronic alcoholism without Korsakoff's syndrome, and 13 control subjects. The brain structures analysed were the hippocampus, the parahippocampal gyrus, the mamillary bodies, the third ventricle, and the thalamus. Brain volumes were correlated with the delayed recall of a verbal learning test. RESULTS: Compared with subjects with chronic alcoholism and control subjects, subjects with Korsakoff's syndrome had a reduced volume of the hippocampus, the mamillary bodies, and the thalamus, and enlargement of the third ventricle. The impairment of delayed recall correlated with the volume of the third ventricle (r=-0.55, p=0.05) in the Korsakoff group. CONCLUSIONS: Anterograde amnesia in alcoholic Korsakoff's syndrome is associated with atrophy of the nuclei in the midline of the thalamus, but not with atrophy of the mamillary bodies, the hippocampus, or the parahippocampal gyrus.

Integratie van opleiding en onderzoek in de opleiding tot psychiater.

In the training program for residents in psychiatry, scientific education and participation in research projects are relatively underdeveloped. This may result in a gap between recently acquired scientific knowledge and its implementation in clinical practice. Since the start of the residency training in psychiatry in 1989 in the Vincent van Gogh Institute for Psychiatry, several research lines have been developed especially concerning dimensional diagnostic procedures, evaluation of treatment effects, stress and psychopathology, pharmacokinetics of psychotropic compounds and disordered impulse and aggression regulation. It is concluded that active participation in research projects by both psychiatrists and residents in psychiatry is increasingly mandatory due to social-economic en scientific developments. Despite several countervailing factors, the Vincent van Gogh Institute for Psychiatry has succeeded in the creation of a scientific orientation in the residency program resulting in a number of publications.

Effects of order of presentation of exercise intensities and of sauna baths on perceived exertion during treadmill running.

Thirteen male subjects performed a running test on the treadmill consisting of four standard exercise intensities [65%, 75%, 85%, 95% maximal O2 uptake (VO2 max)] presented in ascending, descending or random order. At the end of each exercise intensity, O2 consumption, heart rate (fc), venous blood lactate concentration [( Ia]b) and perceived exertion were assessed. This last variable was determined according to the Borg nonlinear CR-20 scale. The same variables were also determined during exercise at a standard intensity (65% or 95% VO2 max) performed before and after a Finnish sauna bath. Ratings of perceived exertion showed a good test-retest reliability (r = 0.77); they were the same when the exercise intensity was expressed in relative (%VO2 max) or absolute (speed) terms, and were independent of the order of presentation of the exercise. The latter had no effect on fc either but it did, however, influence [Ia]b, which was significantly higher in the descending, as compared to the ascending or random modes of presentation. The sauna bath increased fc at a given exercise intensity, but left perceived exertion and [Ia]b unchanged. It was concluded that at least under the present experimental conditions, fc and venous [Ia]b do not play a major role as determinants of perceived exertion.

Electromyogram and force during stimulated fatigue tests of muscles in dominant and non-dominant hands.

Mechanical and electrical properties were studied for the first dorsal interosseous muscle of the dominant (d-FDI) and non-dominant hand (nd-FDI). Observations were made before, during and after a fatigue test, fatigue being evoked by percutaneous electrical stimulation of the ulnar nerve. The test consisted of 30 Hz bursts of ten supramaximal 0.1 ms pulses, repeated once a second for 5 min. The measurements included the amplitude of the first and fifth compound muscle action potentials (M-waves) within bursts, the peak burst force and the amplitude and time course of single twitches. At the end of the fatigue test, burst force had decreased to about the same extent in the FDI of both hands. The final decline in first M-wave amplitude was, however, significantly more pronounced for the nd-FDI than for the d-FDI. There were no longer any significant discrepancies between the two muscles after a subsequent recovery-period of 15 min. Comparisons among nd-FDI of various individuals demonstrated the presence of significant inter-individual differences in fatigue-related force-drop without any associated differences in M-wave decline. Intra-individual variability was similar for fatigue-related force-drop and M-wave decline.

Real time pelvic ultrasonography during the periovulatory period of patients attending an artificial insemination clinic.

Real time ultrasonography was used to examine the ovaries of 50 patients at the calculated time for artificial insemination with donor semen (AID). Forty-two (84%) had one or more follicles greater than 13 mm in diameter. Both ovaries were monitored daily until the main follicle had ruptured (mean number of examinations, 2.4 per patient; range, 1 to 5). Seven women became pregnant (mean follicular diameter, 21.6 mm; range, 18 to 25 mm). The fecundability rate was 12%, compared with 6% for a corresponding group of 50 patients who were not examined with ultrasound. Seven patients experienced mittelschmerz, and in 39 the leading follicle had ruptured before the rise in basal body temperature (BBT). Ultrasonography may be used to confirm the presence or absence of preovulatory follicle prior to treatment.

Real-time ultrasonography for determination of ovarian morphology and volume. A possible early screening test for ovarian cancer?

The accuracy with which ovarian morphology and size can be determined by a real-time, ultrasound mechanical sector scanner was assessed. Both ovaries of 11 climacteric women appeared morphologically normal by ultrasonography and these findings were confirmed at laparotomy the following day. The correlation coefficient between ovarian volumes determined by sonar and those obtained by direct measurement at operation was 0.97. In a series of 31 postmenopausal women in whom clinical examination was unremarkable, both ovaries were identified by sonar in 26 subjects (84%) and a cystic ovary was diagnosed in 1 patient. Ovarian morphology in the other 25 subjects appeared normal and the range of volumes was from 1.47 to 10.43 cm3 with an arithmetic mean of 4.33 cm2 +/- 1.91 (SD). The mean difference between the volumes of the right and left ovaries was 1.48 cm3 +/- 1.19 and the percentage mean difference was 42.88% +/- 32.05. An ovary with a volume more than twice the size of its fellow should be regarded with some suspicion because ovarian volumes within individuals are clearly related (correlation coefficient = 0.82). The potential of the technique as a screening test for the early detection of ovarian cancer warrants further evaluation.

Plasma concentrations of unconjugated and conjugated estrogens and gonadotrophins following application of various estrogen preparations after oophorectomy and in the menopause.

In 55 patients after oophorectomy and 20 women after natural menopause an oral estrogen replacement therapy was performed with estrone-sulfate, estradiol 17-valerate, estriol-succinate, a combination of micronized estradiol and estriol (Estrifam, Trisequens), and natural conjugated estrogens. In 4 patients a 3 mg estradiol per 5 g ointment substance was applied on the abdominal skin. The interindividual variations of estrogen increments during therapy were considerably high. Oral intake of 2 mg estriol-succinate daily was followed by a 500% increase of total (conjugated + unconjugated) estriol. Concentrations of unconjugated estrogens were not altered by this dosage. Following oral application of the other above mentioned preparations, prominent rises--especially of unconjugated estrogens in plasma--were noted. The concentration peaks occurred within 3--6 h after application. Unconjugated estradiol-17 beta in plasma was comparable with values of the follicular phase of a normal menstrual cycle, unconjugated estrone, however, was nonphysiologically high. Consequently, the E1/E2 ratio was greater than one whereas it is normally below one. 12 h after oral estrogen application, plasma estrogens dropped to almost initial values, so that a second medication seems to be necessary in order to guarantee an adequate supplementation over the course of the day. The hormone values determined in this study did not show significant differences between patients after a natural menopause and after oophorectomy. There was a positive correlation between rising estrogen levels and suppressed gonadotrophins during replacement therapy. The occurrence of climacteric symptoms did not exclusively depend on low estrogen and high gonadotrophin levels. Good tolerance of estrogen therapy with significantly elevated estrogen concentrations in plasma can be obtained transcutaneously in the form of estrogen ointments. Such therapy might simulate the physiological estrogen pattern even better than oral application does because of delayed and diluted steroid flow to the liver.