The imaging features of MACROLANE™ in breast augmentation.

Macrolane™ is an injectable, biocompatible, soft-tissue filler that has been available in the UK since 2008 and is promoted for use in breast augmentation. There are few data available on the long-term effects of this relatively new product and concerns have been raised about the implications for breast imaging, in particular breast screening. In this context we present a spectrum of imaging appearances and complications encountered to date.

Occurrence of comorbid substance use disorders among acute psychiatric inpatients at Stikland Hospital in the Western Cape, South Africa.

OBJECTIVE: Little is known about the epidemiology of substance use disorders (SUD) among psychiatric inpatients in the Western Cape, South Africa. Therefore, this study was conducted to examine the prevalence of SUD among acute adult psychiatric inpatients at Stikland Hospital, one of three state acute psychiatric hospitals in the Western Cape. METHOD: A prospective descriptive prevalence survey was undertaken over a three-month period. During this period, data was collected on psychiatric patients (N=298) who were hospitalized in the acute psychiatric wards at Stikland. This included patient demography, psychiatric and substance use history. Urine was also collected and analyzed for substances commonly abused in the Western Cape. RESULTS: A co-morbid SUD (abuse or dependence) was diagnosed in 51% of patients. In addition, a diagnosis of a substance-induced psychiatric disorder was made in 8% of these patients, 1% of who was diagnosed with a substance-induced mood disorder, while 7% was diagnosed with a substance induced psychotic disorder. Patients diagnosed with a co-morbid SUD were younger than those without a SUD and more likely to have been involuntary admissions. These patients also displayed more violence prior to admission that contributed to their admission and were more likely to have used cannabis or methamphetamine as their preferred drug of abuse. Only a small group of patients had documented evidence of any prior interventions for their SUD. CONCLUSION: SUD are prevalent among psychiatric inpatients and contribute to their morbidity. This has implications for staff training and service development.

Alcohol: use, abuse and dependence.

As a drug, alcohol has grave bio-psychosocial effects on patients, their families and society in general. It is very important that clinicians be able to recognise, admit and thoroughly treat alcoholism. Subsequent to the indicated treatment of intoxication and withdrawal, the clinician should outline sound incentives (external initially, becoming internal in time) for rehabilitation and continued sobriety. A variety of alcohol-induced medical and psychiatric disorders should be recognised by doctors, and should be treated or referred appropriately. The multidisciplinary team should be involved, and doctors should not hesitate to seek help and advice. Alcoholism is potentially quite treatable.

Intoxication, criminal offences and suicide attempts in a group of South African problem drinkers.

BACKGROUND: Incidence rates of crime and alcohol abuse in South Africa are unacceptably high. Research suggests a relationship between alcohol and both crime and suicide. This study aims to add to the information base on this topic in South Africa. METHODS: This is a cross-sectional record study of criminal offences and suicide attempts in 269 admissions to an alcohol rehabilitation unit in the Western Cape. Types of criminal offences and suicide attempts are described. Relationships are sought between crime, violent crime and suicide attempts on the one hand, and demographic and alcohol-related variables on the other. RESULTS: One hundred and four subjects (39%) had criminal convictions, the majority of which were committed while the subjects were intoxicated. The commonest alcohol-related crimes were driving-related (17% of subjects) and crimes of violence (15%). Male gender, younger age at initiation of drinking, and earlier onset of problem drinking were significantly associated with criminal behaviour. Violent crime was associated with earlier onset of initial, regular and problem drinking, and maternal alcohol abuse. Suicide attempts (24% of subjects) were associated with female gender, white racial group, not being in a marital relationship, younger current age and early age of problem drinking. CONCLUSIONS: There was an association between intoxication and both violent crime and suicide attempts. The importance of population studies and the need for intervention programmes aimed at teenagers who are drinking, are emphasised.

Sexual disorders not otherwise specified: compulsive, addictive, or impulsive?

Paraphilias are recurrent and intense sexually arousing fantasies, sexual urges, or behaviors generally involving nonhuman objects. These paraphilias cause the suffering or humiliation of the patient or patient's partner, or children, or other nonconsenting persons. However, in many patients symptoms involve more culturally acceptable patterns (eg, repetitive masturbation, Internet pornography); such hypersexual symptoms have been labeled as compulsive, addictive, or impulsive. Growing evidence supports the existence of a discrete syndrome characterized by recurrent and intense sexually arousing fantasies, sexual urges, or behaviors involving patterns that fall outside the definition of paraphilia. There is, however, high comorbidity with paraphilia. While such symptoms have been labeled as sexual compulsion or addiction, these terms are problematic in this context. Modern nosology has neglected this entity, although the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), category of sexual disorders not otherwise specified includes hypersexual behaviors as an example. We suggest that the DSM-IV category of sexual disorders be modified to include explicitly diagnostic criteria for a disorder characterized by hypersexual symptoms involving patterns that fall outside of the current definition of paraphilia. The disorder might be classified as one of the paraphilias, or as paraphilia-related. In the absence of a comprehensive understanding of the pathogenesis of this disorder, we suggest that it simply be termed hypersexual disorder.

Anxiety disorders among abstinent alcohol-dependent patients.

The Spielberger State-Trait Anxiety Index (STAI) and screening questions for anxiety disorders from the Structured Clinical Interview for DSM-IV Disorders were used to assess 146 alcohol-dependent patients on admission for inpatient treatment and just before discharge, after about three to four weeks of abstinence. Eighty-four patients (58 percent) reported excessive anxiety on admission, and 32 patients (22 percent) met DSM-IV criteria for specific anxiety disorders. After three to four weeks of abstinence, both state and trait STAI scores declined significantly, and only 15 patients (10 percent) met criteria for specific anxiety disorders. Anxiety levels on admission were significantly related to severity of alcohol dependence and recent life events but not to severity of withdrawal symptoms.

Experimental studies with Stronglyloides papillosus in goats.

Unusual clinical and pathological observations in the field in goats and sheep suffering from Strongyloides papillosus infection prompted experimental work on this parasite. Goats were infected percutaneously with either single or multiple, low or high levels of S. papillosus. Young goats up to 12 months of age were found to be the most susceptible. Some animals, however, showed substantial resistance to infective doses. Clinical signs included transient diarrhoea, misshapen, elongated faecal pellets terminally, dehydration, anorexia, cachexia, gnashing of teeth, foaming at the mouth, anaemia and nervous signs such as ataxia, a wide-based stance, stupor and nystagmus. A 'pushing syndrome' was seen in 22% of the animals. The pathological changes are described and included enteritis, status spongiosus in the brain, hepatosis leading to rupture of the liver, nephrosis, pulmonary oedema, interstitial pneumonia and pneumonia. About 6% of the goats died acutely from fatal hepatic rupture. The development of an acquired immunity was determined. The immunity elicited an allergic skin reaction at the application site of larvae or injection sites of larval metabolites. This immunity, however, could be breached by large doses of larvae. The most profound clinicopathological changes induced by the parasites were an anaemia (most pronounced in the young goats) and hypophosphataemia. Trace element analyses provided evidence of Cu, Mn and possibly Se deficiencies in some goats.

The thyrotropin releasing hormone stimulation test in alcoholism.

The mechanism for a blunted thyroid stimulating hormone (TSH) response to thyrotropin releasing hormone (TRH) in alcoholics is not known. We performed a combined TRH and gonadoliberin stimulation test on three well-defined groups of nondepressed alcoholic men. Group A comprised patients with acute withdrawal symptoms (n = 28), group B patients abstinent for 5-8 weeks (n = 29) and group C patients who had been abstinent for > 2 years (n = 16). Twenty-two healthy male volunteers were used for comparison. A blunted TSH response to TRH (delta TSH < 5 microU/l) occurred only in groups A (39%) and B (17%). In group A delta TSH showed a significant negative correlation with the severity of withdrawal symptoms and a significant positive correlation with serum magnesium levels. In group B, patients with a family history of alcoholism had significantly lower delta TSH levels than those without such a family history. Groups did not differ with respect to basal and delta prolactin, and TSH responses were not significantly associated with vitamin deficiency, cortisol levels or free thyroid hormone levels. We conclude that TRH stimulation test blunting appears to be related to factors operating in the withdrawal state and improves with continued abstinence. A possible role of genetic factors and serum magnesium needs to be further explored.

Cat bite transmission of Yersinia pestis infection to man.

The transmission of bubonic plague from the kitten of a domestic cat to a man by means of a bite on a finger is described. The human case was complicated by the development of a secondary meningitis, followed, after specific therapy, by protracted recovery. The kitten showed swollen lymph nodes of the head and neck, frothing at the mouth and nostrils, and signs of an acute infectious disease which had a fatal termination. Yersinia pestis was isolated on about the 8th day from the cerebrospinal fluid of the man. The foster mother of the kitten exhibited signs of spinal and cerebral meningitis but recovered following treatment; her serum contained plague antibody levels of 1:512 and 1:1024 on the 22nd and 34th days respectively after the first evidence of illness. Three litter mates of the kitten also died. The outbreak occurred on a farm in the Graaff-Reinet district of the eastern Cape Province, which is situated about 160 km from the nearest known natural plague focus.