[Behavior disturbances in emergency psychiatry or fronto-temporal dementia diagnosis? A challenge for psychiatrists]. / Troubles du comportement aux urgences, ou démence fronto-temporale? Un défi pour les psychiatres.

INTRODUCTION: The diagnosis of fronto-temporal dementia (FTD) represents a challenge for the psychiatrist, especially since this insidious pathology partly mimics other psychiatric diseases. CASE-REPORT: We present a clinical case that illustrates the difficulty of FTD diagnosis particularly well. A 32 year-old woman without previous medical history presented with psychomotor agitation, logorrhea and flight of ideas. The criteria for bipolar disorder according to DSM IV were met and the patient was referred to an outpatient clinic where a mood stabilizer was initiated (lithium, 400 mg/day). An in-depth interview with her husband revealed mild but progressive modification of her personality and behavior over the course of two years. She showed signs of mild fatigue and irritability that evolved into a loss of interest for both leisure and domestic activities. In addition, she showed increasing erratic behavior and emergence of frequent episodes of verbal abuse. After the birth of her second child, the patient's clinical state worsened with the appearance of uninhibited behavior, loss of personal hygiene, sleep disturbances and nightmares. The patient was forced to stop her work as a cleaner, a steady employment that she had maintained for 10 years. The hypomanic state worsened and psychotic symptoms such as delusions and echolalia appeared within a few weeks. These events culminated in a first hospitalization in a psychiatric unit. We evoked both diagnoses of schizoaffective disorder and psychotic disorder not otherwise specified. In the following months, we conducted neurological examinations on account of the progressive deterioration of her cognitive functions. Neuroradiological results (CT scan with contrast agents, MRI, cerebral scintigraphy) coupled with her clinical evolution (neurological examination and neuropsychological testing) permitted diagnosis of fronto-temporal dementia. DISCUSSION: Fronto-temporal dementia usually presents itself as an autosomal dominant disease in 89% of reported cases, with an insidious onset associated with thymic symptoms and behavioral disturbances. The first consultation often concludes with a suspicion of a psychiatric disorder in 33% of the cases (unipolar and bipolar depressive disorders, psychotic disorders, alcohol dependence). The clinical description of such a heterogenic and neuro-psychiatric disorder should be widely disseminated, so that psychiatrists can distinguish early symptoms and diminish the risk of misdiagnosis of FDT. CONCLUSION: Such case reports emphasize the importance for psychiatrists to be aware of the clinical prodromal FDT symptoms, particularly since the neuro-imaging data of dementia are often delayed.

Psychiatric disorders and fitness to drive.

OBJECTIVE: In Switzerland, as in some other European countries, medical doctors may breach patient confidentiality and report to police authorities any patient who seems prone to automobile accidents or traffic violations. The aim of this study was to see if those patients reported to authorities actually represent a higher risk than drivers not reported to the police. DESIGN: This study was designed following a case-control study comparing the characteristics of a group of psychiatric patients who were reported to authorities for preventive purposes, with the characteristics of another group of people who had disorders that were noticed at the time of an accident or traffic violation. RESULTS: The results show that medical doctors tended to report male patients, patients with a low level of education, and patients with a severe psychiatric background. The subjects of the control group, who had often been involved in accidents or committed traffic violations in the past, did not possess these characteristics. CONCLUSIONS: The breach of medical confidentiality by doctors in reporting to authorities patients who are allegedly at risk is ethically questionable as long as the evaluation of driving performance does not rely on objective bases.

The formation of a 1-5 phosphodiester linkage in the spontaneous breakdown of 5-phosphoribosyl-alpha-1-pyrophosphate.

The decomposition of 5-phosphoribosyl-alpha-1-pyrophosphate (PRPP) in the presence of Mg2+ at pH=7.8 yields a combination of products including ribose 5-phosphate, ribose 1-phosphate, 5-phosphoribosyl 1,2 cyclic phosphate, inorganic phosphate, and pyrophosphate. Hydrogen decoupled 31P NMR analysis of the product mixture also exhibits a sharp peak (+2.6 ppm from phosphocreatine) in a chemical shift region which includes phosphodiester bonds. Alkaline phosphatase treatment of the product mixture results in cleavage of monophosphate esters such as ribose 1-phosphate and ribose 5-phosphate, but does not affect the unidentified peak. Homonuclear (1H) correlation spectroscopy (COSY) of a partially purified sample was successful in identifying the hydrogen spectra of this compound. Combined with results from the splitting patterns of selectively decoupled 31P spectra, the COSY data indicate that several hydrogens are directly coupled to the unknown phosphate group with J value matches to the hydrogen on carbon one and to the two hydrogens on carbon five. Heteronuclear (1H-31P) chemical shift correlation studies confirm these couplings and further substantiate the formation of a ribose 1-5 phosphate linkage during the degradation of PRPP under these conditions. It is presently unknown whether this is an intramolecular or intermolecular phosphodiester linkage, although some spectroscopic evidence suggest the intramolecular bond formation, i.e. a ribose 1,5-cyclic phosphate (R-1,5cP). The formation of R-1,5cP helps explain the observation that the 5-phosphate group from PRPP becomes labile during the spontaneous degradation of PRPP.

Synthesis of new pseudodisaccharide aminoglycoside antibiotics from carbohydrates.

Novel pseudodisaccharide-type aminocyclitol antibiotic models, built up from D-arabinose, D-ribose, D-glucosamine, L-ristosamine and L-acosamine have been synthesized by the glycosylation of suitably protected (azido)deoxyinosose aglycones derived by the Ferrier carbocyclic ring transformation of carbohydrate precursors. An alternative approach to related pseudodisaccharides, based on the Ferrier carbocyclization of reducing disaccharides, has also been elaborated. This latter method extends the scope of the Ferrier reaction, by demonstrating that acid-labile 2-deoxydisaccharides can also be readily transformed into the corresponding pseudodisaccharides under the slightly acidic conditions of this ring-transformation.

[Post-Herpes Zoster calcinosis]. / Calcinose post-zostérienne.

INTRODUCTION: Cutaneous calcinosis, without any disturbance of phosphocalcic metabolism, secondary to circumscribed previous skin lesions are quite common. Those secondary to viral skin lesions are rare and worth of publication. CASE REPORT: A 73-year old female patient disclosed progressive calcinosis in the scar of a cervico-thoracic herpes zoster which occurred 20 years ago. DISCUSSION: The occurrence of a secondary calcinosis in an old scar is common and non specific: the eliciting role of a previous herpes virus infection (VZV) may be discussed in the reported case and in few other cases reported in the literature (HSV, CMV)

[A drug ahead of its time: the success story of selegiline]. / Egy gyógyszer, amely megelözte korát: a selegilin siker története.

The racemic form of Selegiline was investigated in clinics a short time after its discovery in the sixties. However its fate seemed to be sealed by the so-called "cheese effect" associated with the applications of other MAO inhibitors. In the seventies the (-) enantiomer, called Selegiline was investigated again in European Clinics, and was finally introduced into therapy as an adjuvant of L-Dopa treatment for Parkinsonism. In the eighties its launch to the market of the USA was influenced by events known as the "MPTP Story" and the "Orphan Drug Act". Further clinical investigations of Selegiline are expected to clarify the real therapeutic value of Selegiline.

High performance liquid chromatography (HPLC) of antibiotics of vancomycin type. Comparative studies.

Comparative HPLC examination of seven antibiotics of vancomycin type has been undertaken. Investigation has shown that on column I in eluent system B, ristomycin A (ristocetin A) can be not only separated from vancomycin, but both antibiotics can be quantitatively determined. Under these conditions the lowest detectable quantities of the individual antibiotics have been also stated. By the application of this column and eluent system A, ristomycin A (ristocetin A) and the major component of the A-35512 B antibiotic complex can be readily separated from one-another and from avoparcin alpha and beta.

Pokeweed mitogen, Bordetella pertussis and breast milk cell factor induce preferentially the synthesis of different immunoglobulin classes.

Human tonsillar lymphocytes were cultured in the presence of different activators and [14C]-isoleucine. De novo synthesized, [14C]-labeled immunoglobulin was determined after separation of the different classes by immunoadsorbants carrying class-specific anti-human IgA, IgG, IgM, IgD or IgE. Pokeweed mitogen and whole killed Bordetella pertussis enhanced the synthesis and secretion of IgA, IgG and IgM. Maximum stimulation was found with pokeweed mitogen in IgM secretion (up to 5-fold), while Bordetella pertussis had the largest impact on IgA and IgG (4-5 fold increase). The human milk cell factor (demonstrated by Pittard and Bill., Cell. Immunol. 1979, 42, 437.) in the supernatant of cultured milk cells stimulated selectively the synthesis of IgA (4-fold).

Surface immunoglobulins of tonsil lymphocytes.

Human tonsillar lymphocytes bound 14C-labelled homologous IgG, IgA, and IgM at 5 degrees C and released them at 35 degrees C. B cells were found to be more active in this type of Ig binding. The amount of lymphocytes which could be labelled with fluoresceinated anti-human Ig-s decreased during preincubation of the cells at 35 degrees C. Intrinsic Ig-s (determinants of lymphocytes) were demonstrated by immunofluorescent staining preceded by preincubation of the cells at 35 degrees C for 60 min. The ratios of IgG, IgA, and IgM bearing cells in the human tonsillar lymphocyte population were 16.0, 8.0 and 7.4% respectively. The weak binding of Ig-s to the surface of lymphocytes is discussed with regard to the demonstration of surface Ig determinants of lymphocytes.

Electrophoretic protein pattern of human parotid saliva in Sjögren's syndrome and sialosis.

The electrophoretic pattern of the basic proteins in parotid saliva was examined in 12 control subjects and 45 patients suffering from xerostomia and parotid swelling of diverse origins. The protein pattern in the control subjects did not differ from the observed in sialotic patients. Characteristic quantitative and qualitative alterations in protein composition were observed in Sjögren's syndrome. The concentration of the protein fractions with a low Rp value showed a considerable increase, while one or two additional protein bands with high Rp value could be detected in these patients. The appearance of these additional protein bands may prove to be a valuable laboratory indicator in the diagnostic work. If they really indicate the beginning of an autoimmune process, the disease could be diagnosed much earlier than by the methods available today.

[Study of the antibiotic parvulomycin. The isolation of alpha,alpha-trehalose and L-glutamic acid]. / Issledovanie antibiotika parvulomitsina. Vydelenie al'fa,al'fa-tregalozy i L-glutaminovoi kisloty.

A non-reducing disugar and amino acid were isolated in the studies on the structure of parvulomycin. The acid hydrolysis of the disugar revealed the presence of 2 moles of D-glucose. Acetylation of the disugar resulted in formation of octa-O-acetyl-alpha,alpha-tregalose, saponification of which resulted in formation of alpha,alpha-tregalose. Its physical parameters, i.e. melting point of the mixed sample, optical rotation, IR-spectrum coincided with those of the authentic alpha,alpha-tregalose. The isolated amino acid proved to be L-glutamic acid on thin-layer chromatography with witness and comparison of the physico-chemical properties of their hydrochlorides.