A meta-review of literature reviews assessing the capacity of patients with severe mental disorders to make decisions about their healthcare.

BACKGROUND: Determining the mental capacity of psychiatric patients for making healthcare related decisions is crucial in clinical practice. This meta-review of review articles comprehensively examines the current evidence on the capacity of patients with a mental illness to make medical care decisions. METHODS: Systematic review of review articles following PRISMA recommendations. PubMed, Scopus, CINAHL and PsycInfo were electronically searched up to 31 January 2020. Free text searches and medical subject headings were combined to identify literature reviews and meta-analyses published in English, and summarising studies on the capacity of patients with serious mental illnesses to make healthcare and treatment related decisions, conducted in any clinical setting and with a quantitative synthesis of results. Publications were selected as per inclusion and exclusion criteria. The AMSTAR II tool was used to assess the quality of reviews. RESULTS: Eleven publications were reviewed. Variability on methods across studies makes it difficult to precisely estimate the prevalence of decision-making capacity in patients with mental disorders. Nonetheless, up to three-quarters of psychiatric patients, including individuals with serious illnesses such as schizophrenia or bipolar disorder may have capacity to make medical decisions in the context of their illness. Most evidence comes from studies conducted in the hospital setting; much less information exists on the healthcare decision making capacity of mental disorder patients while in the community. Stable psychiatric and non-psychiatric patients may have a similar capacity to make healthcare related decisions. Patients with a mental illness have capacity to judge risk-reward situations and to adequately decide about the important treatment outcomes. Different symptoms may impair different domains of the decisional capacity of psychotic patients. Decisional capacity impairments in psychotic patients are temporal, identifiable, and responsive to interventions directed towards simplifying information, encouraging training and shared decision making. The publications complied satisfactorily with the AMSTAR II critical domains. CONCLUSIONS: Whilst impairments in decision-making capacity may exist, most patients with a severe mental disorder, such as schizophrenia or bipolar disorder are able to make rational decisions about their healthcare. Best practice strategies should incorporate interventions to help mentally ill patients grow into the voluntary and safe use of medications.

Intellectual disability and the prison setting.

INTRODUCTION: The prevalence of intellectual disability (ID) in the prison setting has scarcely been studied. Although some approximations or estimates regarding people with intellectual disabilities have been performed in Spain, there is little in the way of reliable data. OBJECTIVES: 1) To determine the prevalence of ID in a sample population in the residential modules of a Spanish prison, 2) Obtain data on the prevalence of ID in prison psychiatric units and hospitals. METHODS: 1) A TONI II test was performed on a sub-sample (n = 398) of a prevalence study in Spanish prisons to identify inmates with intellectual disabilities. 2) We reviewed the reports of the psychiatric department of Parc Sanitari Sant Joan de Deu to establish the diagnosis at discharge of patients with a primary diagnosis of intellectual disability 3) Data from the Directorate General of Prisons on the prevalence of ID in Prison Psychiatric Hospitals was reviewed. RESULTS: The data obtained from the TONI II test found 3.77% of the study population has an IQ below 70, and 7.54 % has a borderline IQ rate. Assessment of penitentiary psychiatric hospitalization data showed these figures to be higher. CONCLUSIONS: The data from a Spanish prison population showed that ID levels were higher than those in the community, especially amongst prisoners requiring specialized psychiatric care. What is also evident is that adequate resources are required in prisons and in the community to provide better care for people with intellectual disabilities who are in the pathway of the criminal justice system.

La discapacidad intelectual y el ámbito penitenciario / Intelectural disability and the prison setting

Introducción: La prevalencia de discapacidad intelectual (DI) en el entorno penitenciario ha estado escasamente valorada. En España, a pesar de diversas aproximaciones o estimaciones no existen datos fiables respecto a las personas que sufren de DI. Objetivos: 1) Determinar la prevalencia de DI en una muestra de la población penitenciaria española, ubicada en módulos residenciales 2) Obtener datos sobre la prevalencia de DI en unidades y hospitales psiquiátricos penitenciarios. Métodos: 1) Se realizó una administración del TONI II en una submuestra (n: 398) de un estudio de prevalencia en cárceles españolas para identificar los internos con DI. 2) Se revisaron la memorias del Área Psiquiátrica Penitenciaria del Parc Sanitari Sant Joan de Deu para determinar los pacientes con diagnostico principal de DI. 3) Se revisaron datos de documentos de la Dirección General de Instituciones Penitenciarias para obtener la prevalencia de discapacidad intelectual en los Hospitales Psiquiátricos Penitenciarios. Resultados: Los datos del TONI II fueron que un 3,77% de la población estudiada presenta un Coeficiente Intelectual (CI) por debajo de 70, y un 7,54% presentaba una inteligencia límite. Siendo mayores cuando valoramos la hospitalización psiquiátrica. Conclusiones: Los datos de DI en población penitenciaria presentan unas tasas elevadas, especialmente aquellos que precisan una atención psiquiátrica especializada. Lo que pone de relieve que son necesarios recursos (penitenciarios y comunitarios) para una mayor atención de las personas con DI durante el recorrido en el ámbito penal (AU)

Introduction: The prevalence of intellectual disability (ID) in the prison setting has scarcely been studied. Although some approximations or estimates regarding people with intellectual disabilities have been performed in Spain, there is little in the way of reliable data. Objectives: 1) To determine the prevalence of ID in a sample population in the residential modules of a Spanish prison, 2) Obtain data on the prevalence of ID in prison psychiatric units and hospitals. Methods: 1) A TONI II test was performed on a sub-sample (n = 398) of a prevalence study in Spanish prisons33 to identify inmates with intellectual disabilities. 2) We reviewed the reports of the psychiatric department of Parc Sanitari Sant Joan de Deu to establish the diagnosis at discharge of patients with a primary diagnosis of intellectual disability 3) Data from the Directorate General of Prisons on the prevalence of ID in Prison Psychiatric Hospitals was reviewed. Results: The data obtained from the TONI II test found 3.77% of the study population has an IQ below 70, and 7.54% has a borderline IQ rate. Assessment of penitentiary psychiatric hospitalization data showed these figures to be higher. Conclusions: The data from a Spanish prison population showed that ID levels were higher than those in the community, especially amongst prisoners requiring specialized psychiatric care. What is also evident is that adequate resources are required in prisons and in the community to provide better care for people with intellectual disabilities who are in the pathway of the criminal justice system (AU)

Violencia y enfermedad mental / Violence and mental illness

En este trabajo se exponen resultados de tres años de trabajo en el Hospital Psiquiátrico Penitenciario de Catalunya. Se analiza la relación entre el trastorno mental y la comisión de delitos violentos revisando un total de 243 pacientes. Se reflexiona sobre la relación entre delito, violencia, trastorno mental y suicidio. Se plantean posibles estrategias de prevención

This study describes the results of three years work at the Hospital Psiquiátrico Penitenciario de Catalunya. The relationship between mental disorder and acts of violence in a sample of 243 patients is analysed. The relationships between crime, violence,mental disorder and suicide are considered. Possible prevention strategies are proposed (AU)

Policonsumo en la Universitat de les Illes Balears / Polyconsumption in the Universitat de les Illes Balears

Objetivos: Caracterizar en qué contexto se viene desarrollando elhábito tabáquico en lo referente a su relación con otras drogas o situacionessocioculturales o personales. Consecuentemente con este planteamiento,se han evaluado las relaciones existentes entre el hábito tabáquicoel consumo de alcohol, cannabis y otras variables como el género,hábitos familiares, hábitos de las amistades, nivel profesional de los padres…entre la población constituida por los alumnos del edificio GuillemCifre, de Colonya, de la Universitat de les Illes Balears (UIB).Métodos: Estudio descriptivo transversal, efectuado mediante unaencuesta autocumplimentada cuyo ámbito es el colectivo de estudiantesdel Edificio Guillem Cifre, de Colonya, de la Universitat de les IllesBalears. La recogida de la información se llevó a cabo suministrando uncuestionario autocumplimentado a alumnos de las facultades dePsicología, Enfermería y Estudios de Ciencias de la Educación. Una vezdepurados los datos, se procedió al análisis con el paquete estadísticoSPSS v.11,5. Se realizó un análisis descriptivo y para conocer la fuerzade asociación entre fumar y las variables predictoras se obtuvieronlas odds ratio (OR) utilizando la regresión logística tanto para el análisisunivariante como multivariante.Resultados: La muestra obtenida fue de 862 alumnos, con una mediade edad de 21,06 ± 0,38 años. La prevalencia total de fumadores habitualesse sitúa en el 35,3%. Admiten consumir semanalmente, al menosuna bebida alcohólica el 69,5% de los encuestados, y fumar al menosun porro el 16%. Ser consumidor de marihuana incrementa en más desiete veces la probabilidad de ser fumador. Si el mejor amigo es ser fumador,aumenta en 5,58 veces la probabilidad de ser fumador habitual.Los fumadores consumen marihuana y beben alcohol en mayor proporciónque los no fumadores. Además, cerca del 90% de los consumidoresde marihuana beben habitualmente. Ser consumidor de marihuanao alcohol, ser mujer, que en la familia haya algún fumador o ser hijode una madre no universitaria, son factores de riesgo independientespara ser fumador.Conclusiones: Fumaron cannabis semanalmente (durante los últimos12 meses) el 14,4%, lo que confirma a la Comunidad Balear comola de mayor consumo de España. Cuanto mayor es el consumo demarihuana y alcohol, mayor es la probabilidad de ser fumador. Se confirmaque el consumo de drogas y especialmente el tabaco depende, deuna forma muy relevante, del contexto familiar y, aún más, del social(OR de 5,58 en el caso de tener amigos íntimos fumadores u OR de 3,75en caso de que la pareja fume). Los datos que aporta este estudio nos hacenpensar en la necesidad de planificar programas de promoción de lasalud globales, tanto a nivel escolar como comunitario, y que estén dirigidosal policonsumo de drogas y no solamente al hábito tabáquico

Objectives: Characterize within what context the smoking habit hasbeen developing in relationship with other drugs or sociocultural orpersonal situations. In consequence with this approach, the relationshipsexisting between smoking habit, consumption of alcohol, cannabis andother variables such as gender, family habits, habits of friends, parents'professional level, etc. between the population made up by the studentsof the building Guillem Cifre de Colonya of the Universitat de les IllesBalears (UIB) have been evaluated.Methods: Cross-sectional descriptive study conducted through aself-filled out survey whose scope is the group of students from thebuilding Guillem Cifre de Colonya of the Universitat de les Illes Balears.Information was collected by providing a self-filled out questionnaireto students of the Psychology, Nursing and Studies of Sciences of theEducation schools. Once the data were purified, analysis was done withthe SPSS v. 11.5 statistical program. A descriptive analysis was doneand the Odds Ratio (OR) was obtained using the logistic regression bothfor the univariate and multivariate analysis to know the force of theassociation between smoking and predictive variables.Results: The sample obtained included 862 students, with a meanage of 21.06 ± 0.38 years. Total prevalence of usual smokers is 35.3%.A total of 69.5% of those surveyed admit that they drink at least one alcoholic drink per week and 16% that they smoke at least one joint.Consuming marijuana increases the likelihood of being a smoker seventimes. If one's best friend smokes, the likelihood of being a regular smokerincreases 5.88 times. Smokers consume marijuana and drink alcoholmore than non-smokers. Furthermore, about 90% of the marijuanaconsumers commonly drink. Being a consumer of marijuana or alcohol,being a woman, that there is someone who smokes in the family or beingthe child of a non-university mother are independent risk factors to bea smoker.Conclusions: Atotal of 14.4% smoked cannabis weekly (during thelast 12 months), which confirms the Balearic Island Community as thathaving the largest consumption in Spain. The greater the consumptionof marijuana and alcohol, the greater the likelihood of being a smoker.It is confirmed that the consumption of drugs and especially tobaccodepends in a relevant way on the family context and even more on thesocial one (OR of 5.58 in the case of having close friends who smoke orOR of 3.75 in case of the partner who smokes). The data supplied bythis study lead us to think about the need to plan global health promotionprograms on both the school and community level that are aimed atpolyconsumption of drugs and not only at the smoking habit

El cumplimiento de la medicación y las implicaciones clínicas a largo plazo en la esquizofrenia en el ámbito penitenciario / Treatment compliance and clinical long time consequences in schizophrenia in prison environment

En este trabajo se revisa la influencia que tienen los nuevos antipsicóticos atípicos inyectables de larga duración en el cumplimiento del tratamiento en enfermos mentales en prisión

In this work is revised the influence that have the new long-acting injection atypical antipsychotic drugs on the treatment compliance in patients with mental ill in prison

Needs and its relation to symptom dimensions in a sample of outpatients with schizophrenia.

OBJECTIVE: To analyse the association between symptom dimensions in schizophrenia and number and type of met and unmet needs. METHOD: A sample of 231 outpatients randomly selected from a register that included all patients treated in 5 mental health care centres (MHCC) was evaluated. Assessment instruments included the Camberwell Assessment of Needs (CAN) questionnaire and the PANSS. RESULTS: Number of needs are related to overall severity of psychopathology. Patients with more symptoms have more total needs (p < 0.001) and unmet needs (p < 0.001). A multiple lineal regression model showed that the disorganized and excited dimensions of the PANSS are the most important components for explaining the variance of number of needs. Type of needs is related to subtypes of schizophrenia, specially with disorganized and excited symptoms. CONCLUSION: Psychosocial needs are related to schizophrenia subtypes. Patients with more needs are those with more disorganized and excitatory symptoms.

[Sexual dysfunction with antidepressive agents. Effect of the change to amineptine in patients with sexual dysfunction secondary to SSRI]. / Disfunción sexual con antidepresivos. Efecto del cambio a amineptino en pacientes con disfunción sexual secundaria a ISRS.

UNLABELLED: Sexual dysfunction secondary to the use of antidepressants, especially clomipramine or SSRI's is an adverse effect that is often underestimated and according to earlier studies, this can affect approximately 60% of the patients. This presents as a decrease in libido, alterations in the ability to reach orgasm/ejaculation, and an erectile dysfunction or a decreased vaginal lubrication. This dysfunction appears to be related with the resulting increase in serotonin and with the stimulation of serotonin 5HT2 receptors. OBJECTIVES: 1) Evaluate the effect of amineptine, a drug with an increased dopamine transmission and scant serotonin transmission, on the sexual function of depressed patients who begin treatment, and 2) evaluate whether the change to amineptine improves the sexual function in patients who presented sexual dysfunction after beginning treatment with a SSRI. MATERIAL AND METHODS: Prospective, observational, open and multicentric design. 111 patients with an average age of 41.3 years (36 men, 75 women) were distributed into three groups: Group 1 (n= 26): patients with depression (DSM IV) who begin de novo treatment with amineptine 200 mg/day. Group 2 (n= 47): depressed patients undergoing treatment with a SSRI who show a favorable response and who present sexual dysfunction secondary to a poorly tolerated treatment, so the treatment is changed to 200 mg/day of amineptine. Group 3 (n= 38): patients with the same characteristics as those of group 2, but whose treatment was changed to 20 mg/day of paroxetine. The <> (Montejo et al, 1996) was used together with the Hamilton Depression Scale, the IGC Scale, and an adverse events scale, over a 6 months follow up period during which visits took place at: baseline, month 1, month 2, month 3, and month 6. RESULTS: In group 1, treated with amineptine from the beginning, of the 5 patients who showed a decrease in the libido at the beginning of the treatment, only one still presented this in the 6th month. The Hamilton Scale decreased from 23.12 (baseline) to 5.25 after 6 months. After substituting amineptine for SSRI's in patients with sexual dysfunction, the incidence of any type of sexual dysfunction decreased significantly from 100% (baseline) to 55.3% after 6 months. (P< 0.001). The incidence of delayed orgasm dropped to 15.8%, anorgasmia to 17.4%, and impotence dropped to 15.8% in this group, with the antidepressant effect that had already been achieved with the SSRI being maintained. However, in group 3 there was barely any improvement on the sexual function after changing to paroxetine (20 mg/day), with the baseline incidence being 100% and the incidence after 6 months being 89.7%. In this last group the antidepressant effect present at the baseline level, was maintained. CONCLUSIONS: Amineptine was shown to be an effective antidepressant in the patients studied, and did not cause secondary sexual dysfunction, and even improved the dysfunction that was present in some patients. In those patients previously treated with SSRI's, amineptine is able to significantly improve the sexual dysfunction and yet maintain the efficacy of the antidepressive treatment used before these 6 months. On the other hand, Paroxetine did not improve the sexual dysfunction of the people in whom this drug substituted another SSRI, as this is an adverse effect common to the entire group of selective serotonin re-uptake inhibiting drugs. Amineptine showed a good safety and tolerance profile. Its most common side effect (anxiety/restlessness) disappeared 2 months after the beginning of the treatment.

[Pediatric radiography. The nurses' role]. / Exploraciones radiológicas infantiles. Rol de Enfermería.

After a brief review of advanced radiographic diagnostic techniques, how to utilize them in the most cost-effective manner and minimize their risks, the authors examine the role of the nurse in using exploratory radiography in children. Patient opposition, immobilization and protection are some of the possible problems that one might encounter when working in this setting.

SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients.

The authors analyzed the incidence of sexual dysfunction (SD) with different selective serotonin reuptake inhibitors (SSRIs; fluoxetine, fluvoxamine, paroxetine, and sertraline) and hence the qualitative and quantitative changes in SD throughout time in a prospective and multicenter study. Outpatients (192 women and 152 men; age = 39.6 +/- 11.4 years) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors and that included questions about the following: decreased libido, delayed orgasm or anorgasmia, delayed ejaculation, inability to ejaculate, impotence, and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRI intake, exclusive treatment with SSRIs or treatment associated with benzodiazepines, previous heterosexual or self-erotic current sexual practices. Excluded were patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recent hormone intake, and significant medical illnesses. There was a significant increase in the incidence of SD when physicians asked the patients direct questions (58%) versus when SD was spontaneously reported (14%). There were some significant differences among different SSRIs: paroxetine provoked more delay of orgasm or ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (chi 2, p < .05). Only 24.5% of the patients had a good tolerance of their sexual dysfunction. Twelve male patients who suffered from premature ejaculation before the treatment preferred to maintain delayed ejaculation, and their sexual satisfaction, and that of their partners, clearly improved. Sexual dysfunction was positively correlated with dose. Patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women, but women's sexual dysfunction was more intense than men's. In only 5.8% of patients, the dysfunction disappeared completely within 6 months, but 81.4% showed no improvement at all by the end of this period. Twelve of 15 patients experienced total improvement when the treatment was changed to moclobemide (450-600 mg/day), and 3 of 5 patients improved when treatment was changed to amineptine (200 mg/day).

[Sexual dysfunction secondary to SSRIs. A comparative analysis in 308 patients]. / Disfunción sexual secundaria a ISRS. Análisis comparativo en 308 pacientes.

UNLABELLED: The authors analyze the incidence of sexual dysfunction (SD) with different SSRIs (Fluoxetine, Fluvoxamine, Paroxetine and Sertraline) and hence the qualitative and quantitative changes in SD throughout time 308 outpatients (169 women, 139 men; mean +/- SD age = 41 +/- 7) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors including questions about the following items decreased libido, delayed orgasm or anorgasmia, delayed ejaculation inability to ejaculation, impotence and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRIs intake, exclusive treatment with SSRIs or associated with benzodiazepines, previous heterosexual or self-orone current sexual practices. We excluded patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recently hormone intake and significant medical illnesses. RESULTS: There is a significant increase in the incidence of SD when the physicians ask the patients direct questions (55.29%) versus spontaneous SD reported (14.2%). There are some significant differences among different SSRIs paroxetine provoked more delay of orgasm/ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (Chi square p < 0.05). Only 22.6% of the patients had a good tolerance about their sexual dysfunction. SD has positive correlation with the dose. The patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women but women's sexual dysfunction was more intense than men. Seven of nine patients (77.7%) experienced total improvement when the treatment was changed to Moclobemide (450 mg/day) and two of four patients (50%) improved when treatment was changed to Amineptine.

Multiple primary malignancies in a renal transplant patient.

Organ transplantation and the use of immunosuppressive therapy has been associated with an increased incidence of malignancy. We report the case of a long-term renal transplant recipient who developed concomitant skin cancers, non-Hodgkin's lymphoma, and malignant fibrous histiocytoma. The development of three seemingly unrelated cancers in the same patient illustrates the favorable host environment in transplant patients for the development of malignancies.

Alpha-V/beta-3 and alpha-V/beta-5 integrin distribution in neoplastic kidney.

Integrins are transmembrane glycoproteins that mediate cell-cell and cell-matrix interactions. Altered integrin expression may contribute to tumor progression, invasiveness and metastases. The alpha-V/beta-3 (alpha v beta 3; osteopontin/ vitronectin receptor) has recently been implicated in neovascularization and tumor-induced angiogenesis. alpha v-Subunit also associates with beta 5 to form an alpha v beta 5-complex, another vitronectin receptor. We studied tissue distribution of alpha v beta 3-and alpha v beta 5-integrins, as well as alpha 1- and beta 1-subunits in nephrectomy samples from 7 subjects with localized renal cell carcinoma. Grossly and histologically uninvolved regions ('normal') from the same nephrectomy specimens were used for comparison. Integrin expression was studied with specific monoclonal antibodies and the immunoperoxidase technique. alpha v beta 3 was expressed in the glomerular epithelial cells, Bowman's capsule, vascular endothelium, and weakly in tubular epithelial cells. alpha v beta 5 had a similar distribution except for minimal expression on vascular endothelium. alpha 1-Expression was observed in mesangium and but weakly in Bowman's capsule. beta 1-Expression was seen in glomerular epithelial cells, Bowman's capsule, vascular epithelium and tubular epithelial cells. Unlike in 'normals', neoplastic expression was more heterogeneous alpha v beta 3 was expressed in tumor cells in 4/7 cases, vascular endothelium in 6/6, and in stroma in 4/7. alpha v beta 5 was weakly expressed in tumor cells in 4/5, vascular endothelium in 5/5, and stroma in 4/5 cases. alpha 1-Expression was seen in tumor cells in 3/7, vascular endothelium in 4/7 and in stroma in 7/7 cases. beta 1-Expression was seen in tumor cells in 7/7 cases, vascular endothelium in 7/7, and in stroma in 4/7 cases. This study delineates the pattern of expression of the alpha v beta 3-and alpha v beta 5-integrins in 'normal' and neoplastic human kidney. Variations in alpha v beta 3-and alpha v beta 5-integrin expression may play a role in normal and neoplastic processes of the kidney.

Inter-relationship between serum potassium and plasma catecholamines and 3':5' cyclic monophosphate in alcohol withdrawal.

Serial analyses of serum potassium and plasma epinephrine, norepinephrine and adenosine 3':5'-cyclic monophosphate (cyclic AMP) concentrations were measured in 13 patients with alcohol withdrawal, six of whom presented delirium tremens. Patients with delirium showed at admission levels of potassium (3.45 +/- 0.45 mmol/l) lower (P less than 0.02) than patients without delirium (3.81 +/- 0.14 mmol/l). Three patients were hypokalemic, all of them with delirium. Serum potassium increased significantly in all the patients during evolution. A close negative correlation (r = -0.751) between the intensity of withdrawal and serum potassium was observed. Plasma epinephrine concentrations were increased at admission (623 +/- 192 pmol/l), patients with delirium showing greater values (705 +/- 137 pmol/l). As the alcohol withdrawal improved, plasma epinephrine concentration decreased. Plasma norepinephrine concentrations were also increased at admission (3422 +/- 1451 pmol/l), but did not change significantly during evolution, being similar in patients with and without delirium. Plasma cyclic AMP levels were high at admission (40.4 +/- 24.3 nmol/l) and increased significantly (P less than 0.05) during evolution. The data obtained suggest that in patients with alcohol withdrawal, as symptomatology improves, plasma epinephrine decreases, while plasma norepinephrine remains increased. The combined actions of the two facts--less beta-stimulus, maintaining of alpha-stimulus--would comprise a significant increase of kalemia, that in cases of initial hypokalemia would lead to normal values of serum potassium.

Masculinization of a female fetus by Krukenberg tumor during pregnancy.

A case of fetal masculinization resulting from a Krukenberg tumor in a pregnant woman is reported in a newborn infant with a sexual ambiguity of the external genitals, of the feminine pseudohermaphrodite type. She also had an incarceration of both ovaries and tubes in a right inguinoscrotal hernia that was surgically corrected.