Effects of meta-chlorophenylpiperazine on cerebral blood flow in obsessive-compulsive disorder and controls.

BACKGROUND: A number of studies have shown that the serotonin receptor agonist meta-chlorophenylpiperazine (mCPP) can exacerbate symptoms in patients with obsessive-compulsive disorder (OCD). The aim of the present study was to study the effect of this compound on regional cerebral blood flow (rCBF) in patients and controls. METHODS: Seven OCD patients and 8 healthy controls were randomly allocated to a double-blind challenge study with mCPP (0.5 mg/kg orally). rCBF was measured by 99m-Tc-hexamethyl-propyleneamineoxime single photon emission computed tomography. RESULTS: mCPP did not induce OCD symptoms in patients, but caused a significant decrease in rCBF in OCD patients, but not in controls. The decrease was seen in the reference regions cerebellum and whole brain, and in the frontal cortex, caudate nucleus, putamen, and thalamus. CONCLUSIONS: The effect of mCPP on the reference regions in patients posed methodological problems in the normalization methods. A possible role of the cerebellum in OCD is discussed.

Postprandial gall bladder motility and hormone release during intermittent and continuous subcutaneous octreotide treatment in acromegaly.

Repeated daily injections of the somatostatin analogue, octreotide (SMS201-995, Sandostatin) are an effective treatment for acromegaly, but lead to gall stone formation in about 50% of cases during longterm treatment. This is probably because of impaired gall bladder contraction. This study examined whether the timing of intermittent injections in relation to meals, or alternatively, continuous 24 hour subcutaneous octreotide infusion (CSOI) might avert adverse effects on gall bladder contraction. In six patients with active acromegaly, gall bladder volume, plasma cholecystokinin (CCK), and pancreatic polypeptide (PP) were measured in the fasting state and after consumption of a fatty meal. Measurements were made on five separate days: (a) without treatment, (b) 45 minutes after 100 micrograms octreotide given subcutaneously, (c) four hours after 100 micrograms octreotide given subcutaneously, (d) eight hours after 100 micrograms octreotide given subcutaneously, and (e) during CSOI of 300 micrograms/24 h for two weeks. Without treatment, postprandial gall bladder contraction was 86.2 (2.1%). Fasting gall bladder volume increased after octreotide injection and was almost doubled during CSOI. Octreotide injections impaired postprandial gall bladder contraction as well as CCK and PP release for at least four hours. Eight hours after injection and during CSOI, postprandial gall bladder contraction was partly restored (43.4% and 50.8% respectively). Postprandial CCK release was normal at eight hours after injection but very low during CSOI. PP release was suppressed by each mode of octreotide treatment. This study indicates that octreotide injections impair postprandial gall bladder contraction for at least four hours. Eight hours after injection and during CSOI, gall bladder contraction is partly restored.

Sellar granulomatous mass in a pregnant woman with active Crohn's disease.

At the end of her third pregnancy, a woman with a history of chronic active proctocolitis which had been diagnosed as Crohn's disease complained of deterioration of visual acuity. The patient was found to have hypopituitarism and progressive bitemporal hemianopia caused by an intrasellar mass with suprasellar extension. At transsphenoidal surgery an intrasellar granuloma was found without remnants of pituitary tissue. This sellar granuloma could have been an extra-intestinal granuloma of Crohn's disease. However, the possibility that giant cell granulomatous hypophysitis had been present was considered more likely. The occurrence of this disorder in the postpartum period has not been reported before.