Psychological profile of somatizing patients attending the integrative clinic.

OBJECTIVE: A clinic to evaluate and treat referred somatizing patients was established in the medicine clinic of a university medical center. METHOD: Fifty-four patients were evaluated and compared to an age- and sex-matched non-somatizing patient group. RESULTS: Somatizing patients had increased rates of psychiatric and alcohol and substance abuse histories. Somatizing patients scored high on all subscales of the SCL-90 and were most frequently found in the Anxious/Moody Cluster of the MBHI. These patients also endorsed highly beliefs in medical problems as a focus of their lives. CONCLUSIONS: These patients' psychological beliefs set the stage for conflict in the medical setting. The implications of these results are discussed in relation to liaison clinics, early identification, and treatment approaches.

Hypoalbuminemia in delirium.

The charts of 100 delirious patients seen by a psychiatric consultation service were reviewed. The most common chronic medical problems included diabetes and cardiovascular disease, while infections and trauma were the most common acute problems. The most frequent laboratory abnormality was hypoalbuminemia, appearing in 66% of those tested. Hypoalbuminemic patients were more likely to have a combination of medical problems, long hospital stays, and increased mortality, while patients with normal albumin were more likely to have drug toxicities and short hospital stays. While hypoalbuminemia develops because of many physiological processes, the data suggest that more attention should be paid to nutrition and serum transport capability in medical patients.

Children from disrupted and adoptive homes on an inpatient unit.

Among 375 children and adolescents admitted to a psychiatric hospital inpatient unit, the proportion of adopted children was considerably higher than that of a general pediatric population or of census figures, and the majority of nonadoptees were from disrupted homes. Based on a review of case records, adoption and family disruptions appear to increase significantly the length of hospitalization and to shift diagnoses toward behavioral disturbances. Implications for prevention and treatment are considered.

Jugular thrombophlebitis resulting from an anaesthetic induction technique in the horse.

Forty-eight hours after general anaesthesia was induced by glycerol guaiacolate and thiopentone sodium in 10 horses, the jugular veins were dissected out at post-mortem and examined visually and histologically. All veins showed a marked thrombophlebitis involving the media and intima at the site of injection. The influence of catheter composition, catheter placement and chemical composition on the occurrence of the thrombophlebitis is discussed. It is concluded that the thrombophlebitis was chemically induced.

An update on selected organic mental syndromes.

The authors review recent literature on four medical conditions that constitute important examples of organic mental disorders: AIDS dementia complex, cocaine abuse, cerebrovascular accident, and traumatic brain injury. These disorders are of particular interest because they are frequently the result of high-risk behaviors and the patients are often young adults. Progress in classification and diagnosis, along with greater understanding of pathophysiological mechanisms, has facilitated therapies to ameliorate some symptoms. More specific classification of organic mental disorders should facilitate the examination of biological factors believed responsible for functional psychiatric disturbances.

Rotaviral diarrhoea and its treatment in a foal.

A severely dehydrated foal with a history of acute diarrhoea was presented to Massey University for treatment. Rotavirus was demonstrated in the faeces by electron microscopy. The failure to detect other pathogens suggested that rotavirus was the primary aetiological agent. Successful treatment of this case is described and the principles of treatment for diarrhoea, particularly fluid therapy, are reviewed. Antibodies to rotavirus were detected in the sera of nine mares and their foals on the stud that referred the case, indicating that rotaviral infection was probably endemic.

Iohexol myelography in the horse.

Iohexol, a water soluble non-ionic contrast agent, was evaluated for myelography in the horse. Both 300 and 350 mg iodine/ml iohexol gave diagnostic cervical myelograms. Pathological changes were limited to extradural oedema and an increase in the number of white blood cells and specific gravity in the cerebrospinal fluid two days after myelography. This increase in white blood cells in the cerebrospinal fluid was, however, much less than that recorded by other authors using metrizamide and iopamidol contrast media. These findings indicate that iohexol is a less irritant myelographic contrast agent than those previously evaluated in the horse.

A method of cerebro-cortical biopsy in lambs.

A suction needle brain biopsy technique is a safe and effective method of obtaining cerebral cortex for experimental purposes in lambs. The biopsies are performed under general anaesthesia using halothane and oxygen following barbiturate induction. The method may have a number of related used in this of other species.

Surgical relief of severe laryngeal malformation in an English Bulldog.

A 22 month old English Bulldog was presented with progressive upper airway obstruction associated with an elongated soft palate, tonsillitis, everted laryngeal saccules and laryngeal malformation. Surgical management of the case consisted of resection of the elongated soft palate and everted laryngeal saccules, unilateral tonsillectomy and correction of the laryngeal stenosis. The latter was achieved by using a castellated incision through the laryngeal cartilages and first tracheal ring. From this case, it is postulated that, at least in some cases, the common upper airway obstruction syndrome in Bulldogs may not be due to laryngeal collapse as previously thought but rather to congenital malformation of the laryngeal cartilages.

When schizophrenia complicates medical care.

Schizophrenia may complicate effective treatment of medical problems. For example, the patient may refuse treatment or may not be competent to give informed consent. When possible, acute psychosis should be treated first; the patient may then cooperate with medical treatment. The patient's ability to give informed consent is important.

Treating psychiatric problems in medical students.

The medical school educational experience is very stressful for many students, prompting some to seek formal psychiatric care. The authors describe the Medical Student Support Services program of the University of Kentucky College of Medicine. From July 1983 to June 1985, this program served 66 patients, representing 417 visits. On the basis of retrospective chart review with the examining clinicians, the authors present DSM-III diagnoses, types of problems seen, descriptive profiles of the patients, duration of treatment, types of therapy used, and data on marital issues. They discuss the intricacies of providing psychiatric services to medical students and make recommendations for program development for such patients.

Suppression of human chorionic gonadotropin by progestational steroids.

The dynamics of the secretion of human chorionic gonadotropin (hCG) were studied by culturing explants of normal term placentas for as long as 144 hours. A significant accumulation of immunoreactive hCG (beta-subunit) was first detected at 48 to 72 hours, and a sixfold increase in hCG was observed in control culture medium at 144 hours. Compared to control cultures, progesterone (P < 0.001) in physiologic tissue levels of 5 to 20 micrograms/ml, pregnenolone (P < 0.001), 20 micrograms/ml, and 20 alpha-dihydroprogesterone (P < 0.001), 20 micrograms/ml, suppressed the secretion of hCG throughout the study period. Progesterone decreased the secretion of hCG in a dose-response manner (r = -0.8S87, P < 0.1). No suppression of hCG was observed in the presence of cortisol, testosterone, dihydrotestosterone, 17 beta-estradiol, or estriol. The secretion of human chorionic somatomammotropin was unchanged in the presence of progesterone. The augmented hCG response in the presence of dibutyl cAMP (P < 0.001) was significantly, but not completely, suppressed by progesterone 20 micrograms/ml culture medium (P < 0.01). Under these conditions progestational steroids or their immediate metabolites suppress the secretion of hCG, and they may be responsible for the decline in the levels of hCG during pregnancy.

Proposed replicative role of the NS polypeptide of vesicular stomatitis virus: structural analysis of an electrophoretic variant.

The structural lesion in the temperature-sensitive mutant E1 of the New Jersey serotype of vesicular stomatitis virus has been assigned to the NS protein. Although the packaged wild-type and mutant NS proteins were similarly phosphorylated, the mutant NS protein migrated faster than the wild-type NS protein in polyacrylamide slab gels electrophoresed in the presence of sodium dodecyl sulfate. The resolution appears to be the result of conformational rather than size differences since the two proteins comigrated in polyacrylamide gels which contained 4 M urea in addition to sodium dodecyl sulfate. Peptide maps, obtained by limited proteolysis of 32P-labeled wild-type and mutant NS proteins with Staphylococcus aureus V8 protease and papain, revealed striking differences which suggested that the mutant alteration could involve an aspartic or glutamic acid residue. Since NS proteins obtained from naturally occurring revertants of E1 were indistinguishable from the wild-type protein in all of these analyses, the structural alteration in the mutant NS protein correlates with the functional lesion. Because E1 is defective in the RNA replication pathway at the restrictive temperature, a replicative role is proposed for the NS protein.

Purification and properties of an inducible beta-galactosidase isolated from the yeast Kluyveromyces lactis.

beta-Galactosidase (EC 3.2.1.32) was purified 80-fold from the yeast Kluyveromyces lactis induced for this enzyme by growth on lactose. When the purified enzyme was subjected to electrophoresis on an acrylamide gel in the presence of sodium dodecyl sulfate, one protein with an apparent molecular weight of 135,000 was observed. The enzyme has a sedimentation coefficient of 9.6S. This beta-galactosidase and the one from Escherichia coli are not antigenically related. Maximal enzyme activity requires Na+ and Mn2+ and a reducing agent. beta-Galactosidase has Km values of 12 to 17 and 1.6 mM for lactose and o-nitrophenyl-beta-D-galactoside, respectively. The hydrolase and transgalactosylase activities of the enzyme are similar to those of E. coli beta-galactosidase.