[Cardiac tumor in a pregnant patient]. / Tumor srdce u gravidní pacientky.

Cardiac myxoma represents the most frequent cardiac tumor with a relatively low overall incidence. Clinical symptoms are hetereogeneous and therefore nonspecific. With regard to high success of the surgical treatment, early diagnosis is crucial. We present a case of cardiac myxoma in a pregnant woman, which was succesfully sugically removed.

[Genetic study of 20 patients with autism disorders]. / Genetická studie dvaceti pacientu s poruchami autistického spektra.

BACKGROUND: Many observations indicate that genetic factors play an important role in the aetiology of autism. Up to now, however, no genetic markers have been convincingly identified which influence the predisposition to this disorder. Complex genetic analysis of autistic patients and their families may therefore lead to the identification of features which could help to direct further search for the predisposing genes. METHODS AND RESULTS: We have analysed a sample of 20 patients with autism spectrum disorders. The patients have been subjected to clinical genetic examination, cytogenetic analysis and DNA analysis of the FMR1 gene. In the sample studied we have observed more boys (15/20), various degree of mental retardation (18/20), high frequency of complications during pregnancy (10/20) and delivery (10/20), increased incidence of psychiatric disorders, behavioural abnormalities and suicides among the relatives, and increased head circumference and unusually formed ears in the probands. Three patients had different chromosomal aberrations or variants (t(21;22), inv(9) and inv(10)). One patient harboured expansion of the trinucleotide repeat sequence in the FMR1 gene on the full mutation level which is characteristic for the fragile X syndrome, and one patient is suspected to suffer from the Rett syndrome. CONCLUSIONS: Our observations confirm and extend the results reported in the literature. Most interesting are mainly the macrocephaly which may be associated with the recently described increased neonatal levels of neural growth factors in autistic individuals, ear malformations which may indicate aberrations in the HOXA1 gene pathway, the occurrence of chromosomal inversions recurrent in autism, and peculiarities in the pedigrees of the patients.

[Genetics of autism]. / Genetika autismu.

Autism is a severe psychiatric disorder characterised by deficits in social interaction, disturbed communication and adherence to stereotype routines and interests. Nowadays it is completely clear that this disorder has a biological basis and many observations show strong genetic determination of autism. The importance of genetic factors is supported by frequent association of this disorder with known hereditary diseases or with various chromosomal aberrations, by high concordance of the disorder in monozygotic twins, higher risk for the siblings of autistic patients and also by the frequent occurrence of milder symptoms of the autistic spectrum in more distant relatives. All these findings show that the autistic phenotype results from unfavourable combination of alleles of several genes in interplay with factors of the environment. This model of multifactorial inheritance of autism serves at present as the starting point for the search for predisposing genes in the human genome. The association is tested between autism and alleles of candidate genes selected based on known biochemical and physiological role of their protein products, or based on their location close to recurrent chromosomal rearrangements or in regions identified by whole-genome linkage analyses. Studies of most of these genes have not yielded clear-cut results yet, but the participation of some of them in the aetiology of autism is possible.

[Use of EEG in electroconvulsive therapy]. / Moznosti uzití EEG u elektrokonvulzivní terapie.

BACKGROUND: From the point of view of time we can divide the use of EEG in the electroconvulsive therapy into 1) screening before starting the treatment, 2) the EEG correlates of the ECT: recording of the paroxysm, immediate postparoxysmal recording, interparoxysmal recording during a series of ECT, and persistent changes after finishing the series of ECT. METHODS AND RESULTS: EEG screening has shown that the patients with abnormal EEG do not respond well to ECT. In the recording of the paroxysm EEG correlates with therapeutic effect of ECT are looked for--particularly the length of the paroxysm on the EEG, intensity and pattern of the paroxysmal activity, and the suppression of the EEG curve in the terminal part of the paroxysm. The suppression models are in the focus of interest also in the immediate postparoxysmal recording. In the interparoxysmal recordings during a series of ECT the associations of the generalised slowing in the range of the theta and delta activity with the therapeutic effect were looked for, particularly in the past. Persistent changes after finishing the ECT are usually examined especially to look if ECT does not cause persistent abnormalities of the EEG recording which would be an evidence for brain damage or for epileptic kindling. The results in this direction have been negative so far.

Delusion of maternity.

A few case reports on the delusion of pregnancy can be found in the published literature. However, the delusion of maternity, a delusional conviction of the patient that she is a mother of one or more children, has not yet been studied closely. The author describes the case of a 62-year-old childless patient with a diagnosis of chronic paranoid schizophrenia. She developed a delusion of maternity, persistent for many years. This markedly influenced her behaviour.

[EEG correlates of therapeutic effects of electroconvulsive therapy]. / EEG koreláty terapeutického úcinku elektrokonvulzivní lécby.

In a group of 52 patients electroconvulsive treatment by means of a Thymatron apparatus was provided under simultaneous EEG control. In addition to parameters of the EEG curve (type of curve according to intensity of the paroxysmal process, duration of electroconvulsion on EEG, type of termination of paroxysm of EEG) also other variables were investigated in relation to the therapeutic effect. The following were identified as significant predictors for marked clinical improvement: type of EEG curve with more marked paroxysmal activity, shorter cumulative duration of electroconvulsions on EEG before first clinical improvement of the patient and a higher CGI entering score. Other variables proved unimportant, e.g. the patient's age, total number of electroconvulsions, total cumulative duration of electroconvulsions on EEG and type of termination of electroconvulsions on EEG.

EEG in electroconvulsive therapy: is more intensive paroxysmal activity associated with a higher therapeutic response?

EEG records of electroconvulsions were evaluated according to a five-point semiquantitative scale grading the intensity of the paroxysmal activity. A more favorable therapeutic effect of ECT was found to be associated with more pronounced paroxysmal activity on the EEG. The role of this finding for the dosage of energy in the convulsive stimulus is discussed.

[Experience with the Thymatron DG apparatus in determining the duration of electroconvulsions]. / Zkusenosti s prístojem Thymatron DG pri stanovení délky elektrokonvulze.

Electroconvulsive therapy was administered, using a Thymatron apparatus DG in a group of 29 female patients with a total number of 150 convulsions. The apparatus makes it possible to take an EEG reading and to evaluate it automatically. Moreover, the paroxysm were evaluated clinically and visually from EEG tracings. The authors proved a significant disagreement as regards evaluation of the length of electroconvulsions assessed by the three methods of evaluation (clinical, automatic EEG analyzer and visual EEG evaluation). They identified moreover in the group, using the automatic EEG analyzer, 11.7% abortive convulsions, by visual EEG evaluation 10.3%, while according to clinical evaluation the rate was as high as 59.2%. Conversely on clinical evaluation no convulsion appeared to be protracted, while according to EEG this was the case in 9.6% (automatic analyzer) and in 10.3% (visual evaluation). On qualitative discrimination of abortive and protracted convulsions and convulsions with a satisfactory duration the automatic and visual EEG evaluation did not differ significantly, and the function of the automatic analyzer seems satisfactory for this basic evaluation of electroconvulsions.

[Sleep apnea syndrome--serious complications in a female patient treated with psychopharmaceutic agents]. / Syndrom spánkové apnoe--závazné komplikace u pacientky lécené psychofarmaky.

The authors present the case-history of a patient treated in the past on account of depressive syndrome who suffered repeatedly from somnolence or even unconsciousness with dyspnoea which called for hospitalization in an anaesthesiological and resuscitation department. The repeatedly expressed suspicion of attempted suicide by drugs was always ruled out by toxicological examination. Based on the clinical picture a preliminary diagnosis of the sleep apnoea syndrome was established confirmed later by polysomnographic examination. The evoking factors of the mentioned serious complications were probably respiratory infections and psychiatric medication, in particular hypnotics--flunitrazepam and triazolam.

[Psychiatric problems in the print media in the past]. / Psychiatrická problematika v nasem starsím tisku.

The author analyzed reports on the mentally sick and psychiatry in our daily newspapers in 1909, 1928 and 1960. He analyzed the number, type, terminology and general character of the informations. In 1909 and 1928 he found a large number of references; their number and subjects were not very dependent on the type of paper nor on the year of publication. Roughly one quarter of the mentioned reports was information on the heteroaggressiveness of the mentally sick which naturally evoked negative attitudes of the public. Reports evoking positive attitudes, e.g. sympathy, were very rare. From the psychopathological aspect most frequently accounts on psychoses were found. In descriptions of the symptomatology the author did not detect any attempts of professional or pseudoprofessional accounts. In 1960 no data were found. We assume that at present when there is an increased interest in the press in psychiatric problems the historical retrospective may prove useful for the under standing of some unfavourable attitudes of the public to psychiatry as well as for possible reflections on improvement of the unsatisfactory attitude of the public to the discipline of psychiatry.

[Preferences concerning settlement in Bohemia]. / Preference sidelnich prostoru Cech

PIP: The factors affecting internal migration in Bohemia, Czechoslovakia, are explored for the period 1961-1975. The preference of migrants for large and medium-size towns is noted. (summary in ENG, RUS)^ieng