[Knowledge, attitudes, and practices related to the Pap smear among women with cervical cancer]. / Conhecimento, atitude e prática do exame de Papanicolaou em mulheres com câncer de colo uterino.

Despite screening programs, Brazil has a high cervical cancer mortality rate. The objective of this cross-sectional study was to analyze knowledge, attitudes, and practices related to the Pap smear and to understand why women fail to submit to this screening test. A structured questionnaire was used to interview 138 women: 90 with high grade intraepithelial neoplasia and 48 with invasive cervical cancer. Inadequate practices were more frequent among women with invasive cancer. In terms of difficulties in obtaining medical care, more than 80% of women reported lack of motivation, 60% reported that physicians failed to conduct a complete physical examination, and some 50% reported that physicians' schedules were busy. Having a Pap smear usually depended on a physician's request and the woman being symptomatic. Women over than 56 years old showed more frequent inadequate knowledge, attitudes and practices. However, those with more schooling were more knowledgeable of the Pap smear procedure. Age and less schooling could be barriers against women participating in screening programs, but socioeconomic problems must also be considered for improving practices related to the Pap smear.

Sneddon's syndrome (livedo racemosa and cerebral infarction) presenting psychiatric disturbance and shortening of fingers and toes.

A 24-year-old man with livedo racemosa and psychiatric disturbances, manifesting as low intelligence (IQ 80) and delusions, had anti-cardiolipin antibody and showed shortening of the fingers and toes. A skin biopsy of the livedo lesion revealed endoarteritis obliterans, being compatible with Sneddon's syndrome. MRI of the brain demonstrated multiple infarction and moderate cortical atrophy. A single photon emission tomography of the brain showed a marked reduction of the blood flow in the front-temporal lobe. These findings might relate to the psychiatric disturbance. After intravenous administration of cyclophosphamide and the start of oral prednisolone, the anti-cardiolipin antibody level decreased and his physical condition improved. However, a low dose of haloperidol is still necessary to maintain his mental condition.

A simplified judgment system for medical informatics.

This report describes a new simplified judgment system which enables users to register appropriate judgment rules with ease and to apply them to a wide variety of medical problems. The rule utilized in this system is 3-AND-3-OR, quite a simple one. By applying this judgment rule to the data of as many as 60 items, judgment results of the individual on each item is given by four different grades or categories, namely: 1) normal, 2) borderline, 3) abnormal, and 4) severe. As many as 20 types can be obtained simultaneously. The simplicity of the algorithm allows medical users who are not the experts in computer technology to use this system on a DOS-based personal computer.

Neurotoxic damage to the nigrostriatal system in rats following intranigral administration of MPDP+ and MPP+.

Unilateral intranigral administration of the oxidative metabolites of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), 1-methyl-4-phenyl-dihydropyridine (MPDP+) or 1-methyl-4-phenylpyridine (MPP+) produced dose-dependently a depletion of dopamine in the ipsilateral striatum of rats two weeks following treatment. d-Amphetamine and apomorphine induced circling toward the lesioned side in these unilaterally treated animals. No contralateral circling behavior was observed after challenging with apomorphine. This dopamine lesioning effect of MPP+ was not blocked by pretreatment of animals with a dopamine uptake blocker, GBR 12909. Furthermore, MPP+ increased the 45Ca accumulation into cells at the site of injection and produced "nonspecific" cell membrane and/or cytotoxic damage seen by histological procedures. These results indicate that MPDP+ and MPP+ produced localized cytotoxic damage to nigrostriatal neurons, caused a decrease in striatal dopamine, and disrupted the nigrostriatal system's functioning following intranigral administration to rats. It is postulated that the cationic surfactant properties of MPDP+ and MPP+ might contribute to its neurotoxic effects.

MPP+ (1-methyl-4-phenylpyridine) is a neurotoxin to dopamine-, norepinephrine- and serotonin-containing neurons.

1-Methyl-4-phenylpyridine (MPP+) is an oxidative metabolite of 1-methyl-4-phenyl-1,2,3,6-tetrahydroxypyridine (MPTP). MPP+ produced local cell death when injected directly into substantia nigra compacta, locus coeruleus, or dorsal and median raphe nuclei of rats. Corresponding significant decreases in dopamine, serotonin and norepinephrine levels were observed in the terminal areas. These observations indicate that MPP+ is a non-selective neurotoxin which causes lesions not only in dopaminergic neurons but also in noradrenergic and serotonergic systems following intracranial administration. Selective lesioning of these monoaminergic systems could only be achieved by a stereotaxic injection of MPP+ into specific brain regions containing monoamine neurons.

Nocturnal enhancement of plasma melatonin could be suppressed by benzodiazepines in humans.

Plasma melatonin levels were determined every 20 and 30 min for 24 hours on the last day of repeated oral administrations (1 or 2 mg a day for 8 or 9 days) of a benzodiazepine derivative (450191-s), which is known to be metabolized to active benzodiazepines after administration. In one of the two subjects, the nocturnal enhancement of plasma melatonin which was obvious on a control day with placebo was diminished almost completely. In the other subject, observed were not only the diminishment of its nocturnal enhancement but also its increase during the daytime almost to the nocturnal levels on a control day, which may indicate a rebound increase in melatonin synthesis or a shift in its day-night rhythmicity. Such suppressing effects of benzodiazepines on the nocturnal plasma melatonin levels were also examined in the case of a single administration of 2 mg of 450191-s or flunitrazepam in the second series of experiments. Even a single flunitrazepam seemed to have lowered nocturnal plasma melatonin levels, which then recovered to the usual levels following the administration of 5 mg of a benzodiazepine antagonist, Ro 15-1788, given 6 hours after the flunitrazepam. However, single 450191-s did not show any remarkable effects. Thus, it has been suggested that benzodiazepines could suppress the nocturnal levels of plasma melatonin or shift its day-night rhythmicity at least when administered repeatedly. The possible action site of benzodiazepines may be the central nervous system, since melatonin synthesis has been though to be under strongly regulated by the central nervous pathway from the retina to the pineal body. Therefore, these effects of benzodiazepines may provide a method for investigating the physiological role of melatonin and its day-night rhythmicity as well as to further clarify the system regulating melatonin synthesis in humans.

Study of HLA antigens among Japanese schizophrenics.

HLA antigens were typed among 136 Japanese schizophrenics. Increased frequencies were seen in A9 (Aw24), A10 (A26) and Bw54, and decreased frequency in B40 antigens when compared to 187 Japanese controls. It is suggested that there may be an association between A9 (Aw24) and schizophrenia with a chronic-progressive course and also an association between A10 (A26) and hebephrenia.