Determining the decision-making capacity of a patient who refused food and water.

A terminal patient expressed the wish to hasten her death and refused nutrition. The psychiatrist asked to render an opinion relevant to her competence employed questions in a semi-structured interview derived from a new instrument originally designed to determine competence to create 'Advance Directives'. Although the patient ultimately demonstrated her resolve by totally ceasing fluid intake, the complexity of the case--including the question of the stability of her choice--illustrates the need for specific patient safeguards.

Spastic entropion after cataract surgery.

Spastic entropion is an acute eyelid condition seen in patients with acute inflammatory ocular conditions. It has been reported after cataract surgery. We describe three cases of spastic entropion after cataract surgery that did not resolve after the ocular irritation subsided. All were associated with eyelid and/or cul-de-sac injection of antibiotics and corticosteroids or anesthetic solution. All had dehiscence of the capsulopalpebral fascia. Spastic entropion is an evolving stage toward permanent entropion.

A quantitative evaluation of rheumatoid arthritic activity with Tc-99m HEDP.

In an attempt to develop a quantitative method of evaluating rheumatoid arthritic activity, Tc-99m HEDP joint uptake values and joint-to-bone ratios were studied in ten adult rheumatoid arthritic patients and 17 nonarthritic patients. A joint-to-bone activity ratio of 1.8 at the fourth hour after injection (RA Index) discriminated clinically active rheumatoid arthritic joints from control joints with 95% accuracy. Serial studies on five patients during drug trial demonstrated a positive correlation between RA Index and the clinical manifestations of rheumatoid arthritic activity. The RA Index may be a useful quantitative parameter for evaluation of rheumatoid arthritic activity following therapy.

The effect of nisoxetine (Lilly compound 94939), a potential antidepressant, on biogenic amine uptake in man.

Preclinical studies with nisoxetine (Compound 94939) (3-[o-Methoxyphenoxy]-N-methyl-3-phenylpropylamine HCl) had shown it to have antidepressant properties and to be almost devoid of anticholinergic activity and depressant effects on cardiac conduction (in contrast to the commonly used tricyclic antidepressants from which nisoxetine significantly differs in structure). Placebo and nisoxetine (10-20 mg b.d. for 7 days) were administered to normal volunteers in a single-bind crossover study. Adverse side effects were minimal. There were no significant changes in heart rate or blood pressure seen when no other drugs were given. The effect of nisoxetine on uptake of biogenic amines was utilized to study its mechanism of action. The transient rise in blood pressure seen after an intravenous bolus of tyramine decreased by one-half to two-thirds while the rise in blood pressure upon continuous noradrenaline infusion was enhanced some two-to eight-fold. Both effects occurred after on dose and were greater with larger doses and chronic administration. In vitro, nisoxetine inhibits 5-HT uptake into platelets. However, platelets harvested from subjects receiving chronic nisoxetine administration did accumulate 5-HT. Plasma concentration of nisoxetine in these individuals was shown to be lower than that needed to block 5-HT uptake. We concluded that nisoxetine, in safe doses, specifically increased the sensitivity of noradrenaline and decreased tyramine responsiveness, presumably by blocking uptake at the axonal membrane. In contrast, in these clinical doses it had virtually no effect on 5-HT uptake into platelets.

Relative effect of transcription-level and translation-level control of protein synthesis during early development of the sea urchin.

Newly synthesized proteins were pulse labeled with radioactive amino acids at several developmental stages of the sea urchin, Arbacia punctulata-in normal embryos and in embryos continuously exposed to the drug Dactinomycin. The soluble proteins were fractionated by electrophoresis through polyacrylamide gels. A simple procedure for complete solubilization of the proteins in slices of gels into a solution of toluene for liquid scintillation counting, and a computer program to display and to compare statistically the distributions of (14)C- and (3)H-labeled proteins fractionated on the same gel, allowed quantitative statements to be made on the relative changes in protein synthesis. The conclusion is that translation-level control provides most of the changes in protein synthesis that occur between fertilization and hatched blastula stage.