Differentiating among prefrontal substrates in psychopathy: neuropsychological test findings

Frontal lobe and consequent executive dysfunction have long been related to psychopathy. More recently, there have been suggestions that specific regions of frontal cortex, rather than all of frontal cortex, may be implicated in psychopathy. To examine this issue, the authors presented 25 individuals with psychopathy and 30 comparison individuals with measures preferentially indexing the orbitofrontal cortex (OFC; object alternation task), dorsolateral prefrontal cortex (DLPFC; spatial alternation task), and anterior cingulate cortex (ACC; number-Stroop reading and counting tasks). The individuals with psychopathy showed significant impairment on the measure preferentially sensitive to OFC functioning. In contrast, the 2 groups did not show impairment on the measures preferentially sensitive to the functioning of the DLPFC or ACC. These results are interpreted with reference to executive dysfunction accounts of the disorder.

Microvascular dysfunction in women with polycystic ovary syndrome

BACKGROUND

Polycystic ovary syndrome (PCOS) is associated with multiple cardiovascular risk factors and an increased prevalence of arterial dysfunction. However, microvascular dysfunction in PCOS has not been assessed.

METHODS

Subjects comprised 12 women with PCOS and 12 age-matched controls with normal ovaries. Microvascular function was assessed by observing forearm skin microvascular erythrocyte flux responses, to cumulative iontophoretic doses of 1% (w/v) acetylcholine (ACh) and 1% (w/v) sodium nitroprusside (SNP), using laser Doppler imaging.

RESULTS

Basal microvascular perfusion was comparable in PCOS and controls. The increase in skin microvascular perfusion in response to ACh was however generally blunted in PCOS women (P = 0.018). Peak ACh-induced erythrocyte flux was also less (p < 0.04) in PCOS women (125.1 +/- 21.7, i.e. 5.3-fold basal flux) than in controls (200.8 +/- 28.5, i.e. 8.3-fold basal flux). Analysis of covariance indicated this effect was unrelated to differences in body mass index or serum testosterone but serum insulin may be a weak confounder. No differences were noted between the PCOS and control groups in their response to SNP.

CONCLUSION

Despite its limited sample size studied, this is the first demonstration that women with PCOS exhibit microvascular endothelial dysfunction, indicated by an inhibited vasodilatory response to ACh.

Is direct radiologist supervision of abdominal computed tomography (CT) scans necessary?

AIM

To determine the effect of direct radiological supervision of patients attending for abdominal CT by assessing the frequency of protocol alteration subsequent to radiologist review of the images obtained.

MATERIALS AND METHODS

A prospective questionnaire-based observational study was performed of 187 consecutive patients undergoing abdominal CT. The CT protocol was determined by a radiologist in advance, with reference to the request form. Any subsequent change in the prescribed study that was contingent on radiologist review of the images obtained was documented on the questionnaire. Comparison was made with a second (control) group of 100 patients undergoing cranial CT.

RESULTS

A protocol change was undertaken following radiologist review of the CT images of 17 (9%) of the group undergoing abdominal CT, compared with 14 (14%) of the group undergoing cranial CT. In the abdominal CT group, further scanning was performed for lesion characterization, to guide a subsequent interventional procedure, because of inadequate anatomical coverage or to evaluate an unexpected lung tumour. There was no significant difference in proportions between the two groups (p=0.23).

CONCLUSION

When abdominal and cranial CT studies were compared, there was no significant difference in the proportion of studies requiring a change in the prescribed protocol following radiologist review of the images obtained. There was no evidence to suggest that abdominal CT was any less suited to protocol.

A fatal case of disseminated aspergillosis caused by a non-sporulating strain of Aspergillus fumigatus

This report describes the case of a 38 year old pregnant woman with fatal disseminated aspergillosis and multiorgan failure, which was preceded by a long history of allergic bronchopulmonary aspergillosis. Postmortem revealed massive infarction and abscess formation in both lungs. Histology revealed a focal granulomatous response. Fungal infiltration with areas of necrosis were also seen in the liver, spleen, and paratracheal, mediastinal, para-aortic, and hilar lymph nodes. Culture of tissue samples produced a non-sporulating, beige coloured fungus that developed green pigmentation only after three weeks of incubation. Nucleotide sequencing of the D1-D2 region of the large ribosomal subunit revealed 100% homology with Aspergillus fumigatus. Minimum inhibitory concentrations for amphotericin B and itraconazole were both 0.25 mg/litre (susceptible). Further work is urgently required to determine the prevalence of such non-sporulating strains and their relevance to clinical infection.

Image analysis of X-ray microtomograms of soft materials during convective drying

X-ray microtomography is used to explore the textural evolution that soft materials undergo during a drying treatment. An original image processing algorithm is applied to vertical projections and reconstructed cross-section images in order to quantify the texture at different stages of drying. Measurements are performed both on grey-level and on binary images. It is shown that X-ray microtomography is a very promising tool in the field of drying investigations. It can be used to determine internal moisture profiles, and to follow crack development and shrinkage in an accurate and non-destructive way. This information is crucial to validate drying models. Waste-water sludges are used as test materials to assess the validity of the proposed methodology. The management of these sludges, often including a drying stage, will become a challenge in the forthcoming years in accordance with environmental regulations. Samples collected in two waste-water treatment plants are investigated. Their analysis by X-ray microtomography brings to the fore two different drying behaviours, illustrating that sludge drying is a complex unit operation very sensitive to the way the material is produced.

Theory of mind and psychopathy: can psychopathic individuals read the 'language of the eyes'?

There have been suggestions that Theory of Mind (ToM) impairment might lead to aggressive behaviour and psychopathy. Psychopathic and matched non-psychopathic individuals, as defined by the Hare Psychopathy Checklist [The Hare Psychopath Checklist-Revised, 1991] completed the 'Reading the Mind in the Eyes' ToM Test [Journal of Child Psychology and Psychiatry, 1997;38:813]. This test requires the self-paced identification of mental states from photographs of the eye region alone. Results indicated that the psychopathic individuals did not present with any generalised impairment in ToM. The data are discussed with reference to the putative neural system mediating performance on this task and models of psychopathy.

Importance of PCR in the diagnosis and understanding of rotavirus illness in the community

Rotavirus infections pose a significant economic burden due to hospitalisation and missed workdays. Recent studies have shown that RT-PCR may detect more symptomatic cases of rotavirus infection than antigen detection methods. We compared RT-PCR, enzyme immunoassay (EIA) and an immunochromatography method (ICG) applied to 107 stool samples. The RT-PCR detected 58 positive samples whereas the EIA and ICG detected 28 and 29 positive samples respectively. The RT-PCR assay detected all 17 samples found positive by both the EIA and ICG. Without sensitive diagnosis, infection control policies will be disadvantaged and the true economic burden of rotavirus underestimated.

Risky decisions and response reversal: is there evidence of orbitofrontal cortex dysfunction in psychopathic individuals?

This study investigates the performance of psychopathic individuals on tasks believed to be sensitive to dorsolateral prefrontal and orbitofrontal cortex (OFC) functioning. Psychopathic and non-psychopathic individuals, as defined by the Hare psychopathy checklist revised (PCL-R) [Hare, The Hare psychopathy checklist revised, Toronto, Ontario: Multi-Health Systems, 1991] completed a gambling task [Cognition 50 (1994) 7] and the intradimensional/extradimensional (ID/ED) shift task [Nature 380 (1996) 69]. On the gambling task, psychopathic participants showed a global tendency to choose disadvantageously. Specifically, they showed an impaired ability to show learning over the course of the task. On the ID/ED task, the performance of psychopathic individuals was not significantly different from incarcerated controls on attentional set-shifting, but significant impairments were found on response reversal. These results are interpreted with reference to an OFC and amygdala dysfunction explanation of psychopathy.

Sacrococcygeal ependymoma: case report and review of the literature

Ependymomas are uncommon glial cell tumors found within the brain, spinal cord, cauda equina, or filum terminale. Ependymomas originating in the parasacral soft tissues are exceedingly rare. The authors report the case of a 7-year-old boy with a primary ependymoma of the sacrococcygeal area and review the world literature of this tumor at this location.

Complications of anterior spinal surgery in children

The purpose of this study was to document the medical and surgical complications of anterior spine surgery in children and to identify risk factors for complications. A retrospective chart review was conducted of 599 anterior procedures (24 anterior only, 300 staged anterior/posterior, 175 combined anterior/posterior procedures) performed between 1967 and 1991. Major complications occurred in 7.5% of procedures and minor complications in 33%. Risk factors for major complications were age > 14 years, male gender, kyphotic curve type, curve sizes > 100 degrees, vital capacity < 40% of predicted, and use of thoracotomy. Risk factors for minor complications were age > 14 years, curves > 100 degrees, vital capacity < 40% of predicted, and use of a staged procedure. Multivariate analyses of risk factors identified age > 14 years and curves > 100 degrees as the most significant risk factors for major complications and age > 14 years for minor complications. We concluded that anterior spinal surgery can be performed in children with an acceptable level of risk and that referral for surgery before 14 years of age and before the curve size progresses will significantly reduce the risk of complications.

Sister chromatid exchanges in human peripheral blood lymphocytes after ingestion of high doses of arsenicals

OBJECTIVE

To evaluate the cytogenetic effects following the ingestion of high doses of arsenicals.

METHODS

Determination of the mean sister chromatid exchange (SCE) frequency and the population of high-frequency cells (HFC, cells with a high SCE frequency) in the peripheral blood lymphocytes in four patients who ingested 150 mg KAsO2, 1 g, 10 g and 20 g As2O3 respectively.

RESULTS

Doses of 10 g and 20 g significantly increased the HFC frequency and produced a shift in the distribution of the cells in accordance with the number of SCEs. The mean frequency of SCEs/cell was affected only after the highest dose (20 g).

CONCLUSION

These results strongly suggest that cytogenetic methods are inappropriate for biomonitoring people occupationally exposed to arsenicals.

Osteogenic sarcoma in the Rothmund-Thomson syndrome

Two children who had the Rothmund-Thomson syndrome and developed osteosarcoma are reported. The 10 previously reported cases are reviewed. The osteosarcomas developed at a younger age than normally expected and 66% occurred in the tibia/fibula. Four of the five patients for whom information was available showed undue sensitivity to cancer chemotherapy agents with prolonged myelosuppression and severe mucositis. It is recommended that doxorubicin in particular should be given with extreme caution in such patients.

Cognitive recovery in idiopathic normal pressure hydrocephalus: a prospective study

Idiopathic normal-pressure hydrocephalus remains difficult to treat. Controversy exists as to whether or not shunting can really improve cognitive functions and whether quantified intracranial pressure monitoring (ICP-Mo) can predict postoperative improvement rates. Several studies have drawn attention to the lack of a prospective study concerning the surgical outcome of this condition. We have performed such a study on idiopathic normal-pressure hydrocephalus patients shunted on the basis of ICP-Mo when "high" waves (amplitude > 9 mm Hg) were present. Twenty-three patients underwent surgery. The preoperative and postoperative clinical states were assessed by a quantitative procedure blind to the ICP-Mo results. A clear postshunting improvement was seen in 96% of the patients at 1 year with a statistically significant correlation between high wave relative frequency and the grade of improvement (P < 0.05). At the same time, 66.6% of shunted patients showed a significant improvement in cognitive functions. Complications of shunting were successfully managed without residual deficits in this series. We recommend the use of quantitative ICP-Mo as a criterion for surgery and to predict the improvement grade.

CT appearances of haematomas in the corpus callosum in patients with subarachnoid haemorrhage

Corpus callosum haematoma is a rare feature in subarachnoid haemorrhage (SAH), which may result from aneurysms of the anterior communicating artery (ACoA) or pericallosal artery (PCA). In 348 patients with aneurysmal SAH, bleeding from ACoA aneurysms in 88 cases produced no abnormality on CT in 7. Blood in the cistern of the lamina terminalis was the most frequent abnormality (76/88); haematomas of the septum pellucidum, confined to patients with ACoA aneurysms, were seen in 26 (30%). Rupture of PCA aneurysms in 12 patients gave rise to blood in the pericallosal cistern, anterior interhemispheric fissure and cistern of the lamina terminalis in 11. There was no blood in the septum pellucidum or the ventricular system in any case, but haematomas in the corpus callosum occurred in 8 (67%). In all of these, blood extended into the anterodorsal aspect of the callosum and spread posteriorly along its dorsal border. An identical, supracallosal pattern was seen in 2 patients (2.5%) with ACoA aneurysms, in whom haemorrhage was more extensive, with a large frontal lobe haematoma extending up from the cistern of the lamina terminalis in 1 and a haematoma of the septum pellucidum, with intraventricular extension in the other. In 8 patients (9%) with ACoA aneurysms a corpus callosum haematoma appeared to result from passage of blood up through the cistern of the lamina terminalis into the septum pellucidum and thence into the ventral aspect of the anterior corpus callosum; blood was present within the cistern, the septum and the ventricles.

M3-subtype muscarinic receptor that controls intracellular calcium release and inositol phosphate accumulation in gastric parietal cells

The muscarinic receptor subtype which triggers acid secretion was investigated in isolated rabbit gastric parietal cells. Cytosolic free Ca2+ concentration ([Ca2+]i), measured with the fluorescent indicator FURA-2, increased rapidly after full agonist (carbachol) stimulation (6-8 sec), then returned to an intermediate sustained value. Other M2-agonists, oxotremorine and arecoline, produced a partial [Ca2+]i increase, whereas M1-agonists, pilocarpine and [4-m-chlorophenylcarbamoyloxyl]-2-butynyl-trimethylammonium, were without any significant effect. [Ca2+]i rise was inhibited by selective muscarinic antagonists: atropine greater than 4-diphenylacetoxy-N-methyl-piperidine methbromide greater than quinuclidinylbenzilate (QNB) greater than pirenzepine greater than 11-[[2-[(diethylamino)methyl]-1-piperidinyl]acetyl]-5,11-dihydro-6H- pyrido[2,3-b][1,4]benzodiazepine-6-one, this sequence being characteristic of the involvement of an M3-subtype. This inhibition was shown to be stereoselective; dexetimide and (-)QNB were more potent than levetimide and (+)QNB. The IC50 values for inhibition of [Ca2+]i increase by muscarinic antagonists were in good agreement with those obtained for inhibition of phospholipase C activation. In conclusion, the muscarinic receptor that controls acid secretion appears to be of the M3-subtype and the biochemical events coupled to the activation of this receptor system are also controlled through the same subtype.

Intracellular coupling of prostaglandin inhibition of acid secretion in isolated rabbit gastric parietal cells

Acid secretion from isolated rabbit gastric parietal cells can be stimulated by gastric secretagogues, histamine (cyclic-AMP pathway) and carbachol (inositol phosphate pathway). Prostaglandins (PG) from E series are potent inhibitors of acid secretion. The intracellular mechanism of this inhibition was examined by using a stable PGE1-analogue, misoprostol. Aminopyrine (AP) accumulations due to histamine, IBMX and forskolin were dose-dependently inhibited by misoprostol, whereas a weak but significant biphasic effect on carbachol-induced AP accumulation was observed. The cyclic-AMP formation induced by histamine and IBMX were also inhibited by misoprostol in a non-competitive way. The potent effect of forskolin on cyclic-AMP levels was not modified by misoprostol in parietal cells, whereas it was potentiated in non-parietal cells. The inhibitory effect of misoprostol on AP accumulation was reduced by incubation of parietal cells with Bordetella pertussis toxin (IAP) but not with Cholera toxin (CT). Pretreatment of the cells with IAP did not alter cyclic-AMP levels of resting and histamine-stimulated parietal cells but abolished the inhibitory effect of misoprostol. Treatment with CT increased basal and histamine-stimulated cyclic-AMP levels and masked the inhibitory effect of misoprostol. The biphasic effect of misoprostol on carbachol-stimulated AP accumulation in parietal cells was confirmed on carbachol-stimulated phospholipase C activity and on [Ca2+]i stimulated by carbachol. These data confirm a direct and specific effect of the prostanoid on the Gi-subunit of the adenylate cyclase coupled to the histamine H2-receptor, and a biphasic effect on the phospholipase C pathway of the parietal cells.

Spontaneous perforation of the extrahepatic biliary tree in infancy. A case report

Spontaneous perforation of the bile duct in infancy is rare, with less than 55 cases described in the literature to date. The authors report the case of a 30-day-old neonate who presented with a 2-week history of progressive abdominal distension and intermittent jaundice. Disofenin technicium 99m sequential scintiscanning provided a preoperative noninvasive confirmation of the diagnosis of biliary ascites secondary to spontaneous perforation of the extrahepatic biliary tract. Distal common bile duct atresia was identified intraoperatively, and end-to-side Roux-en-Y hepaticojejunostomy was performed, with an uneventful postoperative recovery. The etiology, diagnosis, and treatment of spontaneous neonatal biliary perforation is discussed.

Risk factors for PTSD and other diagnoses in a general sample of Vietnam veterans

This study examined the contribution of premilitary, military, and postmilitary risk factors to posttraumatic stress disorder (PTSD) and other postwar diagnoses in a sample of Vietnam veterans. PTSD was explained primarily by war stressors, including threat to life and exposure to grotesque death, but premilitary and postmilitary factors also contributed to the likelihood of a current diagnosis of PTSD. Panic disorder was also highly predicted by war experiences, whereas prewar functioning played a stronger role in several non-PTSD diagnoses. The study supported the notion that PTSD is specifically linked to intense stressors. Mechanisms for interactions among risk factors are discussed.

Calcium involvement in the muscarinic response of the gastric parietal cell

The influence of extracellular Ca2+ on the mediation of carbachol stimulation in isolated rabbit gastric parietal cells was studied. Removing Ca2+ from extracellular medium caused a 42% decrease of the aminopyrine accumulation due to carbachol with the same EC50 value (approximately 5 microM). A short time depletion in extracellular calcium suppressed the carbachol-dependent Ca2+ influx without affecting Ca2+ release from internal stores (fura-2 measurements). Similarly, the production of inositol phosphates under cholinergic stimulation was reduced by 29%. A rapid increase in Ins(1,4,5)P3 was obtained 5 s after carbachol stimulation, and this increase was not changed in Ca2(+)-depleted medium. In contrast, a 20 min incubation with carbachol caused a 50% reduction in both basal and carbachol-stimulated inositol phosphate accumulations. In conclusion, phospholipase C activation, intracellular Ca2+ release and aminopyrine accumulation were sequentially observed following carbachol stimulation of the isolated gastric parietal cell and extracellular calcium contributed to sustain this acid secretory response.

Global aphasia without hemiparesis following prerolandic infarction

Acute global aphasia without hemiparesis (GAWH) is said to result from the association of 2 separate lesions in the anterior and posterior left hemisphere language areas. We present 2 unusual cases of GAWH whose CTs revealed only a single lesion of the posterior part of F2 and F3. There was good recovery of verbal communicative abilities. Functional disconnection of posterior language areas seems responsible for this syndrome in such cases.

Chronic bacterial prostatitis: 10 years of experience with local antibiotics

Direct transperineal infiltration of the prostate with antibiotics was performed in 24 selected patients with refractory chronic bacterial prostatitis. Diagnosis had been made following a modification of the classical lower tract localization studies. Remission periods of at least 6 months were obtained in 71 per cent of these patients after 1 or 2 infiltrations, while 6 of 24 (25 per cent) required several procedures to assume a long-term remission state and 1 (4 per cent) failed therapy (patient 24490). Seven patients had relapse after remission periods ranging from 13 months to 7 years. The last culture in 3 patients was positive. The value of the method compared to other therapeutic alternatives in the management of chronic bacterial prostatitis is discussed.

Inverted papilloma of bladder: clinical significance

Based on 15 cases of inverted urothelial papilloma, we present the clinical significance of these lesions in view of the current literature. An inverted papilloma should raise suspicion with respect to the whole urothelial surface. However, approaching every lesion of this type as a (pre-)neoplastic tumor does not seem justified, since 90 percent of all cases reported so far do not present any clinical or histologic feature of malignancy. Some factors, such as the patient's history, eventually associated urothelial carcinomas, or histologic features of malignant transformation within an inverted papilloma, must be taken into consideration. If no single indication in favor of malignancy has been disclosed, we believe follow-up with yearly endoscopic investigations, in addition to regular urine cytologies, may suffice.

Seminal vesiculography in chronic bacterial prostatitis

A total of 15 patients with proved chronic bacterial prostatitis underwent bilateral seminal vesiculography to determine the morphological appearance of the seminal vesicles and the ampulla ducti deferentis in this condition. A pathological condition, such as segmental stenosis or complete shriveling of the seminal vesicles, was obvious in 21 of 24 vesiculograms (87.5 per cent), while malformations of the ampulla were seen in 7 (29.1 per cent). The role of chronic bacterial prostatitis as an important pathogenetic factor in the history of epididymo-orchitis is discussed.

Characteristics of hazardous material spills from reporting systems in California

Data on hazardous material releases that occurred between January 1, 1982 and September 30, 1983 in California were obtained from the California Highway Patrol (CHP) and the US Department of Transportation (DOT). The majority of incidents involved highway transport of hazardous materials, although some information was available on air, rail, and stationary facility releases. Vehicle accidents and failure of or damage to the container were the most frequent causes of releases. Proportionately more hazardous materials incidents occurred in early summer than at other times of the year, during weekdays, and daytime hours. The largest proportions of incidents involved the chemical categories of corrosives and fuels. Reported exposures and injuries to response personnel and other people at the scene were relatively few; no fatalities were reported. Few incidents were reported in both data sources, suggesting that the examination of only one data source would yield a gross underestimate of the total number of hazardous materials incidents in California. The lack of available denominator data limits the interpretation of the findings.

[Relation between the cytogenetic effect and the dose of radiation and chemical mutagenic exposure of somatic cells in vivo: effect of the duration of exposure and cell selection]

Dose-response relationships obtained in vivo in mammalian cells or in vitro when studying structural chromosome aberrations in somatic cells may be used for monitoring human populations exposed to mutagenic agents. While the method appears of interest for biological dosimetry on people exposed to relatively high doses of ionizing radiation, its value for persons professionally exposed to chemicals is, however, limited.

Population monitoring for genetic damage induced by environmental physical and chemical agents

The short-term tests performed in vitro on different systems, from phage to human cells, or in vivo, on laboratory animals, allow only a qualitative estimate of the action of mutagenic agents, and the extrapolation of such experimental results to man may encounter many difficulties.Direct biomonitoring of populations exposed to chemicals could represent a more realistic approach for an evaluation of the hazards to man. Certain methods are still under development. Nevertheless, other ones can already by used routinely, e.g. the cytogenetic observations on peripheral blood lymphocytes and the Ames test for mutagenic substances in urine, and can provide useful suggestions how to set threshold limits for chemical substances encountered in the working environment.