Effects of coping style on psychological reactions of low-income, minority women to colposcopy

Patterns of coping and adjustment in 36 low-income, minority women with positive cytologic smears were assessed prior to diagnostic follow-up examination (colposcopy). Subjects were divided into high monitors (who attend to threatening cues) and low monitors (who avoid threatening cues) on the basis of their scores on the Miller Behavioral Style Scale, a well-validated measure of coping style. Multivariate analysis of variance showed that high monitors worried more about the seriousness of their condition, expressed more concern about the immediate sensory and procedural aspects of the diagnostic examination and felt more responsible for the onset and course of their disease as compared to low monitors. However, they were no more likely to be concerned about the overall importance or long-term consequences of their abnormal smears. Finally, high monitors displayed greater symptoms of intrusive and avoidant ideation in relation to their medical status. These results were independent of sociodemographic and medical confounding variables. Consistent with results in other populations, the findings suggest that it may be useful to assess attentional coping dispositions in minority populations with high-risk gynecologic conditions and to target psychosocial interventions accordingly.

The interaction of ethanol with the cognitive enhancers tacrine, physostigmine, and AIT-082

Because tacrine, a cognitive enhancing agent, was being considered for approval for use in Alzheimer's disease, its possible interaction with ethanol, a commonly used substance to which elderly individuals are generally more sensitive than younger individuals, was explored. For purposes of comparison, two other drugs, which have also been shown to improve memory in mice, at doses which had activity in a working memory paradigm, were evaluated for an interaction with ethanol. Ethanol-induced sedation in mice was increased by tacrine and decreased by physostigmine, whereas AIT-082 did not alter sedation. However, tacrine had no effect on body temperature or on ethanol-induced hypothermia. Neither tacrine nor physostigmine had any effect on the rate of ethanol elimination from the blood. As tacrine comes into clinical use in the treatment of Alzheimer's disease, adverse interactions with ethanol should be explored further.

The lateral radiograph of neck in laryngo-tracheo-bronchitis (croup)

The films of 61 children who had a lateral radiograph of neck performed in the management of acute laryngo-tracheo-bronchitis were reviewed by a paediatric radiologist. He was unaware of the clinical history and the outcome of the children's illnesses. The clinical records of the same children were reviewed independently and information sought about the clinical relevance of the film results. Sixty per cent of the films were felt to be in keeping with a diagnosis of acute laryngo-tracheo-bronchitis. As judged by the information in the medical records these results did not influence the management of the children other than in one instance where a child underwent laryngoscopy. This decision was strongly influenced by the original film report. No child developed acute airway obstruction while in the Radiology Department. The findings of this study support the concept that a request for a lateral X-ray of neck in croup is an inefficient use of diagnostic facilities.

The terminally ill--secular and Jewish ethical aspects

Many ethical, religious, social and legal dilemmas are involved in the care of dying patients. Major changes and developments in recent years have greatly intensified these moral problems. In this article a comprehensive analysis of the relevant principles and practical approaches is offered in order to enhance the ability of health care providers to attain morally sound decisions concerning the dying patient. The relevant ethical principles include the following: value of life, quality of life, nonmaleficence, beneficence, autonomy, paternalism, justice, and the physician's integrity. In practical terms, there are three major categories: the patient, the treatment and the decision maker. A comparative analysis between secular and Jewish attitudes towards the terminally ill patient has revealed significant differences both in the fundamental underlying principles as well as in the practical solutions to the diverse and difficult ethical problems.

Cefetamet pivoxil vs cefaclor in the treatment of acute otitis media in children

74 children with acute otitis media (AOM) were entered into an observer-blind randomised multicentre general practice study to compare the efficacy and safety of the new third generation oral cephalosporin, cefetamet pivoxil, at a dose of 10 mg/kg twice daily with the efficacy and safety of cefaclor 10 mg/kg twice daily administered for 10 days. Of 36 evaluable patients in the cefaclor treatment group, 28 (78%) were cured, and a further 4 were improved, giving an overall efficacy rate (cure/improvement) of 89%. Of 36 evaluable patients in the cefetamet pivoxil treatment group, 31 (86%) were cured, and a further 4 were improved, giving an overall efficacy rate of 97%. Adverse events were reported in 4 patients: 1 cefaclor recipient and 3 patients in the cefetamet pivoxil treatment group. Diarrhoea, the most frequently observed adverse event, occurred in both treatment groups. The study results indicate that cefetamet pivoxil and cefaclor appear to have similar efficacy and safety in the treatment of AOM in children.

Evidence that substance P is utilized in medial amygdaloid facilitation of defensive rage behavior in the cat

The present study was designed to test the hypothesis that a major excitatory mechanism for the expression of feline defensive rage behavior involves the medial nucleus of the amygdala which utilizes substance P as a neurotransmitter in a direct output pathway that supplies the medial hypothalamus. In phase I of the experiment, stimulating electrodes were implanted into the medial amygdala and cannula electrodes were implanted into the medial and lateral hypothalamus from which defensive rage and predatory attack behavior could be elicited by electrical stimulation, respectively. Response latencies for defensive rage were significantly lowered after dual stimulation of the medial amygdala and medial hypothalamus relative to single stimulation of the medial hypothalamus alone. In phase II, dose- and time-dependent decreases in medial amygdaloid-induced facilitation of defensive rage were observed after the i.p. administration of the NK1 antagonist, CP-96,345 (0.05, 2 and 4 mg/kg). In phase III of the study, the effects of microinjections of CP-96,345 placed directly into defensive rage sites within the medial hypothalamus (0.05, 0.5 and 2.5 nmol) upon medial amygdaloid modulation of this response were assessed. Again, intracerebral administration of this antagonist blocked the facilitatory effects of medial amygdaloid-induced facilitation of defensive rage in a manner parallel to that observed with peripheral administration of the NK1 antagonist. The results suggest that the medial amygdala facilitates defensive rage by acting through a substance P mechanism at the level of the medial hypothalamus. Other experiments revealed that peripheral administration of the NK1 antagonist: (1) had little upon the latency or threshold for elicitation of defensive rage, suggesting that the medial amygdaloid-substance P facilitatory mechanism acts in a phasic rather than tonic manner; and (2) also blocks the suppressive effects of medial amygdaloid stimulation upon predatory attack behavior elicited from the lateral hypothalamus. The latter finding suggest that similar neurochemical mechanisms regulate medial amygdaloid modulation of both forms of hypothalamically elicited aggression. The final aspect of this study utilized the combination of retrograde-tracing of amygdaloid neurons into the medial hypothalamus after microinjections of Fluoro-Gold into defensive rage sites, and the immunocytochemical analysis of substance P neurons within the amygdala. The data indicated that large numbers of retrogradely and immunocytochemically positive labeled cells were identified in the medial nucleus, including many that were double-labeled.(ABSTRACT TRUNCATED AT 400 WORDS)

A reversible case of Klüver-Bucy syndrome in association with shigellosis

The Klüver-Bucy syndrome is characterized by psychic blindness or visual agnosia, blunted affect, hypermetamorphosis, hyperorality, bulimia, and sexual behavioral alterations. To date, there have been fewer than 10 reported cases of Klüver-Bucy syndrome in children, most of them irreversible. We describe here a reversible case of the complete Klüver-Bucy syndrome in a child suffering from Shigella encephalopathy.

Dissociation between the wishes of terminally ill parents and decisions by their offspring

OBJECTIVE

To assess the attitude and factors affecting decision-making by offspring for life-sustaining measures toward their elderly terminally ill parents.

DESIGN

Survey

SETTING

Acute geriatric department of a university-affiliated teaching hospital.

PATIENTS AND PARTICIPANTS

108 offspring of 48 terminally ill elderly patients were interviewed.

MEASUREMENTS

The attitude of offspring regarding life-sustaining measures based on a comprehensive questionnaire, administered by face-to-face interview, that included clinical, social, and religious information for each patient and social, religious, demographic, and educational information for each family member.

RESULTS

A significant majority requested the continuation of fluid, nutrition, and medication (78%, 66%, 73%, respectively). A minority of 25%-29% requested the initiation of resuscitation, mechanical ventilation, and dialysis. Active euthanasia was requested by seven offspring. Factors that significantly affected offspring's decisions were the degree of religious observance and close relationship. Approximately 50% of offspring believed they knew their parents' wishes, but most of them did not comply with the parents' wishes. The offspring's preferences for themselves differed in important aspects from the requests for their parents. The great majority stated that a family member and/or the responsible physician should be involved in the decision-making process (76% and 79%, respectively). Only 2.0% suggested the participation of an ethics committee, and the court was rejected by all.

CONCLUSIONS

Basic life-sustaining measures are requested for the terminally ill parents by most of the offspring. A significant minority even requested aggressive life-sustaining measures. The degree of religiosity and closeness of relationship influenced offspring's request most strongly.

Isochromosome 18p in a mother and her child

We present a familial case of isochromosome 18p [i(18p)] as a supernumerary chromosome. The mother, who is a mosaic for i(18p) with partial tetrasomy 18p syndrome, transmitted the isochromosome to her only child. The child has the full syndrome of tetrasomy 18p. This is the first case of mosaicism i(18p) in an adult patient with clinical manifestations.

Central nervous system involvement in Leber congenital amaurosis

Sixteen patients with ocular criteria of Leber congenital amaurosis (LCA) were studied. Neurological examination was normal in 11 of 16 patients. The electroencephalogram was normal in six of eight patients, while two had nonspecific theta slowing. Computerized tomography of the brain was normal in two of five; hypoplasia of the cerebellar vermis was seen in one, and mild to moderate ventriculomegaly was seen in two of five. Six patients underwent the verbal subtests of the Wechsler Intelligence Scale and a detailed battery of neuropsychological tests. Subtests dependent on early environmental influences were most severely affected, while culture-free subtests showed average or well above average performance. These results strongly support the hypothesis that children with LCA may be capable of normal cognitive functioning, although they perform poorly on standard IQ tests. This is related to their early environmental and sensory deprivation, rather than to a primary central nervous system dysfunction.

Cerebral oedema in congenital nephrotic syndrome

We report an infant with congenital nephrotic syndrome who showed clinical and radiological evidence of cerebral oedema, which resolved during prolonged intravenous albumin therapy. The cerebral oedema in this case can possibly be attributed to the relative immaturity of the blood-brain barrier in early infancy.

Issues in providing mental health services to hearing-impaired persons

Interest in the mental health service needs of hearing-impaired persons has expanded over the past 35 years, but the availability and accessibility of clinical services have lagged behind developments in research. Despite federal mandates, deaf Americans' psychiatric and psychosocial needs remain profoundly underserved. The author provides an overview of deaf culture and the deaf community and discusses issues in communication, including use of American Sign Language and interpreters in clinical settings. Diagnostic considerations, clinical assessment strategies, and inpatient, outpatient, educational, and early intervention treatment strategies are explored, and the needs of special populations, including mentally ill offenders, patients with multiple disabilities, and persons with hearing loss in later life are examined.

Meningomyelocele in the neonate: medical and ethical considerations

Whether to treat or not to treat a high neural tube lesion presents a significant ethical dilemma. In the past two decades, the medical practice regarding the approach to a neonate with a neural tube defect has gone through a series of philosophical and therapeutic changes. Medical, ethical, religious, and legal systems have grappled inconclusively with the various aspects of these issues in recent years. In this article, the pros and cons of relevant medical and ethical considerations are analyzed, and a decision-making process is outlined. It is suggested that in order to enhance the ability of the responsible care provider and the parents to reach reasonable and morally defensible decisions, a properly organized decision-making process ought to be adhered to. Each individual patient should be analyzed according to the following major categories: medical data, basic ethical and religious principles, legal and/or institutional regulations, and physician-parents relationship. Based on current medical knowledge and on pertinent ethical reasoning, it is argued and recommended that almost always, if possible, aggressive management should be favored.

Ethical considerations in modern human experimentation

The use of properly controlled clinical trials in medical experimentation has been of vital importance to the progress of medical science. At the same time, the new form of experimentation has also generated some of our most difficult and perplexing moral dilemmas. The solutions to the many complicated ethical problems involved in human experimentation are not straightforward, and despite numerous books, articles, codes, guidelines, and declarations, many specific issues of right and wrong in human experimentation have not yet been definitively resolved. Society today has an obligation greater than ever to control, regulate, and enforce properly balanced codes of human experimentation in order to minimize the unacceptable ethical problems and maximize the desired results of modern human experimentation. These, however, are not sufficient. The patient's greatest safeguard in experimentation is a skillful, intelligent, and conscientious physician and investigator. Thus, the investigator bears great responsibility in balancing between the common good and the individual's rights. In this article the relevant secular and Jewish ethical principles and rules concerning human experimentation are specified and methodologically organized. Particular emphasis is placed on the elucidation and evaluation of the ethical controversies surrounding randomized clinical trials.

A living systems approach to understanding the concept of stress

In this article, the basic concepts used in conceptualizing stress and classifying its related phenomena are defined and a general conceptual framework for understanding the interrelationships among these concepts is proposed. The conceptual scheme described is intended to be applicable across disciplines including the biological and the behavioral and social sciences. This model is based largely on the living systems theory developed by Miller (1978) and the work of Selye (1950). It provides a coherent conceptual framework in which studies in the various disciplines engaged in stress research can be organized and integrated. Its use across disciplines will facilitate the sharing of information and prevent needless duplication of effort by researchers in different fields. It will also facilitate the generation and formulation of empirically testable hypotheses (including specific cross-level hypotheses), the development of more focused research designs and a clearer interpretation of findings. By understanding at which point in the stress pathway a system is when observed, a clearer picture of both the biological mechanisms involved and the psychosocial ramifications of stress may be obtained. As a consequence of this type of information becoming available, more optimal treatments for patients with stress-related disorders can be developed.

Platelet glutathione peroxidase and monoamine oxidase activity in schizophrenics with CT scan abnormalities: relation to psychosocial variables

We have previously reported that the activity in platelets of the important antioxidant enzyme glutathione peroxidase (GPx) is inversely correlated with computed tomographic (CT) measures of brain atrophy in a population of patients with chronic schizophrenia, suggesting that low GPx may be a vulnerability factor in those schizophrenic patients with structural brain abnormalities. The significance of this finding has now been explored in a larger clinical population by examining the relation of GPx and CT parameters to psychosocial variables and to the activity of platelet monoamine oxidase (MAO), which has also been reported to be altered in certain schizophrenic populations. In the present study, low platelet GPx and high brain atrophy were found to be associated with DSM-III diagnoses of nonparanoid schizophrenia, a high degree of chronicity, and a predominance of negative symptoms. Contrary to some literature reports, atrophy also correlated with age and length of illness among the schizophrenic patients, although the contribution of these factors was less than that of low GPx, which was itself not age dependent. The ventricle-brain ratio (VBR) and atrophy were highly correlated in a control group of affective disorder patients, but not in the schizophrenic group, where large VBRs were found predominantly in the DSM-III undifferentiated subgroup. The low-GPx/high-atrophy schizophrenic patients had normal platelet MAO levels, and MAO was significantly lower only in the paranoid subgroup, consistent with reported observations. There was no evidence for a neuroleptic-induced effect on either enzyme.

An unusual CT appearance in multiple sclerosis

Multiple sclerosis, presenting with a picture on C.T. resembling neoplasia is discussed. A differential diagnosis is presented.

Evoked potential variation in schizophrenic subgroups

Unmedicated chronic schizophrenic inpatients and nonpsychotic controls were tested in a paradigm designed to elicit habituated event-related potentials (ERPs) to auditory stimuli. Analysis of Variance of the ERP components recorded at bilateral frontal (F1 and F2) and temporal (T3 and T4) scalp leads revealed significant decreases in N1 component amplitudes in both frontal leads in the schizophrenic subjects. P2 and N2 amplitudes also tended to be smaller at frontal leads in the schizophrenic subjects, but these differences were not found to be statistically significant overall. The schizophrenic subjects were assigned to diagnostic subgroups following administration of the Diagnostic Interview Schedule, the Maine Paranoid Scale, and the Scale for the Assessment of Negative Symptoms. Subjects meeting DSM-III criteria for paranoid schizophrenia were assigned to one subgroup (PS subgroup), and those meeting DSM-III criteria for residual or undifferentiated schizophrenia were assigned to another subgroup (RS subgroup). The Analysis of Variance of the N1 amplitude measures was repeated with subgroup diagnosis as a factor, revealing significant decreases in N1 amplitude in the PS, but not the RS, patients. Patients in the PS subgroup were found to differ significantly from those in the RS subgroup on this ERP measure, as well as from controls. These results suggest that subgroup differences exist within the schizophrenic population that are reflected in differential changes in ERP morphology.