Difference in brain densities between chronic alcoholic and normal control patients.

The densities of the brains of 11 chronic alcoholics were compared with those of 11 age-matched normal control subjects. Densities were determined from the density numbers generated by computerized tomography at three levels of the brain-the highest level of the lateral ventricles and the next two higher levels-with adjustments made to control for possible artifacts in the data. The advantage of the dominant hemisphere over the nondominant hemisphere was lessened in alcoholics.

Structural brain deficits in schizophrenia. Identification by computed tomographic scan density measurements.

Research has suggested the presence of brain damage as a cause or concomitant of chronic schizophrenia. The most recent research in this area has been the identification of abnormalities in schizophrenia by computed tomographic (CT) scans. A study was done to investigate localized changes in CT scan density numbers in the brains of schizophrenic patients, as opposed to the brains in normal control subjects. Twenty-four normal subjects and 23 schizophrenic patients were tested with CT scans. Density measurements in each area of the brain (left, right, anterior and posterior) were compared to three separate CT scan levels. Of six measurements of anterior left-hemisphere density, it was found that five showed lower density in schizophrenic brains, as compared with normal brains. Of the remaining 18 measurements that evaluated other areas of the brain, only three differentiated between schizophrenic patients and normal subjects. The results support the hypothesis that there are primary structural deficits in some schizophrenic patients, and these deficits are centered in and around the anterior area of the left (dominant) hemisphere. The results also demonstrated further implications.

Cerebral ventricular size and neuropsychological impairment in young chronic schizophrenics. Measurement by the standardized Luria-Nebraska Neuropsychological Battery.

The relationship between size of cerebral ventricles in chronic schizophrenics and performance on a comprehensive neuropsychological battery, the Standardized Luria-Nebraska Neuropsychological Battery, was investigated. Ventricular size was determined by using a planimeter to measure the size of the lateral ventricles and the ventricular body, if present, on the computerized tomographic (CT) scan image that showed the largest lateral ventricles. This number was divided by the size of the brain as a whole on the same image of the CT scan to yield a ventricular brain ratio. This ratio was then correlated with the scores on the Luria-Nebraska Neuropsychological Battery. Eight of the 14 scales of the Luria-Nebraska Neuropsychological Battery correlated significantly at the .05 level with the ventricular brain ratio in a sample of 42 chronic schizophrenics with an average age of 32.3 years. Overall, there was a multiple correlation of .72 between the ventricular brain ratio and Luria scores. The overall ventricular brain ratio for the schizophrenics was significantly above that found in normal populations. Changes in the size of the ventricles in schizophrenics appear to have significant correlates with measures of neuropsychological performance.

Regional cerebral blood flow in schizophrenics. Tests using the xenon Xe 133 inhalation method.

Measurements of intrahemispheric and bilateral regional cerebral blood flow (CBF) for gray and white matter were compared in 29 schizophrenic patients and 22 normal controls, using the xenon Xe 133 inhalation method. Results showed significantly lower CBF values for all brain regions in the schizophrenic group, and post hoc comparisons showed relatively greater reduced gray-matter CBF values in the anterior areas of the brain. There was also a left-hemisphere frontal loss similar to that reported previously, although it was in the context of a generalized loss in anterior functioning. Interhemispheric comparison within both groups showed no differences between homologous regions for gray matter, and greater white-matter CBF values in the right hemisphere than in the left hemisphere. The findings support a hypothesis of a bilateral anterior deficit in schizophrenia.

Neuroendocrine responses to exogenous estrogen: no differences between heterosexual and homosexual men.

Plasma LH concentrations were determined in 55 men before and for four days following injection of 10 mg, 20 mg, or 30 mg Premarin or a placebo injection of vehicle. Testosterone (T) and dihydrotestosterone (DHT) concentrations were also determined in plasma samples taken just prior to Premarin or placebo injection and in samples taken three days later. All subjects provided self-descriptions of their sexual orientation and, based upon these descriptions, were classified as heterosexual (N = 39) or homosexual (N = 16). Premarin injection resulted in a reliable reduction in plasma LH 24 hr later. In subsequent samples, LH values rose and in many cases exceeded baseline levels, most reliably in those subjects receiving the 10 mg dose. Contrary to some previous reports, we observed no significant differences between heterosexual and homosexual subjects in the likelihood of their exhibiting elevated LH concentrations following exogenous estrogens. T, but not DHT, concentrations were suppressed after Premarin injection in both groups of subjects. Other than Premarin dosage, we could not identify any variable which predicted the likelihood of elevated LH values.

Female orgasm: role of pubococcygeus muscle.

An examination is made of the role of the pubococcygeus muscle in relation to female orgasm in 281 women. A statistically significant difference is reported between orgasmic and anorgasmic women and the physiological state of the pubococcygeus muscle as measured using a pressure sensitive device inserted in the vagina. These data suggest the pubococcygeus muscle plays an important part in the pathophysiology of female orgasm.

A circumvaginal muscle nomogram: a new diagnostic tool for evaluation of female sexual dysfunction.

Female orgasmic capacity was previously shown to vary significantly with the condition of the pubococcygeus muscle as evaluated by an extensive digital examination and readings from a perineometer, a pressure sensitive device inserted into the vagina. Subsequently, a discriminant analysis was applied to 6 types of perineometer readings to determine if an optimal combination of readings could alone serve as an accurate evaluation of muscle condition. Initial strength resting and initial strength contracting predicted "good" versus "bad" muscle with 73.4% accuracy. A nomogram is presented for clinical use.

Brain structure and function in sexual molesters of children and adolescents.

Sixteen men incarcerated in a state psychiatric facility pursuant to sexual molestation of children and/or adolescents were evaluated by computed tomography (CT) head scans and regional cerebral blood flow (rCBF) estimation. Compared with controls, child molesters were found to have thinner and less dense skulls and lower rCBF values. Variations from control values in rCBF and characteristics of CT head scans for the sex offenders suggest a role for cerebral dysfunction in the etiology of their aberrant behavior.

The passage of Florida's Statute on Assisted Reproductive Technology.

Until 1993, there were no statutes in the United States covering gestational surrogacy contracts, disposition of stored embryos and gametes, parentage of children born from donated gametes and embryos, and the inheritance rights of cryopreserved embryos of deceased donors. In March 1993, the Florida Assisted Reproductive Technology Act was passed to address some of these issues and to minimize the expense and emotional cost of related courtroom proceedings. Authors of the bill believed that motherhood of a newborn in the eyes of the law should be determined by two factors: genetic inheritance and the original intent of the woman to become the parent of record. The bill included the assumption that, in the cases of children born of gestational surrogacy, the commissioning genetic parents would be the "natural parents" of the child. Some of the reasons for legislative success of the statute include: 1) clear need for statutory guidance in cases involving reproductive technology, 2) relevance of the issue to cost containment (ie, judicial costs) in an era of health care reform, 3) careful use of scientific terminology and the support of the medical community, 4) involvement of a skilled legislative team, 5) participation of physician specialists in the development of the bill (ie, practicing gynecologists in assisted reproductive technology programs), 6) participation of the State of Florida legislative staff, and 7) consultation with appropriate lobbying groups (eg, Florida Catholic Conference). The successful legislative process that was followed to achieve passage of this bill can serve as an example for other states to emulate.

Distribution of chlorpromazine and imipramine in adipose and other tissues of rats.

Adipose tissue kinetics of chlorpromazine and imipramine, two drugs which are more lipophilic than thiopental, were studied in the rat. After single i.v. doses, the time-course of drug distribution was followed in adipose and various other tissues, until their concentrations in adipose tissues declined. Under these conditions the two drugs behaved almost identically. Among the tissues analyzed, the lowest concentrations were found in adipose tissue, with the exception of plasma. At its maximum concentration after about 30 minutes, total adipose tissue contained only 3% of the dose of administered drugs. Adipose/plasma and adipose/lung concentration ratios were 2-5 and 0.05, respectively. After maximum tolerated oral doses of imipramine for 3 weeks, similar steady state concentration ratios (plasma:adipose:brain:lung 1:3:12:96) were observed. In adipose tissue the imipramine/desmethylimipramine ratio was about 1, and the desmethylimipramine steady state levels did not increase with time. Literature data indicate that many basic lipophilic drugs are not stored in adipose tissue. This is now clearly shown for chlorpromazine and imipramine, even under extreme, subchronic conditions in the case of imipramine.

Yohimbine and naloxone: effects on male rat sexual behavior.

We evaluated the effects of yohimbine (2 mg/kg) and naloxone (5 mg/kg), separately and in combination, on copulatory behavior in male rats. In Experiment 1, yohimbine evinced decrements in intromission frequency, ejaculation latency, and copulatory efficiency, whereas naloxone administration was followed by an increased ejaculation latency, and the combination of yohimbine plus naloxone was without effect. In Experiment 2, yohimbine evinced decreases in intromission frequency, ejaculation latency, copulatory efficiency in the first, but not subsequent, copulatory series, as well as a decreased latency to sexual exhaustion. Further, treatment with yohimbine alone, naloxone alone, or yohimbine plus naloxone was followed by a reduction in the number of ejaculation prior to sexual exhaustion. Thus, at the doses tested, no synergistic effects were observed for the combination of yohimbine plus naloxone.

Effects of long-term neuroleptic use on brain density.

Mean density values of the brain in four quadrants were determined for a sample of 16 chronic schizophrenic patients who had received between 0 and 3,000 grams of lifetime neuroleptics. Significant correlations were found between the measures of density in the posterior quadrants of both hemispheres and total lifetime medication usage. Correlations with anterior density were insignificant. Corrections for age and current severity of the disorder (as measured by the Brief Psychiatric Rating Scale) did not alter the significant finding. Possible explanations for the results are discussed as well as their possible implications.

A thirteenth cranial nerve: the cloacal nerve.

The completion by vertebrates of micturition, defecation, and copulation via the cloaca or its derivatives is hypothesized to be best explained by the existence of a thirteenth cranial nerve, the cloacal nerve, which, similar to the facial and trigeminal nerves, functions as a mixed cranial nerve containing both general and special components.

Brain damage among mentally disordered sex offenders.

The incidence and nature of structural brain dysfunction was investigated in a pilot study sample of individuals currently assigned the Nebraska Penal Code designation of mentally disordered sexual offender. It was hypothesized that the sexual offenders would show a significantly higher incidence of dysfunction than a psychosocially normal group as evidenced by computed tomography scan measures, regional cerebral blood flow, and neuropsychological instruments. The hypothesis was tested by two different methods. One method used a 160 by 160 printout of density numbers generated by computer from computed tomography scans administered to the sexual offenders. The second method used mean blood flow data generated from a Harshaw TASC-5 Regional Cerebral Blood Flow analysis system. Additionally, the Luria-Nebraska Neuropsychological Test Battery was administered as a measure of the behavioral correlates of brain dysfunction. Preliminary analyses indicate that 50% of the sexual offenders tested showed brain dysfunction as demonstrated by decreased density measures, decreased blood flow, and performance deficits on the Luria Battery. The implications of these findings, if confirmed, are substantial on issues of criminal responsibility, sentencing, treatment, and rehabilitation of the sex offender. Case reports of the patients studied are presented.

Demystifying "sex therapy".

A mystique has grown around sex therapy in the belief that "sex therapists" possess some specialized skills unavailable to the otherwise competent psychiatrists or trained psychotherapists. The use of movies, gadgetry, and neologisms such as "sexological examination" aid greatly in creating this impression. Careful evaluation of a sexual function disorder requires evaluation of four areas: physical, intrapsychic, interpersonal, and learning. There is nothing in the "sexual therapist's" armamentarium that makes him more of an expert in any of these four except the last. However, the gadgetry and gimmickry attached to sex therapy is used to accomplish the basic principle of desensitization. There is no systematic evidence yet available that demonstrates that any particular set of films, exercises, drills, etc. are more or less successful in accomplishing this task. Specific skill training is the only area that might require additional postgraduate education for the trained psychotherapist who wants to treat diagnosed sexual function disorders.