The wandering psychiatric emergency room--design, location and transformations.

We describe the changes in location and philosophy of a psychiatric emergency room over a period of 20 years. Four phases are described in which location, size, modes of access as well as internal and external boundaries reflect philosophies of treatment and the evolving identity of a psychiatric emergency room. The four phases include an early embryonic stage, a second stage involving rapid development of services, a third stage involving regression and consolidation and a fourth stage representing a fully developed independent service. The authors stress both external and rational considerations, such as mental health policies and budget, as well as unconscious irrational processes, which reflect the dynamic forces within the organization.

[Bromocriptine-associated postpartum psychotic exacerbation].

2 cases are presented in which bromocriptine (Parlodel) was administered to suppress physiological lactation; parturition had precipitated deterioration in mental status and psychotic behavior. Discontinuation of bromocriptine and administration of antipsychotic medication resulted in gradual improvement in the psychotic symptoms, without complications of galactorrhea or breast engorgement. We recommend that changes in mental status be looked for when bromocriptine is given.

Burnei's technique in the treatment of radial head displacement; innovative surgery. Study on two cases.

INTRODUCTION: Dislocation of the radial head, congenital or traumatic, anteriorly, posteriorly or laterally displaced, requires surgery to reseat and stabilize the head of the radius within the joint, in order to restore elbow flexion and, as much as possible, pronation-supination. SCOPE: This article is meant to present the technique of proximal radial-ulnar ligament plasty using the extensor carpi radialis longus (ECRL) tendon, as well as other techniques for the stabilization of a dislocated radial head. The ECRL tendon technique, quadrate and annular ligament reconstruction variant was first used by Gh. Burnei in 1985, at Mangalia Municipal Hospital, Romania. MATERIALS AND METHOD: This study contains two clinical cases, a 6-year-old girl with congenital dislocation of the radial head, and a 10-year-old boy with traumatic dislocation of the radial head, both of whom were treated by open reduction and stabilization of the dislocation with the ECRL tendon, using the Burnei procedure. RESULTS: In both cases, the operation was successful in the reduction and stabilization of the dislocated radial head, whose position was maintained in flexion-extension and pronation-supination, and in the reconstruction of the annular ligament using Burnei's procedure, variant 2. Postoperatively, the clinical evolution was good, the patients having regained elbow mobility. The child with congenital dislocation exhibits normal flexion and pronation-supination within normal range, and the traumatic dislocation also exhibits normal flexion and pronation-supination limited with 20 degrees. Radiologically, in both cases the radial head is anatomically placed relatively to the humeral capitellum, in both flexion and extension. DISCUSSION: Stabilization of the radial head in traumatic or congenital dislocation can only be surgically achieved. Congenital dislocation of the radial head requires the reconstruction of the proximal radial-ulnar joint, preferably at a young age, in order to avoid subsequent complications, culminating in ulnar or radial nerve paralysis. Traumatic dislocation of the radial head is usually accompanied by the fracture of the ulna, but may be encountered in isolation. CONCLUSIONS: The Burnei procedure is an alternative for the treatment of radial head dislocation and is advantageous because of the use of a study, well vascularized tendon, which allows, when needed, the complete reconstruction of the proximal radial-ulnar ligaments, or just the annular ligament, in order to stabilize the head of the radius within the elbow joint. Also, the technique doesn't require osteotomies or an osteosynthesis requiring another surgery to remove the synthesis materials.

Serum melatonin levels in schizophrenic and schizoaffective hospitalized patients.

Conflicting results on changes of the diurnal melatonin rhythms of patients with affective disorders have been reported in the literature. The heterogeneous data may derive from the great discrepancy in the diagnostic criteria of different authors. A study of 12 schizoaffective and chronic schizophrenic psychotic patients found a constant pattern of an obliterated nocturnal melatonin rise only in the latter group. The presence or absence of the nocturnal melatonin rise was determined in drug-free hospitalized patients and remained unchanged despite 2 months of drug treatment including large doses of neuroleptics. This finding, when confirmed in a larger number of patients, could possibly serve as a marker for the type of mental disorder, drug to be applied and response expected.