Physical and ecological effects of rehabilitating the geothermally influenced Waikite Wetland, New Zealand.

Pressure to optimise land use and to maximise the economic viability of land has had a detrimental impact on wetlands worldwide. Rehabilitating wetlands has been identified by resource managers as increasingly important to enhance environmental values and restore ecosystem functions that may have been lost through developments effecting wetlands. This paper investigates rehabilitating a geothermally influenced wetland that had been drained and used for grazing stock. The Waikite Wetland (New Zealand) is a relatively unique wetland because the primary water source to the wetland has a significant geothermal water component. This results in the area hosting populations of rare flora and fauna that are significant to New Zealand. A range of management actions that included diverting a geothermal stream back into the wetland, blocking drains, pest control, weed control, native plantings, fencing and building a weir to increase water levels were used to rehabilitate the wetland. This was done to promote thermotolerant vegetation growth, restore wetland water levels and minimise pest plant species re-establishing while minimising the effects on geothermal surface features and allowing indigenous wetland vegetation to re-establish. Physical, chemical and vegetation monitoring show that management actions have increased thermotolerant vegetation growth in the wetland while having a small potential impact on geothermal discharges into the wetland. Increasing the water level in the wetland appears to be helping control plant pest species close to the weir, but has also made sensitive vegetation growing close to the waterways more susceptible to flooding caused by high-intensity rainfall events.

Unreliability of current screening tests for syphilis in chronic psychiatric patients.

OBJECTIVE: This study examined whether psychiatrists perform adequate diagnostic screening for syphilis in patients with chronic mental illness. METHOD: Two hundred patients with chronic mental illness underwent testing for syphilis with the commonly used RPR test and the microhemagglutination assay for Treponema pallidum (MHA-TP). Sensitivities of the two tests were compared. RESULTS: A substantial number of patients with negative results on RPR tests had reactive MHA-TPs and would have not been identified as having had syphilis with the use of RPR testing alone. CONCLUSIONS: Nontreponemal tests such as the RPR test are less likely than treponemal tests to detect syphilis appropriately in chronically mentally ill patients, and specific treponemal tests such as the MHA-TP should be considered.

Mnemonics for DSM-IV substance-related disorders.

A series of acronyms was developed to assist in recalling the DSM-IV diagnostic criteria for substance-related disorders. In order to facilitate recall, most of the mnemonics are related in some way to the disorder itself. In general, each letter of the acronym relates to an element of the diagnostic criteria. These mnemonics are intended to be helpful in a variety of academic and medical settings.

Trifocal independent periodic lateralized epileptiform discharges.

The EEG of a 2 1/2-year-old female with a severe cerebral insult showed trifocal periodic lateralized epileptiform discharges (TRIPLEDs). We believe this is the first such record reported. As with BIPLEDs, the physical findings associated with this EEG appear to represent a diffuse cerebral insult. The most frequent causes of BIPLEDs are diffuse anoxic encephalopathy and CNS infection. In this patient, the TRIPLEDs are apparently due to a severe anoxic insult suffered in utero. As is true with BIPLEDs, the presence of TRIPLEDs represents a poor prognosis.

Does caffeine cessation increase firing rates of diffuse paroxysmal slowing dysrhythmia? A serendipitous observation.

As part of a quantitative EEG study of caffeine withdrawal a serendipitous observation suggested that individuals with Diffuse Paroxysmal Slowing (a minor EEG dysrhythmia) in their baseline resting EEGs had an increased firing rate of this pattern while undergoing a period of caffeine abstinence. For all EEGs, individual bursts of Diffuse Paroxysmal Slowing were identified by consensus rating and the firing rate for this pattern expressed as the number of bursts per 10 minutes of alert waking activity. The firing rate of this pattern was seen to increase markedly during 4 days of verified abstinence and to return to baseline or lower than baseline levels following reintroduction of caffeine. Some possible implications of this phenomenon are discussed.

The effects of caffeine withdrawal on cognitive P300 auditory and visual evoked potentials.

Auditory and visual P300 cognitive evoked potentials were obtained in 13 individuals who regularly consumed caffeine prior to and during a 4 day period of abstinence from caffeine. During the period of caffeine abstinence auditory P300 evoked potentials showed significant decreases in amplitude measures but no significant changes in latency, while the visual P300 evoked potentials showed significant latency decreases but no significant changes in amplitude. The reason for these opposite effects is unclear and further research in this area is needed.

Topographic quantitative EEG measures of alpha and theta power changes during caffeine withdrawal: preliminary findings from normal subjects.

Neurophysiological consequences of withdrawal from caffeine are poorly understood. In particular, quantitative studies of EEG changes that may occur during the period of caffeine abstinence in caffeine dependent individuals have not been reported. In this pilot study, 13 physically- and psychiatrically-normal caffeine users were asked to abstain from caffeine for a period of 4 days. Quantitative EEGs were obtained prior to stopping caffeine and on Days 1, 2, and 4 of the caffeine abstinence period. Results indicated that significant increases in alpha and theta absolute power accompany the caffeine withdrawal process with return to the pre-abstinent EEG levels when caffeine usage is resumed. The implications of these findings are discussed with special reference to the possible need to control for the variable of caffeine usage in quantitative EEG studies of other phenomena.

Topographic quantitative analysis of the intrinsic alpha rhythm in chronic obstructive pulmonary disease.

Twenty-two patients with documented COPD and no other significant illnesses were studied to assess the effect of varying degrees of COPD on the intrinsic alpha rhythm. The severity of COPD was determined by spirometry with assessment of FEV1, FVC, and FEV1/FVC. The alpha frequency for COPD patients was slower than that which characterizes age equated normals and averages 1.6 S.D. below normative data base mean values (range -0.43 S.D. to -1.85 S.D.). Impairment of pulmonary functioning significantly correlated with the degree of alpha frequency slowing over the posterior cortical regions, and the slowest alpha frequencies occurred in those COPD patients with the lowest FEV1/FVC ratios. Impairment of cognitive functioning is thus an important clinical consideration in treatment of patients with COPD but may go unrecognized until late in the course of the disease.

Decreased multi-band posterior interhemispheric coherence with a lipoma on the corpus callosum: a case report of a possible association.

The corpus callosum plays a role in mediating interhemisphere communication. Coherence may be a quantitative EEG-based measure of this communication. The present report is of a female schizophrenic patient with a marked coherence deficit in the temporal-parietal-occipital region involving multiple frequency bands. An MRI scan of her brain revealed a lipoma involving the splenium of the corpus callosum. It is speculated that this lipoma may have caused a physical impingment on or developmental aberration of adjacent callosal fibers, resulting in the observed coherence deficit. Further studies of coherence measures in patients with collosal lipomas are proposed.

Auditory and visual P300 cognitive evoked responses in patients with COPD: relationship to degree of pulmonary impairment.

Twenty-two subjects with documented COPD and no other significant illnesses were studied to assess the effect of varying degrees of COPD on cognitive P300 auditory and visual evoked potentials. The severity of COPD was determined by spirometry with assessment of FEV1, FVC, and FEV1/FVC. Auditory P300 latency was significantly correlated with the FEV1/FVC ratio (Pearson Product Moment correlations r = -.56, N = 20, probability level = 0.1), indicating that increasingly severe airflow impairment is associated with longer auditory P300 latencies. There was no significant association of FEV1/FVC with visual P300 latency or with auditory or visual evoked potential amplitude measures. Progressive impairment of the auditory P300 evoked potential latency occurs with increasing severity of COPD. This impairment is present even in patients with mild COPD, suggesting some degree of accompanying cognitive decline early in the course of COPD with worsening as the disease progresses.

Cannabinoids in humans. II. The influence of three methods of hydrolysis on the concentration of THC and two metabolites in urine.

Glucuronide conjugates of cannabinoids were previously identified in humans. For gas chromatographic-mass spectrometric (GC-MS) analysis of the unconjugated compounds in human urine, it is necessary to cleave the glucuronide moiety. Base hydrolysis and two forms of enzymatic hydrolysis were compared in this study to examine any quantitative differences between the hydrolysis methods. Human volunteers (n = 8) each smoked one marijuana cigarette containing 3.58% delta 9-tetrahydrocannabinol (THC) and submitted urine samples prior to smoking, 5 min after smoking, and hourly for 8 h thereafter. Urine (1 mL) was buffered to the optimum pH for each form of enzyme tested. beta-Glucuronidase from Escherichia coli (bacteria) or Helix pomatia (mollusk) was added to the specimens, followed by overnight incubation at 37 degrees C. Following hydrolysis, the samples were extracted using hexane-ethyl acetate (7:1) and derivatized with N,O-bis(trimethylsilyl)-trifluoroacetamide plus 1% trimethylchlorosilane, which converted the cannabinoids to their trimethylsilyl derivatives. GC-MS analysis revealed striking differences between the hydrolysis methods. Concentrations of unconjugated THC and 11-hydroxy-THC (11-OH-THC) using E. coli were significantly increased over all other methods tested (p < .05). These results demonstrate the species-dependent nature of glucuronidase activity in hydrolyzing THC and 11-OH-THC glucuronides and the ineffectiveness of base hydrolysis on these hydroxylated compounds. The need for further study to find the optimum conditions necessary for the complete hydrolysis of cannabinoid conjugates is suggested.

Carisoprodol (soma): abuse potential and physician unawareness.

Carisoprodol is a noncontrolled skeletal muscle relaxant whose active metabolite is meprobamate, a Schedule IV controlled substance. Although several case reports have shown that carisoprodol has abuse potential, it continues to be widely prescribed. The usage patterns of 40 patients who had taken carisoprodol for three or more months (20 of whom had no history of substance abuse and 20 of whom carried a diagnosis of substance abuse or dependence) were reviewed and compared and a survey was conducted to assess physician awareness of the abuse potential of the drug. Findings showed that some patients using carisoprodol for over three months may abuse the medication, especially those individuals with a history of substance abuse. A significant percentage of the physician population is unaware of the potential of carisoprodol for abuse and of its metabolism to meprobamate, a controlled substance. Physicians should exercise caution when prescribing carisoprodol, especially if the patient has a history of substance abuse.

Effects of thyroid hormone treatment on 31P-NMR spectroscopy of muscle and on nerve conduction studies in a patient with long-standing severe hypothyroidism.

Hypothyroidism exerts a significant effect on several body systems, including the functioning of muscle and nerve. Described here is the case of a severely hypothyroid patient with weakness and numbness of the legs who showed marked clinical improvement with thyroid hormone treatment. Concurrently obtained phosphorus 31-nuclear magnetic resonance (NRM) spectra and nerve conduction studies showed changes in muscle phosphorus metabolism with increases in conduction velocities. Phosphorus 31-NMR spectroscopy is useful for evaluating metabolism in muscle in hypothyroid patients.

A standardized form for DSM-IV review of symptoms and mental status examination for students and residents.

A common error by medical students and residents is the inadvertent omission of some part of the mental status examination or failure to screen for a psychiatric diagnosis that is not evident on the patient's presentation. The authors introduce a structured questionnaire and standardized form to guide psychiatric and generalist medical trainees through the mental status examination. Based on criteria from the Diagnostic and Statistical Manual of Mental Disorders--Fourth Edition (DSM-IV), the questionnaire and form are intended to facilitate a psychiatric review of patients without missing key points.

Somatic dysfunction increase during caffeine withdrawal.

The authors studied the effects of caffeine withdrawal on 14 subjects at baseline and during a 4-day period of abstinence from caffeine. They studied the results from quantitative electroencephalograms performed on these subjects and gauged any changes that may have been evoked during this withdrawal period. The participants were also evaluated for the occurrence of somatic dysfunctions. Examinations for the presence of somatic dysfunctions were performed on the participants before caffeine cessation and on Days 1, 2 and 4 of abstinence. Results showed that the number of somatic dysfunctions increased significantly during the process of caffeine withdrawal.

Carisoprodol: a drug of continuing abuse.

Carisoprodol (Soma) is a noncontrolled, skeletal-muscle relaxant whose active metabolite is meprobamate. Despite previous indications that the drug may be abused, it continues to be widely prescribed for musculoskeletal conditions involving muscle spasm. Presented here are three cases demonstrating patterns of carisoprodol abuse not previously reported. Carisoprodol usage should be limited to short-term treatment. Patients for whom carisoprodol is prescribed are at risk for meprobamate dependence.

Olanzapine-induced mania.

Olanzapine is a relatively new antipsychotic agent which appears to be effective in the treatment of both the positive and negative symptoms of schizophrenia. Reported here is the case of a patient who developed symptoms of mania secondary to treatment with olanzapine. Physicians prescribing olanzapine should be aware of this potential complication.

Postpartum psychosis induced by bromocriptine and pseudoephedrine.

Bromocriptine is an ergot-derived dopamine agonist sometimes used for postpartum suppression of lactation. On rare occasions (a total of seven previous reports in the literature), use of the medication has been associated with psychotic symptomatology in postpartum patients. This case report describes a 19-year-old postpartum woman who developed severe psychotic symptoms while taking low doses of bromocriptine and pseudoephedrine. The use of bromocriptine for suppression of lactation is controversial. If prescribed for postpartum patients, bromocriptine alone or in combination with sympathomimetic drugs should be used only with caution.