Assessment of Viet Nam veterans for posttraumatic stress disorder in Veterans Administration disability claims.

Since the Veterans Administration (VA) authorized compensation and other benefits for posttraumatic stress disorder, delayed type, in October 1980, the agency has received an increasingly large number of claims--mainly from Viet Nam veterans--for this disorder. An unprecedented challenge of the adequacy of psychiatric disability evaluation in the VA has thus been created. The authors describe efforts in one large program to meet this challenge and review 12 problems in the diagnostic process. Cooperation of all parties in claims transactions, thorough claimant assessment, reliance on DSM-III criteria and methods and consultation with examiners are essential principles for this work.

Special relationship of gamma-aminobutyric acid to the ventromedial nucleus of the hypothalamus during embryonic development.

The ventromedial nucleus of the hypothalamus (VMH) is a key nucleus for regulating homeostatic, neuroendocrine, and behavioral functions. We conducted immunocytochemical analyses by using antisera directed against gamma-aminobutyric acid (GABA), its synthetic enzyme glutamic acid decarboxylase (GAD67), GABA-A receptor subunits (alpha2, beta3, epsilon), estrogen receptor-alpha, and Neuropeptide Y (NPY) in the region of the VMH in embryonic mice to identify potential patterning elements for VMH formation. Cells and fibers containing GABA and GAD67 encircled the primordial VMH as early as embryonic day 13 (E13) when the cytoarchitecture of the VMH was not recognizable by Nissl stain. At E16-17 the cytoarchitecture of the VMH became recognizable by Nissl stain as GABAergic fibers invaded the nucleus, continued postnatally, and by adulthood the density of GABAergic fibers was greater inside than outside the VMH. GABA-A receptor subunit expression (beta3 by E13 and alpha2 by E15) within the primordial VMH suggested potential sensitivity to the surrounding GABA signal. Brain slices were used to test whether fibers from distal or proximal sites influenced VMH development. Coronal Vibratome slices were prepared and maintained in vitro for 0-3 days. Nissl stain analyses showed a uniform distribution of cells in the region of the VMH on the day of plating (E15). After 3 days in vitro, cellular aggregation suggesting VMH formation was seen. Nuclear formation in vitro suggests that key factors resided locally within the coronal plane of the slices. It is suggested that either GABA intrinsic to the region nearby the VMH directly influences the development and organization of the VMH, or along with other markers provides an early indicator of pattern determination that precedes the cellular organization of the VMH.

Severe acidosis from acetazolamide in a diabetic patient.

An insulin-dependent diabetic patient with nephropathy developed severe acidosis after treatment with acetazolamide for glaucoma. A renal tubular abnormality may have allowed the usually self-limiting acidosis of acetazolamide to progress. It is suggested that the plasma electrolytes of patients at risk should be monitored.

Peripheral intrapulmonary lipoma: a rare lung neoplasm.

Lipomas are common benign tumours, but intrathoracic lipomas are rare and peripheral lung lipomas exceptionally rare. Seven cases--all in men--have been described in the world literature, diagnosed after thoracotomy and excision. We report a case of a peripheral intrapulmonary lipoma in a woman presenting as an opacity on a routine chest radiograph. The CT characteristics and the finding of the same lesion on reviewing a barium enema film from 12 years earlier allowed a confident diagnosis, avoiding the need for surgical excision. This is the first reported case of peripheral lung lipoma in a woman and highlights the value of reviewing previous radiographs.

Autologous granulocyte scanning of painful prosthetic joints.

To detect sepsis in the painful joint, autologous granulocytes labelled with indium-111 were used to scan 60 patients with 74 prosthetic joints. All 18 patients with confirmed sepsis had positive scans, that is, migration of granulocytes into the region of the prosthesis. Of the 22 sterile arthroplasties 20 had negative scans. In 34 cases there was good correlation between the clinical impression and the result of the scan. We suggest that indium granulocyte scintigraphy is a reliable method of detecting an infected prosthesis.

The position of the nutrient foramen in the growing tibia and femur of the rat.

In rats of 40, 49 and 59 days of age the positions of the femoral and tibial nutrient foramina were determined by direct measurement, using a travelling microscope. The femoral nutrient foramen remained constant in position with increasing age, whereas the tibial nutrient foramen moved relatively nearer to the distal end of the shaft. In the case of the femur this can be accounted for entirely by differences in growth rates at the epiphyseal plates of the femur compensating for the disproportion in the distances of the foramen from the two plates. In the tibia, however, extension of the extremely oblique nutrient canal as the bone increases in girth is also involved. Bone remodelling in the vicinity of the canal is not necessary to explain the results.

Sex differences in cell migration in the preoptic area/anterior hypothalamus of mice.

The preoptic area/anterior hypothalamus (POA/AH) sits as a boundary region rostral to the classical diencephalic hypothalamus and ventral to the telencephalic septal region. Numerous studies have pointed to the region's importance for sex-dependent functions. Previous studies suggested that migratory guidance cues within this region might be particularly unique in their diversity. To better understand the early development and differentiation of the POA/AH, cytoarchitectural, birthdate, immunocytochemical, and cell migration studies were conducted in vivo and in vitro using embryonic C57BL/6J mice. A medial preoptic nucleus became discernible using Nissl stain in males and females between embryonic days (E) E15 and E17. Cells containing immunoreactive estrogen receptor-alpha were detected in the POA/AH by E13, and increased in number with age in both sexes. From E15 to E17, examination of the radial glial fiber pattern by immunocytochemistry confirmed the presence of dual orientations for migratory guidance ventral to the anterior commissure (medial-lateral and dorsal-ventral) and uniform orientation more caudally (medial-lateral). Video microscopy studies followed the migration of DiI-labeled cells in coronal 250-microm brain slices from E15 mice maintained in serum-free media for 1-3 days. Analyses showed significant migration along a dorsal-ventral orientation in addition to medial-lateral. The video analyses showed significantly more medial-lateral migration in males than females in the caudal POA/AH. In vivo, changes in the distribution of cells labeled by the mitotic indicator bromodeoxyuridine (BrdU) suggested their progressive migration through the POA/AH. BrdU analyses also indicated significant movement from dorsal to ventral regions ventral to the anterior commissure. The significant dorsal-ventral migration of cells in the POA/AH provides additional support for the notion that the region integrates developmental information from both telencephalic and diencephalic compartments. The sex difference in the orientation of migration of cells in the caudal POA/AH suggests one locus for the influence of gonadal steroids in the embryonic mouse forebrain.

Variation in plasma prednisolone concentrations in renal transplant recipients given enteric-coated prednisolone.

Renal transplant recipients receiving intermittent haemodialysis and kept under normal ward conditions showed appreciable differences in plasma prednisolone concentrations after therapeutic doses of enteric-coated prednisolone tablets. This gross day-to-day variation occurred irrespective of the dosage used. Breakfast given before prednisolone tended to reduce the rate of absorption of the drug, the effect being quantitatively most pronounced with large doses. Haemodialysis had no apparent effect on the elimination of prednisolone from plasma. Such erratic blood concentrations of prednisolone as observed in these patients, possibly resulting from variable absorption, may be potentially hazardous. Hence use of enteric-coated tablets in renal transplant recipients should be viewed with caution.

GDP binding to brown-adipose-tissue mitochondria of mice treated chronically with corticosterone.

Cytochrome oxidase activity and mitochondrial GDP binding were decreased in brown adipose tissue of mice treated chronically with corticosterone. These changes occurred both in corticosterone-treated mice fed ad libitum and in treated mice pair-fed to control animals. Although the dietary stimulation of brown-adipose-tissue thermogenesis was suppressed by corticosterone, the acute response to cold was not affected.

Case report: splenic-gonadal fusion--the ultrasound appearances.

We report the ultrasound appearances, with pathological correlation, of splenic-gonadal fusion in a patient who presented with an asymptomatic scrotal swelling. Ultrasound examination showed an echo-poor 2 cm diameter lesion in the upper pole of the left testicle. Histologically the lesion was normal spleen. Splenic-gonadal fusion should be considered in the differential diagnosis of scrotal swellings.

Treatment of renal bone disease with 1 alpha-hydroxylated derivatives of vitamin D3. Clinical, biochemical, radiographic and histological responses.

Forty patients with severe bone disease and chronic renal failure were treated with 1 alpha-hydroxycholecalciferol (1 alpha-OHD3) or 1,25-dihydroxycholecalciferol (1,25(OH)2D3) for 7--49 months (total = 738 patient months). There were symptomatic, biochemical and radiographic improvements in the majority of patients (greater than 70 per cent). Paired bone biopsies, taken before and during treatment in 26 patients, showed no change in bone matrix area, whereas matrix area decreased in a control group of 26 patients over the same period. There were small but consistent decreases in bone marrow fibrosis and in bone cell (osteoblast and osteoclast) counts in treated patients but not in controls. However, the proportion of patients who showed histological 'cure', in the sense of complete reversal of marrow fibrosis or excess osteoid was no greater in the treated than in the control group...