[Manic episode in a patient with Beçhet's disease].

Beçhet's disease (BD) is a chronic, heterogeneous, multisystem disease that affects young males and females around the Mediterranean region, as well as from Far and Middle East. Its etiology is vague with vasculitis being its main pathological feature. International diagnostic criteria have been established and they require the presence of recurrent oral ulcerations plus two of the following: Recurrent genital ulceration, eye lesions, skin lesions and positive pathergy test. A significant number of patients with Beçhet's disease suffers from symptoms from the central nervous system (CNS), while the most common clinical symptoms are pyramidal signs, mental-behavioral changes, hemiparesis and brain stem syndrome. The existence of mental-behavioral changes seems to be one of the most common findings in patients with Neuro-Beçhet (N-BD). These changes seem to be related with memory and attention deficits, and the process of deterioration continues even in attack-free periods, suggesting a continuously active disease process in the CNS. The prevalence of anxiety, depression and general psychiatric symptoms is higher among patients with BD compared to healthy individuals. However, the association between psychiatric symptoms and BD is not clearly understood. On the other hand, syndromes like psychosis or bipolar disorder appear to be less frequent, especially in attack-free periods. We describe the case of a 52-year old woman with Beçhet's disease who developed a single manic episode 13 years after the onset of Beçhet's disease. A 52-year old woman, suffering from Beçhet's disease since the age of 39, developed manic symptoms, namely elevated mood, pressured speech, flight of ideas, distractibility and decreased need for sleep. The above symptoms developed during a period that no other symptoms of Beçhet's disease were present. Moreover there was no other manifestation from the nervous system. A brain MRI was unremarkable, while a brain SPECT study revealed severe hypoperfusion of the left prefrontal cortex. Neuropsychological examination revealed severe disturbance in attention, working memory and learning ability, while her visuaspatial ability and executive functions were well spared. Her symptoms were well controlled after treated with quetiapine 800 mg. The manic episode developed in the absence of any neurological manifestation (Neuro-Beçhet), or other symptom of Beçhet's disease, and was clearly distinguishable from euphoria, disinhibition or irritability that are common in patients with Beçhet's disease. It looks probable that CNS damage caused by the disease constitutes a biological substrate for the development of manic episodes in patients suffering from Beçhet's disease.

Controlled shifting of attention in schizophrenia and bipolar disorder through a dichotic listening paradigm.

The dichotic listening (DL) task was developed originally to examine bottom-up or "automatic" information processing. More recently, however, it has been used as a tool in the study of top-down or "controlled" information processing. This has been done by including forced-choice conditions, wherein the examinee is required to focus attention on one or the other ear. It has been widely utilized with patients with schizophrenia, who exhibit rather severe deficits in managing their attention, but not with other patient groups, such as patients with bipolar disorder. In the present study, we examined potential performance similarities in the DL listening task. In total, the sample consisted of 38 patients with schizophrenia, 20 patients with psychotic bipolar disorder and 35 healthy individuals, who performed a DL task with verbal stimuli once at the beginning of their hospitalization and again on the last day before discharge. Our findings indicated that both patient groups showed similarly diminished performance when compared to healthy participants at both times of administration. Symptom improvement between the two evaluations did not significantly influence performance in the DL task. In conclusion, impaired automated and controlled information processing appears to be a common deficit in both schizophrenia and bipolar disorder.

Semantic priming in remitted patients with bipolar disorder.

BACKGROUND AND OBJECTIVES: Semantic priming disturbances are increasingly recognized as a feature of schizophrenia, and increased priming has been suggested to constitute a "cognitive correlate" of positive formal thought disorder (FTD). The present study aimed to investigate semantic priming in patients with bipolar disorder (BD). METHODS: A primed lexical decision task with strongly related (STR), weakly related (WR), or unrelated (UR) prime-target pairs (SOA = 250 ms) was administered to fourteen remitted patients with BD and twelve control subjects matched on key demographic variables. FTD was measured by means of the Scale for Thought, Language and Communication (TLC). RESULTS: Control subjects showed a robust (59.6 ms) and statistically significant priming effect for STR words, while priming for UR words was non-significant. In patients there was no evidence of priming in either condition. In patients, there were no significant correlations between priming magnitude and TLC scores. However, the only patient with a positive score on the TLC disorganization factor exhibited evidence of hyperpriming. LIMITATIONS: The present patient sample exhibited very low TLC scores, and no direct comparison to patients with schizophrenia was possible. CONCLUSIONS: The finding of decreased priming in patients with BD raises the possibility that semantic processing abnormalities in BD are of a different nature than those encountered in schizophrenia. Due to the small size and very low TLC scores of the present patient sample, no definite conclusions can be drawn as to the relationship of formal thought disorder and semantic processing abnormalities in BD.

[Chronic renal insufficiency after long term lithium treatment].

Lithium is, in the era of evidence-based psychiatry, an efficacious and, simultaneously, cost-effective treatment for bipolar disorder, despite the existence of alternative mood-stabilizers (antiepileptics, atypical antipsychotics). A prerequisite for lithium administration in patients with bipolar disorder is the patient 's cooperation, in order to ensure monitoring of drug plasma levels as well as thyroid and renal function. Lithium-related renal complications include impairment in renal concentrating ability resulting in polyuria, increase of plasma creatinine levels and, more rarely, renal insufficiency. In this paper we present the case of a patient with bipolar disorder, who developed chronic renal insufficiency after 25 years of treatment with lithium.

[Neuroleptic malignant syndrome and atypical antipsychotics: two case reports].

Neuroleptic malignant syndrome (NMS) constitutes the most serious adverse effect of antipsychotic medications. Although it was initially described as a complication of conventional neuroleptics, atypical antipsychotic agents are also capable of inducing the syndrome. It has been suggested that atypical antipsychotic-induced NMS may be qualitatively and quantitatively different from the NMS caused by conventional neuroleptics; however, atypical antipsychotics can also be associated with severe forms of NMS. We report two patients who manifested severe NMS in association with atypical antipsychotic agents. Both patients were receiving low antipsychotic doses; moreover, one of the patients had not undergone any recent changes in his antipsychotic regimen. Thus, it is pointed out that vigilance for signs of NMS should not be influenced by antipsychotic type and dose.

[Extracorporeal shockwave lithotripsy for treatment of sialolithiasis of salivary glands]. / Die extrakorporale Stosswellenlithotripsie in der Behandlung der Sialolithiasis der Kopfspeicheldrüsen.

BACKGROUND: Following the clinical introduction of extracorporeal shockwave lithotripsy in the 1980s for the treatment of sialolithiasis of salivary glands this method has been widely used and replaced surgical interventions in selected patients. PATIENTS: Between 1/1995 and 1/1999 35 patients were treated by extracorporeal shockwave lithotripsy (ESWL) with the "Minilith SL-1" lithotripter on an outpatient basis. Radiography and sonography were performed to verify sialolithiasis and scintigraphic investigation was done to control sufficient gland function. Treatment was performed in a fractionated manner with up to 3000 shockwaves per session, normally without anesthesia or analgosedation. RESULTS: After treatment 45.4 % of the patients with sialolithiasis of the parotid gland (n = 11) were stone-free and in 36.3 % an adequate desintegration of the stones was achieved. These patients underwent 2.6 sessions on average for sufficient stone-destruction. 41.6 % of the patients with sialolithiasis of the submandibular gland (n = 24) were stone-free and 3.1 sessions were necessary on average. Desintegration of the stones was achieved in 25 %. Mild pain, swelling, bleeding out of the intraoral orifice of the affected gland and skin petechia were the only complications. All patients were symptom-free after lithotripsy, although fragmented stones persisted in the parotid gland (18.3 %) and the submandibular gland (33.4 %). CONCLUSIONS: The advantages of ESWL are the relatively painless treatment and the elimination of the need for an operation with its surgical risks.

[Inhibition of angiogenesis of xenotransplanted squamous epithelial carcinomas. Effectiveness of TNP-470 in the nude mouse tumor model]. / Angiogeneseinhibition xenotransplantierter Plattenepithelkarzinome. Wirksamkeit von TNP-470 am Tumornacktmausmodell.

Clinical and histopathological results in human tumors indicate that the connection of solid tumors to the vascular system precedes the exponential tumor growth and further progression. Acknowledging the concept of tumor angiogenesis, the search for angiogenesis inhibiting agents as potential drugs in cancer treatment began rather early. In the present preclinical nude mice model, the antitumoral effect of TNP-470 on xenotransplanted squamous cell carcinoma was tested. The chosen dosage of 30 mg/kg and 60 mg/kg resulted in a significant growth inhibition (P = 0.006 and P = 0.01) compared to the control group. The available in vivo and in vitro data lead to the conclusion that the concept of angiogenesis inhibition will have some impact on treatment of solid tumors in the near future.

[Experimental chemotherapy of xenotransplanted oral squamous epithelial carcinoma: effectiveness of docetaxel (taxotere) in the nude mouse model]. / Experimentelle Chemotherapie eines xenotransplantierten oralen Plattenepithelkarzinoms: Wirksamkeit von Docetaxel (Taxotere) im Nacktmausmodell.

Originating from plants, the taxoids, in particular docetaxel (Taxotere), represent progress in antitumoral chemotherapy. In addition to their use as palliative treatment they have also proved to be increasingly important for adjuvant and neoadjuvant treatment of oral squamous cell carcinoma (SCC). In the present nude mouse model the efficacy of chemotherapeutic agents against exemplary oral SCC were examined using cell line HNSCC 001. Typical biological properties such as expression of serum tumor markers and treatment-related alteration were reviewed. Intraperitoneal administration of 30 mg docetaxel per kilogram body weight at a time resulted in significant growth inhibition (P < 0.001), however without complete remission. Mean values of relative tumor volume ranged from 95% to 131% in the treated groups as compared to 311% in animals without treatment. Application more frequently than weekly did not result in a significant increase in antitumor activity. From the present experimental study no final conclusion can be drawn regarding weekly docetaxel administration mostly used in clinical phase II trials. Except for SCC, for which values correlated well with tumor volume (r = 0.85 without treatment and r = 0.87 with treatment), on the one hand, and a distinct treatment-related decrease, on the other, the tested tumor markers TPA and TPS proved to be less valuable for screening of treatment and follow-up in this murine model.

Relationships among the subjective quality, magnetic resonance spectra, and price of wine: a randomized trial.

RATIONALE AND OBJECTIVES: We sought to discriminate among wines on the basis of three techniques: physical properties such as smell, taste, and quality; market price; and chemical analysis using proton nuclear magnetic resonance (MR) spectroscopy. METHODS: A randomized, double-masked, controlled crossover wine-tasting trial was conducted. Participants included seven men and seven women affiliated with an urban academic medical center, half of whom were physicians. The interventions consisted of eight red and eight white wines, including two respective, lower priced control wines. Each subject sampled all wines. Participants rated the overall quality of wine samples on a 5-point scale. The outcome measures were mean wine quality score, market price, and visual analysis of proton nuclear MR spectra. RESULTS: One subject dropped out. Three white wines (ps = .0245, .0275, and .0425) and two red wines (ps = .0072 and .0128) were rated significantly higher than their respective, lower priced control wines. The mean wine quality score was not significantly correlated with market price (white wine, rho = .371, p = .326; red wine, rho = -.072, p = .8492). Visual analysis of proton nuclear MR spectra from the highest scoring wines and their respective control wines revealed more similarities than differences. CONCLUSION: Quality assurance of wine may best be left to the discriminating palate rather than market price or visual analysis of proton nuclear MR spectra.

Comparative experimental study of the serum prostate specific antigen and prostatic acid phosphatase in serially transplantable human prostatic carcinoma lines in nude mice.

Three different human lines of prostate carcinoma were successively transplanted on Balb/c nude mice and the serum values of the prostate specific antigen (PSA) and prostatic acid phosphatase (PAP) were determined simultaneously. In a group of the tumor-bearing animals the influence of endocrine manipulation (castration, estradiol) on the serum concentration of these tumor markers was studied. As far as untreated tumor-bearing mice are concerned, the serum values of both PAP and PSA proved to be strictly dependent on the tumor volume measured. In the exponential growth phase of the grafted tumors, linear growth was linked with a correspondingly increasing PAP and PSA serum level of the test animals. A close correlation was found to exist between the two tumor markers; however, the indicator value of PSA was 20 to 50 times higher than that of PAP under the test conditions. PSA determination yielded no false-negative results, if PAP was elevated. PAP determination was false-negative in 21 per cent of cases with measurable tumors, although the serum level of PSA already showed marked elevation. In treated animals both markers were found to decrease. Arrested growth and tumor regression was associated with falling PAP and PSA serum levels or with levels within normal range. The results of this experimental study support the conclusion that prostate specific antigen represents a substantially more sensitive tumor marker than prostatic acid phosphatase.