Pituitary-adrenal axis function in dogs with neoplasia*.

Abstract Adrenocorticotropic hormone (ACTH) stimulation tests were done in healthy and tumour-bearing dogs. In the tumour-bearing dogs, plasma endogenous ACTH (eACTH) concentration was measured and adrenal gland size was assessed ultrasonographically. Measurements in the tumour-bearing dogs were taken prior to therapy. No difference existed in basal or ACTH-stimulated cortisol concentration between tumour-bearing and healthy dogs. No difference existed in eACTH concentration between dogs with non-haematopoietic neoplasia (NHN) and lymphoma. However, of 20 dogs with lymphoma, 15% had increased basal serum cortisol concentration, 5% had an exaggerated response to ACTH and 5% had an increased eACTH concentration. Of 15 dogs with NHN, 20% had increased basal cortisol concentration, 7% had an exaggerated ACTH response and no dogs had an increased eACTH concentration. Of the dogs with lymphoma and NHN, 5 and 13%, respectively, had decreased basal cortisol concentrations; 20% of dogs with lymphoma and 13% with NHN had a subnormal ACTH response. eACTH levels were below the reference range in 10% of dogs with lymphoma and 7% with NHN. Overall, 10 adrenal glands were enlarged in seven dogs, five with lymphoma and two with NHN. The clinical significance of these findings remains to be determined.

Suicide: a four-pathway clinical-biochemical model.

This chapter, based on a review of recent research as well as data presented in this report, proposes four hypothetical pathways leading to suicide in clinical depression: (1) an acute pathway involving severe anxiety/agitation associated with high brain corticotrophin-releasing factor (CRF or CRH) levels, (2) trait baseline and reactivity hopelessness, (3) severe anhedonia, and (4) trait impulsiveness associated with low brain serotonin turnover and low total cholesterol as a possible peripheral correlate. Clinical research showing evidence for acute versus chronic high-risk suicide factors and other studies linking severe anxiety/agitation to high CRF levels will be presented as associated with acute suicidal risk, which is potentially reversible with recognition and treatment. Evidence for anhedonia severity as a risk factor and trait, as well as evidence that baseline hopelessness and sensitivity are traits related to chronic suicide risk, will be presented. Finally, evidence relating low serum cholesterol to suicide in depressed inpatients will be presented in the context of literature suggesting a relationship between low serum cholesterol and violent death and suicide in population studies. Data suggesting a relationship between low serum cholesterol and decreased CSF 5-HIAA, suggesting reduced serotonin turnover, will be presented, in light of prior studies relating low CSF 5-HIAA and violent suicide. These data taken together suggest four pathways to suicide that are worth investigating in order to better understand the mechanisms leading to this behavior. Future possibilities and applications of these findings are discussed.

Neuropsychiatric aspects of AIDS and psychopharmacologic management.

This article will review the current literature on the wide range of neuropsychiatric symptoms and syndromes seen in HIV illness. It will then describe the literature and the authors' experience in the use of psychotropic medications in this illness.

Automated surface area measurement of cultured cardiac myocytes.

An automated method for rapidly measuring surface area of individual cardiac myocytes was used as an index of myocyte growth. Hearts from 2- to 4-day-old rats were digested by overnight incubation in cold trypsin solution. Enriched suspensions of myocytes were plated at 2 x 10(5) cells/well in 12-well-culture plates. Cells were grown in M199 supplemented with 1%, 10% serum or 10% serum plus 10(-7) M norepinephrine. On days 1-4 after plating, cells were fixed in Bouin's Solution and stained with Weigert's Iron Hematoxylin and Biebrich Scarlet-Acid Fuchsin. An inverted microscope, video camera and monitor were coupled to a video image processor (Image Technology Corp.). The enhanced image of stained heart cells was digitized, and perimeter, length, width and area of each selected cell were calculated. One hundred randomly selected cells were measured in each of eight wells from each treatment-day group. Areas of individual myocytes varied widely in culture dishes and the distribution was skewed toward larger cells. The standard deviation increased in proportion to an increase in mean cell area. A logarithmic transformation of the data normalized the data and yielded a more homogeneous variance. The geometric mean area of heart cells supplemented with 1% serum increased only slightly, but significantly, during four days in culture. Geometric mean area of cells supplemented with 10% serum increased nearly four-fold. Supplementing cells with norepinephrine (10(-7) M) in addition to 10% serum did not induce a further increase in cell size. This technique has the potential to rapidly and objectively monitor heart cell growth following pharmacological or toxicological treatments.

The chemically dependent physician: clinical and legal considerations.

The medical community has made great advances in recognizing chemical dependence in the physician community. However, difficulties remain in terms of the clinician treating this disease and maintaining a liaison between legal and clinical aspects.

Oral defense mechanisms are impaired early in HIV-1 infected patients.

We have examined the hypothesis that individuals infected with human immune deficiency virus type 1 (HIV-1) experience significant, specific alterations in mechanisms protecting the oral cavity prior to the appearance of AIDS-related systemic opportunistic infections. In a study of 13 early-stage, stable anti-HIV antibody positive patients, parotid salivary function was found to be generally intact. In contrast, several indicators of submandibular gland dysfunction were detected. In particular, stimulated fluid output was decreased and salivary lysozyme levels were increased relative to controls by 50-60% for both resting (p less than 0.05) and stimulated (p less than 0.001) conditions. Also, the frequency of albumin detection in submandibular saliva samples was approximately 65% in HIV-1 infected patients vs. 0% in controls (p less than 0.05). In addition, cytologic evaluation of oral mucosa revealed a fivefold increase in the prevalence of candidal hyphae in HIV-1 infected patients compared to controls (41% vs. 8%, p less than 0.05). We conclude that normal oral defense mechanisms show signs of compromise in HIV-1 infected individuals. We suggest that (a) effects of HIV-1 infection are seen early in the oral cavity, (b) impairment of oral defense mechanisms may facilitate entry of microorganisms with an attendant increased risk of morbidity and mortality, and (c) intensive oral surveillance and prophylactic care should be part of the routine management afforded to AIDS patients soon after HIV-1 infection is recognized.

Subjective reports of xerostomia and objective measures of salivary gland performance.

This study involves collecting saliva under unstimulated and stimulated conditions and asking standardized questions of 100 patients with xerostomia. The study examines which questions are useful in identifying and predicting current major salivary gland output deficiency or dysfunction.

Physical examination of psychiatric outpatients: medical and legal issues.

The nation's courts are increasingly defining standards for the practice of psychiatry, but they have not given substantial attention to whether a psychiatrist can be found liable for failure to perform or obtain a physical examination of an outpatient. The few court decisions on this issue involve obvious infractions against good medical care and do not provide useful clinical guidelines. The authors' review of the literature indicates that although psychiatric patients are less healthy than the general population, and the majority of psychiatrists feel physical examination of outpatients is important, psychiatrists rarely conduct such examinations and only a small percentage initiate them. The authors offer recommendations concerning physical examinations that they believe are consonant with good psychiatric outpatient care.