Application of the powers of compulsory admission to psychiatric hospital by general practitioners, social workers and psychiatrists.

Ways of extending or consolidating the powers of compulsory admission under the Mental Health Act 1983 have been discussed by the government and other organizations, including the Royal College of Psychiatrists. However there is little data on how existing legislation is applied. The authors examined the differential application of the Act between GPs, psychiatrists and social workers by means of an anonymous, confidential questionnaire. Fourteen case vignettes were interpreted by 20 social workers, 19 GPs and 28 Section 12 approved psychiatrists, who were asked to decide if they would detain the patient under the Act. Responses were analysed between and within the three groups. There was general agreement between groups on situations involving 'danger to self' and 'danger to others', but social workers were less likely to detain on health grounds and GPs tended to use the Act unpredictably, in areas not covered by the Act. The authors conclude that the Act may not be used to its fullest extent due to differences in interpretation or in knowledge, which may arise from differential constructs of mental illness and training. A national study of knowledge of mental health law is suggested.

Caffeine: use and effects in long-stay psychiatric patients.

In a double-blind crossover study of 26 long-stay schizophrenic patients, no correlation was found between caffeine consumption and levels of anxiety and depression. No significant changes in patients' behaviour or levels of anxiety and depression occurred when the wards changed to decaffeinated products. Serum caffeine levels confirmed compliance. No evidence was found to support a removal of caffeinated products from this group of patients.

Disulfiram treatment of alcoholism.

To assess the efficacy of supervised disulfiram as an adjunct to out-patient treatment of alcoholics, a randomised, partially blind, six-month follow-up study was conducted in which 126 patients received 200 mg disulfiram or 100 mg vitamin C under the supervision of a nominated informant. In the opinion of the (blinded) independent assessor, patients on disulfiram increased average total abstinent days by 100 and patients on vitamin C by 69, thus enhancing by one-third this measure of treatment outcome. Mean weekly alcohol consumption was reduced by 162 units with disulfiram, compared with 105 units with vitamin C, and the disulfiram patients reduced their total six-month alcohol consumption by 2572 units compared with an average reduction of 1448 units in the vitamin C group. Serum gamma-GT showed a mean fall of 21 IU/I in patients on disulfiram but rose by a mean of 13 IU/I with vitamin C. Unwanted effects in the disulfiram group led to a dose reduction in seven patients and to treatment withdrawal in four (and in one vitamin C patient). Two-thirds of the disulfiram group asked to continue the treatment at the end of the study. There were no medically serious adverse reactions.

A survey of patients' attitudes towards inpatient psychiatric ward rounds.

Attitudes towards the multidisciplinary ward round were assessed in fifty psychiatric inpatients, from two wards, using a semi-structured interview. About three quarters of them had at least a moderately favourable impression of the ward round but more than half would still prefer not to be interviewed in this way. Levels of anxiety and perceived helpfulness were positively correlated. Afro-Caribbeans found the interview significantly less helpful, less understandable and less memorable. Men found it less helpful than women and there were differences found between the two wards. Possible explanations for these findings are discussed.

A survey of patients' attitudes towards inpatient psychiatric ward rounds

Attitudes towards the multidisciplinary ward round were assessed in fifty psychiatric inpatients, from two wards, using a semi-structures interview. About three quarters of them had at least a moderately favourable impression of the ward round but more than half would still prefer not to be interviewed in this way. Levels of anxiety and perceived helpfulness were positively correlated. Afro-Caribbeans found the interview significantly less helpful, less understandable and less memorable. Men found it less helpful than women and there were differences found between the two wards. Possible explanations for these findings are discussed. (AU)

Patients leaving hospital without the knowledge or permission of staff--absconding.

A series of 100 consecutive psychiatric in-patients who absconded from a psychiatric hospital a total of 231 times over ten months was studied. The reasons given for absconding, duration of absence, and mode of return are described. The legal status and ethnic origins of absconders differed significantly from those of the base hospital population.

Inhibitory effect of substituted aromatic hydrocarbons on adherence of Escherichia coli to human epithelial cells.

Adherence of Escherichia coli to epithelial cells is postulated to be a necessary step in the pathogenesis of urinary tract infections. Investigations have focused on the role of carbohydrates in adherence because of the ability of mannose to inhibit adherence; however, there have been several reports of an additional hydrophobic receptor. Here we describe the inhibition of adherence mediated by substituted aromatic hydrocarbon compounds and the relationship of our findings to support the role of a postulated hydrophobic-binding domain.

Maggot in the salt, the snake factor and the treatment of atypical psychosis in West African women.

We describe psychotic illness in a Nigerian and a Togoese woman respectively. Although the clinical presentation was familiar to the clinical team, neither responded to conventional methods of treatment. Detailed ethnic enquiry revealed cultural beliefs which had a profound impact on each illness. Swift recovery occurred after repatriation. Eisenbruch (1983) has reported a case of 'wind illness' in a paper described as a 'study of psychiatric anthropology', which stresses the importance of understanding the patient's own view of his illness and it causes, in arriving at the correct diagnosis and intervening effectively. We describe here two cases of atypical psychosis in West African women, which lead us to endorse this view; as in his case, Western medicine proved useless, although complete recovery occurred once both had been repatriated.

Mannose-sensitive adherence of Escherichia coli to epithelial cells from women with recurrent urinary tract infections.

The effect of D-mannose on adherence of 73 Escherichia coli strains to vaginal and buccal epithelial cells from women with recurrent urinary tract infections, and on agglutination of human and guinea pig erythrocytes was tested. Urinary, vaginal or anal isolates from women with such infections were used. Of the strains 66 (90 per cent) demonstrated adherence to epithelial cells. D-mannose inhibited completely the adherence of 25 strains (42 per cent) that adhered to vaginal cells and inhibited an additional 11 strains (18 per cent) by at least 50 per cent. Similar results were obtained with buccal cells. The inhibitory effect of D-mannose was similar regardless of the origin of the strains. Hemagglutination frequently was inhibited by D-mannose but no consistent association between hemagglutination, and epithelial cell adherence and the effect of D-mannose was observed. The results suggest that mannose-sensitive as well as mannose-resistant adhesins frequently mediate Escherichia coli adherence to vaginal epithelial cells, and may contribute to vaginal colonization and cystitis.

Variable adherence of uropathogenic Escherichia coli to epithelial cells from women with recurrent urinary tract infection.

The adherence of 74 Escherichia coli strains to vaginal and buccal epithelial cells from women with recurrent urinary tract infections was studied. The strains were isolated from the urine, vaginal introitus or anal mucosa of women with recurrent bacteriuria. Vaginal and anal isolates were judged to be associated with urinary tract infection if they had the same biotype and serotype as the strain isolated subsequently from the urine. Adherence levels of urinary and anal isolates, and vaginal isolates associated with urinary tract infection were similar for vaginal and buccal cells. Adherence of vaginal isolates not associated with urinary tract infection was significantly lower than adherence of urinary isolates for vaginal (p less than 0.001) and buccal (p less than 0.005) epithelial cells. A positive nonlinear correlation between vaginal and buccal adherence was observed for urinary (r equals 0.87, p less than 0.0001), vaginal (r equals 0.70, p less than 0.0005) and anal (r equals 0.32, p equals 0.047) isolates. Strains of O-serogroups commonly and less commonly associated with bacteriuria had similar adherence. The results suggest that adherence of vaginal isolates is associated with the ability to cause urinary tract infections. The strong correlation between vaginal and buccal cell receptivity suggests that susceptibility to such infections may be controlled by genotypic traits.

Ultrasonographic features of prostatic carcinoma.

Over an 18-mo period, 93 prostate examinations were performed by a suprapubic transabdominal approach. By applying ultrasonographic tissue textural analysis, we were able to identify 16 out of 19 carcinomas. Most of these analyses showed ill-defined focal abnormalities located either in the posterior or the posterior-lateral portion of the gland. Ten of the analyses demonstrated increase echogenicity, while six demonstrated decreased echogenicity. Irregularity of the capsule was an unreliable sign in determining capsular invasion. The degree of extension appears to be better evaluated by computed tomography (CT). In conclusion, transabdominal ultrasound holds promise in the detection of prostatic carcinoma, while staging should be done by CT.

Use of computerized tomography in the evaluation of filling defects of the renal pelvis.

Computerized tomography has been used in the evaluation of 5 patients with radiolucent masses of the collecting system. There were 3 cases of renal calculi. 1 peripelvic cyst and 1 squamous cell carcinoma of the renal pelvis. The results of computerized tomography scanning are correlated with the results of excretory urography and ultrasonographic scanning. The diagnostic advantage of computerized tomography scanning for evaluation of radiolucent masses of the upper collecting system is elucidated.

Adhesion of uropathogenic Escherichia coli to epithelial cells from women with recurrent urinary tract infection.

Adherence of Escherichia coli to human uroepithelial cells obtained from the midstream urine of healthy women, nd to vaginal and buccal cells obtained from 11 healthy women and 24 patients who had had at least three urinary tract infections in the preceding year was studied. Bacteria labeled with [3H] uridine were used, and unattached organisms were separated from the epithelial cells by vacuum filtration through a polycarbonate membrane filter (5-micrometers-pore-size). A day-to-day variation in the receptivity of uroepithelial cells was noted. The range and rapidity of change in adherence to both vaginal and buccal cells were greater in patients than in controls. Adherence to vaginal cells was greater in patients than in controls (10.1 +/- 0.92 vs. 3.8 +/- 0.47 bacteria per cell [mean +/- S. E.], P less than 0.001), as was adherence to buccal cells (1.7 +/- 1.29 vs. 7.1 +/- 0.49, P = 0.002). There was a very strong, positive non-linear correlation between vaginal and buccal cell receptivity (R = 0.87, P less than 0.0001). The data suggest that susceptibility in women to urinary-tract infections is associated with widespread, fluctuating changes in the adhesive characteristics of epithelial cells.

Ultrasound of the prostate. Analysis of tissue texture and abnormalities.

Thirty-nine patients with benign prostatic hypertrophy, prostatic carcinoma, or prostatitis underwent ultrasonography using a transabdominal suprapubic approach. In both benign hypertrophy and prostatitis, the gland was enlarged and exhibited a homogeneous echo pattern, being hypoechoic in prostatitis and either hypo- or hyperechoic in hypertrophy. Carcinoma was characterized by focal areas of increased or decreased echogenicity with irregular margins. The various sonographic appearances are explained by correlation with the histological findings, and the advantages of the transabdominal approach are discussed. The authors suggest that widespread application of this technique will improve early detection of prostatic carcinoma.

Long-term survivor of prostatic carcinoma with lung metastases.

A patient with stage D2 carcinoma of the prostate is presented with biopsy-proved pulmonary metastases. Treatment consisted of hormonal therapy in the form of orchiectomy and ethinyl estradiol and he is alive 14 years later without evidence of disease. The pulmonary manifestations of prostatic carcinoma are discussed as well as the prognostic implications. This long-term survival, in view of the patient's initial presentation, makes this case unique.

Testicular torsion: the role of radioisotopic scanning.

Radioisotopic scortal scanning was used as a triage maneuver to assess 18 boys with scrotal and/or testicular complaints. In 4 puberal boys the diagnosis was torsion and treatment consisted of orchiectomy because of testicular necrosis. This technique proved to be of value in studying infants and older children. It appears to be highly reliable and accurate. We believe that it should be used in making the diagnosis of non-operable conditions, such as epididymitis and idiopathic scrotal swelling, thereby avoiding an unnecessary operation.