Dopaminergic and clinical correlates of pathological gambling in Parkinson's disease: a case report.

Dopaminergic medication for motor symptoms in Parkinson's disease (PD) recently has been linked with impulse control disorders, including pathological gambling (PG), which affects up to 8% of patients. PG often is considered a behavioral addiction associated with disinhibition, risky decision-making, and altered striatal dopaminergic neurotransmission. Using [(11)C]raclopride with positron emission tomography, we assessed dopaminergic neurotransmission during Iowa Gambling Task performance. Here we present data from a single patient with PD and concomitant PG. We noted a marked decrease in [(11)C]raclopride binding in the left ventral striatum upon gambling, indicating a gambling-induced dopamine release. The results imply that PG in PD is associated with a high dose of dopaminergic medication, pronounced motor symptomatology, young age at disease onset, high propensity for sensation seeking, and risky decision-making. Overall, the findings are consistent with the hypothesis of medication-related PG in PD and underscore the importance of taking clinical variables, such as age and personality, into account when patients with PD are medicated, to reduce the risk of PG.

Effect of sustained-release isosorbide dinitrate on post-prandial gastric emptying and gastroduodenal motility in healthy humans.

Nitric oxide (NO) is an inhibitory neurotransmitter released by non-adrenergic and non-cholinergic neurons that innervate the smooth muscles of the gastrointestinal tract. We examined whether NO, derived from a sustained-release preparation of isosorbide dinitrate, influenced gastric emptying and gastroduodenal motility after a meal. Eleven healthy volunteers participated in a double-blind, placebo-controlled, cross-over study. Each subject ingested 40 mg isosorbide dinitrate orally as a sustained-release formulation or oral placebo, in random order. Gastric emptying and gastroduodenal motility were measured using scintigraphic and manometric techniques. Isosorbide dinitrate did not change the area under the curve of gastric retention versus time, and did not influence the frequency of antral contractions as assessed at 15-min intervals or the integrated duodenal motility index, as recorded over consecutive 15-min periods. A 40 mg single dose of sustained-released isosorbide dinitrate does not seem to alter gastric emptying or gastroduodenal motility after a meal.

Anxiety level and severity of skin condition predicts outcome of psychotherapy in atopic dermatitis patients.

BACKGROUND: Atopic dermatitis (AD) is a skin disease associated with an increased anxiety level. Psychotherapy studies of AD patients report improvement in anxiety level and skin condition after psychotherapy. METHODS: This psychotherapy study investigated 32 adult AD patients with mild to severe AD. Sixteen participants received 6 months of brief dynamic psychotherapy, while 16 were controls. The participants were compared using Spielberger's State-Trait Anxiety Index (STAI) and Severity Scoring of Atopic Dermatitis Index (SCORAD) pre- and post-therapy, and at follow-up after 12 months. RESULTS: Initially, no outcome differences were found between the two groups; however, a post hoc multiple regression analysis indicated that AD patients with a higher intake level of trait anxiety (TA) showed greater improvement after psychotherapy, in terms of anxiety level and skin condition, than did AD patients with a low intake level of TA. Atopic dermatitis patients with a higher anxiety level, in the no-treatment group, were more likely to discontinue the program. CONCLUSIONS: The results suggest that AD patients with a higher anxiety level are more likely to improve their psychologic and dermatologic condition after psychotherapy, but are more vulnerable to nonadherence when no adequate psychologic treatment is offered. The results underscore the importance of proper psychologic assessment and treatment in addition to dermatologic treatment.

Results of a neurosurgical two-wall orbital decompression in the treatment of severe thyroid associated ophthalmopathy.

PURPOSE: Follow-up of patients with severe thyroid associated ophthalmopathy treated with a transcranial two-wall orbital decompression and reconstruction. METHODS: A two-wall transcranial orbital decompression was performed in 30 such patients (50 eyes). The patients were evaluated one month postoperatively, and long-term evaluation (median 14 months, range 2-54 months) was carried out. The main outcome measures were visual acuity, proptosis measured by Hertel ophthalmometry, soft tissue involvement, and restriction of eye motility. RESULT: Visual acuity improved rapidly in 28 of 32 affected eyes with normalization in 19 eyes (p<0.001). Worsening was not seen. Median proptosis was reduced by 4.0 mm, range 0-10.0 (p<0.001). Double vision was present in 24 patients before operation 14 of whom achieved binocular vision (p<0.001). Three patients had unchanged complaints and the double vision worsened in one patient. Seventeen of 20 patients on preoperative corticosteroid treatment discontinued this medication in relation to surgery. Complications included one case of perioperative minor stroke and two cases of facial nerve frontal branch palsy. CONCLUSION: The transcranial two-wall decompression is a simple, an efficient and a low-risk procedure for treatment of patients with severe thyroid associated ophthalmopathy.

An assessment of anxiety and dermatology life quality in patients with atopic dermatitis.

Anxiety is a prevalent psychological factor associated with atopic dermatitis (AD). AD patients generally suffer from a high anxiety level, and psychological treatment documents a positive effect on the anxiety level, as well as the course and management of the disease. The Dermatology Life Quality Index (DLQI) has been suggested as a relevant clinical measure in AD. This study investigated the relationship between the severity of AD, dermatological life quality and anxiety. Thirty-two adults suffering from AD were examined using the Severity Scoring of AD Index (SCORAD), the DLQI and the Spielberger State-Trait Anxiety Index (STAI). Twenty-two healthy controls were examined using the DLQI and STAI. Results showed that the AD group had higher anxiety and lower dermatological life quality than the control group. In the AD group a significant positive correlation was found between SCORAD and DLQI and between DLQI and STAI. However, no correlation was found between SCORAD and STAI. The results suggest that: (i) both severity of eczema and anxiety are important for dermatological life quality; (ii) psychological inferences should not be made from the severity of eczema, but from the psychological measures, and vice versa; and (iii) both dermatological and psychological assessment is important in AD.

[Scintigraphy of bleeding. The diagnostic value based on a 10-year period]. / Blødningsskintigrafi. Den diagnostiske voerdi ud fra en tiårsopgørelse.

The purpose was to examine the diagnostic value of 99mTc-labelled red blood cell scintigraphy for detection of gastrointestinal haemorrhage. In a retrospective investigation 85 patient files over a 10 year period (1.1.1984-31.12.1993) were evaluated. Data regarding the patients' clinical condition, number of blood transfusions, findings with angiography, gastroscopy, colonoscopy, proctoscopy, operation, x-ray of colon and autopsy were registered. A bleeding site was localized in 52% of the scintigraphies. Among these patients the scintigraphic localization was confirmed or made "very possible" in 65% by operation, autopsy or one of the other mentioned diagnostic modalities. Among the 25 operated patients the localization of the bleeding site was confirmed in 19 patients. In 40 patients with a "negative" scintigraphy a bleeding site was found in 10 patients 1-18 days after the scintigraphy by operation or one of the listed diagnostic modalities. It is concluded that 99mTc-labelled red blood cell scintigraphy is a valuable diagnostic tool for identification of acute gastrointestinal haemorrhage. Operation after scintigraphic guidance is well indicated. A "negative" scintigraphy can only exclude ongoing bleeding from the gastrointestinal tract.

Effects of isoniazid treatment on human lymphocyte proliferative response, lymphocyte subsets and natural killer cell activity.

The effect of isoniazid on proliferative response, natural killer (NK) cell activity and lymphocyte subset distribution of blood mononuclear cells (BMNC) was investigated. To evaluate the effect of treatment with isoniazid in pharmacologic concentrations, twenty healthy HIV-seronegative volunteers were randomized into two groups: one group received isoniazid tablets plus pyridoxin tablets once a day for 30 days, the other group received pyridoxin only. Blood samples were collected on day 0 and day 30. Inhibition of the PHA-induced proliferative response was demonstrated in lymphocyte cultures from isoniazid-treated volunteers (p < 0.001). However, no effect was seen on the IL-2- or antigen (PPD)-induced proliferative response or the NK cell activity of isolated BMNC. Inhibition of the PHA-induced proliferative response could not be related to changes in the distribution of CD3+, CD4+, CD8+, CD14, or CD19+ lymphocyte subsets. The effects, in vitro, were investigated by addition of isoniazid to cultures of BMNC isolated from either HIV-seroposive or HIV-seronegative donors who did not receive any treatment. We found that isoniazid did not influence the mitogen- or antigen-stimulated proliferative response or the NK cell activity.

Hypoglosso-facial nerve anastomosis.

The hypoglosso-facial nerve anastomosis (HFA) is a valuable surgical procedure for the treatment of certain types of facial paralysis. HFA was performed 1 to 22 months after resection of an acoustic neurinoma in 32 patients where the operation was complicated by unilateral facial palsy. 56% of these patients obtained excellent facial function, and a total of 66% were satisfied and would have repeated the operation even with their present knowledge about the disadvantages. The recovery of facial function after any nerve anastomosis or plastic procedure is never perfect but HFA usually results in symmetry of the face in response and animation of the face during conversation. HFA is most effective when used as soon as possible after facial palsy has developed, provided a sufficient time has passed for any possible spontaneous recovery. This waiting period should not exceed six months. If the operation is done promptly the results improve, probably because only slight atrophy has occurred in the facial muscles. The disadvantages of HFA are hemiatrophy of the tongue, mass movement of the face and, in some instances, hypertonia of the face. The advantages are improved facial tone with ameliorated cosmetic result, protection of the eye, intentional facial movements controlled by the tongue, and movements associated with physiological function of the tongue.