Gaslighting in alleged assault ascertained as Munchausen syndrome transcending to malingering in highly counterintuitive self inflicted acid burns.

A factitious disorder leading to the self-infliction of highly counter-intuitive burns was diagnosed in a middle-aged female. The injuries were otherwise alleged to have been sustained by assault inflicted upon her by an unknown person. The case was diagnosed by medico-legal interpretation of injuries, in spite of a highly deceptive and concocted history by the patient and her husband. The entity was unique in being associated with magnificent primary, secondary and tertiary gains. The exploitation of the morbid sequel to malinger by the patient, and the involvement of the husband for the prolongation of the illness of his wife for financial gains as gaslighting was highly unusual. The self-infliction of injuries over hands is seen in factitious disorder. However, a combination of a guarded self-immersion of the hands and feet in a corrosive by an illiterate female, followed by malingering to earn livelihood is unprecedented in factitious disorders. The delayed presentation which required amputation of all the limbs to save the life of the patient is a glaring highlight of this case.

Effect of cimetidine on weight gain in rats.

Effect on food intake and body weight was studied in rats after oral administration of cimetidine. Rats in experimental (E) group exhibited less increase in food intake (20%) compared to control (C) rats (43.8%). Mean body weight showed first reduction (-9.56%) and then very small increment in experimental animals compared to gradual gain in body weight in control animals. At the end of 6 weeks, total gain in body weight was 22.5 gm in rats of E group against 53.8 gm in rats of C group. Food efficiency ratio (FER) showed much reduction (1.13) in E group against 2.07 in C group. These results demonstrate that cimetidine (H2-receptor blocker) may have ability to reduce food intake and body weight in rats.

Pulse wave velocity and lipid profile in varicose vein patients.

In 20 varicose vein patients, aged twenty-five to forty-five years, and suffering the disease for more than two years, pulse wave velocity (PWV) of the femoral-dorsalis pedis artery of the lower limbs was measured and compared with that of 20 age-matched normal subjects. Blood pressure and fasting serum total cholesterol level, triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL) were also estimated for these subjects. PWV showed a significant increase (P < 0.001) in varicose vein patients as compared with control subjects. There was no significant difference either in the blood pressure or lipid profile. It appears that neither hypertension nor atherosclerosis is responsible for the increase in PWV in varicosities. On the basis of the present study, it may be suggested that arteries are also involved in the pathogenesis of varicose veins. The involvement of the arterial tree in the pathogenesis of varicose veins, if given due consideration, may add a new dimension to the understanding of many ill-defined facets of this disease.

Effect of vitamin D repletion on testicular function in vitamin D-deficient rats.

Freshly weaned 30-day-old male Wistar rats were fed a vitamin D-deficient diet adequate in calcium and phosphorus for 3 months. On the 120th day of age three different doses of vitamin D were injected intramuscularly into three groups of rats and maintained for another month with water and a normal diet ad libitum. One group was continued with a vitamin D-deficient diet up to the 150th day. One group of animals was killed by decapitation on the 120th day and testicular functions like sperm count in testis and epididymis, testicular glutamyl transpeptidase activity and Leydig cell count as well as body weight were noted. On the 150th day animals of all groups were killed and testicular function was studied. Body weight and testicular function decreased significantly on the 120th and 150th day of age in vitamin D-deficient rats as compared to age-matched normal control rats. Injection of lower doses of vitamin D on the 120th day of age improved testicular function after 1 month whereas administration of a high dose of vitamin D caused a deterioration of the testicular function. The result suggests that retardation of spermatogenesis due to disturbances in Sertoli and Leydig cell function in vitamin D deficiency is reversible and can be corrected by supplementing an optimal dose of vitamin D.

Autonomic functions in chronic severe anaemia.

The autonomic functions were evaluated in uncomplicated chronic severe anaemia. Elevation of heart rate and systolic blood pressure without any alteration of diastolic blood pressure were observed in anaemics as compared to control group. Expiration/inspiration ratio and BVL did not show any significant difference in two groups. The results suggest possibility of increased activity of sympathetic part out of two divisions of autonomic nervous system.

Circanual variation of sperm count and motility in men.

Seasonal variation in rhythmicity of spermatogenesis might be due to external temperature fluctuation which could partially be responsible for decreased sperm counts in summer. Other factor like exposure to light might contribute for the reduction in sperm counts. These facts should be taken into account before diagnosing male fertility.

Vasopressin antagonist disrupts the circadian rhythm of water intake on suprachiasmatic injection.

The present study makes an attempt to find out the action of arginine vasopressin (AVP) and its antagonist d-(CH2)5 Tyr (Me) AVP applied at the suprachiasmatic nuclei (SCN) on the circadian rhythm of water intake. Chronic implantation of a 22 G stainless steel cannula for injection was performed using a stereotaxic technique under Nembutal anesthesia. AVP and its antagonist were injected into the SCN of free-moving rats at the beginning of light and dark phases of the light-dark (LD) cycle. Injections of AVP during either phase did not disrupt the circadian pattern of water intake while the injections of the antagonist disrupted it. The findings are suggestive of the involvement of AVP as a mediator of the circadian rhythm of water intake at the level of the neural pacemaker, SCN.

Changes in arterial blood pressure during traction of extra-ocular muscles. A study in rabbits.

A significant reflex fall in mean arterial blood pressure from baseline values was observed during extra-ocular muscle traction in rabbits. This effect could be abolished only by retrobulbar block (afferent pathway block) and not by vagotomy, intravenous atropine or glycopyrronium, suggesting that it is distinct from, and independent of, the oculocardiac reflex. We suggest that these reflex changes in blood pressure be known as the 'oculodepressor reflex'.

An experimental model of oculorespiratory reflex.

An experimental study of the oculorespiratory reflex (ORR) was conducted on 20 albino rabbits using a square wave (SW) type of stimulus. The ORR could be elicited in 100% of animals. The medial rectus was observed to be most reflexogenic for ORR. The frequency and pattern of ORR was not affected by bilateral vagotomy, intravenous atropine or glycopyrrolate, but could be completely abolished by retrobular block.

Cardiovascular responses to cold pressor test: a test for autonomic functions.

Circulatory dynamics during the cold pressor test, done by immersing the hand in water at 5 degrees C for one minute, were studied in 30 male healthy volunteers. All the subjects responded to the test with statistically significant increase in blood pressure (22.04%, p less than 0.001), heart rate (11.21%, p less than 0.001), galvanic skin resistance (36.17%, p less than 0.001) and decrease in forearm blood flow (40.85%, P less than 0.001). The measurement of cardiovascular responses following cold pressor test constitutes another test which can be used to test the efficiency of the autonomic nervous system in various autonomic neuropathies.

Role of vagal and sinoaortic baroreflexes in restoration of arterial pressure after acute mild haemorrhage in rabbits.

To evaluate the contribution of vagal and sinoaortic baroreflexes (SBR) in circulatory adjustments, anaesthetized rabbits were subjected to acute mild haemorrhage and the extent of recovery produced after haemorrhage was estimated. The recovery of arterial pressure after acute mild haemorrhage with reflexes intact was 96.19%, after elimination of SBR it was 79.20%, after bilateral vagotomy 87.38%, and after eliminating both reflex systems it was 75.66%. The results suggest that vagally mediated baroreflexes from cardiopulmonary baroreceptors contribute significantly in restoring the arterial pressure in response to haemorrhage while the sinoaortic baroreflexes play the major role.

Baroreceptor reflexes in postural control of circulation in rabbits.

The present study was undertaken to evaluate reflex cardiovascular responses to postural stress in rabbits. The changes in mean arterial pressure (MAP) and heart rate (HR) were monitored in the supine position and following sudden passive head up tilt (HUT), and head down tilt (HDT) to 70 degrees. The results show a significant increase in MAP (18.57%, P less than 0.001) and HR (2.92%, P less than 0.02) with HUT; and a marked decrease in MAP (43.48%, P less than 0.001) and HR (8.21%, P less than 0.001) with HDT (as compared to the values in supine position). The changes in MAP were found to be more marked than those in HR. The depressor responses to HDT were more marked than the pressor responses to HUT.

Decreased tolerance to orthostatic stress in diabetics.

Cardiovascular responses to head up tilt (HUT) were investigated in chronic diabetics (having disease of 8 to 10 years duration) and in control subjects. The parameters recorded were heart rate (HR), blood pressure (BP), forearm blood flow (FABF) and forearm vascular resistance (FAVR). Recordings were made first in the supine position, next after HUT, and thirdly in the recovery period after return to the supine position. Normal subjects responded to HUT by a marked increase in HR (P less than 0.001), decrease in FABP (P less than 0.001) and increase in FAVR (P less than 0.001). The diastolic blood pressure (DBP) and mean blood pressure (MBP) showed appreciable increase (P less than 0.001, P less than 0.01 respectively) without significant fall in systolic blood pressure (SBP). The maximum alteration in cardiovascular responses was observed immediately after HUT (within 15 sec). The cardiovascular responses to HUT in diabetics were found to be significantly impaired compared to control subjects. The impairment of cardiovascular responses in diabetics in indicative of autonomic neuropathy which can be detected by these tests before the development of clinical signs of the neuropathy.

A unique left-right flow imbalance compensation scheme for an implantable total artificial heart.

A new method has been developed for accommodating the difference between pulmonary and arterial flows in a totally implantable, hydraulically actuated total artificial heart (TAH). The left and right sides are alternately pumped, with concurrent filling of one pump and ejection from the other. A small hydraulic fluid chamber is used to compensate for the higher left sided flow. This chamber is incorporated into the left inflow of the TAH, with the flexing bladder in contact with atrial blood, and the hydraulic fluid communicates with the right sided hydraulic chamber. The volume of hydraulic fluid that enters and exits the latter chamber constitutes a corresponding reduction in the right sided blood chamber stroke volume. Placement of this compensation chamber in the left side inflow provides a negative feedback of the right sided flow, based on the left atrial pressure (LAP). Higher LAP (indicating too much right sided flow) leads to higher fluid flow to and from the compensation chamber and a lower right sided blood flow and vice versa. The hydraulic flow resistance can be preadjusted to yield a 15% flow difference at an LAP of 15 mmHg.

Noninvasive evaluation of left ventricular function in chronic severe anemia.

Left ventricular function was evaluated noninvasively in cases of chronic severe anemia (CSA) by recording systolic and diastolic time intervals (STI and DTI). These time intervals were recorded in 38 patients with CSA (hemoglobin below 7 g%), without cardiac decompensation, and in 30 control subjects. STI and DTI were measured from the simultaneous recordings of the apexcardiogram, carotid arterial pulse, electrocardiogram and phonocardiogram. The left ventricular ejection time was significantly prolonged (p less than 0.02), and associated with marked shortening of the PEP and reduction of the PEP/LVET ratio (p less than 0.001 in each case) in cases of CSA as compared to controls. Regarding the DTI, there was significant shortening of total filling time, slow filling time (p less than 0.001 in each case) and atrial systole (p less than 0.01) with no appreciable change in rapid filling time and isovolumic relaxation time. The SFT/RFT ratio and a/H ratio (the amplitude of the a-wave relative to the total height of the apexcardiogram) showed significant reductions (p less than 0.001 in each case). These changes in STI and DTI indicate enhanced left ventricular performance during diastole followed by faster and more complete relaxation during diastole in CSA.