[Overdosing of pipamperone from a squeeze bottle]. / Overdosering van pipamperon uit een knijpflacon.

BACKGROUND: Medication is not always delivered in a safe dosing format. Up to 33% of medication errors can be attributed to confusing packaging or labelling. CASE DESCRIPTION: A 6-year-old boy with ADHD, for which he was being treated with methylphenidate and pipamperone drops, was brought to the A&E department with signs of severe encephalopathy. He had apparently been given pipamperone in streams rather than in drops in the previous months. The pipamperone level in his blood was raised to toxic levels. The pipamperone drops were delivered in a plastic squeeze bottle (LDPE bottle), which makes correct dosing almost impossible. The treating psychiatrist and the prescribing GP had not noticed this medication error. The incident was reported to the Netherlands Pharmacovigilance Centre Lareb, the Netherlands Medicines Evaluation Board and the Portal for Patient Safety. A warning was also added to the Netherlands paediatric medication prescription website about pipamperone in a squeeze bottle. CONCLUSION: Drug packaging can be a cause of intoxication. The treatment provider should be aware of this in cases of drug intoxication.

Coherent control of vibrational transitions: discriminating molecules in mixtures.

Identifying complex molecules often entails detection of multiple vibrational resonances, especially in the case of mixtures. Phase shaping of broadband pump and probe pulses allows for the coherent superposition of several resonances, such that specific molecules can be detected directly and with high selectivity. Our particular implementation of coherent anti-Stokes Raman scattering (CARS) spectroscopy and imaging employs broadband pump and probe fields in combination with a narrowband Stokes field. We describe our approach for combining spectral phase shaping and closed-loop optimization strategies to perform chemically-selective microscopy. To predict the optimal excitation profile we employ evolutionary algorithms that use the vibrational phase responses of five distinct molecules with overlapping resonances and investigate the effect of phase instability on the optimization. We have recently shown that modified polynomials and orthogonal rational functions can give rise to improved contours for CARS fitness landscapes. Now, by considering the landscapes associated with different basis sets, we introduce two figures of merit to quantitatively rank basis functions in terms of their "appropriateness" for modeling nonlinear phase-shaped processes.

Application of spectral phase shaping to high resolution CARS spectroscopy.

By spectral phase shaping of both the pump and probe pulses in coherent anti-Stokes Raman scattering (CARS) spectroscopy we demonstrate the extraction of the frequencies, bandwidths and relative cross sections of vibrational lines. We employ a tunable broadband Ti:Sapphire laser synchronized to a ps-Nd:YVO mode locked laser. A high resolution spectral phase shaper allows for spectroscopy with a precision better than 1 cm(-1) in the high frequency region around 3000 cm(-1). We also demonstrate how new spectral phase shaping strategies can amplify the resonant features of isolated vibrations to such an extent that spectroscopy and microscopy can be done at high resolution, on the integrated spectral response without the need for a spectrograph.

Tall stature and duplication of the insulin-like growth factor I receptor gene.

Trisomy of 15q26-qter is frequently associated with tall stature and mental retardation. Here we describe a patient with such trisomy, without a partial monosomy of another chromosome. The tall stature in this patient is most probably caused by duplication of the IGF1R gene. A duplication of the IGF1R gene is not a frequent finding in patients with tall stature. In 38 patients with features of Sotos syndrome without NSD1 alterations, a duplication was found only once. This patient was already known to have an unbalanced 2;15 translocation. Looking for a duplication of the 15qter region is still worth consideration in patients with tall stature and features of Sotos syndrome without an NSD1 alteration, especially when there is craniosynostosis or marked speech delay.

High density lipoprotein fatty acids in dementia.

High density lipoproteins (HDL) are small plasma particles which may be able to pass through the blood-brain barrier. We have therefore studied the fatty acids of HDL in patients with dementia to determine whether the changes are consistent with those previously reported in brain tissue. The HDL phospholipid and the HDL cholesteryl ester both showed reduced concentrations of arachidonic acid (20:4n6) as compared to normal controls. HDL may be a useful plasma fraction for study of lipids in neurodegenerative diseases.

Cholesterol metabolism and violence: a study of individuals convicted of violent crimes.

To examine the relationship between plasma lipoproteins and apolipoproteins in men with convictions for violent offences, blood was obtained from 15 men with a history of violence who were serving prison sentences for violent offences, and 25 age-matched male controls from the staff of the Argyll and Bute Psychiatric Hospital, who had no criminal records. The two groups did not differ in plasma total cholesterol concentrations, HDL-C, LDL-C, VLDL-C or in HDL subfractions. The most significant differences in the offenders were higher apoprotein AIV (3.62 vs 0.85: p = < 0.000001) and higher apoprotein E (7.70 vs 5.19: p = < 0.0002).

Dominantly inherited microcephaly, short stature and normal intelligence.

A large family is reported in which microcephaly and short stature is segregating as a probably autosomal dominantly inherited trait. Some affected members also show a delayed onset of puberty. No other clinical or radiological symptoms are present, and psychomotor development is normal. This short report confirms an earlier description of a similar family by Burton in 1981.

Tin and fatty acids in dementia.

Serum elements and fatty acids of red cell and plasma phospholipids, cholesterol esters and high density lipoproteins, were studied in patients with Alzheimer's disease (SDAT) and with multi-infarct dementia (MID). Increased 20:4n6 in MID was the finding most consistent in the different tissues. The red cell phospholipids were more unsaturated in MID than in SDAT but in SDAT the plasma phospholipids were more saturated. Serum Al, Sn and V concentrations were higher in SDAT than in MID while serum Mn concentrations were higher in MID. Sn and V correlated negatively with the unsaturation index of the red cell phospholipids and Sn showed a striking pattern of correlations with the red cell phospholipid fatty acids in SDAT: it was significantly positively correlated with 16:0 and 18:1n-9 and negatively correlated with 20 and 22 carbon n-3 and n-6 essential fatty acids. Since we have shown elevated tin levels in patients with Alzheimer's disease, and since organic tin compounds given to animals produce a syndrome with similarities to Alzheimer's disease, there is a need for investigation of the role of tin in lipid metabolism in dementia.

Essential fatty acids in Alzheimer's disease.

Concentrations of essential fatty acids (EFAs) in plasma and red blood cell phospholipids were found to be abnormal in patients with Alzheimer's disease. A double-blind, placebo-controlled trial of treatment with EFAs plus appropriate antioxidants was carried out in 36 patients with Alzheimer's disease. After 20 weeks both the EFA and placebo groups had improved, but the degree of improvement was consistently greater in the EFA group.

Renal cell carcinoma in a multilocular renal cyst: a case report of a 27-year-old female and review of the literature.

A case of renal cell carcinoma in a multilocular renal cyst is reported. Excretory urography showed a mass, and ultrasound revealed multiple renal cysts in the middle part of the left kidney. This finding could also be visualized by computer tomography, a solid structure could not be detected. During operation a 6-cm multiloculated cyst was enucleated from the left kidney. A frozen section of the cystic lesion did not indicate a malignancy; however, further histopathological examination revealed a renal cell carcinoma, especially in the septal parts of the tumor.

[Ambulatory treatment and monitoring of children with insulin-dependent diabetes mellitus (IDDM)]. / De ambulante behandeling en begeleiding van het kind met insuline afhankelijke diabetes mellitus (IDDM).

In recent years diabetes research has made substantial progress. Insight in epidemiology, aetiology, patho-physiology of diabetes and pharmacokinetics of insulin is increased. Furthermore the development of self-monitoring has changed the management of diabetes. In this paper the consequences of this progress for modern ambulatory treatment of diabetes in childhood are discussed.

Liver damage in the hemolytic uremic syndrome.

During the recovery stage of the hemolytic uremic syndrome in 2 cases an increase of serum levels of GOT, GPT, LDH, gammaGT, 5'ND and AP was noticed, without signs of a recurrence of the disease. In one patient also jaundice and hepatomegaly were found. The observations suggest a parenchymal damage of the liver.