The neurology of depression. Cognitive and behavioral deficits with focal findings in depression and resolution after electroconvulsive therapy.

Deficits in cognition and behavior have frequently been described in severely depressed patients. Recent reports have drawn attention to focal left-sided neurologic findings occurring in depression. We describe a depressed patient with marked cognitive and behavioral impairment and focal left-sided signs. The depression, mental status deficits, and physical findings all resolved after electroconvulsive therapy.

Thrombophlebitis and disturbed hemostasis following administration of intravenous hematin in normal volunteers.

PURPOSE: Acute porphyria episodes are routinely treated with hematin, but side effects, including disturbances of hemostasis and peripheral thrombophlebitis, are associated with the compound's use. Thrombophlebitis is particularly troublesome in patients who require repeated administration of hematin, and may eventually lead to the placement of central venous lines or implantation of indwelling venous access ports. We undertook this study to determine whether only patients with porphyria experienced peripheral thrombophlebitis and disturbed hemostasis following administration of hematin, or if this was a general phenomenon that could also be observed in normal volunteers. SUBJECTS AND METHODS: Hematin was administered intravenously in the doses customarily used in therapy of acute porphyria crises (4 mg/kg body weight) to nine normal male volunteers, who were screened by history, physical examination, routine blood cell counts, urinalysis, biochemical screening profile, and coagulation tests. Hemostasis tests were performed in each subject, and hematin concentrations were determined. RESULTS: Within the first 24 hours, the activated partial thromboplastin time was prolonged in all subjects (mean of 25 percent), the prothrombin time was increased in eight subjects (mean of 20 percent), and the thrombin time in five subjects rose (mean of 15 percent), whereas the concentration of circulating platelets decreased in three subjects (mean of 20 percent). In four subjects (45 percent), thrombophlebitis developed following hematin infusion. CONCLUSION: Although hematin is frequently effective in the treatment of acute porphyria crises, it is often associated with abnormalities in coagulation and these effects also occur in normal volunteers.

Hyperthyroidism in a patient with agitated depression: resolution after electroconvulsive therapy.

A patient with hyperthyroidism is described whose clinical presentation was that of agitated depression. Her psychologic abnormality and thyroid hyperfunction responded to electroconvulsive therapy.

Increased expression of basic fibroblast growth factor in squamous carcinogenesis of the head and neck is less prevalent following smoking cessation.

Basic fibroblast growth factor (bFGF), a potent angiogenic peptide, is thought to provide a growth advantage to a number of tumors including squamous cancer of the head and neck. The purpose of this study was to demonstrate the in situ expression of bFGF in lesions of the upper aerodigestive tract (UADT) and to correlate that with clinical parameters and known risk factors for carcinoma. On surgical specimens from 52 patients, we used a colorimetric in situ hybridization assay to determine the expression of bFGF mRNA in normal and pathologic conditions commonly seen in squamous mucosa. The extent of reactivity for the bFGF transcript was recorded on a subjective scale from 1+ to 3+, based on the visual intensity of labeling. These findings were subsequently correlated with clinical data. Basic fibroblast growth factor mRNA was detected at low to moderate levels in all sections of normal mucosa, with no distinction between patients with or without squamous cancer. Inflamed mucosa had comparatively strong expression of bFGF mRNA. Among lesions implicated in the stepwise nature of squamous carcinogenesis, we found increases in bFGF expression that were most significant at the level of carcinoma in situ, persisting through the invasive and nodal metastatic stages of the disease (P < 0.005). Interestingly, those increases were significantly less frequent among former smokers (P = 0.02). We have established the expression of bFGF mRNA in normal, inflammatory, and neoplastic tissue within the UADT. Furthermore, we note for the first time that increased expression is associated with the acquisition of more aggressive biologic behavior in squamous carcinogenesis.