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BACKGROUND: The need for more effective smoking-cessation interventions is firmly established. However, access to these services can be problematic in real life. E-mail messages may be a convenient alternative to deliver smoking-cessation interventions. The aim of this pilot study was to assess the effectiveness of incorporating tailored e-mail consultation messages in a smoking-cessation program for smokers willing to quit. METHODS: This pilot study examined the feasibility of integrating e-mail consultation messages in a smoking-cessation program for smokers willing to quit and with Internet access. At baseline, demographic data, smoking history and expired carbon monoxide (CO) levels were collected at a clinic visit. The subjects were provided with the specialist's e-mail address and instructed to prepare e-mail messages containing simple and clear information about their quitting progress. The counselor offered e-mail counseling throughout the smoking-cessation program. A 6-month follow-up visit was arranged, at which abstinence was reviewed. RESULTS: Of the 30 participants initially enrolled in the study, 21 (70%) attended the follow-up 6-month visit. E-mail counseling was more frequently offered (4-8 times) to the participants who completed the study, compared to those lost to follow-up (1-4 times). Comparisons with baseline exhaled CO values showed a significant within-group reduction at 6 months after smoking-cessation (P < .001) in the quitters, compared to smoking-cessation failures. Sustained smoking abstinence at 6 months was 37%. CONCLUSIONS: The integration of e-mail consultation counseling in a smoking-cessation intervention is feasible and effective. E-mail counseling as part of a smoking-cessation program warrants further evaluation. [ABSTRACT FROM AUTHOR]

Selective serotonin [5-hydroxytryptamine (5-HT)] reuptake inhibitors (SSRIs) and the 5-HT noradrenaline reuptake inhibitor, venlafaxine, are mainstays in treatment for depression. The highly specific actions of SSRIs of enhancing serotonergic neurotransmission appears to explain their benefit, while lack of direct actions on other neurotransmitter systems is responsible for their superior safety profile compared with tricyclic antidepressants. Although SSRIs (and venlafaxine) have similar adverse effects, certain differences are emerging. Fluvoxamine may have fewer effects on sexual dysfunction and sleep pattern. SSRIs have a cardiovascular safety profile superior to that of tricyclic antidepressants for patients with cardiovascular disease; fluvoxamine is safe in patients with cardiovascular disease and in the elderly. A discontinuation syndrome may develop upon abrupt SSRI cessation. SSRIs are more tolerable than tricyclic antidepressants in overdose, and there is no conclusive evidence to suggest that they are associated with an increased risk of suicide. Although the literature suggests that there are no clinically significant differences in efficacy amongst SSRIs, treatment decisions need to be based on considerations such as patient acceptability, response history and toxicity. [ABSTRACT FROM AUTHOR]

Lasthénie de Ferjol syndrome is a very rare psychiatric illness that occurs mainly in women. It is characterized by severe recurrent iron-deficiency anemia caused be repeated episodes self-induced blood-letting. We report the case of a young homosexual male repeatedly admitted to various hospitals for severe hypochromic anemia. We discovered that the anemia was indeed due to psychotic self-provoked hemorrhages. Based on this experience and a review of the few cases reported in the literature, we discuss issues of early diagnosis, management and treatment of Lasthénie de Ferjol patients.

We describe the clinical cases of two male subjects, respectively 73 and 41 years old, affected with insulinoma, misdiagnosed for many years as psychiatric subjects and scarcely responsive to therapy with benzodiazepins, antidepressants and antiepileptics. Although Whipple's triad was satisfied in both subjects since the onset of symptoms, they had to wait a long time for the correct diagnosis and appropriate treatment. Once the surgical therapy was carried out, our subjects recovered totally and ended the psycho-drugs.

We describe the case of a 70-year-old male with the catastrophic antiphospholipid syndrome admitted for skin gangrene of the fingers. The initial diagnosis was antiphospholipid antibody syndrome in a patient with rheumatoid arthritis and a history of deep vein thrombosis of the lower limbs. Liver involvement, the characteristic skin gangrene, pneumonia and worsening severe renal failure were determinant to make the final diagnosis of catastrophic antiphospholipid syndrome that led the patient to death.

A multiple case of Mandragora autumnalis poisoning is described. Mandragora autumnalis, a solanaceous plant that is common in the Sicilian countryside, contains a variable concentration of solanum alkaloids, which cause gastrointestinal irritation, and tropane alkaloids, which have anticholinergic properties and produce typical and sometimes severe atropine-like symptoms. Vital function support, decontamination, symptomatic treatment and, in severe cases, antidote therapy with physostigmine are useful to control acute poisoning.