Background. Increased oxidative stress may play a role in morbidity and mortality of patients with renal failure. Most studies have examined serum markers of oxidation, but it is unclear whether oxidative stress is involved in skeletal muscle atrophy. Methods. This study examined markers of oxidative stress in the skeletal muscle of 10 haemodialysed patients and 10 control subjects. Biopsies from the quadriceps femoris were analysed for reduced and oxidized glutathione, protein thiols, malonaldehyde and heat shock proteins (HSP27, HSP60 and HSP70), superoxide dismutase and catalase activities. A novel microdialysis procedure was used to examine hydroxyl radical activity in the interstitial fluid of the tibialis anterior . Results. Patients had muscle atrophy with a reduced diameter of both type I and II fibres (by 15 and 20%, respectively). Muscle microdialysates contained 2,3- and 2,5-dihydroxybenzoates formed from salicylate indicating hydroxyl radical activity, with no differences between patients and control subjects. Muscle protein thiol and oxidized glutathione contents were unchanged in patients, but malonaldehyde content was reduced. In contrast, total muscle glutathione and heat shock protein contents were increased. Muscle superoxide dismutase activity was unchanged, but catalase activity was reduced in patients. Conclusions. The muscle of patients undergoing haemodialysis undergoes some adaptive responses in total glutathione content, heat shock protein content and catalase activity that are potentially related to chronic oxidative stress. However, there is no evidence of gross oxidation, nor any clear relationship between oxidative stress and muscle fibre atrophy, arguing against a direct role of oxidants in the degenerative processes.

Use of the diagnosis of Parental Alienation Syndrome (PAS) in family law cases has generated substantial debate. When one parent alleges the other is alienating a child or committing a similar wrongdoing, it is incumbent upon the attorneys within the adversarial process to explore and challenge the factual basis of both positions. In cases involving PAS, not only is the diagnosis of PAS questioned in predictable ways in the courtroom, the critique often extends on a more personal level to the syndrome's originator, Richard Gardner, M.D.(1) Much of the literature often considered by courts as authoritative in challenging Gardner or PAS is based on opinion rather than fact. Recently published articles contain criticisms and even misconceptions of PAS, and in some cases are critical of Gardner himself. To sort through the misconceptions, they have been extracted from various sources and cataloged below. Following each "myth" is a counter argument that places each criticism in context. Myth #1: PAS is not in the DSMIV and therefore does not exist. The DSM-IV is the diagnostic manual for all mental health providers. It is re-written every 10 to 12 years, and is the collaborative result of committees of mental health professionals reviewing the most recent scientific literature on all psychiatric disorders. The committees make recommendations on modifications of symptom lists for the diagnosis of a disorder, consider the inclusion of newly identified disorders, and in some cases remove disorders from classification. The argument is that since PAS is not in the DSM-Iv, it does not exist. The DSM-IV, was published in 1994, with its committees first meeting from 1991 to 1993.(2) The first publication on PAS appeared in 1987.(3) At By J. Michael Bone, Ph.D., Winter Park that time there were understandably too few published articles and research studies on PAS to warrant its inclusion into the DSM-Iv. It is also important to note that inclusion into the DSM is necessarily a very conservative and stringent process, requiring many years of study and publication in peer-reviewed journals. Research on PAS was still in its infancy at the time of the DSM-IV, and was never even submitted for consideration. Currently, there are in excess of 135 peer-reviewed published articles on PAS from over 150 authors, as well as numerous books either devoted to PAS or including it.