Primary total hip replacement: a comparison of a nationally agreed guide to best practice and current surgical technique as determined by the North West Regional Arthroplasty Register

BACKGROUND

In 1999, a statement of best practice in primary total hip replacement was approved by the Council of the British Orthopaedic Association (BOA) and by the British Hip Society (BHS) to provide a basis for regional and national auditable standards. We have compared practice in the North West Region of England to this document to ascertain adherence to this guide to best practice.

METHODS

A total of 86 surgeons from 26 hospitals were included in a questionnaire study.

RESULTS

A mean of 93.3% of operations were performed in the surgeon's usual theatre. All of these theatres had vertical laminar air flow systems. Of respondents, 42.2% routinely used exhaust suits, 68.1% routinely used impermeable disposable gowns, and 26.1% used impermeable re-usable gowns. The Charnley femoral and acetabular prostheses were the most commonly used prostheses. All surgeons used some form of anti-thromboembolic prophylaxis: 66.2% use a combination of both mechanical and chemical means. All surgeons used antibiotic prophylaxis. The most popular choice of antibiotic was a cephalosporin--70.7% used a 3-dose regimen over 24 h, 2.6% of surgeons continued antibiotic prophylaxis for 48 h after surgery, and 93.7% of surgeons routinely use antibiotic-loaded cement. All surgeons routinely cleaned, irrigated and dried the acetabulum and femur before cement insertion. Only one surgeon did not use any form of femoral canal occlusion. 69.4% used an intramedullary bone block. Retrograde filling of the femoral shaft by means of a cement gun was practised by 65.1%.

CONCLUSIONS

This study has demonstrated considerable variation of practice in total hip arthroplasty across the North West Region and significant divergence from the statement of best practice approved by the BOA and BHS. The introduction of a properly funded national hip register will surely help to clarify the effect of such diverse practice on patient outcome. We would recommend that all trusts locally audit their practices and correlate them with these nationally agreed guidelines.

PLACENTA PREVIA ACCRETA

Placenta accreta is defined as any placental implantation in which the placenta isabnormally and firmly adherent to the underlying uterine wall in part or in total. Theprobable cause is defective decidual formation as shown by its occurence in area wherethe endometrium is deficient or damaged.The commonest condition associated with it are placenta previa and previous caesareansection. A case of placenta previa accreta is described herewith in a 2nd gravida whoeventually needed emergency caesarean hysterectomy (total) due to profuse bleeding.Key Words: Placenta accreta, placenta, caesarean hysterectomy.

Analysis of Septic Abortion During Six Year Period(April 1992-1998) in Teaching hospital, Nepal

Abstract

CERVICAL CERCLAGE

ABSTRACT

UTERINE PERFORATION AS A SEQUEL TO REPEATED CURETTAGE FOR MOLAR

An 18 year old girl was subjected to emergency hysterectomy and unilateral salpingo-oophorectomy for uterine perforation because of repeated dilatation and curettagefor persisting vaginal bleeding following molar evacuation.As significant proportion of molar do progress into Gestational trophoblastic Neoplasiawhich in this case was choriocarcinoma; directs our attention to the fact that properfollow up of post molar cases using at least urinary beta HCG and institutingchemotherapy whenever necessary should be advocated in order to avoid such adrastic management.Key Words: Uterine perforation, molar, Gestational Trophoblastic Neoplasia (GTN)

A Double-Blind Comparison of Sinusoidal Wave and Brief-Pulse Electroconvulsive Therapy in Endogenous Depression

In a double-blind prospective study, 29 endogenously depressed patients (RDC) were randomized into sinusoidal wave (SW) and brief-pulse (BP) electroconvulsive therapy (ECT) groups. Bilateral modified treatments were administered on alternate days, three per week, and the treatment variables of current dosage and seizure duration were monitored for each treatment. Significantly more patients responded to SW than to BP ECT, but a comparable number of treatments was required to produce this response in the two groups. There was no difference in clinical or treatment variables between the SW and the BP groups, nor between ECT responders and nonresponders, with the exception that the SW-treated patients received larger doses of current per treatment than did the BP patients. For endogenous depression treated with ECT, we conclude that cumulative seizure duration may not be a parameter of significance, that overall rate of recovery in ECT responders is independent of stimulus waveform, and that some depressives may respond to SW but not to BP ECT. We suggest that the antidepressant effect of the ECT seizure may be characterized by a therapeutic window in current requirements; alternatively, a putative response threshold (again in terms of current requirement) may exist, which is higher in some patients than in others.

EEG alpha coherence and psychopathological dimensions of schizophrenia

The aim of this study was to evaluate the correlation between psychopathological dimensions in recent-onset neuroleptic-naive schizophrenic patients and EEG alpha coherence in the resting state. 37 neuroleptic-naive recent-onset schizophrenic patients were assessed on the Scale for the Assessment of Negative Symptoms and the Scale for the Assessment of Positive Symptoms, and psychopathological dimension scores on reality distortion, psychomotor poverty and disorganization were calculated. EEG alpha coherence was computed across 14 intra-hemispheric and 8 interhemispheric electrode pairs in the resting eyes closed and eyes open conditions. The relationship between the psychopathological dimension scores and coherence values was assessed using Pearson's product moment correlation with Bonferroni correction for levels of significance. Significant associations between higher psychomotor poverty scores and lower inter-hemispheric coherence values were found across the central and parietal regions in the eyes closed condition and across central regions in the eyes open condition. Reality distortion and disorganization dimensions were not significantly correlated with intra- or inter-hemispheric coherences in both eyes closed and eyes open conditions. However there was a trend for an inverse correlation between disorganization dimension and intra-hemispheric coherence across left frontal, left temporo-parietal and right parieto-occipital regions in the eyes open condition. These findings suggest a possible differential pattern in the extent of brain involvement across the three psychopathological dimensions of schizophrenia in neurolepticnaive patients with recent-onset illness.

Central nervous system stimulatory action from the root extract of Plumbago zeylanica in rats

The effects of a 50% ethanol extract of the root of Plumbago zeylanica (P. zeylanica) were investigated on locomotor behaviour and central dopaminergic activity in rats. The effects on the ambulatory behaviour were assessed along with the levels of dopamine (DA) and its metabolite homovanillic acid (HVA) in the striatum after a single oral dose (100, 200 and 300 mg/kg body weight) of the extract. The extract significantly increased the spontaneous motility in animals. The ambulatory and rotatory behaviour in the treated groups were higher than in the control group (p < 0.05). There were marked differences in the ambulatory behaviour between 100 and 300 mg/kg, indicating that the responses were stimulatory and dose-dependent. The stereotypic behaviour which is characteristic of a dopamine agonist showed biphasic effects. However, there was no significant difference between the groups (p > 0.05). The results showed that the extract of the root of P. zeylanica specifically enhanced the spontaneous ambulatory activity without inducing stereotypic behaviour. The neurochemical estimations revealed elevated levels of DA and HVA in striatum compared with the control rats (p < 0.01). The levels were higher for the 100 mg/kg treated group than the other groups. The levels declined by increasing the dosage of the extract to 200 mg/kg and 300 mg/kg, however, these levels remained higher than the control group. The relationship between motor activity and levels of dopamine are not parallel. These behavioural and biochemical results indicated stimulatory properties of the extract of the root of P. zeylanica, which may be mediated by dopaminergic mechanisms in the rat brain.

Pharmacological study on antidepressant activity of 50% ethanol extract of a formulated ayurvedic product in rats

The effects of 50% ethanol extract of one formulated ayurvedic product, consisting of a mixture of medicinal plant species, was investigated on behavioral despair test (forced swimming test, FST), central dopaminergic and serotonergic activity in rats. The effects on the forced swimming test were assessed along with the levels of dopamine (DA), serotonin (5-HT) and its metabolites homovanillic acid (HVA) and 5-hydroxyindoleaceticacid (5-HIAA) in striatum, frontal cortex, hippocampus, hypothalamus and brain stem after 21 days of chronic oral administration of the extract (500 and 1500 mg/kg-body weight). The extract significantly increased climbing behavior at 500 mg/kg and increased swimming behavior by reducing immobility time at 1500 mg/kg when compared with the control group in forced swimming test (P<0.05). This showed that the active substances present in 50% ethanol extract of the ayurvedic preparation possess antidepressant activity and their specificity towards particular behavior, depends on the concentration of the extract. Further it showed that the enhancement of active behavior in FST is not due to generalized motor activity. The neurochemical estimations revealed the swim stressor inducing alterations in the levels of DA, 5-HT and their metabolites HVA and 5-HIAA in the brain regions assayed as compared with the non-stressed control rats. These changes were prevented extract treated rats. The 500 mg/kg extract treated group had significantly increased the levels of DA in frontal cortex, hypothalamus and hippocampus whereas the 5-HT in hypothalamus (P<0.05). However, there were no significant changes in the levels of HVA and 5-HIAA. These behavioral and biochemical results indicate antidepressant properties of the extract, which may be mediated by the dopaminergic and serotonergic mechanisms in rat brain.

Significance of time scales in nonlinear dynamical analysis of electroencephalogram signals

We propose to show in this paper, that the time series obtained from biological systems such as human brain are invariably nonstationary because of different time scales involved in the dynamical process. This makes the invariant parameters time dependent. We made a global analysis of the EEG data obtained from the eight locations on the skull space and studied simultaneously the dynamical characteristics from various parts of the brain. We have proved that the dynamical parameters are sensitive to the time scales and hence in the study of brain one must identify all relevant time scales involved in the process to get an insight in the working of brain.

The nature of dominant Lyapunov exponent and attractor dimension curves of EEG in sleep

The dynamical behaviour of the brain is currently being viewed from the perspective of nonlinear dynamics. There are several reports of low dimensional chaotic activity in various states of human behaviour. The time evolution of chaotic systems exhibit many transitional states and brain is known to undergo a number of transitions in sleep. It evolves from random looking states to almost periodic states with an increase in the depth of sleep. There occurs intermittent random-like behaviour in REM (rapid eye movement) sleep. In this paper, we examine the transitional processes of brain activity in sleep from the patterns of attractor dimension (D2) and its corresponding dominant Lyapunov exponent (lambda 1) curves of EEG signals. Results indicate the occurrence of different degrees of chaoticity in the transitional states that may be related to various sleep stages. The chaotic parameter curves yield an objective measure of the neurodynamics of sleep comparable to an hypnogram. The parallelism of D2 and lambda 1 curves implies the validity of Kaplan-Yorke conjecture for EEG. It is suggested that the nonlinear dynamical measures of EEG may yield information about the nature of underlying neural processes of brain in sleep.

Detection of seizure activity in EEG by an artificial neural network: a preliminary study

Neural networks, inspired by the organizational principles of the human brain, have recently been used in various fields of application such as pattern recognition, identification, classification, speech, vision, signal processing, and control systems. In this study, a two-layered neural network has been trained for the recognition of temporal patterns of the electroencephalogram (EEG). This network is called a Learning Vector Quantization (LVQ) neural network since it learns the characteristics of the signal presented to it as a vector. The first layer is a competitive layer which learns to classify the input vectors. The second, linear, layer transforms the output of the competitive layer to target classes defined by the user. We have tested and evaluated the LVQ network. The network successfully detects epileptiform discharges (EDs) when trained using EEG records scored by a neurologist. Epochs of EEG containing EDs from one subject have been used for training the network, and EEGs of other subjects have been used for testing the network. The results demonstrate that the LVQ detector can generalize the learning to previously "unseen" records of subjects. This study shows that the LVQ network offers a practical solution for ED detection which is easily adjusted to an individual neurologist's style and is as sensitive and specific as an expert visual analysis.

Phenobarbital in the anticonvulsant dose range does not impair learning and memory or alter brain AChE activity or monoamine levels

The learning and memory in adult, male Wistar rats were assessed using the T-maze and passive avoidance tests after chronic administration of phenobarbital (PB) at 5, 15, 30, 60, or 75 mg/kg intraperitoneally (IP) for 21 days. The PB levels in plasma, the acetylcholine esterase (AChE) activity in the motor cortex, pyriform cortex, olfactory bulb, striatum, septum, and hippocampus and the levels of serotonin (5-HT), 5-hydroxyindoleacetic acid (5-HIAA), dopamine (DA), dihydroxyphenylacetic acid (DOPAC), and homovanillic acid (HVA) levels in the hippocampus were measured. There was no significant change in learning and memory, AChE activity, or monoamine levels at plasma PB levels of 1.5, 6.0, 9.0, and 25 micrograms/ml (corresponding to doses of 5, 15, 30, or 60 mg/kg PB, respectively). However, at a plasma level of 55 micrograms/ml (75 mg/kg), PB caused impairment in learning and memory. It was associated with an increase in AChE activity and 5-HT levels in the hippocampus. The results indicate that chronic PB administration may not be linked to impaired learning and memory functions at doses used in anticonvulsant therapy.

Patterns of attractor dimensions of sleep EEG

Low dimensional chaos is a property of many physiological oscillatory systems including the brain. Time series of sleep EEG records have been analyzed in the framework of recent developments in nonlinear dynamics. One of the characteristics of a chaotic time series is its attractor dimension. The running attractor dimension of a chaotic time series may reflect changes in states more accurately than manually scored records. In the present study the attractor dimensions of consecutive EEG segments of five sleep records were analyzed. The block of the EEG segment (window) was shifted by various lengths along the entire sleep data of each subject thus producing a running attractor dimension curve for each record. The attractor dimension values for different sleep stages were significantly different. The pattern of the running attractor dimension closely matched the scored hypnograms in these five sleep records.

Chronic phenytoin induced impairment of learning and memory with associated changes in brain acetylcholine esterase activity and monoamine levels

Groups of adult, male, Wistar rats were administered phenytoin (DPH) at 5, 12.5, 25, 50, or 75 mg/kg i.p. for 21 days. The learning and memory of these rats were assessed using the T-maze and passive avoidance tests. The plasma DPH levels, acetylcholine esterase (AChE) activity in different brain regions, and the levels of monoamines in the hippocampus were measured. The results indicate that DPH below the therapeutic plasma level did not significantly impair learning and memory. Correspondingly, no changes were noted in the brain 5-HT or AChE activity. However, DPH, at therapeutic plasma concentrations (i.e., 10.5 micrograms/ml in the dosage range of 50 and 75 mg/kg, respectively), significantly impaired learning and memory in rats. The impaired learning and memory functions were associated with increased 5-HT levels and decreased AChE activity in the hippocampus. With a dose of 75 mg/kg DPH, there was a reduction in the AChE activity in the striatum, in addition to hippocampus. It is conjectured that the neurochemical changes brought about by DPH at therapeutic plasma levels may account for the impairment of learning, memory, and cognitive functions in epilepsy.

Stress-induced changes in regional monoamine metabolism and behavior in rats

Groups of adult, male, Sprague-Dawley rats were subjected to either restraint at room temperature or cold restraint at 4 +/- 1 degree C for 2 h. Spontaneous motility, measured immediately after the stress, was decreased and defecation scores were increased in the cold restraint group but not in the restraint group. The rats were then sacrificed and prefrontal cortex, nucleus accumbens, and striatum dissected out. The levels of dopamine (DA), dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA), serotonin (5-HT), and 5-hydroxyindole acetic acid (5-HIAA) were measured in these areas by high performance liquid chromatography (HPLC) with electrochemical detection. DA levels were decreased in the prefrontal cortex (-68%), nucleus accumbens (-40%), and striatum (-76%) of the cold restraint group when compared to the controls. DA levels were decreased only in the prefrontal cortex of the restraint rats (-31%) when compared to the controls. The cold restraint group also had increased levels of DOPAC in the prefrontal cortex (+66%) and nucleus accumbens (+65%) and increased levels of HVA in the prefrontal cortex (+43%) when compared to the control group. Our results therefore indicate that cold restraint activates DA metabolism in the prefrontal cortex, nucleus accumbens, and striatum while restraint activates DA metabolism in the prefrontal cortex alone. Thus, cold restraint may be a more potent stressor than restraint alone.

Changes in learning and memory, acetylcholinesterase activity and monoamines in brain after chronic carbamazepine administration in rats

Groups of adult male Wistar rats were administered carbamazepine (CBZ) in doses of 5, 10, 20, 40 or 80 mg/kg/day intraperitoneally (i.p.) for 21 days. The learning and memory of the rats were assessed by the T-maze and passive avoidance tests. The CBZ plasma levels, the activity of acetylcholinesterase (AChE) in different brain regions, and the levels of monoamines in the hippocampus were also measured. None of the administered doses of CBZ impaired learning and memory. Rats with CBZ plasma levels of 2.5 and 4.5 micrograms/ml corresponding to the doses of 20 and 40 mg/kg, learned significantly better than controls. AChE activity was decreased in hippocampus and pyriform cortex (19%) in these groups. Simultaneously, an increase in the serotonin (5-HT) (36%) and dopamine (137%) levels in the hippocampus was noted in the 20-mg/kg CBZ group. 5-Hydroxyindole acetic acid (5-HIAA) and homovanillic acid (HVA) levels were increased at 10-, 20-, and 40-mg/kg CBZ doses. However, a dose of 80-mg/kg caused no change in learning performance as compared with that of controls. Correspondingly, no changes were evident in the AChE activity or monoamine levels. We postulated that the decreased AChE activity caused by CBZ in the therapeutic range may lead to increased ACh levels in brain, thus producing improvement in learning and memory. The increased turnover of 5-HT and dopamine (DA) in the hippocampus may play a role in long-term potentiation and improvement in memory.

Autoregressive spectral array for graphical display of EEG data

A graphical display of the frequency content of background electroencephalogram (EEG) activity is obtained by calculating the spectral estimates using autocorrelation autoregressive method and the classical Fourier transform method. Display of spectral content of consecutive data segments is made using hidden-line suppression technique so as to get a spectral array. The autoregressive spectral array (ASA) is found to be sensitive to baseline drift. Following baseline correction the autoregressive technique is found to be superior to the Fourier method of compressed spectral array (CSA) in detecting the transitions in the frequencies of the signal. The smoothed ASA gives a better picture of transitions and changes in the background activity. The ASA can be made to adapt to specific changes of dominant frequencies while eliminating unnecessary peaks in the spectrum. The utility of the ASA for background EEG analysis is discussed.

Data compression by linear prediction for storage and transmission of EEG signals

The EEG time series has been subjected to various formalisms of analysis to extract meaningful information regarding the underlying neural events. In this paper the linear prediction (LP) method has been used for analysis and presentation of spectral array data for the better visualisation of background EEG activity. It has also been used for signal generation, efficient data storage and transmission of EEG. The LP method is compared with the standard Fourier method of compressed spectral array (CSA) of the multichannel EEG data. The autocorrelation autoregressive (AR) technique is used for obtaining the LP coefficients with a model order of 15. While the Fourier method reduces the data only by half, the LP method just requires the storage of signal variance and LP coefficients. The signal generated using white Gaussian noise as the input to the LP filter has a high correlation coefficient of 0.97 with that of original signal, thus making LP as a useful tool for storage and transmission of EEG. The biological significance of Fourier method and the LP method in respect to the microstructure of neuronal events in the generation of EEG is discussed.

A nonlinear perspective in understanding the neurodynamics of EEG

The developments in nonlinear dynamics and the theory of chaos have considerably altered our perception and analysis of many complex systems, including the brain. This paper reviews the physical and dynamical aspect of brain's electrical activity from this new perspective and indicates possible future directions. The importance of emerging trends of nonlinear dynamics and chaos to neurobiology has been discussed in the context of various states of consciousness and behaviour. In the past, EEG analysis has been confined to descriptive stochastic statistics and any understanding of the transitional process of brain activities was either nonexistent or not amenable for investigation. With the developments in nonlinear dynamics, the chaotic dynamical parameters and trajectory behaviour will find their use as feature detection techniques in EEG. Furthermore, nonlinear dynamics provides a model for EEG generation and temporal prediction which will help in determining the nature of neuronal processes governing various states of brain activity. The formalism of globally coupled dynamic systems will find applications in modelling the transitional states of EEG.

Use of running fractal dimension for the analysis of changing patterns in electroencephalograms

Running fractal dimensions were measured on four channels of an electroencephalogram (EEG) recorded from a normal volunteer. The changes in the background activity due to eye closure were clearly differentiated by the fractal method. The compressed spectral array (CSA) and the running fractal dimensions of the EEG showed corresponding changes with respect to change in the background activity. The fractal method was also successful in detecting low amplitude spikes and the changes in the patterns in the EEG. The effects of different window lengths and shifts on the running fractal dimension have also been studied. The utility of fractal method for EEG data compression is highlighted.

Behavioral consequences of predictable vs. unpredictable shocks in rats

Adult, male, Sprague-Dawley rats were given either predictable or unpredictable footshocks coupled with predictable or unpredictable warning stimuli in a factorially designed experiment. The effect of footshocks on different parameters of motility was studied immediately, 1 h and 24 h later. Footshock-induced stress caused increases in the motility of rats, and this increase persisted for 24 h. Of the parameters studied, distance travelled and time spent in ambulatory behavior were significantly affected, but there was no difference between the predictably and unpredictably shocked animals in the pattern or time course of stress-induced locomotion changes. The defecation scores recorded in footshocked rats were lower than in controls in both the predictably and unpredictably shocked groups, but there was no difference between the predictably and unpredictably shocked groups. Lack of differences in motility and defecation between the two groups limits the usefulness of these parameters in behavioral experiments based on predictability of noxious stimuli.

Effect of disulfiram administration on brain tryptophan, serotonin and peripheral tryptophan content

The prophylactic deterrent effect of disulfiram (DS) has been attributed to its ability to exacerbate sympathetic function. Though there are reports to indicate that DS administration could as well affect the neurotransmitter metabolism, few reports implicate the possibility of central nervous system (CNS) mediated anticraving effect of the drug. The present study involving the oral administration of DS to rats for 45 days has clearly shown a significant increase in 5-HT (815.4 +/- 74.7 ng/g, P < 0.01) and 5-HIAA (506.1 +/- 86.3 ng/g, P < 0.02) contents in brain when compared to control rats. The observed increase in 5-HT and 5-HIAA content was found to correlate (zeta = 0.89) with the concomitant increase in brain tryptophan content (4.15 +/- 1.05 nmol/g, P < 0.001) following DS administration. Further, the study on peripheral tryptophan content has shown an increase in both total and free fraction (ultrafiltrate) of plasma, which in turn was found to have an inverse relationship (zeta = -0.94, P < 0.05) with the decrease in liver tryptophan content following DS administration. Thus the observed increase in brain 5-HT level is attributed to the ability of DS to mobilise peripheral tryptophan for 5-HT synthesis in CNS. As there are reports to imply the hyposerotonergic function as responsible for craving, the present findings, that DS could enhance the 5-HT metabolism in brain, may partially explain the CNS mediated anticraving effect of DS.

A mimetic-based frequency domain technique for automatic generation of EEG reports

This paper describes a novel mimetic technique of using frequency domain approach and digital filters for automatic generation of EEG reports. Digitized EEG data files, transported on a cartridge, have been used for the analysis. The signals are filtered for alpha, beta, theta, and delta bands with digital bandpass filters of fourth-order, cascaded, Butterworth, infinite impulse response (IIR) type. The maximum amplitude, mean frequency, continuity index and degree of asymmetry have been computed for a given EEG frequency band. Finally, searches for the presence of artifacts (eye movement or muscle artifacts) in the EEG records have been made.

Heterogeneity in plasma homovanillic Acid levels in schizophreniform disorder

Plasma homovanillic acid (pHVA) levels were estimated in 20 cases of schizophreniform disorder, 14 cases of schizophrenia 'on medication' and 17 cases of schizophrenia 'off medication'. A bimodal distribution of pHVA was seen in schizophreniform disorder subjects, suggesting heterogenous groups in terms of dopaminergic function. No significant difference in the pHVA values was seen in the 3 groups, nor was there a relationship between the severity of the illness and the pHVA values; these results suggest plasticity of the dopaminergic system to neuroleptics.

Correlations of motility, defecatory behavior and striatal dopaminergic activity in rats

The spontaneous motor activity, fecal pellet scores and content of dopamine and its metabolites, dihydroxyphenyl acetic acid and homovanillic acid in corpus striatum were measured in a group of randomly selected Sprague-Dawley rats. The spontaneous motility, fecal pellet scores and neurochemical parameters measured showed significant variations. The correlations between these parameters were investigated. A significant correspondence was seen between the motility, fecal pellet scores and the striatal dopaminergic activity. The implications of the behavioral models of motility and defecation scores in studying the central dopaminergic function is discussed. It is suggested that striatal dopaminergic activity may be responsible not only for motor activity but also may contribute to the de novo emotionality as expressed by the defecation scores in rats.

Single electroconvulsive shock and dopamine autoreceptors

Dopamine (DA) auto receptor down regulation has been suggested to mediate the therapeutic effect of antidepressant treatments including electroconvulsive therapy (ECT). Suggestion has also been made that a single ECT may have antidepressant potential via such a mechanism. The present study was therefore conducted to assess the effects ill a single electroconvulsive shock (ECS) on dopamine auto receptors in the rat brain. Using the low dose, Apomorphine-induccd by pomotilily behavioural paradigm, DA auto receptor function was studied one and eight days alter a single true ECS, and 8 days alter a single sham ECS. No significant difference was observed between the groups. The results suggest that single ECS exerts neither acute nor time-dependant DA auto receptor effects; however, the issue in certain aspects remains open for further study.

Dopamine postsynaptic receptor effects of restricted schedules of electroconvulsive shock

Little work is available on the acute and time-dependant dopaminergic effects of single electroconvulsive shock (ECS) and multiple ECS despite the posited clinical utility of such schedules of electroconvulsive therapy (ECT) administration and the posited role of dopaminergic mechanisms in iieuropsychiatric disorders. In this study, using the apomorphine-induced motility-alteration behavioural paradigm, single session multiple ECS was found to produce no significant effect while single ECS behaviourally downregulated dopamine postsynaptic receptor functioning one week after the ECS, which effect was also seen (albeit to a lesser extent) a further week later. These findings indicate a possible application of restricted schedules of ECT to dopamine postsynaptic receptor supersensitivity syndromes. Lines for future research are suggested.

Changes in the sensitivities of dopamine receptors to chronic treatment with imipramine & haloperidol in rats

Apomorphine induced locomotor activity was studied in Wistar rats treated with imipramine and haloperidol with the help of automated measuring devices. The control rats showed a biphasic response of hypomotility and sedation to low dose apomorphine, and hypermotility to high dose apomorphine. In chronic imipramine-treated rats, the hypomotility and sedative response to low dose apomorphine challenge was significantly attenuated (P less than 0.05), as compared to saline treated controls. A similar response was observed in the chronically haloperidol treated rats (P less than 0.01). However, there were no significant differences in motility responses to high dose apomorphine challenge between the control and experimental groups. These results suggest that presynaptic dopamine auto receptors may not be involved in mediating the loss of response to low dose apomorphine by chronic imipramine treatment. Imipramine being predominantly a monoamine uptake inhibitor and haloperidol a potent postsynaptic D-2 blocker, some indirect mechanisms may be involved in the loss of response to low dose apomorphine challenge.

Tardive dyskinesia: a potential new neurochemical animal model

Conventional neurochemical animal models of tardive dyskinesia are based upon the production of dopamine postsynaptic receptor supersensitivity by the chronic administration of neuroleptics. This study demonstrates that the same result is obtained by injecting Sprague-Dawley rats with a single ('high') dose of ipomorphine. It is hence suggested that apomorphine-induced time-dependant potentiation of dopaminepostsynaptic receptor response may be a more convenient neurochemical animal model of tardive dyskinesia; related theoretical and practical issues are discussed briefly, as also he methodological differences between the present study and an earlier report.

Behavioral and neurochemical differences in an inbred strain of rats

The spontaneous motility of 75 Sprague-Dawley rats obtained from an inbred strain was found to vary widely. To test the hypothesis that heterogeneity in motility is accompanied by heterogeneity in neurochemical and vegetative function variables, the median motility score was used to divide the animals into high and low motility groups. Subgroups of high and low motile animals were compared on fecal pellet scores and on dopamine, dihydroxyphenyl acetic acid and homovanillic acid content of the corpus striatum. Significant differences were obtained between the two groups, indicating that even in an inbred strain considerable heterogeneity (possibly representing further subtypes) may exist. The theoretical and experimental implications of these findings are discussed.

Initial response to ect as a predictor of outcome in endogenous depression

In a double-blind, prospective study, 29 patients with endogenous depression were treated with electroconvulsive therapy (ECT). The degree of attenuation in Hamilton Rating Scale for Depression scores after the first ECT was compared between ECT responders and non-responders at the end of the treatment course; a significant difference was obtained, indicating higher initial response in ECT responders. It is therefore suggested that response to a single trial ECT may form the basis for prediction of response of endogenous depression to a course of ECT. An operationalization of this concept is proposed, its sensitivity and specificity calculated, and its implications discussed.

Dopaminergic Effects of Repeated Electroconvulsive Shocks

Dopamine (DA) autoreceptor and postsynaptic receptor changes following repeated electroconvulsive shocks (ECS) were investigated in rats using the indices of low- and high-dose apomorphine-induced motility responses. Repeated ECS produced no changes in the DA autoreceptors; however, enhanced postsynaptic receptor-mediated responses were observed, suggesting increased sensitivity of the DA postsynaptic receptors.

Clinical prediction of rate of response of endogenous depression to electroconvulsive therapy

In depression, the identification of predictors of fast response is necessary to improve patient selection for ECT. In a double-blind, prospective study of 32 endogenously depressed patients treated with ECT, we attempted to identify the clinical characteristics of ECT responders which predicted fast (requiring ≤ 5 treatments to produce maximum recovery) and slow (requiring ≥ 6 treatments to produce maximum recovery) response to ECT. Of the 22 ECT responders in the study, 13 were fast and 9 were slow responders. We found that male sex, and greater age associated with lesser initial severity of depression were significantly associated with fast recovery. Surprisingly, factors suggested or expected to predict good outcome with ECT failed to predict fast outcome. Finally, the treatment variables of mean seizure duration and stimulus waveform were found to be unrelated to recovery rate. The findings are briefly discussed.

Psychobiology and therapeutic approaches to anxiety States

The current psychobiology and the therapeutic principles of anxiety states have been reviewed. The seprohippocampal system probably operates as the organ of match-mismatch comparator. A dysfunction of this internal comparator could possibly be the source of anxiety. There seem to be two distinct psychobiologic models for pain disorder and chronic anxiety state. The therapeutic responses of panic disorder to TCA and MAOI and the response to the chronic anxiety state to benzodiazepines supports the classification ot two distinct syndromes. However different provocative challenge tests have not clearly delineated the role of nor-adrenergic (NF) mechanisms in panic disorder and benzodiazepine receptor theory for chronic anxiety state. Challenge tests with receptor specific pharmacologic agents may reveal the molecular basis of these disorders unlike the tests with non-specific agents like lactate and caffeine.

Catatonia associated with uraemic encephalopathy

Catatonia is oily a clinical diagnosis with a variety of possible aetiological conditions. Among the many neuropsychiatric disorders in renal failure, catatonia is one which has not been established well. The authors report two cases in which despite strong evidence for primary psychiatric disorder, on investigation the catatonic state was found to be associated with ureaemic encephalopathy.

A report of subclinical psychological deterioration (a type of alcoholic dementia)

Alcoholics could present with various degrees of deterioration of cognitive functioning. The subclinical psychological deterioration had been one of the least recognized entities. This condition could be reversed or atleast arrested with treatment. The application of the term alcoholic dementia happened to be a misnomer for the clinical entity. A case of subclinical psychological deterioration that improved with treatment has been described here.

The relationships of plasma and erythrocyte sodium, potassium and lithium in lithium prophylaxis

The relationship of intracellular Na+ K+ Li+ to their extracellular concentrations had been studied on 22 cases bipolar affective disorders who had been on prophylactic lithium. 6 of these cases were nonresponders who were admitted repeatedly despite a therapeutic serum lithium values of 0.8-1.1 m moi/L. Parameters measured were Plasma lithium (Lp), Erythrocyte Lithium (Le), Plasma potassium (Kp), Erythrocyte potassium, Ke) Plasma sodium (Nae). Eli had been calculated by using Nerst's equation. Significant correlations have been obtained for dosage and Lp, Lp and Le, and Lp and Le/Lp. There were no significant difference between the responders and non-responders as regards to values of Le, Lp, Nap, Nae, Kp and Ke.

Treatment of mania with carbamazepine and lithium

A young manic patient who showed poor response to lithium, neuroleptics and ECT and developed severe cxtrapyramidal side effects restricting the use of neuroleptics in high doses; showed marked clinical improvement with a combination of carbamazepine and lithium with sustained recovery. The case reported to illustrate the possible synergistic action suggested earlier, encouraging the authors to take up a crossover trial.

A bi-compartmentl model system for lithium kinetics in mania

Lithium T½ has been determined from Lp decay. It is clear that calculation of a single T½ from Lp decay is essentially incorrect as the decay is not exponential. The same data points have been analysed on a kinetic model yielding 3 different half lives too. The implication of the study is that the plasma and the erythrocyte systems undergo many local steady states instead of any global steady state. The rate of movement of Li (+) across plasma and erythrocyte undergoes fluctuations and may exhibit many more different half lives over a time period in either direction.