Adolescent Onset of Acute Heart Failure

Heart failure in adolescents can manifest due to a multitude of causes. Presentation is often quite variable ranging from asymptomatic to decompensated heart failure or sudden cardiac death. Because of the diverse nature of this disease, a thoughtful and extensive evaluation is critical to establishing the diagnosis and treatment plan. Identifying and addressing reversible pathologies often leads to functional cardiac recovery. Some disease states are irreversible and progressive, requiring chronic heart failure management and potentially advanced therapies such as transplantation.

Metabolomics of Mouse Embryonic CSF Following Maternal Immune Activation

The cerebrospinal fluid (CSF) serves various roles in the developing central nervous system (CNS), from neurogenesis to lifelong cognitive functions. Changes in CSF composition due to inflammation can impact brain function. We recently identified an abnormal cytokine signature in embryonic CSF (eCSF) following maternal immune activation (MIA), a mouse model of autism spectrum disorder (ASD). We hypothesized that MIA leads to other alterations in eCSF composition and employed untargeted metabolomics to profile changes in the eCSF metabolome in mice after inducing MIA with polyI:C. We report these data here as a resource, include a comprehensive MS1 and MS2 reference dataset, and present additional datasets comparing two mouse strains (CD-1 and C57Bl/6) and two developmental time points (E12.5 and E14.5). Targeted metabolomics further validated changes upon MIA. We show a significant elevation of glucocorticoids and kynurenine pathway related metabolites. Both pathways are relevant for suppressing inflammation or could be informative as disease biomarkers. Our resource should inform future mechanistic studies regarding the etiology of MIA neuropathology and roles and contributions of eCSF metabolites to brain development.

Current State of Pediatric Cardio-Oncology: A Review

The landscape of pediatric oncology has dramatically changed over the course of the past several decades with five-year survival rates surpassing 80%. Anthracycline therapy has been the cornerstone of many chemotherapy regimens for pediatric patients since its introduction in the 1960s, and recent improved survival has been in large part due to advancements in chemotherapy, refinement of supportive care treatments, and development of novel therapeutics such as small molecule inhibitors, chimeric antigen receptor T-cell therapy, and immune checkpoint inhibitors. Unfortunately, many cancer-targeted therapies can lead to acute and chronic cardiovascular pathologies. The range of cardiotoxicity can vary but includes symptomatic or asymptotic heart failure, arrhythmias, coronary artery disease, valvar disease, pericardial disease, hypertension, and peripheral vascular disease. There is lack of data guiding primary prevention and treatment strategies in the pediatric population, which leads to substantial practice variability. Several important future research directions have been identified, including as they relate to cardiac disease, prevention strategies, management of cardiovascular risk factors, risk prediction, early detection, and the role of genetic susceptibility in development of cardiotoxicity. Continued collaborative research will be key in advancing the field. The ideal model for pediatric cardio-oncology is a proactive partnership between pediatric cardiologists and oncologists in order to better understand, treat, and ideally prevent cardiac disease in pediatric oncology patients.

Impact of orthognathic surgery on the body posture

BACKGROUND

Postural control is classically described as being based on the visual, vestibular, and proprioceptive musculo-articular sensory systems. The influence of mandibular proprioception on postural stabilization remains controversial. Most previous studies analyzed how postural stability is influenced by partial changes in mandibular proprioception (dental occlusion and jaw position).

RESEARCH QUESTION

In the present experiment, we asked whether drastic mandibular changes, resulting from orthognathic surgery (including dental, joint and muscular efferents), modify postural control.

METHODS

The analyzes were performed in 22 patients tested before, and 2.5 months, after orthognathic surgery for treatment of dysmorphic jaws. Experiments were performed under 4 experimental conditions: 2 visual conditions: Eyes Open (EO) and Eyes Closed (EC), and 2 occlusal conditions: Occlusion (OC: mandible positioned by the contact of the teeth), and Rest Position (RP: mandible positioned by the muscles without tooth contact). The analyses focused on head orientation in the frontal plane and on postural stabilization in a static task, consisting of standing upright.

RESULTS

The results show that, 2.5 months after orthognathic surgery, head orientation in the frontal plane was improved, since patient's external intercanthal lines became closer to the true horizontal line when they were tested EC and in OC condition. Postural responses, based on the wavelet transformation data, highlight an improvement in maintaining an upright stance for all the tested sensory conditions. However, such improvement was greater in the EC and RP conditions.

SIGNIFICANCE

These results show, for the first time, that after drastic mandibular changes, the weight of proprioceptive cues linked to the mandibular system may be so enhanced that it may constitute a new reference frame to orient the head in space, in darkness, and improve static postural stabilization, even in the presence of visual cues.

Upper aerodigestive tract cancer and oral health status before radiotherapy: A cross-sectional study of 154 patients

OBJECTIVES

We aimed to determine primarily the oral health status of patients with upper aerodigestive tract cancer before radiotherapy, and secondarily the prevalence of risk factors for poor oral status.

METHODS

A cross-sectional study was conducted in Marseille University hospital. Assessment criteria were the Decay, Missing and Filled (DMF) Index and periodontal status.

RESULTS

One hundred and fifty-four patients, mean age 60.9years, were included. The most common sites of primary tumors were the larynx (28.6%) and oral cavity (26.6%). Current or past smokers accounted for 80.5% of patients and 67% were alcohol abusers. Most patients (83.8%) did not have xerostomia. They ate three meals a day (61%), with sugar consumption in 40%. The median number of daily tooth brushings was 2, with a manual toothbrush (81.2%). Few patients used dental floss or interproximal brushes. Individual DMF index was 17.6 (D=2.3, M=9.3, F=6.0) and was higher in patients with xerostomia and alcohol abusers (P=0.01). Osseous level was 62.3% and 57.8% of patients had osseous infections, which were more common with poor hygiene (P=0.04). Most patients (85.7%) had periodontal disease, but incidence did not significantly differ according to risk factors.

DISCUSSION

The DMF index was higher in presence of periodontal disease and osseous infections. Alcohol and xerostomia were associated with a high individual DMF index and osseous infections were more frequent in patients with poor hygiene. Patients with upper aerodigestive tract cancer are at high risk of osteoradionecrosis if they do not receive dental treatment before radiotherapy.

Monitoring of the intra-dermal tuberculosis skin test performed by Belgian field practitioners

The present study aimed to monitor skin test practices as performed by veterinarian field practitioners in Belgium. For this purpose, an anonymous postal questionnaire was elaborated and dispatched to veterinarians involved in bovine tuberculosis detection. The questionnaire included items focusing on the skin test performance. International experts in the field of bovine tuberculosis were asked to fill the questionnaire and a scoring scale was built as follows: 0 = 'ideal' answer, 1 = acceptable answer, whereas 2 = unacceptable answer. Furthermore, experts were asked to rank the questionnaire's items according to their possible impact on the risk of not detecting reactors. A global score was further calculated for each participant and a comparison of practices was carried out between the two regions of the country, i.e. Wallonia and Flanders. Significant differences were observed between both regions, a harmonization at the country level is thus essential. No veterinarian summed a null score, corresponding to the ideal skin test procedure, which suggests that skin-testing is far from being performed correctly. Field practitioners need to be sensitized to the importance of correctly performing the test. The authors recommend the questionnaire is suitable for application in other countries or regions.

Effect of Dual Cure Composite as Dentin Substitute on the Marginal Integrity of Class II Open-Sandwich Restorations

Dual-curing composites may present a good alternative to RMGIC in open-sandwich restorations and act as a dentin substitute. However, this study showed that RMGIC remains the best intermediate material when open-sandwich restorations are indicated.

Effect of dual cure composite as dentin substitute on marginal integrity of class II open-sandwich restorations

The current study compared the marginal adaptation of Class II open-sandwich restorations with a RMGIC versus a dual-cure composite as dentin substitute. Class II cavities were prepared on 50 extracted human third molars. The teeth were randomly assigned to two groups of 25 teeth to compare one dual cure composite (MultiCore Flow) with one resin-modified glass-ionomer cement (Fuji II LC) in open-sandwich restorations recovered with a light cure composite. The teeth were thermomechanocycled (2000 cycles, 5 degrees C to 55 degrees C; 100,000 cycles, 50 N/cm2). The specimens were then sealed with a 1 mm window around the cervical margin interface. Samples were immersed in a 50% w/v ammoniacal silver nitrate solution for two hours and exposed to a photo-developing solution for six hours. The specimens were sectioned longitudinally and silver penetration was directly measured using a light microscope. The results were expressed as a score from 0 to 3. The data were analyzed with a non-parametric Kruskal and Wallis test. The degree of leakage significantly increased with MultiCore Flow (median 2) compared to Fuji II LC (median 1). Resin-modified glassionomer cements remain the best intermediate material when open-sandwich restorations are indicated. A comparison of the degradation of these materials over time remains a topic to be investigated by future studies.

Wound complications from idiopathic clubfoot surgery: a comparison of the modified Turco and the Cincinnati treatment methods

PURPOSE

Treatment protocols using the Turco and the Cincinnati incisions are widely used for the surgical correction of clubfoot deformity. However, it is unclear which surgical approach leads to fewer wound problems. We therefore sought to determine which treatment method led to a lower incidence of wound complications.

STUDY DESIGN

A retrospective chart review of 217 consecutive patients (308 feet) who underwent a primary posteromedial release for the treatment of idiopathic clubfoot under the age of 24 months via either the modified Turco or Cincinnati treatment methods was used to document the incidence of postoperative wound complications. The modified Turco protocol involved immediate postoperative casting in neutral, whereas the Cincinnati method involved staged casting with the foot initially in equinus, then to neutral with a cast change 7 days later.

RESULTS

A significantly lower incidence of wound complications was seen in the Cincinnati treatment group when compared with the modified Turco treatment method (6.9% vs 19.6%, respectively, P < 0.003). When patients were stratified based on immediate versus staged postoperative casting methods, there was a significantly lower incidence of wound complications (P < 0.05) in feet in the Cincinnati treatment group versus the modified Turco treatment method; however, the statistical populations were markedly unequal. Among all feet treated with the Cincinnati method, patients who underwent a staged cast change had significantly fewer wound problems when compared with those who underwent immediate casting with the foot in neutral (5.1% vs 16.7%, respectively, P < 0.04).

CONCLUSIONS

In the surgical correction of idiopathic clubfoot, the incidence of wound complications is significantly decreased with the use of the Cincinnati treatment method rather than the modified Turco treatment protocol. Whether this effect is a result of the incision or the postoperative casting protocol is unclear.

Reliability of in vitro microleakage tests: a literature review

PURPOSE

The literature contains conflicting data about in vitro microleakage evaluations and their usefulness and reliability. No standardization has yet been established. Here we consider features of published studies that might affect the results of the in vitro microleakage tests.

MATERIALS AND METHODS

We reviewed 144 in vitro microleakage studies, published in 14 international reviews between 1992 and 1998, which comprised 917 sets or groups of experiments. The published studies were entered in a database and compared using selected literature criteria: sample, cavities, restoration procedures, thermocycling and mechanical cycling, evaluation method.

RESULTS

The methods employed vary widely. The most frequent methodological choices (%) were (1) specimen storage after extraction: duration (unspecified, 59.2), medium (distilled or deionized water, 33.8), temperature (unspecified, 52.2), additives (none, 47.0); (2) aging method (79.1): duration before aging (< 24 h, 35.9); medium and temperature of storage before aging (distilled or deionized water, 26.8; 37 degrees C, 54.3); (3) medium of cycling (tap water, 50.5), number of cycles ([250-500], 34.6), number of baths (2, 84.0), bath temperature (5 degrees C to 55 degrees C, 60.6), immersion dwell time (30 s, 44.3); (4) tracer: type (basic fuchsin, 40.7), time of immersion (after thermocycling and/or mechanical cycles, 64.1), immersion duration (basic fuchsin: 24 h, 59.5); assessment of dye penetration of sections (91.7): direction (perpendicular, 88.5), number (1, 47.1).

CONCLUSION

The great variability in the methods used in these 144 studies prevented meta-analysis and comparison of the results, thus reducing the value of these methods.

Predictors of depression in geriatric medically ill inpatients

OBJECTIVE

Depression in medically ill inpatients has been associated with increased morbidity and mortality. The purpose of this study was to identify variables that would successfully predict depression in this population.

METHODS

The sample consisted of 314 male, medically ill veterans, age 60 and older, admitted to the acute medical service at Baltimore Veteran Administration Medical Center. Sixty of 314 patients met criteria for Major Depression and scored 11 or higher on the Geriatric Depression Scale. Variables assessing age, race, social support, severity of illness, degree of functional disability, life satisfaction, and hopelessness were included in a logistic regression analysis as predictors of depression.

RESULTS

The variables that significantly predicted depression were derived from the Beck Hopelessness Scale, Life Satisfaction Score, and the Cumulative Illness Rating Score.

CONCLUSIONS

The results indicated that medically ill inpatients who feel hopeless about the future, feel the best years of their lives are behind them, and have serious medical problems are likely to be clinically depressed.

Psychiatric assessment of a nursing home population using audiovisual telecommunication

The purpose of this study was to demonstrate that psychiatric assessment of nursing home residents could be reliably carried out remotely via telecommunications. Twenty-seven nursing home residents each had two interviews consisting of the following three rating scales: the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Brief Psychiatric Rating Scale (BPRS). The interviews were conducted by three trained psychiatrists, each of whom interviewed two-thirds of the subjects. Subjects were sequentially assigned to have either two in-person interviews (in-person group) or one in-person and one remote interview via telecommunication (remote group). Inter-rater reliability was calculated separately for each condition (in-person vs remote group) for each of the three rating scales. Intraclass correlations on the MMSE were .95 for the remote group and .83 for the in-person group. On the GDS, they were .82 for the remote group and .86 for the in-person group. Finally, on the BPRS, they were .81 for the remote group and .49 for the in-person group. There were no statistically significant differences in intraclass correlation on any of the three scales for the remote group compared with the in-person group, indicating that nursing home residents can be reliably assessed remotely via telecommunication.

Religion and end of life treatment preferences among geriatric patients

The purpose of this study was to determine if religious preference and religiosity influenced choosing end of life treatments in medically ill geriatric patients. The sample consisted of 374 males 60 years of age or older, hospitalized on the acute medical service at the Baltimore Veterans Affairs Medical Center. Choices for end of life treatment preferences were CPR, medical ventilation, tube feeding and IV fluids within six different illness scenarios. Patients indicated how often they attended religious services, how much strength and comfort they got from religion and how religious they would describe themselves. Analyses of variance were performed using as the dependent variables the summation scores across the six scenarios of a willingness to undergo each of the four life saving procedures. The religious preference, race and religiosity scores served as the independent variables. Only tube feeding showed a significant (p<0.05) relationship, with Catholics less willing to undergo this procedure than other Christians. The same trend was found for the other life saving procedures, but was not statistically significant.

Racial differences in the prevalence of dementia among patients admitted to nursing homes

OBJECTIVE

The purpose of this study was to determine the prevalence of dementia among black and white residents on admission to nursing homes and to determine whether demographic and health characteristics known to be associated with dementia were correlated with dementia in this population.

METHODS

Data from medical records and structured interviews with family members, nursing staff, and nursing home residents were gathered for 2,285 persons newly admitted to nursing homes in Maryland from 1992 to 1995. A stratified sample of 59 nursing homes was used. An expert panel of five physicians classified each resident as demented, nondemented, or indeterminate. Associations between dementia status, race, and selected characteristics were examined.

RESULTS

Black residents (77 percent) were significantly more likely than white residents (57 percent) to be classified as demented. Older age was associated with dementia in both races. Less education, male gender, and a history of a cerebrovascular accident were associated with an increased prevalence of dementia among white residents only. After demographic and health characteristics associated with dementia were controlled for, black race remained independently associated with a diagnosis of dementia.

CONCLUSIONS

The rate of dementia on admission to nursing homes was higher among black residents than among white residents, a finding that has implications for the delivery of care. The higher rate may be due to psychosocial factors operating differently in blacks and whites that influence the timing of admission to a nursing home.

Influence of the isolation method on the 10-year clinical behaviour of posterior resin composite restorations

The aims of this prospective randomised clinical study were to clinically evaluate a radiopaque, highly filled, hybrid, light-activated resin-based composite for posterior teeth (Occlusin, ICI Dental, Macclesfield, UK and GC Dental, Tokyo, Japan) and compare the performance of restorations placed using rubber dam or cotton roll isolation. One clinician placed 100 (42 Class I and 58 Class II) restorations of the material under investigation. The isolation mode for each restoration was determined randomly: 52 preparations were protected from contamination with cotton rolls and aspiration, and 48 preparations were isolated under rubber dam. At baseline and periodically thereafter (0.5, 1, 2, 3, 4, 5, 6, and 10 years), each composite was evaluated by two practitioners using a modified (USPHS) rating system. After 10 years, 37 restorations were reviewed. The results showed satisfactory clinical performance with and without rubber dam after 10 years. A concern was the number of failures at 10 years due to unsatisfactory proximal contact. The evaluations for the surviving restorations were acceptable but with a large reduction in the percentage with ideal occlusal and proximal anatomy. The 10-year comparison of isolation modes showed no statistically significant differences (Kruskal-Wallis test) for each of the evaluation criteria. Furthermore, survival analysis showed no significant difference between the groups (Mantel-Haenszel method). It was concluded that the 10-year clinical behaviour of the restorations of a posterior composite placed under well-controlled, effective isolation with cotton rolls and aspiration, was not significantly different from the behaviour of restorations placed using rubber dam isolation.

Prevalence of bovine herpesvirus-1 in the Belgian cattle population

The national bovine herpesvirus 1 (BHV-1) seroprevalence (apparent prevalence) in the Belgian cattle population was determined by a serological survey that was conducted from December 1997 to March 1998. In a random sample of herds (N=556), all cattle (N=28478) were tested for the presence of antibodies to glycoprotein B of BHV-1. No differentiation could be made between vaccinated and infected animals, because the exclusive use of marker vaccines was imposed by law only in 1997 by the Belgian Veterinary Authorities. Twenty-one percent of the farmers vaccinated continuously against BHV-1. In the unvaccinated group, the overall herd, individual-animal and median within-herd seroprevalences were estimated to be 67% (95% confidence interval (CI)=62-72), 35.9% (95% CI=35.0-36.8) and 33% (quartiles=14-62), respectively. Assuming a test sensitivity and specificity of 99 and 99.7%, respectively, the true herd, individual-animal and median within-herd prevalence for the unvaccinated group of herds were estimated to be 65, 36 and 34%, respectively. The true herd prevalence for dairy, mixed and beef herds were respectively, 84, 89 and 53%; the true individual-animal prevalence for those types of herds were, respectively, 35, 43 and 31%; whereas, the true median within-herd prevalences were 36, 29 and 38%.

Prevalence of herds with young sows seropositive to pseudorabies (Aujeszky's disease) in northern Belgium

In Belgium, pseudorabies in swine has been the subject of a mandatory eradication programme since 1993. From December 1995 to February 1996, a survey was conducted in the five provinces of northern Belgium to estimate the provincial pseudorabies virus (PRV) herd seroprevalence. Seven hundred and twenty randomly selected herds were included in this survey. To detect recently infected animals, only young sows were sampled. The results show that 44% of these herds had an important number of PRV-seropositive young sows. The highest herd seroprevalence was observed in West Flanders (68%), followed by Antwerp (60%), East Flanders (43%), Limburg (18%), and Flemish Brabant (8%). Assuming a diagnostic test sensitivity and specificity of 95% and 99%, respectively, and a true PRV within-herd prevalence of 43%, the overall true PRV herd prevalence was estimated to be 35%. A logistic multiple-regression revealed that the presence of finishing pigs was associated with a two-fold increase in odds of a herd being seropositive (odds ratio (OR)=2.07, 95% confidence interval (CI) = 1.31-3.26); a breeding herd size > or =70 sows was associated with a four-fold increase in odds of a herd being seropositive (OR = 4.09, 95% CI = 2.18-7.67); a pig density in the municipality of >455 pigs/km2 was associated with a 10-fold increase in odds of a herd being seropositive (OR = 9.68, 95% CI = 5.17-18.12). No association was detected between the PRV herd seroprevalence and purchase policy of breeding pigs (purchased gilts, or use of homebred gilts only).

A 24-week randomized trial of controlled-release physostigmine in patients with Alzheimer's disease

OBJECTIVE

To evaluate the safety and efficacy of controlled-release physostigmine, an acetylcholinesterase inhibitor, in patients with probable AD of mild to moderate severity.

METHODS

A prospective, 24-week, randomized, multicenter, double-blind, parallel group study of patients was conducted. The study enrolled 475 patients at 24 sites. Patients met criteria for probable AD and were randomized to one of three arms: placebo, controlled-release (CR) physostigmine 30 mg daily, or CR physostigmine 36 mg daily. Dosage was escalated by a forced upward titration during the first 6 to 9 weeks of the trial, then maintained at a constant dose to 24 weeks. Primary outcome measures were the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) and the Clinician's Interview-Based Impression of Change-Plus with caregiver input (CIBIC+). Secondary outcome measures included the Clinical Global Impression of Change (CGIC), the Geriatric Evaluation by Relatives Rating Instrument, and an Instrumental Activities of Daily Living Scale.

RESULTS

In an intent-to-treat population, the last observation carried forward analysis revealed a 2.9-point ADAS-Cog (p = 0.002) difference between physostigmine and placebo-treated patients for both dosages, and a 0.26 to 0.31-point difference on the CIBIC+ (p = 0.048). There were no significant differences on the secondary outcome measures except for a difference on the CGIC when analyzed by use of the Cochran-Mantel-Haenszel statistic (p = 0.014). There were significant increases in gastrointestinal side effects including nausea, vomiting, diarrhea, anorexia, dyspepsia, and abdominal pain for patients on either dose of physostigmine, resulting in a high dropout rate. Agitation was decreased significantly. There was no evidence of cardiac rhythm disturbance or liver function abnormalities.

CONCLUSION

CR physostigmine enhanced cognitive and global function. It is relatively safe for the treatment of cognitive dysfunction secondary to AD. However, in light of the gastrointestinal side effects, a lower starting dose and a flexible titration schedule might lead to a more favorable adverse event profile in the clinical arena.

Clinical evaluation of a posterior composite 10-year report

OBJECTIVE

The 10-year findings of one of the studies which comprised the multicentre clinical evaluation of a light-cured posterior composite restorative are reported, with special emphasis on the reasons and timing of failure of restorations included in the study. Effects of the use of rubber dam or cotton rolls and aspiration for isolation at the time of placement are considered.

METHOD

One hundred Class I and II restorations of the resin composite investigated were placed by a single operator in a group of selected, predominantly young-adult patients under highly controlled conditions, with the use of rubber dam or cotton rolls and aspiration for isolation being determined according to a scheme of randomisation. The restorations were reviewed clinically after 1 week and within 1 month of placement (baseline) and, thereafter, at 6 months, 1, 2, 3, 4, 5, 6 and 10 years using modified USPHS codes and criteria. Epoxy models and photographs were obtained for retrospective analysis.

RESULTS

After 10 years, 37 restorations were reviewed and 32 restorations were known to have failed. Regarding the reasons for failure, loss of occlusal anatomic form during the first 5 years and loss of approximal contacts near the end of the study accounted for most of the failures. Only two failures were attributed to recurrent caries. Few of the restorations found to be clinically satisfactory at 10 years had retained ideal functional characteristics. Location, Class and size of restoration and the method of isolation were not found to significantly influence 10-year performance and survival.

CONCLUSION

The actual 10-year failure rate, estimated to have been between 40 and 50% is considered to have been high, notably given the limited incidence of recurrent caries and bulk fracture. However, the findings indicate that certain restorations of the material investigated, despite the use of outdated operative techniques, may be found to perform satisfactorily over periods in excess of 10 years.

The psychological effects of the war in Afghanistan on young Afghan refugees from different ethnic backgrounds

This study examined the psychological effects of the war in Afghanistan on two groups of young Afghan refugees currently residing in the United States. One group, with Tajik parents showed significantly less evidence of post-traumatic stress disorder (PTSD) and depression than the second group with Pashtun parents. These two groups of young refugees came from very different socioeconomic and cultural backgrounds. Some of these differences persist to the present. The Tajik parents are wealthier, more likely to speak English at home and less religious than the Pashtun parents. Their wartime experiences were also different. The Pashtun parents and their children spent more time in Afghanistan during the war, and experienced or witnessed more traumatic events, such as torture or combat, than the Tajik parents and their children. The possible effects of these ethnic differences on current psychopathology are described and discussed.

A psychoeducational program for caregivers of the chronic mentally ill residing in community residencies

The objective of this study was to develop a psychoeducational program for caregivers of the chronically mentally ill residing in community residencies. An evaluative component was added to determine how well the program was received by caregivers and what impact the program had on the residents. A total of 20 caregivers and 63 residents participated in the program. In general, the psychoeducational program was well received by the caregivers. They especially liked the mental health component and opportunity to meet and interact with other caregivers. There was a significant drop in hospital admissions following the program. There was also improvement in a number of quality of life activities such as trips to the local coffee shop and mall.

Central propranolol and pindolol, but not atenolol nor metoprolol, inhibit sexual behavior in male rats

Are the anti-sexual effects of propranolol and pindolol due to actions within the brain? To answer this, these agents were administered directly into the brain ventricular system (ICV). Additionally, atenolol and metoprolol were evaluated to see whether differential delivery to the brain contributed to the observed lack of effect of systemically administered beta 1-adrenoceptor antagonists. ICV administration of pindolol (45 or 90 micrograms) was followed by a suppression of copulation. At 45 micrograms, inhibition was limited to performance aspects of copulation, whereas at 90 micrograms, decrements in motivational and performance aspects of copulation were evident. ICV administration of propranolol also suppressed copulatory behavior. At 45 micrograms, no significant effects were observed, whereas at 90 micrograms decrements in motivational and performance aspects of copulation were evident. In contrast, ICV administration of the beta 1-adrenoceptor antagonists, atenolol and metoprolol, was not associated with any major modifications in copulatory behavior. We suggest that the inhibitory effects of propranolol and pindolol may involve interactions with 5-HT1A receptors in the CNS. Alternatively, it may be that the adverse effects of pindolol and propranolol are due to the simultaneous blockade of both beta 1- and beta 2-adrenoceptors.

Depression and posttraumatic stress disorder among a community sample of adolescent and young adult Afghan refugees

This study was designed to determine the prevalence of posttraumatic stress disorder (PTSD) and other psychiatric disorders among a community sample of adolescent and young adult refugees from Afghanistan. The study also measured the correlation of their current psychiatric disorders with the number of traumatic events experienced, parental acculturation and distress, and other important demographic factors. Thirty-eight refugees between 12 and 24 years of age were interviewed with the Structured Clinical Interview for DSM-III-R. Five subjects met DSM-III-R criteria for PTSD, 11 subjects met the criteria for major depression, and 13 had either PTSD or major depression or both. Significant positive correlations were found between the subjects' psychiatric diagnosis and the total number of traumatic events experienced and the parental level of psychological distress (especially maternal distress). There were negative correlations between children's symptomatology and a measure of maternal acculturation. These results suggest that a significant proportion of adolescent and young adult Afghan refugees in the community suffer from severe but undiagnosed psychiatric disorders.

Partial lateral meniscectomy in athletes

Arthroscopic partial lateral meniscectomies performed for isolated meniscal tears, without associated ligamentous injury, in 41 athletes between August 1, 1988 and June 1, 1991 were reviewed for clinical and functional outcome. The study population was composed of 27 males and 14 females, with an average age of 26 years (range 17-40). Thirty-seven patients (90%) reported previous trauma to the knee. At an average follow-up of 3 years (range 2-5), 85% of the patients had excellent/good results, and 98% of the athletes returned to full sports activities after an average of 55 days. Patients' prognoses depended on (a) type of meniscal tear and (b) presence/absence of an articular cartilaginous lesion. Athletes who had isolated, longitudinal type tears of the lateral meniscus had the best outcome: 100% achieved excellent/good results and averaged 41 days to return to full sports activities. Athletes with complex meniscal tears and tears associated with articular cartilaginous lesions had the poorest results, achieving 79% and 64% excellent/good results, respectively, and averaging 64 and 78 days, respectively, for return to full sports activities.

Meniscal ossicles: two case reports and a review of the literature

Intrameniscal ossicles of the knee are rare lesions. We present two cases. The first case occurred in a male soccer player who had knee trauma, with radiographic findings of a meniscal ossicle. Meniscal motions were normal, and symptoms resolved with conservative measures. The second case was found in a male athlete with acute medial compartment instability and complex meniscal tears. His medial meniscus, containing the ossicle, was removed. Initial conservative management is recommended for all cases of meniscal ossicle, and arthroscopic resection of the ossicle is recommended for symptomatic cases.

Arthroscopic treatment of anterolateral ankle impingement

Fifty-five ankle arthroscopies performed for anterolateral ankle impingement between January 1987 and April 1992 were reviewed for functional outcome and patient satisfaction. There were 33 men and 22 women with an average age of 34 years (range 20-67). All patients reported a previous history of ankle injury, and 60% of the patients had at least one ankle sprain. At an average follow up of 2.6 years (range 1.0-4.5), 87% of the patients had good/excellent results, 98% were satisfied, and 84% returned to their previous sports.

Competency evaluations in a VA hospital. A 10-year perspective

The authors reviewed all 228 competency evaluations performed at the Baltimore VA Medical Center during a 10-year period. Between 1980 and 1984 and 1985 and 1989, the rate of inpatients who had competency evaluations increased from 0.20% to 0.42%, and the average number of competency evaluations per year doubled from 12 to 24.6. The percentage of all psychiatric consultations which were for competency evaluation nearly doubled from 5% to 9.4%. The rate of competency evaluations was slightly but not significantly higher for patients over age 65 than the rate for younger patients (0.44% vs. 0.33%). However, older patients were significantly more likely to be judged incompetent.

Negative symptom assessment of chronic schizophrenia patients

A new scale for assessing negative symptoms in schizophrenia, the Negative Symptom Assessment (NSA), was administered to 101 male chronic, inpatient schizophrenia patients. Factor analysis of the NSA yielded seven factors, but most of the explained variance resided in Factor 1, Restricted Affect/Emotion. The factors that emerged from this study closely resembled NSA factors derived from an earlier study of outpatient schizophrenia patients, which indicates the factor structure of the NSA is robust. A constellation of variables reflecting long-term or chronic illness were significantly related to six of the seven factors. These results suggest that "institutionalism" may play a role in the evolution of some negative symptoms.

Psychosocial factors associated with urban adolescent female suicide attempts

This study identified psychosocial factors that differentiated 19 adolescent female suicide attempters from 21 demographically similar nonattempters in a low income, urban area. Adolescents and their parents independently completed questionnaires and participated in structured and semistructured interviews. Attempters expressed significantly higher levels of suicidal ideation and were described by their parents as displaying higher levels of depressed mood and delinquent behavior problems than nonattempters. Attempters also identified fewer support persons, were less likely to be living with their mothers, were less likely to describe confiding relationships with parents/guardians, and had less active and affectionate relationships with mother figures than nonattempters. Finally, attempters reported more undesirable life stresses than nonattempters.

Arteriosclerosis, infarcts, and dementia

A study was made of 343 elderly mental-hospital patients whose mental disorder had begun late in life. Of the 31 brains examined at autopsy, 14 showed cerebral infarcts without senile brain disease and ten showed senile brain disease without infarcts. The amounts of arteriosclerosis in the two groups were compared. The microscopic evidence was not treated statistically, but the macroscopic evidence was subjected to Fisher's exact test and chi square for comparison of the amounts of arteriosclerosis noted at the base of the brain and the number of plaques on the named arteries within the brain. The results showed an overwhelming preponderance of arteriosclerosis in the infarct patients compared with the senile brain disease patients. It is concluded that in elderly patients with mental disorders, brain infarcts occur in close and causal relationship with cerebral arteriosclerosis. The bearing of this observation upon the concept of multi-infarct dementia is discussed.

Parent-child relationships and adult depression

Reports of early parental behavior provided by 714 hospitalized depressed patients were compared with those provided by 387 normal adults. The 2 groups were also compared on ratings of parental behavior along the acceptance-rejection and autonomy-control dimensions, based on reports of other informants. Differences between the groups suggest that depression in adult life may be related to parental rejection and control through techniques such as derision, negative evaluation, and withdrawal of affection during childhood. Maternal rejection was found more closely associated with depression in female than in male children, and the effect was essentially the same among black and white subjects. Paternal rejection, on the other hand, appeared more closely associated with depression in males than females among blacks, while among whites paternal rejection was related to depression in females rather than males. It is suggested that the thoughts of personal worthlessness and inferiority seen in depression and theorized by Beck to be of principal etiologic significance in the disorder may have their origin in the early parent-child relationships.

Initial response to drugs in depressive illness and psychiatric and community adjustment a year later

Three hundred and sixty depressed in-patients initially treated with imipramine, chlorpromazine or a placebo were re-evaluated a year later. Patients showing the poorest adjustment at one year were those who failed to show a good initial response to treatment and those who responded positively to a placebo.

The effects of hyperbaric and normobaric oxygen on cognitive impairment in the elderly

Eighty-two elderly subjects with significant cognitive impairment were randomly assigned to treatment with either hyperbaric oxygen, hyperbaric air, normobaric oxygen, or normobaric air. Treatment consisted of two 90-minute sessions a day for 15 consecutive days. Subjects were evaluated on measures of memory and intellectual capacity, as well as on psychiatric symptom rating scales. Results immediately after treatment and at one, two, three, and eight weeks following treatment did not show enhanced cognitive functioning or significantly greater symptom reduction in experimental subjects who received either normobaric or hyperbaric oxygen as compared to controls who received hyperbaric or normobaric air. There was also no evidence of differential treatment effects as a function of initial severity of illness, sex, response to a CO2 loading test, or presumed evidence of cerebrovascular disease.

The effect of methylphenidate on test performance in the cognitively impaired aged

It was hypothesized that a central nervous system stimulant with relatively weak peripheral effects would facilitate test performance in the cognitively impaired aged. Twelve elderly subjects participated in a counter-balanced, crossover comparison of 10 mg methylphenidate, 30 mg methylphenidate and placebo. All treatments were administered double-blind as a single dose of oral medication. Neither dosage of active medication was found to effect psychomotor or psychological test performance, subjective report, heart rate or blood pressure. A subsequent open trial of 45 mg methylphenidate resulted in heart rate, blood pressure and subjective changes in two of eight subjects but no effects on test performance. The results suggest that cognitive performance in the moderately impaired aged is unimproved following administration of methylphenidate, and perhaps similar sympathomimetic amines, below a dosage level associated with clinically significant peripheral effects.

The endogenous--neurotic distinction as a predictor of response to antidepressant drugs

An inverse factor analysis of 880 depressed inpatients on 33 endogenous-neurotic variables yielded four patient types. Type 3 resembled the endogenous depressions and Type 2 the neurotic depressions. Type 3 patients responded well to both imipramine and chlorpromazine and did poorly on a placebo. Type 2 patients showed the greatest overall improvement at three weeks irrespective of treatment received, including a placebo.