Vascular depression: a new view of late-onset depression

We have suggested that cerebrovascular disease may predispose, precipitate, or perpetuate some late-life depressive syndromes. The mechanisms of "vascular depression" include disruption of cortico-striato-pallido-thalamo-cortical (CSPTC) pathways or their modulating systems. This view is supported by the presentation of vascular depression, which consists of depressive symptoms, cognitive abnormalities, as well as neuroimaging findings that may result from CSPTC impairment. Moreover, clinical and electrophysiological evidence of CSPTC impairment, an abnormality frequently found in patients with vascular depression, appears to be associated with poor response to antidepressant treatment and early relapse and recurrence. The vascular depression hypothesis provides the conceptual background for studies that may have clinical and theoretical impact. Agents influencing dopamine, acetylcholine, and opioid neurotransmitters may be studied in vascular depression, since these are essential neurotransmitters of the frontostriatal circuitry. Drugs used for prevention and treatment of cerebrovascular disease may be shown to reduce the risk for vascular depression or improve its outcomes. The choice of antidepressants in vascular depression may depend on their effect on neurological recovery from ischemic lesions. Finally, identification of specific relationships between specific symptoms, cognitive deficits, and disability may lead to interventions that target the patients' deficits as well as their interactions with psychosocial factors known to contribute to depression. Research can clarify the pathways to vascular depression by focusing on the site of lesion, the resultant brain dysfunction, the presentation of depression and time of onset, and the contribution of nonbiological factors.     

International comparison of the treatment of polytraumatized patients

Summary Worldwide there will be an increase in polytraumatized patients. The number of death after trauma will increase from 5,1 Mill. to 8,4 Mill. The reason is the technical progress in the third world. In western countries there was a decrease in trauma death, in Germany below 8.000 due to traffic accidents in 1998. In most countries the paramedic system and ATLS are established (USA, South Africa). Long rescue times and inadequate shock treatment preclinically are the bigest problems in Russia and Greece. Worldwide the institution of trauma centers (Level I, II, III) has brought much better results comparing to nontrauma centers but is economically expensive. The annual number of polytraumatized patients (Level I 600–1.000 severe trauma, > 65 personal experience) is essential for the success rate. Infrastrucure, Algorithmus and the personal experience of the trauma leader are the keys for optimal results. One parameter for Quality measurement is the number of potentially preventable deaths. Retrospective analysis of treatment protocols and pathological results by an expert team is the best practical way. The results of level I trauma teams reach between 1 and 2 % preventable deaths. A further instrument of quality improvement are Trauma registers like in US and England (MTOS) and the German Trauma register of the German Society of Trauma. The Trauma register in Germany contents till now 2.069 polytraumatized patients.The lethality is 18,6 % (ISS 21 ± 13), comparing to MTOS (ISS 12,8 ± 11,3, lethality 9,2 %). The differences in injury pattern show in the US three times more penetrating injuries than in the German Traumaregister (21,1 % versus 7,2 %).      

Conservative treatment of neurogenic bladder dysfunction

Summary In neurogenic bladder dysfunction conservative treatment is preferred whenever possible and preservation of renal function remains the main topic. Additionally, a patient-related form of bladder management with decreased intravesical pressure and social dryness is needed. Therefore many strategies are available and after evaluation of the underlying neurogenic bladder dysfunction an individual kind of treatment can be used. Possible options are the clean intermittent catherization, anticholinergic drugs, detrusor triggering, electrical stimulation and bladder emptying by Valsalva's manouvre.      

贲门癌术后生存15年以上者的生活质量评价

目的　研究贲门癌术后超长期生存者生活质量的影响因素。方法　1996年1月～1998年6月,对贲门癌术后生存15年以上病人进行了生活质量问卷随访调查。结果　本组中88.2%的个体自我感觉精神状态良好,86.8%的个体可进普通饮食,64.7%的个体可参加正常或一般工作和劳动。全组中89.7%的个体生活质量很满意,77.9%的个体生活质量非常好。结论　病人术后的精神状态、远期消化道并发症是影响其术后生活质量的主要因素。     

252例儿童哮喘的门诊治疗和管理

目的为探讨儿童哮喘得到长期缓解有效方法。方法我们开展前瞻性的对２５２例哮喘儿童进行了门诊治疗与管理和家庭治疗与自我管理相结合地研究,强调长期规范治疗,并对部分患儿进行了缓解期肺功能的测定,以此评价疗效。结果经半年～１年随访,系统管理治疗规范组哮喘缓解率明显高于间歇规范组及不规范组（Ｐ＜０００１）。缓解期肺功能测定也表明规范组肺功能基本正常率明显高于其他两组（Ｐ＜００５）。结论儿童哮喘要得到长期缓解及根本控制,必须要有系统的门诊治疗管理和家庭治疗与自我管理相结合。     

硫酸奈替米星注射液与硫酸丁胺卡那注射液临床疗效及安全性的比较

为评价硫酸奈替米星的临床疗效及安全性,在１７０例急性细菌感染性病人中作多中心临床研究。结果显示：硫酸奈替米星的有效率（９５．３％）显著高于对照药硫酸丁胺卡那的有效率（８４．１％）,试验组病人咳痰和腰痛症状的平均下降显著高于对照组;硫酸奈替米星治疗后细菌清除率达９７．２％;２组病人不良反应发生率均为４．８％,对照组中有２例（３．２％）出现耳鸣、１例（１．６％）听力减退,但试验组病人用药后未发现听力异常。结论：硫酸奈替米星临床疗效优于硫酸丁胺卡那且较少耳毒性。     

乳腺癌（改良）根治术住院流程与平均住院日

参照业务流程重组的理论与方法研究了乳腺癌根治术的住院流程。结果显示,该病种住院流程存在的主要问题有：诊疗服务的随意性过大,等待诊疗服务的时间过长,患者入院标准的掌握过松,对该病种往院注程进行重组,将在不影响医疗服务质量的前提下有效缩短平均住院日。     

Indocyanine green guided laser photocoagulation in patients with occult choroidal neovascularisation

AIMS: To determine whether indocyanine green (ICG) guided laser photocoagulation of occult choroidal neovascularisations (OCNV) is beneficial for patients with occult choroidal neovascularisation secondary to age related macular degeneration (AMD). METHODS: A prospective pilot study was performed in 21 eyes with OCNV secondary to AMD that could be identified extrafoveolarly or juxtafoveolarly in an early ICG angiographic study. Laser photocoagulation was applied to the neovascular membrane identified in the early ICG angiographic study. RESULTS: Visual acuity ranged from 20/400 to 20/20 (logMAR 0.54 (SD 0.29) before and hand movements and 20/30 (logMAR 0.81 (0.69)) at the last follow up after laser photocoagulation. During the follow up (30 (13) months) vision improved in four eyes (two lines), in seven eyes the initial visual acuity could be stabilised (two lines), in five eyes vision dropped moderately (three to five lines), and in five eyes vision decreased severely (six or more lines). Recurrences (seven patients) or persistent CNV (six patients) was observed in 13 patients. CONCLUSION: This preliminary study of ICG guided laser photocoagulation of occult extrafoveal and juxtafoveal choroidal neovascularisations suggests that this technique may improve the visual prognosis of these patients. Further prospective controlled studies are necessary to confirm these data.     

Effects of acute and chronic administration of olanzapine in comparison to clozapine and haloperidol on extracellular recordings of substantia nigra reticulata neurons in the rat brain

Rationale: Previously, we have shown that the atypical antipsychotics clozapine and risperidone, unlike haloperidol, decreased the firing rate of substantia nigra reticulata (SNR) neurons. As the SNR receives substantial input from the striatum, an area where motoric side-effects of antipsychotics are thought to be mediated, the SNR might be an interesting brain structure with regard to motor side-effects. Objective: The newly developed atypical antipsychotic olanzapine was studied for its effects on the firing rate of SNR cells. In addition, to gain insight in the implications of our experimental setup for clinical use, responses upon clozapine, olanzapine and haloperidol were studied after chronic treatment. Methods: In chloralhydrate-anaesthetized male Wistar rats, extracellular recordings were made from SNR neurons upon intravenously (IV) administered cumulative doses of the antipsychotics. Naive rats and rats that were subcutaneously (SC) injected for 21 days with an antipsychotic were used. Results: Olanzapine (50–1600 mg/kg; IV), significantly inhibited the firing rate of the SNR neurons. Upon 21 days of treatment with a daily SC injection of 20 mg/kg clozapine, the challenge on day 22 with cumulative injections of clozapine (200–6400 mg/kg; IV) significantly inhibited the firing rate of the SNR neurons. Olanzapine (50–1600 mg/kg; IV) also significantly inhibited the SNR activity when pretreated with olanzapine in an SC administered dose of 1 mg/kg, but not 5 mg/kg. Haloperidol (12.5–800 μg/kg; IV) did not significantly affect the SNR activity in rats pretreated with SC administered 0.5 mg/kg haloperidol. Conclusions: Upon acute and chronic administration of clozapine and olanzapine versus haloperidol, differential effects on SNR neuronal firing could be obtained. The experimental setup seem to be valid for further studies into the mechanism of action of typical versus (relatively low doses of) atypical antipsychotics. The implications of the inhibitory effect of atypical antipsychotics on the SNR firing rate are presently unknown, but could be associated with the lower propensity to induced motoric side-effects. On the other hand, the SNR activity might also reflect non-motoric activity possibly related to negative symptoms. Received: 11 December 1998/Final version: 20 January 1999     

Characterizing withdrawal in rats following repeated drug administration using an amphetamine-vehicle-haloperidol drug discrimination

Rationale: Previous research using an amphetamine (AM)-haloperidol (HA) drug- drug discrimination task has shown that predominant responding on the HA-appropriate lever occurs 24 h after a single or multiple administrations of 10 mg/kg AM. Conversely, rebound responding on the AM-appropriate lever occurs following single or multiple administrations of 1 mg/kg HA. HA-appropriate responding was also observed 24 h following a single injection of AM using a three-lever, AM-vehicle-HA discrimination task. However, a single administration of HA did not produce robust rebound responding on the AM-appropriate lever. The present studies seek to clarify the discrepancy between responding following HA in the two- and three-choice tasks. Objective: Experiment 1 examined the extent of rebound responding that could be achieved following ten daily administrations of either 10 mg/kg AM or 1 mg/kg HA. Experiment 2 explored potential differences between the two- and three-choice tasks in characterizing the post-HA cue. Methods: Animals were trained to discriminate 0.35 mg/kg AM, vehicle, and 0.033 mg/kg HA. In experiment 1, animals received ten daily injections of 10 mg/kg AM, vehicle, or 1 mg/kg HA, and were tested 24 h after the final injection, and again 8, 15, and 22 days post-treatment. In experiment 2, animals were retrained and then treated daily with either vehicle or 1.0 mg/kg HA for 10 days, and then tested 24 h after the final injection, and again 5 and 11 days post-treatment, with either all three levers or with only the AM- and HA-appropriate levers available. Results: In experiment 1, multiple injections of AM produced robust HA lever responding, which is consistent with results from previous studies that used the two-choice, AM-HA discrimination task. However, multiple injections of HA did not produce predominant responding on the AM-appropriate lever. In experiment 2, animals treated with either vehicle or HA responded predominantly on the vehicle-appropriate lever when tested with all three levers present. When tested with the vehicle lever removed, however, animals treated with vehicle responded predominantly on the HA-appropriate lever, whereas those treated with HA responded predominantly on the AM-appropriate lever. Conclusions: These results suggest that the two-choice and three-choice task used here differ in how the post-HA withdrawal cue is characterized. This finding emphasizes the importance of knowing the relative locations of the agonist-, vehicle-, and antagonist-produced cues on the interoceptive stimulus continuum established by discrimination training. Received: 3 December 1997/Final version: 16 November 1998