Nonepileptic Posttraumatic Seizures

Summary: Purpose: Epileptic posttraumatic seizures (PTSs) are a well-recognized consequence of head injury (HI), but HI and nonepileptic seizures (NESs) have not been related. We describe a significant subset of patients with NESs who had their seizures attributed to HI.
Methods: We reviewed the records of all patients diagnosed with NES at the University of Maryland Medical Center over a 6-year period (1989–1995) and selected patients with seizures attributed to a head injury occurring ≥3 years before the onset of their seizures.
Results: Of 157 patients with video-EEG confirmed NES, 37 (24%) had the onset of their seizures attributed to an HI. Their average age was 34 years (range, 15–56 years); 68% were women. Nonepileptic PTS usually developed within the first year after HI (89%). Convulsive symptoms were present in 54%. Whereas epileptic PTSs characteristically follow severe HI, the majority (78%) of our patients with nonepileptic PTSs sustained only mild HI. Before their HI, 76% of our patients were employed, working in the home, or students, but only 11% could continue those activities after developing nonepileptic PTSs.
Conclusions: Nonepileptic PTSs are frequently mistaken for epileptic PTSs and result in serious disability. The misdiagnosis of nonepileptic PTSs leads to ineffective and inappropriate treatment. Patients with intractable seizures after HIS, articularly mild HIS, should be carefully evaluated for NESs.     

Cultural Meanings of Childbirth

In no known culture in the world is childbearing treated with indifference. Cultural beliefs about and values associated with childbearing touch all aspects of social life in any given culture. Such beliefs and values lend perspective to the meaning of childbirth to the childbearing woman. Having the opportunity to share the woman's perceptions of the meaning of childbearing may foster the self-actualization, promote maternal role attainment, and improve her relationship with her significant other and enrich the family perspective. Nursing interventions across the childbearing year should be culturally sensitive to promote positive outcomes for the woman and her family.     

Predicting life span for applicants to inpatient hospice

The advent of hospice programs and their funding under Medicare has recently made eligibility for substantial insured services turn on whether a patient has less than three or six months to live. The implicit assumption is that physicians can provide this prediction accurately. To test this assumption and to improve predictions, the life spans of 108 consecutive applications for inpatient hospice care were estimated independently by two oncologists, an internist, an oncology nurse, and a hospice social worker, based on data in a ten-page multidisciplinary application packet. The applicants were followed up until death. Actual life span was correlated with predictions. The median (+/- SD) life span was 3.5 +/- 12.4 weeks. The predictions as a group were overly optimistic about survival by an average of 3.4 weeks. The best prognosticator's prediction was only moderately correlated with actual life span, and no two prognosticator's predictions correlated closely with one another. Predicting actual interval until death was more accurate than predicting a 90% confidence interval around the time of death, though the latter procedure was better at avoiding the error of unpredicted long-term survivors. This imprecision in "expert" estimation of life span poses substantial problems for hospice programs and policymakers.     

The importance of chronicity and controllability of stress in the context of stress-illness relationships

The primary purpose of the present study was to increase our understanding of the roles of chronicity and controllability in the measurement of stress within the context of stress-illness relationships. Controllability and chronicity were assessed directly using a modified version of the Everyday Problems Scale. In addition to this scale, measures of depression, psychosomatic symptoms, and social support were administered to 128 women and 100 men. The results indicated that, for both men and women, the number of stressors was the best single predictor of symptoms. However, for women, chronicity and controllability of the stressors accounted for a significant amount of the variance in health outcomes over and above that accounted for by the number of stressors endorsed; for men, the addition of neither chronicity nor controllability consistently increased the strength of the association. While available social support was not found to influence the stress-illness relationships, greater willingness to utilize social support was associated with lower levels of depression.     

Human immunodeficiency virus (HIV-1) cytotoxicity: perturbation of the cell membrane and depression of phospholipid synthesis

The molecular mechanism(s) by which human immunodeficiency virus (HIV-1) injures a T-cell line was studied. A pathological role for viral env proteins, which are inserted into the plasma membrane, has been previously demonstrated for HIV as well as other retroviruses which are cytopathic. We therefore initiated studies examining whether perturbations of the cell membrane or membrane-associated biochemical events may be occurring in cells acutely infected with HIV and whether such perturbations, if present, may be responsible for cytopathology. A human T-cell line (ERIC), which is sensitive to the cytopathic effects of HIVs, was infected with HTLV-IIIB and its membrane permeability to cations and its lipid metabolism were studied coincident with the peak expression of viral p24 and with the first sign of cytopathology (slowing of cell division) 72 to 96 hr after infection. It was found that the rate of influx of Ca2+ into the cell increased over that of uninfected cells and that phospholipid synthesis, primarily phosphatidylcholine, became depressed. Diacylglycerol, which serves both as an intermediate for synthesis of phospholipids and as a second-messenger for lymphocyte activation, was also greatly reduced. However, triglyceride synthesis was enhanced, indicating that not all lipid metabolic pathways were being shut down. This decreased membrane-synthetic ability and reduced second-messenger for cell division are likely to be important causes of HIV-1 cytopathology in ERIC cells. This hypothesis was supported by our finding that HIV cytopathology of ERIC cells could be partially prevented by treatment with compounds (diacylglyceride or PMA and transiently by oleic acid) which either replenish diacylglycerol in the infected cell and/or activate protein kinase C or phosphocholine cytidyltransferase, the latter being the rate-limiting step in synthesis of the major structural phospholipid in most cells.     

Changes in the cytoskeleton of 3T3 fibroblasts induced by the phosphatase inhibitor,calyculin-A

Summary Addition of the protein phosphatase inhibitor, calyculin-A, to 3T3 fibroblasts causes a marked change in cell morphology. Initially the cells become rounded, develop surface blebs and then detach from the substratum. In the detached cells an unusual ball-like structure is observed. This study focuses on the cytoskeleton during these calyculin-A-induced morphological changes. Stress fibres disappear as the cells begin to round and aggregates of actin are formed towards the apical surface of the cell. These aggregates condense, in the detached cells, to form the ball structure of approximately 3 m diameter. Between the ball and the nucleus are cables of intermediate filaments that appear to be attached to the surface of the ball and to the nuclear lamina. Using a procedure designed for the isolation of nuclei the nucleus-ball complex can be obtained. Analysis of the nucleus-ball preparation by immunofluorescence and electron microscopy demonstrate that the ball contains actin and that intermediate filaments are located between the ball and the nucleus. In this preparation, the intermediate filaments also appear to attach to the surfaces of the ball and the nucleus. Electrophoretic analysis of the nucleus-ball preparation indicates that, in addition to actin, a major component of the ball is myosin. It is suggested that the formation of the ball is caused by an actin-myosin-based contractile process, initiated by the phosphorylation of myosin. The aggregation of the actomyosin draws together the intermediate filaments into the area between the ball and nucleus. This hypothesis requires that vimentin binds both to the nucleus and to some component of the ball.