Methedrine interviews: clinical and Rorschach studies

Summary Methedrine was administered intravenously in 20 to 40 mg. doses to 21 hospitalized patients in intensive psychotherapy. Interviews using this drug were found to be of value both in diagnosis and in psychotherapy. It was found that methedrine does not predictably produce changes in psychopathology, but may exaggerate previously suspected features. Methedrine does seem to increase verbal facility and the need for communication of dynamically important material in most patients. Most patients demonstrated a temporarily increased ability to tolerate consciously the anxiety and unhappiness of the illness itself, and transference was usually both increased and clarified. In some patients productiveness and the need for communication did not reach the maximum until six to eight hours after methedrine was injected.Rorschach studies conducted with 10 patients before and during methedrine interviews substantiate the increase in emotional responsiveness noted clinically, and are valuable in confirming psychopathology and in revealing further psychodynamic factors.There are contraindications to the use of methedrine, as well as certain dangers. However, if the interviews are integrated with the total psychotherapeutic effort, they offer distinct and appreciable advantages.From the Department of Psychiatry, Cornell University Medical College and the New York Hospital (Payne Whitney Psychiatric Clinic), New York, N. Y.     

The effect of social selection on the population dynamics of Huntington''s disease

Wallace (1976) postulated the importance of social selection on the frequency of Huntington's disease. This effect of social selection was studied with respect to the population dynamics of Huntington's disease genes. It is shown that social selection operates mainly through heterozygotes. Existing data indicate that the frequency of Huntington's disease in the population is determined by its social effects.     

Continuous subcutaneous infusion of morphine for postoperative pain relief

A double-blind randomised study of 48 patients in whom continuous subcutaneous infusion and regular intramuscular injection of morphine were compared as analgesic regimens after upper abdominal surgery, is described. Over a 48-hour period, no difference in pain intensity between the two groups was found by comparing linear analogue scores, assessments on a four-point rank scale, peak expiratory flow rates or requirement for additional analgesia. Nausea and sedation were assessed using a four-point rank scale. These side effects were less frequent with subcutaneous infusion (p less than 0.05). Two patients from each group were judged to have received an overdose. The infusion apparatus was simple and convenient to use. Continuous subcutaneous infusion of morphine is a practical and effective means of achieving post-operative analgesia but, as with other mandatory dosing regimens, relative overdosage may occur.     

Congenital anomalies in children with cerebral palsy: a population‐based record linkage study

Aim Our aim was to determine the proportion of children with cerebral palsy (CP) who have a congenital anomaly (CA) in three regions (Isère Region, French Alps; Funen County, Denmark; Northern Region, England) where population‐based CP and CA registries exist, and to classify the children according to CA subtype. Method Data for children born between 1991 and 1999 were linked using electronic matching of cases. All potential matches were checked manually by each centre and verified as true matches. Results A total of 1104 children with CP were born during the study period (663 males, 441 females). Of these, 166 (15%; 95% Confidence Interval [CI] 13.0–17.3) children with CP had a CA: 8.8% had a cerebral anomaly, 4.8% had a non‐cerebral anomaly, and 1.4% had a non‐cerebral‐related syndrome or a chromosomal/genetic anomaly. Interpretation The prevalence of cerebral anomaly was highest in children with ataxic CP (41.7%) and lowest in those with dyskinetic CP (2.1%). Cerebral anomalies were found in 8.4% and 7% of children with bilateral and unilateral spastic CP respectively. The most frequent cerebral anomalies were primary microcephaly (26.5%) and congenital hydrocephalus (17.3%). The most common non‐cerebral anomalies recorded were cardiac (12.6% of children with CP and CA), urinary (5.4%), and musculoskeletal (5.4%). The prevalence of cerebral anomalies was higher among children born at term (13%) than among those born preterm (3.8%). Associated sensorineural or intellectual impairments occurred more often in children with CP and cerebral anomalies. We concluded that cerebral and non‐cerebral CA prevalence was higher among the CP population than in the general population of live births.     

Evidence that fibrinogen γ′ directly interferes with protofibril growth: implications for fibrin structure and clot stiffness

Summary. Background: Fibrinogen contains an alternatively spliced γ‐chain (γ′), which mainly exists as a heterodimer with the common γA‐chain (γA/γ′). Fibrinogen γ′ has been reported to inhibit thrombin and modulate fibrin structure, but the underlying mechanisms are unknown. Objective: We aimed to investigate the molecular mechanism underpinning the influence of γ′ on fibrin polymerization, structure and viscoelasticity. Methods: γA/γA and γA/γ′ fibrinogens were separated using anion exchange chromatography. Cross‐linking was controlled with purified FXIIIa and a synthetic inhibitor. Fibrin polymerization was analyzed by turbidity and gel‐point time was measured using a coagulometer. We used atomic force microscopy (AFM) to image protofibril formation while final clot structure was assessed by confocal and scanning electron microscopy. Clot viscoelasticity was measured using a magnetic microrheometer. Results: γA/γ′ fibrin formed shorter oligomers by AFM than γA/γA, which in addition gelled earlier. γA/γ′ clots displayed a non‐homogenous arrangement of thin fibers compared with the uniform arrangements of thick fibers for γA/γA clots. These differences in clot structure were not due to thrombin inhibition as demonstrated in clots made with reptilase. Non‐cross‐linked γA/γA fibrin was approximately 2.7 × stiffer than γA/γ′. Cross‐linking by FXIIIa increased the stiffness of both fibrin variants; however, the difference in stiffness increased to approximately 4.6 × (γA/γA vs. γA/γ′). Conclusions: Fibrinogen γ′ is associated with the formation of mechanically weaker, non‐uniform clots composed of thin fibers. This is caused by direct disruption of protofibril formation by γ′.     

Level of Confidence in Diagnosis: Clinical Examination Versus Dermoscopy Examination

BACKGROUND: Confidence is an important factor in decision making and may influence patient care. OBJECTIVES: To evaluate whether short-training-based dermoscopy increases confidence in the diagnosis of skin lesions. METHODS AND MATERIALS: After a 1-hour course on dermoscopy, 20 pairs of clinical and dermoscopic images of lesions were presented to 19 dermatology residents with little or no dermoscopy experience. After viewing the clinical image, they were asked to assess their confidence in the diagnosis in a seven-point scale, with 1 reflecting that the respondent was 100% confident that the lesion was benign, while number 7 reflected 100% confidence that it was malignant. The same technique was used for dermoscopic images. RESULTS: Ten of the 20 pairs of evaluations showed a significant difference (p<.05). The largest differences were observed in lesions where clinical scores suggested that participants were uncertain about the diagnosis, but tended to decide that the lesion was benign after dermoscopy. Dermoscopy did not improve confidence in the evaluation of dysplastic lesions as well as lesions with obvious clinical diagnoses. CONCLUSIONS: Short-training-based dermoscopy improved confidence in the diagnosis of clinically challenging skin lesions, but the impact was not demonstrable for clinically obvious lesions and dysplastic nevi.     

Developing methodologies for evaluating community-wide health promotion

There has been growing recognition that health promotion programswhich target whole communities are more likely to be effectivein changing health behaviour. However, studies evaluating theimpact of community-wide health promotion programs rarely useadequate methodology. Randomised control trials where multiplewhole communities are randomly assigned to control and interventiongroups are optimum if evaluators hope to validly attribute changesin health behaviour to the intervention. However, such trialspresent a number of difficulties including cost and feasibilitylimitations and the evolving nature of statistical techniques.This paper proposes applying a fairly well-accepted phased evaluationapproach to the evaluation of community participation programs,using three defined phases. Phase 1 consists of small-scalestudies to develop the measures and assess acceptability andfeasibility of the intervention; Phase 2 consists of studiesin a small number of communities designed to trial the interventionin the real world; Phase 3 studies use an appropriate numberof entire communities to provide valid evidence of efficacyof the intervention. It is suggested that criteria be resolvedto identify adequate studies at each stage and that advantagesand limitations of Phase 1 and 2 studies be clearly identified.The paper describes the major design, sampling and analysisconsiderations for a Phase 3 study.