The screening and treatment of undiagnosed depression in patients with chronic obstructive pulmonary disease (COPD) in a general practice.

AIMS AND OBJECTIVES: To screen for, and to treat, depression in COPD patients in a general practice surgery, and to test the feasibility of the screening method. METHODS: We sent The Beck Depression Inventory (BDI) Short-Form Questionnaire to all patients on the COPD register (n=69) by post, excluding those already diagnosed with depression (n=3). We sent appointments to all responders with moderate to severe depression and offered them treatment including antidepressants and pulmonary rehabilitation if the diagnosis was confirmed. RESULTS: Of the 66 patients to whom we sent questionnaires, 43 were returned completed and 13 of these had significant depression (30%). 10 of these patients were contactable and attended for review. The diagnosis of depression was confirmed in all 10 cases. Treatment options were discussed; five chose antidepressant medication, three chose pulmonary rehabilitation and two declined treatment. CONCLUSION: We identified and treated a significant number of depressed COPD patients in a general practice setting using this screening method. This method could have wider applications for screening, although further trials are needed.     

Frontotemporal dementia and parkinsonism linked to chromosome 17 with the N279K tau mutation

We present a case of frontotemporal dementia and parkinsonism linked to chromosome 17 (FTDP‐17) harboring the N279K mutation in the MAPT gene from the family known as pallido‐ponto‐nigral degeneration (PPND). This 49‐year‐old man was followed for 17 years. He presented at age 41 years with left leg stiffness and en‐bloc turning. During the course of his illness he developed a constellation of symptoms including parkinsonism, pyramidal signs, vertical gaze palsy, dysphagia, dystonia, personality and cognitive dysfunction, weight loss and mutism. Gross neuropathological examination showed mild atrophy of the cerebral cortex, hippocampal formation, amygdala, thalamus, subthalamic nucleus and depigmentation of the substantia nigra. Microscopy revealed neuronal loss and gliosis in the same regions. Tau immunohistochemistry showed pretangles, numerous threads, grain‐like structures and oligodendroglial tau‐positive inclusions (“coiled bodies”). In the spinal cord the tau pathology was more abundant in gray than white matter. Pretangles and threads were present in the anterior and, to a lesser extent, in the posterior horns. FTDP‐17 should be suspected in patients with a history of familial parkinsonism combined with behavioral and cognitive changes, onset before age 65 years and an aggressive clinical course.     

Estimation of gestational age by last menstrual period, by ultrasound scan and by SP1 concentration: comparisons with date of delivery

The date of delivery in 62 normal pregnant women was predicted by last menstrual period, by ultrasound scan and by the serum concentration of Schwangerschaftsprotein 1 (SP1). It was found that SP1 concentration in the first trimester gave as reliable an indication of when labour would occur as did the last menstrual period or ultrasound scan.     

A laboratory study of cyromazine on Aedes aegypti and Culex quinquefasciatus and its activity on selected predators of mosquito larvae

In a laboratory study, the insect growth regulator, cyromazine, exerted a high level of biological activity on Aedes aegypti and Culex quinquefasciatus treated in the 4th larval instar. At 1.5 and 1.0 ppm this IGR produced 97 and 99% inhibition of emergence in adult Ae. aegypti, respectively. In Cx. quinquefasciatus, there was 99% inhibition at 1 ppm and complete inhibition at 1.5 ppm. The overall pupal mortality was higher than larval or adult stages of both species. This material induced different types of morphogenetic abnormalities in pupae and adults of the 2 species similar to those induced by other IGRs. However, most abnormalities were observed in the pupal stage. Adverse effects were not detected on the 4 mosquito predator species during the acute or posttreatment tests.     

Electrophysiologic target localization in posteroventral pallidotomy

Summary The current interest in stereotactic posteroventral pallidotomy (PVP) for treating Parkinson's disease and the variability of published results have raised questions regarding techniques for target localization. In our technique the probe is guided to the optimum target at the most ventral pallidum and ansa lenticularis by macroelectrode stimulation of the internal capsule and optic tract from within the globus pallidus, with the thresholds providing a relative measure of the electrode proximity to these structures. We have characterized these localizing macroelectrode stimulation parameters in 57 posteroventral pallidotomies with consistent anatomic lesion placement, excellent outcome, and no complications.Using a 1.8 × 2.0 mm radiofrequency electrode for macroelectrode stimulation (RFG-3C, Radionics Inc.), minimum voltages (thresholds) to activate motor (at a frequency of 2 Hz) or visual (at a frequency of 100 Hz) responses as well as impedance measurements were obtained at the final target (Tf) and at distances proximal to Tf along the electrode trajectory. The visual and motor threshold voltages at Tf via our standard approach angles (50 ° above base plane, 20 ° from the sagittal plane), had a range of 1.0 to 1.5 V, and 2.0 to 3.5 V respectively. We also found that as the probe approaches Tf there is a significant decrease in voltage thresholds for motor (P<.0001) and visual (P<.0001) responses in an individual patient indicating that the probe is converging on these structures. Increases in impedance between Tf, 2–3 mm, and 4–5 mm proximal to Tf were also statistically significant (P<.0001). Microelectrode recording of electrophysiological neuronal activity at various points along the trajectory towards the target showed distinct firing patters providing identification of the globus pallidus externus and internus, ansa lenticularis, and optic tract.Macroelectrode electrophysiological stimulation within the target volume, inducing threshold responses in the internal capsule and optic tract, provides for accurate localization of the most effective PVP target in the ansa lenticularis. In unresponsive patients, the utilization of microelectrode recording for the identification of the pallidal borders and the optic tract improves safety.     

Benign polyps with prostatic-type epithelium of the urethra and the urinary bladder

The clinico-pathological features of nine urethral and urinary bladder polyps with prostate-type epithelium are described. The average age of the patients was 46 years. Three patients previously had cystoscopy and the lesion was not noticed on the initial examination. The commonest presentation in this series was haematuria, dysuria and frequency of micturition. One patient presented with postmicturition dribble and another with haemospermia. The polyps contained acini and papillae lined by prostate-type epithelium which was confirmed by immunohistochemical tests for prostate specific antigen and prostate acid phosphatase. In this series no age versus location relationship could be established. Symptoms resolved following resection or initial biopsy followed by fulguration. Recurrence is extremely rare.