Persistence of chronic mood disorders: A 2 year follow-up

Abstract Chronic mood disorder patients who remain frequent and long-term users of psychiatric facilities constitute a major clinical concern today. A 2 year naturalistic prospective follow-up study was conducted on a cohort ( n = 40) randomly extracted out of 335 such patients. Longitudinal data involving semi-structured interviews, observer-rated scales and self-report measures were available for 37 patients (93%). While three (8%) remitted completely, the cohort on the average showed no statistically significant change in the severity of depression, social adjustment or global functions during the 2 years under observation. Two baseline features that characterized ameliorated patients were the absence of panic disorder and lower level of education.     

Prostaglandin E-type receptor subtypes and gastroduodenal bicarbonate secretion in rats

Abstract We investigated the relationship between prostaglandin E-type receptor (EP receptor) subtypes and gastroduodenal HCO₃^- secretion in rats. Under urethane anaesthesia, a stomach mounted in an ex vivo chamber or a proximal duodenal loop was perfused with saline and the HCO₃^- secretion was measured at pH 7.0 using a pH-stat method and by adding 10 mmol/L HCl. Prostaglandin E₂ (PGE₂, i.V.) increased HCO₃^- secretion in both the stomach and duodenum; this action was verapamil sensitive and only in the duodenum was potentiated by isobutylmethyl xanthine (IBMX). Duodenal HCO₃^- secretion was also stimulated by both sulprostone (EP₁/EP₃ agonist), enprostil (EP₁/EP₃ agonist), misoprostol (EP₂/EP₃ agonist), 11-deoxy PGE₁ (EP₃/EP₄ agonist) and ONO-NT-012 (EP₃ agonist), but was not affected by either butaprost (EP₂ agonist) or 17-phenyl-ω-trinor-PGE₂ (EP₁ agonist). In contrast, gastric HCO₃^- secretion was stimulated by sulprostone, enprostil and 17-phenyl-ω-trinor-PGE₂, but not by misoprostol, butaprost, 11-deoxy PGE₁ or ONO-NT-012. The EP₁ antagonist SC-51089 inhibited the HCO₃^- stimulatory action of sulprostone in the stomach but not in the duodenum. Isobutylmethyl xanthine potentiated the HCO₃^- response to sulprostone in the duodenum, while verapamil reduced the response in both the stomach and duodenum. These results suggest that PGE₂ stimulates HCO₃^- secretion via different EP receptor subtypes in the stomach and duodenum: in the former the EP₁ receptors linked to Ca²⁺ and in the latter, the EP₃ receptors coupled with both cAMP and Ca²⁺.     

Marked retention of indocyanine green and sulfobromophthalein with chronic persistent hepatitis

A hepatitis B virus (HBV) carrier with marked retention of indocyanine green (ICG) and sulfobromophthalein (BSP) was admitted to our hospital for assessment of liver function. On admission, he was asymptomatic and blood chemistry tests showed normal values for transaminases and bilirubin. Serum hepatitis B surface antigen (HBsAg) and antibody to hepatitis B e antigen (anti-HBe) were positive. A history of drug abuse or alcoholism was denied. Dye excretion tests revealed marked retention of ICG (R₁₅= 70%) and BSP (R₄₅= 23%). Histopathological examination of a liver biopsy specimen obtained during laparoscopic observation showed chronic persistent hepatitis (CPH). Familial research of the patient failed to prove the existence of dye excretory defect in his siblings. Usual cases of CPH due to continuous HBV infection do not show such severe disturbance of organic anion transport. This pattern of the dye excretory defect with CPH has not been reported. Although the relationship between this dye excretory defect and HBV infection is unclear, the existence of the constitutional dye excretory defect due to abnormal organic anion transport in the liver might be considered.     

Alternation of QRS Morphology and Effect of Radiofrequency Ablation in Idiopathic Ventricular Tachycardia

We performed electrophysiological studies in 13 patients with idiopathic VT and attempted radiofrequency (RF) catheter ablation in 4 of them.Results: VT was induced by programmed stimulation in all patients and the mean cycle length was 363 ± 58 msec. In 8 of 13 patients (62%), alternation of either the cycle length and/or morphology of VT was observed. Transient entrainment was achieved in all patients by rapid pacing from the right ventricular outflow tract so reentry was considered the underlying mechanism of VT. The site of earliest activation (EAS) during VT was located at the apicoposterior portion of the left ventricular septum and used as the target site for RF catheter ablation. Spikelike presystolic activity was detected 20–40 msec prior to the large deflection of the local electrogram in four patients. VT was terminated by a few seconds of RF current in all four patients, but subsequently new VTs with a slightly different morphology were induced in three of them and re-mapping showed a shift of the EAS. After additional RF ablation at the new EAS, VT was no longer induced. No complication was noted and VT did not recur during a follow-up period for a mean of 9.3 ± 5.2 months.Conclusion: RF catheter ablation seems useful and safe for idiopathic VT. The alternation of QRS morphology and the findings at the time of catheter ablation suggest that an alternative pathway or multiple exits may be present in some patients with idiopathic VT, because the change in VT morphology was associated with a shift of the EAS.     

Conductive Properties of the Reentrant Pathway of Ventricular Tachycardia During Entrainment From Outside and Within the Zone of Slow Conduction

Ventricular tachycardia (VT) was entrained with rapid ventricular pacing outside and within the zone of slow conduction (SCZ), and the conductive properties of the reentrant pathway were compared between the two pacing sites. Underlying heart diseases were old myocardial infarction (n = 2), postoperative tetralogy of Fallot (n = 1) or double outlet of the right ventricle (n = 1), dilated cardiomyopathy (n = 1), and pulmonary regurgitation of unknown cause (n = 1). Rapid pacing was continued for 5–10 seconds, and the time interval from paced stimulus to the entrained electrogram at the exit from SCZ (St-Ex) or to the QRS complex (St-QRS) was measured. Rapid pacing was performed at three or more cycle lengths after a decrement in steps of 10 msec. During rapid pacing outside of SCZ and entrainment of VT, constant fusion and progressive fusion were observed, and St-Ex and St-QRS showed the same response pattern: either a frequency dependent prolongation in 4 of 7 VTs or a constant time interval in the others VTs. When rapid pacing was attempted within SCZ, the response of the time intervals from paced site to the QRS (St-QRS) was the same as those observed during pacing outside SCZ except for one VT. In VT with repaired tetralogy of Fallot, the frequency dependent prolongation was observed during pacing from outside of SCZ but not within SCZ. Diseased myocardium extending widely into the outflow tract of the right ventricle may be responsible for the frequency dependent prolongation of St-Ex. In conclusion, the conductive property of the reentrant pathway might be assessed by observing the response patterns of St-Ex or St-QRS interval during transient entrainment of VT outside of SCZ, but exceptions may exist.     

Genetic and clinical correlates of season of birth of schizophrenics

Abstract The genetic and clinical characteristics of 55 patients with schizophrenia and 138 control patients (with major psychiatric disorders), were studied in relation to the season of birth. The morbid risk (MR) of schizophrenia was significantly higher among relatives of the schizophrenic probands born in Spring than among those of the psychiatric controls born in the same season. The MR of schizophrenia was also significantly higher among relatives of schizophrenic probands born in Winter or Spring (6.9%) than in those of schizophrenic probands born in Summer or Autumn (0%). Among the schizophrenic cases, Winter births were marginally related to the paranoid subtype, whereas other clinical variables showed no clear relationship with the season of birth.     

Serum regulated upon activation, normal T cell expressed and presumably secreted concentrations and eosinophils in respiratory syncytial virus infection

BACKGROUND: The aim of this study was to characterize respiratory syncytial virus (RSV) infection. To do this, the authors evaluated eosinophil counts and chemokines including regulated upon activation, normal T cell expressed and presumably secreted (RANTES) in children with RSV, adenoviral, and influenza virus infections. METHODS: The authors enrolled 80 patients who had been diagnosed with acute viral respiratory infection caused by RSV, adenoviral, or influenza viruses. In total, 35 patients (Group A) had RSV infection, 18 (Group B) had adenoviral infection, and 27 (Group C) had influenza virus infection. The authors evaluated clinical manifestations, white blood cell and eosinophil counts, and serum chemokines including RANTES concentrations in the acute and recovery phases in each group. RESULTS: In recovery phase, eosinophil counts were higher in Group A than Groups B and C. In Group A, eosinophil counts were higher in recovery phase than in the acute phase. In Group A, serum RANTES concentration was significantly higher in the recovery phase than in the acute phase (132+/-76 pg/mL vs 52+/-25 pg/mL, P<0.05). CONCLUSION: The findings suggest that high values of RANTES in children with RSV infection may be associated with the presence of eosinophils and be an important mediator of inflammatory response.     

High CD4/CD45RO+ and CD8/CD45RO+ frequencies in children with vaccine-modified measles

BACKGROUND: Despite availability and wide vaccine coverage, measles infections still occur especially in developing countries. An outbreak of measles occurred among previously immunized older Ghanaian children who had milder clinical symptoms with measles-specific IgG antibodies that could have been attributed to secondary vaccine failure, suggesting that the infection was vaccine-modified measles (VMM). METHODS: Two-color immunophenotyping of the peripheral blood mononuclear cells was performed at acute, recovery and convalescence phases for 19 VMM patients (mean age 6.2 +/- 3.5 years) using flow cytometry, and compared with that of 20 healthy, sex- and age-matched controls. RESULTS: The results showed a significantly higher memory helper (CD4(+)/CD45RO(+)) cell frequency and increased suppressor cell (CD8(+)/CD45R0(+)) frequency in VMM patients compared to healthy controls. There were no complications and all the patients recovered completely. CONCLUSIONS: These findings show that the mild symptoms in patients with VMM may have correlated with the increase of memory T cells, which is in sharp contrast with previous reports on acute measles infection. This may suggest that the intact immunologic memory cells could have been crucial for the resolution of VMM.