Transseptal Left Heart Catheterization and Left Atrial Angiocardiography in the Diagnosis of Cor Triatrium

The necessity for postoperative inhaled nitric oxide (NO) therapy and predictive factors for that need were retrospectively analysed in 457 paediatric patients at risk of pulmonary hypertensive events following open-heart surgery for congenital heart disease. Inhaled NO was given postoperatively to 46% of the study group and to 23% of all patients undergoing open-heart surgery during the study period. Factors associated with increased need for postoperative NO were age <1 year, Down's syndrome, preoperative pulmonary hypertension and increased pulmonary vascular resistance. Using a multivariate model based on these factors, 73% of the patients who were given NO were identified. Thus, in a setting with unrestricted access to NO therapy, almost half of the patients with cardiac lesions that commonly give rise to postoperative pulmonary hypertension were given postoperative NO. Seventy-three percent of postoperative NO treatment was associated with a relatively small number of pre- and perioperative patient-related risk factors.     

New operative technique for treatment of arthroscopically–confirmed injury to the scapholunate ligament by volar capsuloplasty augmented with a free tendon graft

We report how scapholunate (SL) lesions found during arthroscopy were treated using a new palmar operation based on the use of a tendon loop formed using the palmaris longus tendon, with promising preliminary results. Scapholunate instability induced by hyperextension injury was diagnosed and graded arthroscopically. Volar capsuloplasty was then done by free tendon graft in the same session in 31 patients with grades II-IV scapholunate instability. Half of the patients operated on had a normal range of movement, and all except one had flexion-extension of at least 75% of the normal. Half of the patients had no pain or limitations of the use of the wrist, and although half the patients had some pain on exertion, not one had severe pain. These results are comparable to, or even better than, those reported using other methods of repair. The combined procedure saves money, diminishes the total recuperation time and, as autologous tissues are used for the repair, secondary operations for removal of the implant are unnecessary. This method seems to be a useful adjunct to the types of operative treatment available, although it is apparently not suitable in static grade IV SL instability.     

Mental health at population level during an economic recession in Finland

The aim of this study was to investigate the prevalence of mental disorder and associated factors during an economic recession. Random samples of Finnish general population were collected in 3 consecutive years, 1993-95. The prevalence of mental disorders was assessed by means of the 12-item General Health Questionnaire (GHQ). The prevalence of mental disorders varied among Finnish men from 15.6% to 19.2% and among women from 21 to 24.5%. Mental disorder was more common among women than among men in every study year. Mental disorder was more common among the unemployed than among other respondents both in women and men in every year. Subjective poor health, suicidal thoughts and poor economic situation were constantly associated with mental disorder in both sexes every year. Using logistic regression analyses, problems with a partner, uncertain future orientation and use of psychoactive drugs, in particular, were found to be fairly permanent independent risk factors in relation to mental disorder. As studied by gender no major changes occurred in the mental health status of Finns during economic recession, although in many specific groups mental disorder was markedly more common than in the general population.     

Recorded psychiatric comorbidity with bipolar disorder – A Finnish hospital discharge register study

Bipolar disorder is frequently connected to other psychiatric disorders. On the basis of The National Hospital Discharge Register in Finland, we studied the recorded prevalence of psychiatric comorbidity among bipolar inpatients by clinicians, and the factors that were associated with it. Of the 2687 hospital stays in 1998, 82% had no other recorded psychiatric diagnosis except an episode of bipolar disorder. Psychiatric comorbidity was recorded in 18% of hospital stays, of which 20% had two comorbid psychiatric diagnoses. Substance-related disorders (11%) were the most commonly recorded comorbid disorders. Personality disorders were recorded in 6%, and anxiety disorder in 1% of the hospital stays. These figures should be considered far below the expected ones. Recorded comorbidity was associated with the type of episode. Comorbidity in bipolar disorder in psychiatric hospitals in Finland seems to go greatly undetected and may have a deteriorating impact on the course of the illness.     

Impact of multiple traumatic experiences on the persistence of depressive symptoms – a population-based study

The objective of this population-based study was to determine whether traumatic experiences in general, and multiple traumatic experiences in particular, are associated with persistent self-rated depressive symptoms in adult Finnish subjects over 2?years of follow-up. The study sample included 1405 subjects aged 25–64?years. Subjects (n=217) who were depressed both at baseline in 1999 and on follow-up 2?years later in 2001 (having persistent depressive symptoms) were compared with subjects (n=987) having no depressive symptoms either at baseline or on follow-up. All six categories of traumatic experiences (wartime experience, natural disaster, life-threatening accident, victim of violent crime, domestic violence and childhood sexual abuse) pertained to the respondents’ whole life span. Odds ratios, adjusted for significant covariates, were obtained from multiple logistic regression models that estimated the likelihood of persistent depressive symptoms in different trauma categories. Persistent depressive symptoms had a significant positive graded relationship with the number of traumatic experiences. The adjusted odds of persistent depression was 6.05 (95% CI 1.76–20.7) for men and 6.99 (95% CI 2.69–18.2) for women in those with three or more traumatic experiences compared with those with no such experiences at all. Multiple traumatic experiences substantially increase the likelihood of persistent depressive symptoms. Mental health intervention, as early as possible, may serve to prevent the chronicity of depressive reactions among victims of multiple traumas.     

Prospective relations between alexithymia,substance use and depression: findings from a National Birth Cohort

Abstract

Purpose: This study examined a developmental model that links affect-regulation difficulties in childhood with three dimensions of alexithymia in adolescence (difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking) and substance use and depression in adulthood, while accounting for cumulative contextual risk in childhood, and testing potential gender moderation.

Methods: Multiple group path analyses were conducted using data from the Northern Finland Birth Cohort 1986 (N?=?6963). Analyses used data collected during prenatal/birth, childhood, adolescence, and young adulthood periods.

Results: Our examination of early precursors for alexithymia indicated that the associations of affect-regulation problems in childhood with alexithymia were stronger for girls, potentially putting girls with affect-regulation difficulties in childhood at higher risk for developing alexithymia in adolescence. The associations of cumulative contextual risk in childhood with alexithymia, substance use disorder, and depression diagnosis in adulthood were significant for both girls and boys. Our findings in regard to substance use and depression disorders revealed that alexithymia in adolescence predicted depression diagnosis in adulthood, particularly due to a contribution from the alexithymia domain of ‘difficulties identifying feelings.’ However, none of the alexithymia domains was directly associated with substance use disorder in adulthood.

Conclusions: Our study contributes to research that links alexithymia with difficulties in affect regulation and cumulative contextual risk in childhood, yielding findings that may be relevant for preventive interventions.     

A Randomized,Sham-Controlled Trial of Repetitive Transcranial Magnetic Stimulation Targeting M1 and S2 in Central Poststroke Pain: A Pilot Trial

ObjectivesCentral poststroke pain (CPSP), a neuropathic pain condition, is difficult to treat. Repetitive transcranial magnetic stimulation (rTMS) targeted to the primary motor cortex (M1) can alleviate the condition, but not all patients respond. We aimed to assess a promising alternative rTMS target, the secondary somatosensory cortex (S2), for CPSP treatment.Materials and MethodsThis prospective, randomized, double-blind, sham-controlled three-arm crossover trial assessed navigated rTMS (nrTMS) targeted to M1 and S2 (10 sessions, 5050 pulses per session at 10 Hz). Participants were evaluated for pain, depression, anxiety, health-related quality of life, upper limb function, and three plasticity-related gene polymorphisms including Dopamine D2 Receptor (DRD2). We monitored pain intensity and interference before and during stimulations and at one month. A conditioned pain modulation test was performed using the cold pressor test. This assessed the efficacy of the descending inhibitory system, which may transmit TMS effects in pain control.ResultsWe prescreened 73 patients, screened 29, and included 21, of whom 17 completed the trial. NrTMS targeted to S2 resulted in long-term (from baseline to one-month follow-up) pain intensity reduction of ≥30% in 18% (3/17) of participants. All stimulations showed a short-term effect on pain (17–20% pain relief), with no difference between M1, S2, or sham stimulations, indicating a strong placebo effect. Only nrTMS targeted to S2 resulted in a significant long-term pain intensity reduction (15% pain relief). The cold pressor test reduced CPSP pain intensity significantly (p = 0.001), indicating functioning descending inhibitory controls. The homozygous DRD2 T/T genotype is associated with the M1 stimulation response.ConclusionsS2 is a promising nrTMS target in the treatment of CPSP. The DRD2 T/T genotype might be a biomarker for M1 nrTMS response, but this needs confirmation from a larger study.