Evaluation of depression and anxiety in patients with systemic sclerosis

OBJECTIVE: To determine the prevalence of depression and anxiety in patients receiving follow-up in France for systemic sclerosis. PATIENTS: We prospectively evaluated 42 patients admitted for a follow-up evaluation of systemic sclerosis, including 18 with diffuse cutaneous scleroderma and 24 with limited cutaneous scleroderma. Patients admitted for recent organ involvement were excluded. Mean age was 57 +/- 13 years, mean disease duration was 10.2 +/- 8 years, and the mean functional Health Assessment Questionnaire score was 0.682 +/- 0.649. Only four patients had a history of antidepressive drug therapy. We used the Montgomery-Asberg Depression Rating Scale (MADRS) and the Hamilton Anxiety Rating Scale to evaluate depression and anxiety, respectively. RESULTS: Eighteen (43%) patients met criteria for depression and 11 (26%) had scores above the cutoff usually taken to define moderate-to-severe depression. Twenty-seven (64%) patients met criteria for minor anxiety and eight (19%) for major anxiety. Depression and anxiety were strongly correlated with each other (r = 0.89; P < 0.0001). The MADRS score was significantly higher in the patients with pulmonary restrictive disease (P = 0.009) but was not associated with the extent of skin involvement, organ involvement, or disability. CONCLUSION: Systemic scleroderma is associated with a high prevalence of depression and anxiety. These disorders should be looked for routinely and the need for specific treatment evaluated.     

Guanylate cyclase—Cyclic GMP in mouse cerebral cortex and cerebellum: Modification by anticonvulsants

Incubated tissue slices from mouse cerebral cortex and cerebellum readily accumulate cyclic GMP in response to a challenge by ouabain, NaN₃, NH₂OH, or KCl. Under similar conditions, l-glutamate, l-aspartate, glycine, γ-aminobutyric acid, kainic acid, and the calcium ionophore, A-23187, were ineffective. Inhibition of the ouabain-induced accumulation of cyclic GMP was evident with valproate, carbamazepine, clonazepam, phenytoin, and phenobarbital. Only phenytoin blocked the action of KCl and cyclic GMP responses to NaN₃ were inhibited by high concentrations of valproate, carbamazepine, phenytoin, or phenobarbital. The effects of NH₂OH were attenuated by high concentrations of carbamazepine, phenobarbital, and clonazepam (cortex only). Guanylate cyclase activity in homogenates of cortex and cerebellum was enhanced in the presence of NaN₃, NH₂OH, or Ca²⁺ (in low concentrations of Mn²⁺). The enzyme activation induced by Ca⁺ was blocked only by large (1 mm) amounts of carbamazepine. In like manner, large concentrations of carbamazepine, phenytoin (cortex), or clonazepam (cortex) were effective in reducing guanylate cyclase stimulation by NaN₃. No agent affected the NH₂OH responses. The results suggest that anticonvulsant drug actions with regard to central cyclic GMP systems are related to the Na⁺-induced depolarization of nerve tissue and not to any direct actions on the guanylate cyclase enzyme.     

99mTc ovalbumin labelled eggs for gastric emptying scintigraphy: in-vitro comparison of solid food markers

BACKGROUND: The reliability of solid phase gastric emptying measurements by scintigraphy requires a marker that remains within the solid component of the test meal, and which is not degraded by the gastric juice throughout the scintigraphic procedure. In Europe, foods are most often labelled with 99mTc rhenium sulfide macrocolloid (RSMC) but this solid phase marker was withdrawn from the market in January 2004. OBJECTIVE: To test other potential solid phase markers and to compare them to the reference marker RSMC. These markers were rhenium sulfide nanocolloid (RSNC), tin fluoride colloid (TFC), phytates and two albumins (Alb and AlbC). All were radiolabelled with 99mTc. METHODS: After quality control, each 99mTc marker was incorporated into the albumin of one egg. Then, egg white and yolk were mixed together, and a well-cooked omelette was prepared. Aliquots of the omelette were incubated with an acidic solution of pepsin at 37 degrees C which mimicked gastric juice. Unbound radioactivity in the supernatant fraction was measured at various times up to 3 h. RESULTS: The radiochemical purity was > 95% for all radiopharmaceuticals. During the in-vitro incubation, the percentage of 99mTc labelled colloids released from the omelette increased continuously: after 3 h, 5% for TFC and RSMC, 8% for phytates, and > 9% for the two albumins and RSNC. CONCLUSION: Considering quality controls and release of 99mTc during in-vitro incubation of the omelette, TFC showed the same behaviour as the reference marker RSMC. Thus, TFC seems to be the best candidate to replace RSMC for the radiolabelling of the solid phase of the gastric emptying test meal.