A prospective study of the association of cerebrospinal fluid monoamine metabolite levels with lethality of suicide attempts in patients with bipolar disorder

Objectives:  Bipolar disorder is a severe illness that is associated with suicidal behavior. A biological predictor of highly lethal suicide attempts in patients with bipolar disorder would be valuable. We hypothesized that cerebrospinal fluid (CSF) monoamine metabolite levels are related to lethality of suicide attempts in bipolar patients and examined the relation between CSF 5-hydroxyindolacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) levels and maximum lethality of suicide attempts at baseline and during a 2-year follow up.
Methods:  Twenty-seven bipolar depressed patients participated in the study. Demographic and clinical parameters were examined and recorded. Lumbar punctures were performed and CSF 5-HIAA, HVA, and MHPG were assayed by high-performance liquid chromatography with electrochemical detection. Following discharge, patients were evaluated after 3 months, 1 year, and 2 years. Each follow-up interview included an in-depth assessment of suicidal behavior during the intervening time period.
Results:  Six subjects made suicide attempts during the 2-year follow-up. Bipolar patients who attempted suicide during the follow-up period had higher aggression and hostility scale scores compared to bipolar subjects who did not make a suicide attempt during the follow-up period. CSF 5-HIAA, HVA, and MHPG levels were negatively correlated with the maximum lethality of suicide attempts during the 2-year follow-up period.
Conclusions:  Our finding is the first observation that CSF monoamine metabolite levels may be predictors of lethality of suicide attempts in patients with bipolar disorder. Further studies are necessary to answer the question whether CSF monoamine metabolite levels are clinically useful biochemical predictors of highly lethal suicide attempts or completed suicides.     

Efficacy of various methods in evaluation of eustachian tube function

In the present study 35 patients with preforated and 15 cases with intact ear drums, were studied and eustachian tube function was assessed by Saccharine test. Bortnick-Miller test, and manual impedance audiometry. The merits and demerits of one over the other were evaluated. It was observed thal more than one test when employed provides better information as every test has its own advantages and limitations     

Role of Bengal gram (Cicer arietinum) seed coat as an antiatherogenic agent in rabbits.

Bengal gram seed coat appeared to be a potent hypocholesterolemic/hypolipidemic agent in rabbits. When fed to hypercholesterolemic rabbits, it lowered hepatic cholesterol/lipid much more than in the control group. Aortic lipid levels were rather marginally increased but the increase was less in Bengal gram seed coat fed rabbits. Though seed coat of Bengal gram failed to prevent the development of atherosclerosis in hypercholesterolemic rabbits, but certainly it slowed down the process of its development. The hypocholesterolemic action of Bengal gram seed coat appeared to be due to the increased catabolism and excretion of cholesterol.     

Cases of buprenorphine abuse in India.

Buprenorphine was introduced as a potent analgesic with low abuse potential. Reports of buprenorphine abuse by opiate abusers have accumulated over the years, highlighting its use as a cheap alternative to heroin. The lower potency compared with heroin is being compensated by using a cocktail of buprenorphine with benzodiazepines or cyclizine. This study of 18 cases seen over 3 years broadly confirms these findings. Four cases reported haematemesis during acute withdrawal, a symptom not reported in earlier studies.     

Postoperative Intravenous Drip Infusion is not Required after Minilaparotomy Cholecystectomy

Objective: To determine if drip infusion should be discontinued after full recovery of the patient from anaesthesia after minilaparotomy cholecystectomy in uncomplicated cases.Design: A randomised controlled clinical trial on 60 patients, from the waiting list, of cholelithiasis/cholecystitis operated by minilaparotomy cholecystectomy between November 1995 to March 1996. 30 patients did not receive postoperative IV drip infusion and in 30 patients 12–24 hours of standard drip transfusion was continued according to the current practice.Setting: Single Surgical Unit, SS Hospital, Banaras Hindu University, Varanasi, India.Main outcome measure: Recognition of clinical indication for continuation of. IV drip infusion after full recovery from anaesthesia.Results: In the cohorts of 30 patients each who were or were not given IV drip infusion after full recovery from anaesthesia following minilaparotomy cholecystectomy the observations on pulse rate, blood pressure, time to first voiding of urine and time to start first oral intake of fluids were identical. However postoperative urinary retention occured in 6 (20%) patients in whom the IV drip infusion was given.Conclusion: There is no clinical indication to continue IV drip infusion after full recovery from anaesthesia in patients operated for minilaparotomy cholecystectomy.     

Serum ceruloplasmin in acute myocardial infarction.

Serum ceruloplasmin levels were estimated in 81 patients within one week after an attack of acute myocardial infarction. A total of 126 healthy subjects were taken as controls and investigated for this copper containing protein. Results showed that there is an elevation in the levels of serum ceruloplasmin in patients as compared to the controls. Ceruloplasmin levels showed a return to almost normal values in 54 follow-up cases of acute myocardial infarction during the fourth week after infarction.     

Prospective Randomized Comparison of Sodium Tetradecyl Sulfate and Polidocanol as Variceal Sclerosing Agents

A prospective randomized controlled study was designed to evaluate differences in efficacy and complication rate between the two most commonly used sclerosing agents, sodium tetradecyl sulfate (STD) and polidocanol. Of 52 patients with esophageal variceal bleeding, 26 were randomized to receive sclerotherapy with 1.5% STD and 26 to receive 1% polidocanol at weekly intervals. Eradication of varices was achieved in 88% patients each of the STD and polidocanol group. There was no significant difference between patients injected with STD and polidocanol with regard to re-bleeding (27% vs. 15%) and mortality (11.5% in both). The use of STD, in contrast to polidocanol, was associated with a higher incidence of complications in terms of severe retrosternal pain (27% vs. 4%), deep ulceration (53% vs. 23%), dysphagia (88% vs. 46%), and stricture formation (27% vs. 8%). It was concluded that these two agents were similar in efficacy. However, polidocanol was superior due to a lower incidence of complications.