Increased risk for pulmonary embolism in patients with bipolar disorder

OBJECTIVES: The purpose of this study was to investigate the increased risk for pulmonary embolism (PE) in patients with manic-depressive psychosis/bipolar disorder (BD). Affective patients show increased mortality compared with the background population. METHODS: A register study was carried out in which somatic and psychiatric information in 25,834 BD patients and 117,815 controls was extracted from The Danish Psychiatric Central Research Register, The National Register of Patients, The Danish Central Person Register and The Danish Register of Causes of Death, with similar information about patients with schizophrenia and anxiety for comparison. RESULTS: Patients with BD had a significantly increased occurrence of PE [increased incidence rate ratio (IRR)=1.61; 95% confidence interval (CI) (1.38, 1.88)]. An association was also found in schizophrenic patients [IRR=1.78; 95% CI (1.27, 2.51)] and in anxiety patients [IRR=1.49; 95% CI (1.10, 2.02)]. CONCLUSIONS: Increased occurrence of PE in patients with BD is one of the explanations of increased mortality in the affective patient group. A similar finding in females with schizophrenia and females with anxiety suggests 'mental disorder' as the risk factor for PE. The causes for the increased occurrence of PE in BD patients (and other diagnostic groups) need further investigation.     

Prediction of growth discordance in twins with the use of abdominal circumference ratios

OBJECTIVE: The purpose of this study was to assess the accuracy of sonographic prediction of twin birth weight discordance using the abdominal circumference ratio. STUDY DESIGN: This was a prospective cohort of diamniotic twin gestations that underwent serial ultrasound examinations every 2 to 4 weeks from 11 to 38 weeks of gestation. Birth weight discordance was defined as > or =25% difference in birth weight, relative to the larger twin. The sensitivity, specificity, and predictive values for the abdominal circumference ratio were assessed for the prediction of growth discordance. RESULTS: Of 503 diamniotic twin pregnancies, 64 pregnancies (12.7%) had discordant fetal growth. The abdominal circumference ratio could be measured consistently throughout gestation in 100% of twin pairs. Receiver operating curve analysis showed that the abdominal circumference ratio was a good predictor of birth weight discordance (area under the curve = 0.80). An abdominal circumference ratio cutoff of 0.93 yielded a sensitivity and specificity of 61% and 84%, respectively. CONCLUSION: Twin birth weight discordance may be predicted at any gestational age with an abdominal circumference ratio <0.93.     

Canadian Consensus on cardiac transplantation in pediatric and adult congenital heart disease patients 2004: executive summary

Cardiac transplantation is an acceptable therapeutic option for the pediatric age group and for adult patients with congenital heart disease. There are a myriad of clinical diagnoses in these two patient populations. Survival has continued to improve, with graft half-lives of 14 years and greater in pediatric heart transplantation patients. There are issues unique to these patient populations in relation to heart transplantation for which the present document summarizes the relevant literature and presents management guidelines. Donor availability remains a major limiting factor in organ transplantation at present. Efforts need to be made to increase organ donor awareness, identify potential donors and aggressively manage marginal donors. Indications for transplantation and determination of timing of listing continue to be challenging due to a lack of evidence-based guidelines specifically for prognostic indices of outcome and pretransplant survival. The current status system for listing patients for transplantation does not necessarily reflect the typical clinical course of deterioration experienced by these two patient populations; therefore, consideration needs to be given to a parallel listing strategy. Evidence is accumulating pointing to an advantage to performing transplantations in patients in early infancy. ABO-incompatible heart transplantation has lead to a reduction in waiting time and waiting list mortality. Care of children after heart transplantation must take into consideration physical growth and multisystem development; stage of immunological maturation; intellectual, emotional and social maturation; educational activities; and other pediatric quality of life parameters. Post-transplantation issues are somewhat different, including rejection, coronary artery disease, malignancies and infections. Efforts need to be made to support multicentre trials to determine optimal treatment protocols.     

Bone scintigraphy of calciphylaxis: a syndrome of vascular calcification and skin necrosis

Calciphylaxis is a highly morbid syndrome of vascular calcification and skin necrosis, the pathophysiology of which remains largely elusive. We report a patient with end-stage renal disease and multiple painful skin lesions who underwent a bone scan for extremity pain. Increased tracer accumulation was seen in the subcutaneous tissues of the trunk and lower extremities. In this case, the bone scan aided in the diagnosis and treatment of calciphylaxis for a patient who experienced a relatively short hospital stay.     

Measuring social participation: reliability of the LIFE-H in older adults with disabilities

PURPOSE: Much more attention should be paid to instruments documenting social participation as this area is increasingly considered a pivotal outcome of a successful rehabilitation. The purpose of this study was to document the reliability of a participation measure, the Assessment of Life Habits (LIFE-H), in older adults with functional limitations. METHODS: Eighty-four individuals with physical disabilities living in three different environments were assessed twice with the LIFE-H, an instrument that documents the quality of social participation by assessing a person's performance in daily activities and social roles (life habits). RESULTS: The intraclass correlation coefficients (ICC) computed for intrarater reliability exceeded 0.75 for seven out of the 10 life habits categories. For interrater reliability, the total score and daily activities subscore are highly reliable (ICC 相似文献   

Perceived inspiratory difficulty in neuromuscular patients with primary muscle disorders

Intensity of perceived inspiratory difficulty was investigated in 17 patients with severe respiratory insufficiency due to muscle disease, compared with healthy matched controls. Subjects breathed through a threshold valve generating a constant inspiratory negative pressure proportional to their maximal inspiratory pressure. Four load levels ranging from 10 to 40% of the maximal inspiratory pressure were applied in random order. Patients had significantly less perceived inspiratory difficulty than controls at each load level expressed as a percentage of maximal inspiratory pressure P < 0.001. However, when the load was expressed as the absolute value, the slope of the Borg scale score versus mouth pressure was similar in the two groups (P = 0.11). The ventilatory pattern remained unchanged in each group as the load increased. We conclude that in patients with myopathy, loads leading to respiratory muscle fatigue (40% of maximal inspiratory pressure) may fail to produce perceived inspiratory difficulty.     

Victimization: a newly recognized outcome of prematurity

Victimization by peers affects 10 to 20% of school children under the age of 12 years. Physical, verbal, and psychological victimization (being pushed, hit, called names, teased, being the target of rumours, theft, extortion) is associated with short- and long-term adjustment problems, such as peer rejection, social withdrawal, low self-esteem, anxiety, loneliness, and depression, as well as academic problems and school drop-out. Research on populations of school children (primary and secondary) has associated victimization with personal risk factors (the victim's characteristics and behaviour) and interpersonal risk factors (social relationships between peers). Studies on the social adjustment of preterm children at school age show that, even in the absence of a major motor or cognitive disability, this population has several personal risk factors associated with victimization. The objective of this study was to compare the level of victimization experienced by a group of 96 seven-year-old children born extremely preterm (EP, < 29 weeks of gestation; 49 females) against that experienced by a group of 63 term children (34 females) matched for age and sex, maternal level of education, and family socioeconomic status. The children born EP had a mean gestational age of 27.3 weeks (SD 1.2) and a mean birthweight of 1001.1g (SD 223) and normal birthweight children had a mean gestational age of 39.5 weeks (SD 1.5) and a mean birthweight of 3468.7g (SD 431). Physical and verbal victimization were assessed in a school setting by peers with individual sociometric interviews (Modified Peer Nomination Inventory). After controlling for physical growth (height and weight) at the age of 7 years, the data indicate two independent effects: males were more victimized than females, and children born preterm experienced more verbal victimization by their peers than their term classmates, even when participants with a visible motor, intellectual, or sensory disability were excluded. Several hypotheses are presented to account for the higher incidence of verbal victimization of preterm children.     

Technetium-99m-Labeled N-(2-Hydroxypropyl) Methacrylamide Copolymers: Synthesis,Characterization, and in Vivo Biodistribution

PURPOSE: To synthesize novel technetium-99m (99mTc)-labeled N-(2-hydroxypropyl) methacrylamide (HPMA) copolymers and characterize the effect of charge and molecular weight on their biodistribution in SCID mice. METHODS: Electronegative and neutral 7-kDa, 21-kDa, and 70-kDa HPMA copolymers containing a 99mTc chelating comonomer, bearing N-omega-bis(2-pyridylmethyl)-L-lysine (DPK), were synthesized by free-radical precipitation copolymerization. The copolymers were labeled via 99mTc tricarbonyl chelation to DPK-bearing comonomer. They were characterized by side-chain content, molecular weight, molecular weight distribution, radiochemical purity, and labeling stability. Scintigraphic images were obtained during the first 90 min and at 24 h postintravenous injection in SCID mice. At 24 h, organ radioactivity was determined from necropsy tissue counting. RESULTS: 99mTc-labeled HPMA copolymers showed greater than 90% stability over a 24-h challenge with cysteine and histidine. Scintigraphic images and the necropsy data showed that the negatively charged copolymers were eliminated from the body significantly faster than the neutral copolymers in a size-dependent manner. CONCLUSIONS: To facilitate clinical scintigraphic imaging, stable chelation of 99mTc may be achieved by incorporation of a DPK-bearing comonomer into the HPMA backbone. Electronegative and neutral 99mTc-labeled HPMA copolymers of 7, 21, and 70 kDa show significant variation in organ biodistribution in SCID mice. 99mTc-labeled HPMA copolymers could be used as diagnostic agents and to study pharmacokinetics of delivery systems based on these copolymers.     

Corneal autofluorescence in relation to permeability of the blood-aqueous barrier in diabetic patients with clinically significant macular edema and in an age-matched control group

PURPOSE: Corneal autofluorescence is related to advanced glycation end products formed by glucose that reaches the cornea via the aqueous humour. The aim of the study was to examine the influence on autofluorescence of changes in permeability of the blood aqueous barrier. METHODS: Corneal autofluorescence was measured in 50 diabetic patients with clinically significant macular edema and in 28 age-matched control subjects. Permeability of the blood aqueous barrier was assessed using the diffusion coefficient of fluorescein. RESULTS: Corneal autofluorescence was higher in diabetic subjects than in the control group, mean (SD) at an excitation wavelength of 458 nm was 41.2 ng f-eq/ml (11.7) in diabetic patients and 26.5 ng f-eq/ml (7.3) in the control group, p < 0.001. The mean permeability of the blood aqueous barrier, Kd(F), was 492.0.10(-6) min(-1 )in the diabetic patients and 484.2. 10(-6) min(-1)in the control group. There was no association between permeability of the blood aqueous barrier and corneal autofluorescence, p = 0.99 for the diabetic patients and p = 0.15 for the control group (458 nm). CONCLUSIONS: Corneal autofluorescence was unaffected by permeability of the blood aqueous barrier suggesting that formation of advanced glycation products is limited by other factors than the concentration of glucose in the aqueous humour, or that other factors unrelated to nonenzymatic glycation of stromal proteins are involved.