Shared obsessive-compulsive disorder

BACKGROUND: Shared psychotic disorder (folie à deux) is an uncommon entity reported mainly in the context of delusions. Obsessions and compulsions occur very rarely as shared psychopathology. MATERIAL AND METHODS: We present two sisters who manifested shared obsessive-compulsive disorder. RESULTS: Both sisters were managed in keeping with their shared obsessive-compulsive disorder leading onto a similar pattern of response. CONCLUSIONS: Shared obsessions could represent the continuum concept of obsessions and delusions, and their relationship needs to be evaluated in greater detail.     

Mortality after cardiac bypass surgery: prediction from administrative versus clinical data

BACKGROUND: Risk-adjusted outcome rates frequently are used to make inferences about hospital quality of care. We calculated risk-adjusted mortality rates in veterans undergoing isolated coronary artery bypass surgery (CABS) from administrative data and from chart-based clinical data and compared the assessment of hospital high and low outlier status for mortality that results from these 2 data sources. STUDY POPULATION: We studied veterans who underwent CABS in 43 VA hospitals between October 1, 1993, and March 30, 1996 (n=15,288). METHODS: To evaluate administrative data, we entered 6 groups of International Classification of Diseases (ICD)-9-CM codes for comorbid diagnoses from the VA Patient Treatment File (PTF) into a logistic regression model predicting postoperative mortality. We also evaluated counts of comorbid ICD-9-CM codes within each group, along with 3 common principal diagnoses, weekend admission or surgery, major procedures associated with CABS, and demographic variables. Data from the VA Continuous Improvement in Cardiac Surgery Program (CICSP) were used to create a separate clinical model predicting postoperative mortality. For each hospital, an observed-to-expected (O/E) ratio of mortality was calculated from (1) the PTF model and (2) the CICSP model. We defined outlier status as an O/E ratio outside of 1.0 (based on the hospital's 90% confidence interval). To improve the statistical and predictive power of the PTF model, selected clinical variables from CICSP were added to it and outlier status reassessed. RESULTS: Significant predictors of postoperative mortality in the PTF model included 1 group of comorbid ICD-9-CM codes, intraortic balloon pump insertion before CABS, angioplasty on the day of or before CABS, weekend surgery, and a principal diagnosis of other forms of ischemic heart disease. The model's c-index was 0.698. As expected, the CICSP model's predictive power was significantly greater than that of the administrative model (c=0.761). The addition of just 2 CICSP variables to the PTF model improved its predictive power (c=0.741). This model identified 5 of 6 high mortality outliers identified by the CICSP model. Additional CICSP variables were statistically significant predictors but did not improve the assessment of high outlier status. CONCLUSIONS: Models using administrative data to predict postoperative mortality can be improved with the addition of a very small number of clinical variables. Limited clinical improvements of administrative data may make it suitable for use in quality improvement efforts.     

The presentation and early diagnosis of the rudimentary uterine horn

OBJECTIVE: The key to successful management of the rudimentary uterine horn is early detection. This review of the literature seeks to illustrate important aspects of diagnosis and management of this anomaly. DATA SOURCES: An English language MEDLINE search from 1966 to 2003 was performed, using the search terms "rudimentary uterine horn," "accessory horn," "uterus bicornis unicollis," "hematometra," "unicornuate or bicornuate uterus," and "mullerian anomaly." References from previously published sources were also obtained. METHODS OF STUDY SELECTION: One hundred thirty letters, case reports, case series, and review articles featuring rudimentary uterine horn were found. Reports before 1966 were excluded because outcomes before the advent of modern diagnostic techniques were not relevant to this study. TABULATION, INTEGRATION, AND RESULTS: Three hundred sixty-six rudimentary horn presentations (210 gynecologic and 156 obstetric) were found. Noncommunicating horns accounted for 92% of cases (95% confidence interval [CI] 88-95%, P < .001), and renal anomaly was found in 36% (95% CI 29-44%). Contrary to the American Fertility Society classification of uterine anomalies, rudimentary horns may occur without a corresponding unicornuate uterus. The mean age of presentation was similar for gynecologic and obstetric presentations (23 and 26 years, 95% CIs 21.2-24.6 and 124.9-27.3 years, respectively). Presentation in the third decade of life or later occurred in 78% of patients (95% CI 70-84%, P < .001). Sensitivity of ultrasound examination for diagnosis was 26% (95% CI 18-36%). Diagnosis before clinical symptoms occurred in 14% (95% CI 7-23%). CONCLUSION: Many functional noncommunicating horns present during or after the third decade of life with acute obstetric uterine rupture. Surgical removal before pregnancy is recommended. Rates of prerupture diagnosis remain disappointingly low.     

Solitary calvarial metastases: an unusual presentation of thoracic neuroblastoma

A primary thoracic origin occurs only in 20% of neuroblastomas, and their classical presentation is mediastinal or cord compression. Skeletal metastases of neuroblastomas are characteristically multiple, and calvarial deposits usually show simultaneous involvement of orbit. Solitary metastases in neuroblastoma, is an unusual entity and its presentation as a large calvarial mass, especially from a thoracic primary, is rare. Furthermore, calvarial metastases are relatively uncommon in children compared to adults. We discuss the clinical, radiographic, CT features, and differential diagnosis of a large calvarial mass with sunray spiculation in a child, which was due to a solitary metastases from an occult thoracic neuroblastoma. The possibility of neuroblastoma presenting in this unique fashion and the importance of considering a chemosensitive tumor such as neuroblastoma in the differential diagnosis of a solitary calvarial mass in a child is highlighted by our report.     

Graves’ exophthalmos: Volumetric assessment of orbital expansion

INTRODUCTION:

Graves’ ophthalmopathy is characterized by an increase in the volume of orbital soft tissue contents and an associated increase in intraorbital pressure. Surgical expansion of bony orbital volume is therefore an effective method of treating moderate to severe exophthalmos. Numerous correlations between specific decompression procedures and reduction of proptosis have been made. The main emphasis of the majority of these studies, however, appears to be of a qualitative nature rather than quantitative.

OBJECTIVES:

To quantitatively examine the consequences of surgical orbital decompression in the treatment of severe Graves’ exophthalmos, with respect to changes in ocular globe projection and orbital soft tissue and bony volume.

MATERIAL AND METHODS:

A series of three patients (five orbits) with severe exophthalmos were evaluated. All patients were operated on by a single surgeon using a standard technique of orbitozygmatic osteotomy in conjunction with three-wall orbital decompression and release of periorbita. Data obtained from standardized preoperative and three-month postoperative computed tomography scans were transferred to an offline computer workstation. Scalar and volumetric parameters were quantitatively analyzed to determine changes in globe projection in relation to intraorbital volume differences.

RESULTS:

Following surgery, mean globe retrodisplacement from the lateral orbital rim and from the optic foramen were 6.7 mm and 3.3 mm, respectively. Osteotomy and decompression were effective in producing an 18.6% increase in bony orbital volume. However, the volume of intraorbital soft tissues increased substantially following surgery, with a 23.4% increase in orbital fat volume and a 12.2% increase in neurovascular tissue volume.

CONCLUSIONS:

The degree of globe retrodisplacement achieved by surgical expansion of the bony orbital cavity in patients with Graves’ ophthalmopathy may be less than anticipated, due to a post-operative increase in the intraorbital soft tissue volumes.     

Application of WHONET for the surveillance of antimicrobial resistance

World over antimicrobial resistance is a major public health problem. The WHONET software program puts each laboratory data into a common code and file format, which can be merged for national or global collaboration of antimicrobial resistance surveillance. In this study, antimicrobial sensitivity of 4,289 bacterial isolates was studied by Kirby-Bauer disk diffusion method. -lactamase production was assessed by iodometric test method. Extended spectrum -lactamase (ESBLs) were screened by ceftazidime disk sensitivity. Drug resistance was high in most of the isolates. It was maximum (80-94%) for ampicillin, nalidixic acid and cotrimoxazole. It varied between 40-60% for gentamicin, clindamycin, fluoroquinolones and coamoxyclav. It ranged from 21 to 38% for amikacin and third generation cephalosporins. Constitutive -lactamase production was highest in S.aureus (28.9%) and ESBL production was maximum in Klebsiella spp. (53.6%). WHONET software has in-built analysis program which helps in forming hospital drug policy, identification of hospital outbreaks and recognition of quality control problems in the laboratory.     

Survival pattern of reported HIV infected individuals in the city of Delhi (India)

There is very little data on the survival period of HIV in India. In this paper survival experience of 836 HIV infected patients was studied whose illness was diagnosed upto Dec. 2003. On analysis, it was observed that the mortality was maximum in the age-group of 41-50 years (25%), 24.4% in males and 24.2% in females. For patients with tuberculosis morality was 23% and was higher among those with unsafe sex (24.5%) as a risk factor. Mortality of AIDS patients in Delhi decreased from 63.2% in 1994 to 24.2% in the year 2003. Also tuberculosis was found to be the major opportunistic infection affecting 83.2% of the patients. An increasing trend was observed with tuberculosis from 84.2% in 1994 to 89.1% in 1997 (p<0.05), but overall tendency was around 84% during the period 1994 to 2003. In AIDS related symptoms chronic diarrheoa accounted for only 5.2%. The median length of survival of HIV infected patients with all subjects was 75 months. The hazard rate showed an increasing trend and reached its peak at 102 months. The survival of HIV infected patients in Delhi was found to be shorter than that of patients in developed countries and developing African countries.