Obsessive-compulsive symptoms in schizophrenia: prevalance and clinical correlates

Obsessive-compulsive symptoms (OCS) have been observed in a substantial proportion of schizophrenic patients. In this study, the rate of occurrence of OCS and obsessive-compulsive disorder (OCD) in schizophrenic patients, and also the interrelationship between OCS and schizophrenic symptoms and depressive symptoms were assessed. A total of 100 subjects with a diagnosis of schizophrenia from the 4th edition of the Diagnostic and Statistical Manual (DSM-IV) were evaluated by the structured and clinical interview for axis-1 DSM-IV disorders-patient edition (SCID-P), the Positive and Negative Syndrome Scale (PANSS), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and the Calgary Depression Rating Scale for Schizophrenia. The prevalance of OCS in individuals meeting criteria for schizophrenia was 64%. A total of 30 of these patients (Y-BOCS total score > or =7) also met the DSM-IV criteria for OCD. The total score on Y-BOCS was significantly correlated with total score on PANSS, Positive-PANSS score, General-PANSS score and total score on Calgary Depression Rating Scale for Schizophrenia. OCS and OCD relatively frequent in schizophrenic patients and OCS are significantly correlated with the severity of psychosis, positive symptoms, and depressive symptoms in schizophrenic patients. These findings provide further evidence for the importance of OCS in schizophrenia.     

Antibody titers and immune response to diphtheria-tetanus-pertussis and measles-mumps-rubella vaccination in children treated for acute lymphoblastic leukemia

The objective of this study was to investigate the diphtheria-tetanus-pertussis and/or measles-mumps antibody titers before and after vaccination at various time points of acute lymphoblastic leukemia (ALL) therapy and to suggest an appropriate vaccination approach for ALL patients. The authors studied 37 ALL patients and 14 healthy control subjects, divided into three groups. In group 1 (newly diagnosed patients), baseline anti-diphtheria, anti-tetanus, and anti-pertussis titers were determined. Patients in group 2 (on maintenance chemotherapy) and group 3 (patients not receiving therapy for 3-6 months) were vaccinated with diphtheria-tetanus with or without acellular pertussis; group 3 and control subjects were also given measles-mumps-rubella vaccine. Preimmunization and 1-month postimmunization titers were drawn. Preimmunization anti-diphtheria and anti-tetanus antibody titers between the groups and the controls were statistically similar. The seropositivity rate for anti-measles antibody in group 3 was significantly lower than controls. After vaccination, all of the patients developed protective anti-diphtheria and anti-tetanus antibody titers. The seroconversion rates of group 3 and controls for anti-measles and anti-mumps antibodies were statistically similar. The results showed that patients on maintenance therapy and after cessation of therapy made good antibody responses to diphtheria and tetanus toxoids, but response to measles and mumps vaccines was not as sufficient as toxoid vaccines. Children with ALL can receive the appropriate vaccines during and after maintenance treatment.     

Alopecia treatment with scalp expansion: some surgical fine points and a simple modification to improve the results

In the current study, authors present their clinical experience with the esthetic reconstruction of alopecia by means of a tissue expansion technique in 74 consecutive patients who were treated between May 1986 and June 2002 in the Department of Plastic and Reconstructive Surgery. The principles of the conventional technique are mentioned briefly, but the authors essentially tried to explain a number of surgical fine points together with some simple modifications so as to get the maximum profit from the expanded tissue and to decrease the complication rate. In the first 39 patients of this study, who were treated with a conventional tissue expansion technique, the major complication rate was found to be 15.4%. In the last 35 patients, this rate was found to be decreased to 5.7%. The improvement in the major complication rate is attributed to the authors' surgical modifications compared with the conventional technique. The article provides a supplement to the existing literature, underscoring the importance of some surgical fine points and outlining a systematic way of planning expander placement and tissue expansion.     

Juvenile polyarteritis: results of a multicenter survey of 110 children

OBJECTIVE: To characterize pediatric patients who had been diagnosed with polyarteritis nodosa (PAN) through necrotizing vasculitis of the small and mid-size arteries or those with characteristic findings on angiograms data were collected. STUDY DESIGN: Pediatricians were asked to classify their patients into one of the four suggested groups for juvenile PAN. Twenty-one pediatric centers worldwide participated with 110 patients. RESULTS: The girl:boy ratio was 56:54, with a mean age of 9.05 +/- 3.57 years. The cases were classified as: 33 (30%) cutaneous PAN; 5 (4.6%) classic PAN associated with hepatitis B surface antigen (HBs Ag); 9 (8.1%) microscopic polyarteritis of adults associated with antineutrophil cytoplasmic antibodies (ANCA); and 63 (57.2%) systemic PAN. Cutaneous PAN was disease confined to the skin and musculoskeletal system. All patients with HBs Ag-associated classic PAN were diagnosed with renal angiograms. Antiviral treatment was administered in most cases. Microscopic PAN patients had pulmonary-renal disease, in combination or separately. ANCA was present in 87%, and 2 patients progressed to end-stage renal failure. Patients classified with systemic PAN had multiple system involvement, almost all had constitutional symptoms, and all had elevated acute phase reactants. Corticosteroids and cyclophosphamide were the first choices of immunosuppressive treatment. The overall mortality was 1.1%. CONCLUSIONS: There were remarkable differences among pediatric patients with PAN, with different clinical manifestations and overall better survival and lower relapse rates when compared with adults.     

Narrow pubic arch and increased risk of failure for vaginal hysterectomy

OBJECTIVE: The purpose of this study was to evaluate the risk factors involved in failed vaginal hysterectomies. METHODS: Data on all vaginal hysterectomies performed by a single gynecologic surgeon were collected prospectively. Patients requiring pelvic floor repair were excluded. Any procedure converted to the abdominal approach was classified as a failed vaginal hysterectomy and comprised the study group. For every woman who had a failed vaginal hysterectomy, the next 2 women who had successful vaginal hysterectomies immediately after the failed vaginal hysterectomy were taken as controls. Risk factors such as age, parity, body weight, surgical indication, uterine size, presence of leiomyomata in the anterior lower uterine segment, previous pelvic surgeries, abdominopelvic adhesions, location and length of cervix, narrow pubic arch, intraoperative complications such as bleeding requiring transfusion, visceral injury, nulliparity, and adnexal removal were compared between groups. RESULTS: We compared 25 failed vaginal hysterectomies with 50 controls whose procedures were completed successfully through the vagina. Among all the factors gynecologists can assess preoperatively, only the presence of a narrow pubic arch increased the risk of failure for vaginal hysterectomy (odds ratio [OR] 4.1; 95% confidence interval 1.32-12.69). Intraoperative bleeding with transfusion was also found as an independent cause for conversion to laparotomy (OR 7.37; 95% confidence interval 1.75-31.06). CONCLUSION: Women with a narrow pubic arch are not good candidates for vaginal hysterectomy. The most common unpredictable cause for conversion to laparotomy from the vaginal approach is intraoperative bleeding requiring transfusion. LEVEL OF EVIDENCE: II-2     

Stabilization of anterior cervical spine with bioabsorbable polymer in one- and two-level fusions

OBJECTIVE: We present our experience using a bioabsorbable polymer in the surgical management of one- and two-level degenerative disc disease of the cervical spine with anterior cervical discectomy and fusion. Twenty-six patients were treated at the University of California, San Diego Medical Center or the Veterans Affairs Medical Center in San Diego, CA. All cases were performed under the direction of a single neurosurgeon (WRT). METHODS: A retrospective review of patients' charts and imaging was performed to determine outcomes after anterior cervical spine operations. Specifically, we looked at the need for additional surgery, local reaction to the bioabsorbable polymer, fusion rate, and complications. Procedures involved the C3-C4, C4-C5, C5-C6, and/or C6-C7 levels, and fibular allograft was used in all but one case. The anterior cervical discectomy and fusion procedures with internal fixation were performed in 26 patients between March 2000 and November 2001. The patients were followed for up to 2 years after surgery (average, 14 mo). RESULTS: Radiographic fusion was achieved in 25 (96.2%) of 26 patients. Only one instance of treatment failure was encountered that required additional surgery and the placement of a titanium plate. There were no clinical signs or symptoms of reaction to the bioabsorbable material. CONCLUSION: The rates of fusion after single-level anterior cervical discectomy and fusion with internal fixation using bioabsorbable polymer and screws in this study match those using metallic implants, as previously reported in the literature, and are superior to those achieved with noninstrumented fusions. Preliminary results suggest that this newly available technology for anterior fusion is as effective in single-level disease as traditional titanium plating systems. The bioabsorbable material seems to be tolerated well by patients. A larger, randomized, controlled study is necessary to bring the results to statistical significance.     

Morphometry of the anterior third ventricle region as a guide for the transcallosal-interforniceal approach

The transcallosal-interforniceal approach is the most appropriate approach to localize and totally remove space-occupying lesions around the anterior third ventricle region such as craniopharyngiomas and gliomas. This study examined the microsurgical anatomy of the normal anterior third ventricle region in 81 adult cadaver hemispheres. The central sulcus was identified and surface landmarks determined as the points 5 cm (P5) and 7 cm anterior to the central sulcus (P7). The distances between P5 and P7 and the upper margin of the interventricular foramen, which delineate the surgical corridor chosen to avoid disturbance of important neural structures, were 46.26-60.96 (54.09 +/- 3.35) mm and 48.00-62.00 (54.94 +/- 3.09) mm, respectively. The distances between the upper margin of the hemisphere and the cingulate sulcus, especially important for avoiding damage to the cingulate gyrus and other mesiolimbic structures, were 13.54-30.00 (21.28 +/- 3.89) mm and 12.22-29.52 (21.12 +/- 3.90) mm at the level of P5 and P7. The distances between the upper margin of the hemisphere and the callosal cistern containing the pericallosal artery were 28.34-40.50 (33.94 +/- 2.84) mm and 28.16-40.26 (33.50 +/- 2.61) mm, respectively. Normative morphometric data of the structures involved in the surgical procedure are necessary for planning and performance of the transcallosal-interforniceal approaches. This study of a large series of specimens shows that these measurements have large individual variations.     

Efficacy of anti-adhesive barriers in secondary thyroidectomy: an experimental study

HYPOTHESIS: This study was conducted to compare the effectiveness of two anti-adhesive barriers (Seprafilm and Interceed) for reducing adhesions after thyroidectomy in a rat model. The anti-adhesive barriers are suggested for use in repeated surgeries in general and the gynecologic fields in particular. STUDY DESIGN: Controlled, randomized study. METHODS: Twenty-eight male Wistar Albino rats that underwent right subtotal thyroidectomy were randomly assigned to three groups. One group received Seprafilm (n = 10), and the other received Interceed (n = 10) as anti-adhesive barriers. The third group was the control group (n = 8). At postoperative day 14, the rats were killed under general anesthesia, and the surgical fields were evaluated for the adhesion formation. The extent of the adhesion formation is scored from 0 (no adhesions) to 2 (fibrous adhesions that required sharp dissection). Histopathologically, chronic inflammation, histiocyte, fibroblast, fibrosis, collagen, vascularization, granuloma, giant cell, and fat necrosis were examined. RESULTS: All the subjects in the control group, 7 of 10 in the Interceed group, and 4 of 10 in the Seprafilm group needed to be dissected bluntly or sharply. There was significant difference between the Seprafilm and the control group (P < .05) whereas there was no significant difference between the Interceed group and the control group (P > .05). When examined histopathologically, the criteria showing adhesion, such as fibrosis, fibroblast, and collagen were higher in the control group compared with the Seprafilm and Interceed groups. There was no significant difference between the Seprafilm and Interceed groups, whereas a significant difference was found between these two groups and the control group. CONCLUSION: This study suggests that both Seprafilm and Interceed decrease the incidence of posthyroidectomy adhesions in a rat model. Both agents showed no foreign body reaction.