Utility of the dexamethasone suppression test in the diagnosis of poststroke depression.

The utility of the dexamethasone suppression test (DST) in the diagnosis of depression was examined in an outpatient sample of 29 stroke patients. Results indicated that the DST's sensitivity was 15%, its specificity was 67%, and its positive predictive value was 48%. These findings suggest that the DST yields no more information than would be gained from random assignment of the diagnosis of depression. Therefore, it is not a useful measure of mood in these patients.     

Area variation of avoidable causes of death in Auckland, 1977-85

An area analysis is presented of deaths in Auckland that were ostensibly avoidable, by appropriate medical intervention and treatment. Mortality data from the National Health Statistics Centre for the period 1977-85 were used in the analysis. The definition of an avoidable death was based on the International Classification of Diseases (ICD) code using established criteria. Eight percent of deaths of people under 65 years of age met the criteria. The basic spatial entity for the analysis is the census area unit and maps of Auckland are presented to show the distribution of avoidable mortality. It is found that there are significant and consistent spatial variations. Three areas with avoidable mortality that is generally higher than elsewhere are apparent: in south Auckland; to the north-west of the central urban sector centered on Grey Lynn; and in the eastern parts of the central sector from Glenn Innes to Onehunga.     

Unicanalicular stent for nasolacrimal duct obstruction

The authors describe a method for silicone intubation of a single patent canaliculus associated with a nasolacrimal duct obstruction. Although bicanalicular intubation is always preferable when possible, unicanalicular stenting is necessary when only one canaliculus is patent. A chief advantage of this technique is that the lacrimal stent is inaccessible to the child and thus cannot be accidentally pulled out.     

Synthesis and teratogenic action of n-hydroxythalidomide

N-Hydroxythalidomide (1d), a potential metabolite of thalidomide (1a), was synthesized from N-phthalyglutaminic acid anhydride (1b) and O-tetrahydropyraline hydroxylamine, followed by deprotection. The teratogenicity of 1d was studied using the Hen's-Egg-Test model which had been found applicable for 1a. 1d was more teratogenic to chicken embryos compared to 1a. The percentage of teratogenic malformations in the 1d groups was 28-46%, whereas the percentage in the 1a groups was 20-23%. The oxygen protected precursor N-hydroxythalidomide (1c) was less teratogenic (11-15%).     

Diacylglycerol in the synergy of bradykinin and thrombin stimulation of prostaglandin synthesis

Simultaneous addition of bradykinin and thrombin to 3T3 fibroblasts for 5 min resulted in less than additive stimulation of prostaglandin E2 synthesis. However, if cells were stimulated with either agonist alone, then the other added 15 min later, prostaglandin E2 synthesis was synergistically enhanced. In contrast, if either agonist was added, then prostaglandin E2 synthesis in response to the same agonist assessed 15 min later, synthesis was markedly reduced. Bradykinin and thrombin caused increased diacylglycerol accumulation in the cells, and addition of the diacylglycerol kinase inhibitor R59022 dramatically increased the effects of sequential addition of the agonists. These results suggest that diacylglycerol generated in response to activation of one receptor amplifies the effects of activation of other receptors.     

Morphological observations in skeletal muscle from patients with a mitochondrial myopathy

The regional distribution of the phenylalanine-sensitive ATP-sulphurylase in fetal calf brain coincides with demyelinated lesions observed in the central nervous systems of untreated PKU patients. This would be expected if this species of ATP-sulphurylase played a role in the pathogenesis of brain dysfunction in the untreated or poorly controlled phenylketonuria patient.     

Role of immediate versus delayed nephrectomy for failed renal transplants

The role of timing of transplant nephrectomy after renal transplantation has not been well defined. This report compares the morbidity, mortality, and hospitalization costs of 37 patients undergoing transplant nephrectomy within 14 days after graft failure and return to dialysis, with 31 patients undergoing delayed transplant nephrectomy (less than 14 days after graft failure and return to dialysis). This analysis revealed that there were no significant (P greater than .05) differences in patient morbidity and mortality between these groups. There was, however, a substantial increase (P less than .05) in the cost of hospitalization in the delayed nephrectomy group. For this reason, we recommend early nephrectomy after renal transplant failure in order to minimize the cost of health care for these patients undergoing failed cadaver donor transplant nephrectomy.