Role of thrombophilic risk factors in children with non-stroke cerebral palsy

BACKGROUND: Thrombophilic risk factors play an important role in the pathogenesis of perinatal stroke and resultant cerebral palsy (CP). The association between thrombophilia and CP caused by etiologies other than stroke is undetermined. METHODS: We assessed three genetic thrombophilic markers (mutation of Factor V Leiden [FV G1691A], 677T polymorphism of thermolabile methylenetetrahydrofolate reductase [MTHFR] and G20210A mutation of the prothrombin gene) in 49 pediatric patients with non-stroke CP and compared the findings with 118 apparently healthy controls. CP in the study group was due to periventricular leukomalacia (n=27), intraventricular hemorrhage (n=9), hypoxic ischemic encephalopathy (n=4), prematurity with no apparent complication (n=8) and intrauterine growth retardation (n=1). Twenty-five children had spastic diplegia, 20 had spastic quadriplegia and 4 had spastic hemiplegia. CP was graded as being severe in 26 children (53%). RESULTS: No significant difference in the prevalence of thrombophilic risk factors was found between the study and control groups. Twelve study children (24.5%) had at least one of the three thrombophilic mutations compared with 27 controls (23%). There was no significant difference in the prevalence of each thrombophilic risk factor in the various etiologic groups and in the subgroups of mild/severe CP and the control group. CONCLUSION: These findings support the notion that thrombophilia neither contributes to the occurrence nor affects the clinical outcome and severity of non-stroke CP.     

Optease Vena Cava Filter Optimal Indwelling Time and Retrievability

The purpose of this study was to assess the indwelling time and retrievability of the Optease IVC filter. Between 2002 and 2009, a total of 811 Optease filters were inserted: 382 for prophylaxis in multitrauma patients and 429 for patients with venous thromboembolic (VTE) disease. In 139 patients [97 men and 42 women; mean age, 36 (range, 17–82) years], filter retrieval was attempted. They were divided into two groups to compare change in retrieval policy during the years: group A, 60 patients with filter retrievals performed before December 31 2006; and group B, 79 patients with filter retrievals from January 2007 to October 2009. A total of 128 filters were successfully removed (57 in group A, and 71 in group B). The mean filter indwelling time in the study group was 25 (range, 3–122) days. In group A the mean indwelling time was 18 (range, 7–55) days and in group B 31 days (range, 8–122). There were 11 retrieval failures: 4 for inability to engage the filter hook and 7 for inability to sheathe the filter due to intimal overgrowth. The mean indwelling time of group A retrieval failures was 16 (range, 15–18) days and in group B 54 (range, 17–122) days. Mean fluoroscopy time for successful retrieval was 3.5 (range, 1–16.6) min and for retrieval failures 25.2 (range, 7.2–62) min. Attempts to retrieve the Optease filter can be performed up to 60 days, but more failures will be encountered with this approach.     

Mood Alterations and Sleep

Abstract: We have reviewed literatures about neurobiological aspect of mood disorders in the light of abnormalities of REM sleep. A shortened REM latency is a consistent finding in depressed patients and may be considered a biological marker for depression. Most depressed patients with shortened REM latency also show non-suppression on dexamethasone-suppression test (DST). The commonly used antidepressant drugs cause a significant reduction in REM sleep. Patients with abnormal DST show a better response to sleep deprivation than those with normal DST. Recent studies indicated that borderline patients, primary dysthymic patients and obsessive-compulsive patients (OCD) have shortened REM latency. Farthermore, patients with OCD have a fairly good response to antidepressant clomipramine. Diagnostic and therapeutic strategies can conceivably be related on the examination of sleep patterns of psychiatric patients.     

Clozapine-induced QEEG changes correlate with clinical response in schizophrenic patients: a prospective, longitudinal study

BACKGROUND: The changes of theta activity (3.5-7 Hz) in the quantitative electroencephalography (QEEG) and serum clozapine levels and their correlation with clinical response, measured by the Positive and Negative Syndrome Rating Scale (PANSS) for schizophrenia, were examined prospectively in 16 patients suffering from schizophrenia during 18 weeks of clozapine (CLO) treatment. METHODS: Evaluations were performed on five occasions: before the initiation of CLO treatment at baseline and after 1, 3, 10, and 18 weeks of treatment. Doses of CLO starting from 50 mg/day were determined on the basis of clinical response. In the PANSS subscales for positive and negative symptoms, a significant (P < 0.05) improvement was observed after the first week, and in the subscale for general symptoms, improvement was seen after three weeks of treatment with CLO. A significant increase in theta power (P < 0.01) was found after three weeks of CLO treatment in the electrodes over the fronto-central scalp area, most distinctly in the midline. RESULTS: After three weeks we observed significant inverse correlations between the theta power increase and the changes in PANSS subscales for negative (P < 0.01) and positive (P < 0.05) symptoms, and after 10 weeks, between the theta power increase and the change in PANSS subscales for general (P < 0.05) and positive (P < 0.05) symptoms. After 18 weeks a trend of inverse correlation between the PANSS subscales for general and negative symptoms and the right and midline theta power increase was observed, but not with regard to positive symptoms. There were trends, but no significant correlations, between CLO treatment response and serum CLO levels. CONCLUSIONS: These findings indicate that the change in the theta frequency in QEEG and particularly in the midline electrodes over the fronto-central scalp area might be a more sensitive indicator for the evaluation of CLO treatment adequacy than the serum CLO level.