Ureteric obstruction after radical hysterectomy

Two patients with invasive carcinoma of the cervix treated with radical hysterectomy developed total unilateral ureteric obstruction postoperatively. A temporary percutaneous nephrostomy was inserted. Because both patients needed adjuvant radiotherapy, intended reimplantation of the ureter was postponed. During this period spontaneous passage through the ureter was observed after 5 and 14 weeks, respectively. It is emphasized that a 'wait and see' policy may be justifiable in the case of ureteric obstruction of unclear etiology after radical hysterectomy for at least 3 months, as long as renal function is preserved by percutaneous nephrostomy drainage of the affected kidney side.     

Acute hemodynamic effects of nifedipine in infants with bronchopulmonary dysplasia and pulmonary hypertension

The acute hemodynamic effects of nifedipine were evaluated and compared to the effects of 95% oxygen in six children with bronchopulmonary dysplasia and pulmonary artery hypertension. The children ranged in age from 7-26 months and all were oxygen dependent. In the cardiac catheterization laboratory, hemodynamic data were collected in 95% oxygen, room air, and 15 and 30 min after nifedipine administration (0.5-0.6 mg/kg per nasogastric tube). Compared to values in room air, nifedipine resulted in a 34% decrease in pulmonary artery mean pressure (from 69.3 +/- 2.4 to 45.8 +/- 1.2 mm Hg, p = 0.03) and a 49% decrease in pulmonary vascular resistance (from 14.8 +/- 1.4 to 7.5 +/- 0.9 U/m2, p = 0.03). A linear relationship was found between the arterial pO2 and the change in the ratio of pulmonary to systemic resistance after nifedipine (% decrease in Rp/Rs ratio = 86.3 - 1.3 x pO2, r = -0.95, p = 0.004) suggesting that nifedipine may act to oppose the vascular effects of arterial hypoxemia. There was no significant change in heart rate, arterial pO2, or pCO2 with nifedipine, but cardiac output increased significantly. Compared to 95% oxygen, nifedipine achieved a lower pulmonary vascular resistance (7.5 +/- 0.9 versus 10.9 +/- 1.2 U/m2, p = 0.03) and a greater cardiac output (5.25 +/- 0.71 versus 3.54 +/- 0.35 liter/min/m2, p = 0.03) with comparable systemic oxygen delivery (699 +/- 85 ml versus 698 +/- 91 ml O2/min/m2, p = 1.0). Thus, nifedipine is an acute pulmonary vasodilator in some children with bronchopulmonary dysplasia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Longitudinal relationship between pain and depression in older adults: sex, age and physical disability

Objective Better understanding of the relationship between pain and depression in older adults in the community is of particular importance considering the high prevalence of both conditions in these adults. In the present study, the longitudinal relationship between pain and depression in older adults was examined, thereby taking into account the role of physical disability and the possibly modifying effect of sex and age. Methods The study is based on a sample which at the outset consisted of 325 non-depressed and 327 depressed persons (55–85) drawn from a larger random community-based sample in the Netherlands. Depression (CES-D) and pain (subscale of the Nottingham Health Profile) were measured at eight successive waves over 3 years. Results Pain was very persistent over time as was to a lesser extent depression. The prognosis of comorbid pain and depression was poor. In longitudinal analyses (Generalized Estimating Equations), pain and depression were strongly associated. At the symptom level, the pain-depression relationship was found to be stronger in men than in women. There was no effect of age on the pain-depression relationship. No support was found for the hypothesis that the pain-depression relationship is mediated by disability. Conclusion The persistent nature of pain and to a lesser extent depression and the intimate and probably reciprocal association between them stress the need for adequate treatment strategies. Accepted: 30 October 2001     

Religious denomination as a symptom-formation factor of depression in older Dutch citizens

OBJECTIVES: The type of symptoms in depression is likely to be influenced by cultural environment. As religion represents an important cultural resource for older adults, it is hypothesised that religious denomination represents a symptom-formation factor of depression in the older generation. Focusing on older Dutch citizens, it is expected that depressed Calvinists report: (1) less depressed affect, (2) more vegetative symptoms, and (3) more guilt feelings, than Roman Catholics and non-church members. METHODS AND PROCEDURES: The Center for Epidemiologic Studies Depression Scale (CES-D) was used to distinguish depressed (N=395) and non-depressed (N=2333) older adults, and to assess depressive symptom-profiles. The Diagnostic Interview Schedule (DIS) was used to assess major depressive episodes and criterion-symptoms of depression. RESULTS: Depressed Calvinists, especially males, had higher scores on the vegetative CES-D subscale. The same was found for non-church members with Calvinist parents. Among those who have had a major depressive episode in later life (N=84), support was found for all hypotheses. Feelings of guilt were also more prevalent among Roman Catholics. CONCLUSIONS: Religious denomination modified the type of symptoms in late-life depression. As a Calvinist background was associated with less depressive affect and more inhibition, there is a risk of underdiagnosis of major depression in older Calvinists in The Netherlands.     

Severe mitral insufficiency in mucopolysaccharidosis type III-B (Sanfilippo syndrome)

Summary A 6-year-old girl with mucopolysaccharidosis (MPS) III-B (Sanfilippo syndrome) who developed severe mitral regurgitation and congestive heart failure requiring surgery (valvuloplasty) is reported. One year after surgery the patient remains well, with marked improvement in her physical activity, and without signs of heart failure. This is only the second report of severe mitral regurgitation in MPS III, and is the first report of a successful repair (valvuloplasty) of a dysplastic mitral valve in the MPS. Mitral valvuloplasty should be considered instead of valve replacement in any MPS patient with mitral valve regurgitation requiring surgery.     

Parallel statistical image reconstruction for cone-beam x-ray CT on a shared memory computation platform

Statistical reconstruction methods offer possibilities of improving image quality as compared to analytical methods, but current reconstruction times prohibit routine clinical applications. To reduce reconstruction times we have parallelized a statistical reconstruction algorithm for cone-beam x-ray CT, the ordered subset convex algorithm (OSC), and evaluated it on a shared memory computer. Two different parallelization strategies were developed: one that employs parallelism by computing the work for all projections within a subset in parallel, and one that divides the total volume into parts and processes the work for each sub-volume in parallel. Both methods are used to reconstruct a three-dimensional mathematical phantom on two different grid densities. The reconstructed images are binary identical to the result of the serial (non-parallelized) algorithm. The speed-up factor equals approximately 30 when using 32 to 40 processors, and scales almost linearly with the number of cpus for both methods. The huge reduction in computation time allows us to apply statistical reconstruction to clinically relevant studies for the first time.     

Effects of exposure to a predator on behaviour and serotonergic neurotransmission in different brain regions of C57bl/6N mice

Clinical studies and animal models have provided evidence that stress and serotonin may play a role in the aetiology of psychiatric diseases such as depression and anxiety. In addition, reciprocal interactions between stress and serotonergic neurotransmission have been demonstrated. However, the relationships between stress, serotonin and behaviour are far from completely understood. In this integrative study, we aimed to elucidate the effect of the psychological stress model predator exposure on behaviour and serotonergic neurotransmission in mice. We used a high time-resolution microdialysis method to measure extracellular levels of serotonin (5-hydroxytryptamine, 5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) in the hippocampus, prefrontal cortex, lateral septum and caudate putamen of C57BL/6N [corrected] mice, before (08:30-10:30 h), during (10:30-11:00 h) and after exposure (11:00-14:00 h) to a rat. Detailed behavioural observations were also made. Rat exposure resulted in behavioural activation, with predominant risk-assessment activities, and in increases in hippocampal, cortical, septal but not striatal 5-HT and 5-HIAA. When rat exposure was repeated on the consecutive day, small behavioural differences and reductions in 5-HIAA levels, but no differences in the 5-HT response, as compared with the first exposure were observed. As increases in 5-HT often coincide with behavioural activation, it was particularly interesting to find that 5-HT also increased in periods when mice only made minor movements such as sniffing, and that an effect of predator stress was absent in the caudate putamen. Our results indicate that the presence of the rat leads to differential activation of serotonergic neurotransmission in higher brain structures, probably involved in the coping response to this potentially life-threatening situation.