Depression 1. Clinical aspects and nurses' evaluation

OBJECTIVES: To review the recent advances made in evaluation and treatment procedures in cases of depression and their repercussions in nursing care. The growing efficiency of antidepressive medication, together with the importance given to community awareness of the upheavals which affect mental health, have modified the role nursing plays in evaluation of patients suffering depressive episodes. In this changing context, the therapeutic relationship between nurse and patient has developed into one of the pillars which sustain a correct and long-lasting stability in the depressed patient's state of mind. SOURCES: Primary source information on treatment methods by nurses handling depressed patients published from 1995 through 1999 and identified in the Medline data base. In a second article, these same authors will evaluate the intervention and the follow-up procedures carried out by nurses caring for patients suffering from depression.     

Malignant schwannoma of the rectum: a clinical and pathological contribution

Schwannomas of the rectum are uncommon and incompletely characterized tumours, and only a limited number of cases have been reported. On the basis of a case of rectal schwannoma and a review of the literature on this rare condition, we stress the importance of the clinical features, diagnostic difficulties and surgical indications for the various therapeutic approaches. The basis for radical operation, due to the tendency of such tumours to recur locally and the real possibility of malignant degeneration, is discussed. We also emphasize the difficulty of making a benign diagnosis with histological certainty.     

Plastic reorganization of hippocampal and neocortical circuitry in experimental traumatic brain injury in the immature rat

The reorganization of circuitry in the immature forebrain resulting from controlled cortical impact was examined with viral transneuronal tracing. Animals injured on postnatal day (PND) 17 and sham controls from the same litters received an intracerebral injection of a recombinant strain of pseudorabies virus (PRV) into the entorhinal cortex on PND 45. Fifty hours following injection of virus the animals were perfused and infected neurons were localized immunohistochemically with antisera specific for PRV. Prior studies have demonstrated that the PRV recombinant used in this analysis moves exclusively in the retrograde direction through synaptically linked neurons. CCI induced a necrotic loss of cortex at the site of impact and variable damage to the underlying corpus callosum and rostral (dorsal) hippocampus that was not present in sham controls. Analysis of viral transport in sham controls revealed retrograde transport of virus through hippocampal and neocortical circuitry in a pattern consistent with established patterns of connectivity and topography. Injured animals exhibited preservation of topographically organized connections in both the hippocampus and neocortex. However, the magnitude of labeling in the injured hemisphere was significantly increased relative to control animals and correlated with the magnitude of the injury. The distribution of infected neurons in the contralateral uninjured hemisphere also conformed to known connections. However differences in the involvement of the corpus callosum in the injury resulted in greater variability in the number of infected neurons among cases. These data provide novel insights into trauma induced reorganization of the developing brain and add to the experimental tools that can be used to assess the basis for functional recovery in animal models of developmental traumatic brain injury.     

Immunochemical studies of foot-and-mouth disease

Summary Polyethylene glycol (Carbowax 20M) was found to be an efficient precipitant of foot-and-mouth disease virus. Infected tissue culture fluids from baby hamster kidney-21 cells were clarified and polyethylene glycol added to 6% (w/v) concentration. The precipitate was collected, resuspended to 1/10 the original volume in buffer solution, and reprecipitated with 6% polyethylene glycol. The second precipitate was resuspended to 1/60 the original volume and the virus purified from these concentrates by two cycles of cesium chloride density gradient ultracentrifugation. The purified virus was physically characterized by analytical ultracentrifugation and spectroscopy. Immunological reactivity was established by immunodiffusion, complement fixation and immunogenicity. The procedure was used with several virus types. Yields of 12–65% of the original viral material were obtained and varied with the virus type.Presented, in part, at the 53rd Annual Meeting of the Federation of American Societies for Experimental Biology, Atlantic City, New Jersey, April 1969. This work was conducted during the senior author's tenure as a Postdoctoral Resident Research Associate of the Agricultural Research Service and the National Academy of Sciences, National Research Council.     

Spanish Heart Transplantation Registry. 16th official report of the Spanish Society of Cardiology Working Group on Heart Failure, Heart Transplantation, and Associated Therapies

This paper describes the general situation regarding heart transplantation in Spain and the results obtained using the technique, incorporating data for the year 2004. In 2004, 294 heart transplants were carried out, which brings the total number of procedures performed since 1984 to 4680. Clinically, the typical heart transplant recipient in Spain is male, aged around 50 years, has blood group A, has non-revascularizable coronary artery disease, and is in NYHA functional class IV/IV. The percentage of emergency heart transplantations was 35%, which is higher than in the previous year (29%), and higher than the mean for the preceding 5 years (22%). The early mortality rate was 10%, which is lower that the mean for the preceding 5 years (13%). After combining the results for 2004 with those of previous years, the probability of survival at 1, 5 and 10 years was 80%, 70% and 60%, respectively. When the survival rates for different time periods were analyzed, a significant improvement could be seen in the last 5 years, with recent survival rates being 85% and 72% at 1 and 5 years, respectively. The most frequent cause of death in the first month was acute graft failure; in the first year, infection and rejection; and, over the long term, tumors and a combination of graft vasculopathy and sudden death. A comparative analysis of survival rates showed that long-term results in Spain are slightly better than those published in the world literature. Moreover, survival has tended to improve gradually in recent years.     

The case of the floating gel

In patients with chronic renal failure, blood samples for laboratory analysis are often taken via dialysis catheters. This report describes a case of gross spurious hypernatraemia in a blood sample collected from a patient undergoing haemodialysis. After centrifugation of the blood sample in question, the separator gel formed the topmost layer, with the serum in the middle and the clot at the bottom. Subsequent analysis of the serum showed severe hypernatraemia (serum sodium, 744 mmol/litre). It was established that the blood sample had been taken from the patient's dialysis catheter into which 3 ml of Citra-Lock (46.7% trisodium citrate) had been instilled previously as a "catheter locking" solution. The hypernatraemia seen in this case was recognised immediately as an artefact, but it was found that even minimal contamination of blood samples with Citra-Lock may significantly affect sodium concentrations. This contamination may be missed, with potentially adverse consequences for patient management.     

Synthesis and structure-activity relationships of novel histamine H1 antagonists: indolylpiperidinyl benzoic acid derivatives

A series of indolylpiperidinyl derivatives were prepared and evaluated for their activity as histamine H(1) antagonists. Structure-activity relationship studies were directed toward improving in vivo activity and pharmacokinetic profile of our first lead (1). Substitution of fluorine in position 6 on the indolyl ring led to higher in vivo activity in the inhibition of histamine-induced cutaneous vascular permeability assay but lower selectivity toward 5HT(2) receptor. Extensive optimization was carried out within this series and a number of histamine H(1) antagonists showing potency and long duration of action in vivo and low brain penetration or cardiotoxic potential were identified. Within this novel series, indolylpiperidines 15, 20, 48,51 and 52 exhibited a long half-life in rat and have been selected for further preclinical evaluation.     

Microglial activation precedes dopamine terminal pathology in methamphetamine-induced neurotoxicity

Previous studies have demonstrated methamphetamine (METH)-induced toxicity to dopaminergic and serotonergic axons in rat striatum. Although several studies have identified the nature of reactive astrogliosis in this lesion model, the response of microglia has not been examined in detail. In this investigation, we characterized the temporal relationship of reactive microgliosis to neuropathological alterations of dopaminergic axons in striatum following exposure to methamphetamine. Adult male Sprague-Dawley rats were administered a neurotoxic regimen of methamphetamine and survived 12 h, or 1, 2, 4, and 6 days after treatment. Immunohistochemical methods were used to evaluate reactive changes in microglia throughout the brain of methamphetamine-treated rats, with a particular focus upon striatum. Pronounced morphological changes, indicative of reactive microgliosis, were evident in the brains of all methamphetamine-treated animals and were absent in saline-treated control animals. These included hyperplastic changes in cell morphology that substantially increased the size and staining intensity of reactive microglia. Quantitative analysis of reactive microglial changes in striatum demonstrated that these changes were most robust within the ventrolateral region and were maximal 2 days after methamphetamine administration. Analysis of tissue also revealed that microglial activation preceded the appearance of pathological changes in striatal dopamine fibers. Reactive microgliosis was also observed in extra-striatal regions (somatosensory and piriform cortices, and periaqueductal gray). These data demonstrate a consistent, robust, and selective activation of microglia in response to methamphetamine administration that, at least in striatum, precedes the appearance of morphological indicators of axon pathology. These observations raise the possibility that activated microglia may contribute to methamphetamine-induced neurotoxicity.     

Risk of malignancy in diagnosed coeliac disease: a 24-year prospective, population-based, cohort study

BACKGROUND: There is recent evidence from studies of hospitalized and of undiagnosed patients that the risk of lymphoma for people with coeliac disease may be lower than previously thought. In addition, there have been no precise estimates of small bowel lymphoma risk due to a lack of population data. AIM: To examine these and other malignant risks in a cohort of patients more typical of those seen in routine clinical practice. METHODS: A prospective cohort study of incident malignancy rates in patients with coeliac disease in southern Derbyshire compared with general population figures. RESULTS: During 5684 person years of follow-up 31 malignancies (excluding non-melanoma skin cancer) occurred in comparison with 30.30 expected [standardized incidence ratio (SIR) 1.02 (0.69-1.45)]. There were four non-Hodgkin's lymphomas (0.69 expected) SIR 5.81 (1.58-14.86), of which one originated in small bowel (0.02 expected) SIR 40.51 (1.03-225.68). GI malignancy occurred in nine (5.71 expected) SIR 1.58 (0.72-2.99), and breast cancer in three (5.08 expected) SIR 0.59 (0.12-1.73). CONCLUSIONS: There is no increase in the risk of incident malignancy in this population and the risk of non-Hodgkin's lymphoma in general or of the small bowel is lower than previously found from UK coeliac cohorts.