Screening for infectious diseases among patients in a state psychiatric hospital

This cross-sectional retrospective study examined the frequency of positive tests for infectious diseases among 655 patients who were admitted to a state psychiatric hospital from 1997 to 1999. Not all patients who were admitted to the hospital were tested for each disease. Rates of positive tuberculin (20.2 percent), hepatitis B (23.9 percent), and hepatitis C (21.5 percent) tests were all significantly greater than estimates for the U.S. general population. A minority of patients were tested for HIV, and 29.0 percent were positive. The rate of hepatitis A was similar to that in the general population (33.2 percent). Independent risk factors for markers of disease included age, immigrant status, homelessness, and history of substance use. These results confirm the importance of screening for infectious diseases among individuals with severe and persistent mental illness.     

The distinctiveness of compulsive hoarding from obsessive-compulsive disorder

The present study investigated the relation of compulsive hoarding to other obsessive-compulsive disorder (OCD) symptoms in a sample of 162 patients with OCD. Obsessions and compulsions reported on the Anxiety Disorders Interview Schedule for DSM-IV were submitted to an exploratory factor analysis. Results suggested a four-factor model: "Certainty," "Contamination," "Obsessions," and "Numbers/Ordering." Hoarding did not load on any factor. The sample was divided into three groups: pure hoarding, nonhoarding OCD, and mixed OCD and hoarding. The hoarding group endorsed significantly less anxiety, worry, stress, and negative affect on self-report measures than the mixed and nonhoarding groups. Although hoarding sometimes functions as a compulsion among individuals with OCD, hoarding in the absence of other OCD symptoms may be a clinically distinct syndrome.     

Status epilepticus and frequent seizures: incidence and clinical characteristics in pediatric epilepsy surgery patients

PURPOSE: The literature suggests that pediatric epilepsy surgery cases that present in status epilepticus (SE) are an unusual occurrence. However, this concept is based on case reports, and the incidence and clinical characteristics of these patients have not been systematically assessed. METHODS: The cohort consisted of resective epilepsy surgery cases from 2000 to 2005 (n = 115), and they were classified as presenting with continuous SE requiring medical suppression therapy (n = 6) or intermittent SE (greater than 3 seizures/hour; n = 17). The SE categories were compared with extratemporal surgery patients without SE (non-SE; n = 64) for differences in clinical variables abstracted from the medical record. RESULTS: Continuous SE was noted in 5% and intermittent SE in 15% of resective surgery cases, and all had extratemporal cortical involvement. Compared with continuous SE and non-SE cases, intermittent SE patients were younger at surgery with shorter duration of seizures, and had an increased incidence of active infantile spasms during video scalp EEG monitoring. Compared with non-SE cases, the continuous and intermittent SE groups required a larger number of antiepileptic medications presurgery and 6-months postsurgery, underwent hemispherectomy more frequently, and had an increased incidence of hemimegalencephaly and Rasmussen encephalitis and a lower occurrence of infarct/ischemia and infectious etiologies. Seizure control was over 71% up to 2 years postsurgery, and there were no differences between patient groups. Finally, seizure frequency per hour was greater in continuous SE cases compared with the intermittent SE group. CONCLUSIONS: Children presenting with continuous or intermittent SE are not rare in pediatric epilepsy surgery centers, and such cases are more commonly associated with infantile spasms, Rasmussen's syndrome, and hemimegalencephaly pathologies. Seizure outcome after surgery was not altered in pediatric patients because they had presented with continuous or intermittent SE.     

P50 inhibitory gating deficit is correlated with the negative symptomatology of schizophrenia

Abnormal sensory gating in schizophrenia has frequently been reported. The strength of central inhibitory pathways was measured using the P50 component of the auditory evoked potential in a conditioning-testing paradigm. The relationships between a relative decrease in P50 amplitude to repeated auditory stimuli and clinical symptoms remain controversial. Using the Positive and Negative Syndrome Scale, we studied the P50 auditory conditioning-testing paradigm in 81 schizophrenic subjects, categorized into subgroups with and without prominent negative symptoms, in comparison with 88 control subjects. We found increased ratios of testing stimuli to conditioning stimuli in both schizophrenic subgroups relative to findings in the control group. In addition, we found significantly increased mean latencies of the P50 responses to conditioning (C) and testing (T) stimuli and significantly increased T/C ratios in the subgroup with negative symptoms compared with the subgroup with non-negative symptoms.     

The flexor hallucis longus: tenographic technique and correlation of imaging findings with surgery in 39 ankles

PURPOSE: To examine the use of tenography for evaluation of the flexor hallucis longus (FHL) sheath. MATERIALS AND METHODS: Institutional review board approval was waived, patient consent was obtained, and the study was HIPAA compliant. Retrospective review of 192 FHL tenograms and associated surgical records identified 39 ankles in 37 patients (17 male, 20 female; mean age +/- standard deviation, 38 years +/- 13.8; range, 14-68 years) in which both tenography and surgery had been performed. Two radiologists reviewed tenographic findings, including contrast agent extravasation, synovial irregularity, stenosis, fibrous bands, sheath outpouching, extent of opacification, and communications with adjacent structures. Alterations in pain after anesthesia of the tendon sheath were also recorded. Surgical reports were reviewed. RESULTS: Thirty-four of 39 tenograms were diagnostic. Some extravasation occurred in nine (45%) of 20 injections with an initial injection method and in two (11%) of 19 with a new injection technique. Synovial irregularity was present in all 34 studies (15 mild, 16 moderate, three severe). Stenoses were identified in 23 (68%) of 34 ankles, fibrous bands were seen in 16 (47%) of 34 ankles, and outpouching of the sheath above a stenosis was present in 13 (38%) of 34 ankles. Communication of the FHL sheath with the ankle, flexor digitorum longus, or subtalar joint occurred in half the cases. Most patients with pain reported relief; relief was complete (100% reduction from preprocedural pain) in eight of 27, moderate (50%-90% reduction) in nine of 27, and mild (<50% reduction) in eight of 27 patients. CONCLUSION: Tenography of the FHL sheath produced diagnostic images in almost all patients and effectively demonstrated abnormalities of the tendon sheath. Pain relief with anesthetic injection helped confirm the FHL sheath as the pain generator.     

Direct cardiac effects of coronary site-directed thiopental and its enantiomers: a comparison to propofol in conscious sheep

BACKGROUND: Previous evidence from laboratory animal studies indicates that R-thiopental has a greater margin of safety than either the more potent S-thiopental or the clinically used rac-thiopental. Although thiopental can cause cardiovascular depression from direct myocardial effects as well as indirect central nervous system and peripheral effects, no studies have yet determined whether its myocardial effects are enantioselective. A lesser direct effect would provide further evidence supporting R-thiopental as a preferred single enantiomer replacement for rac-thiopental. METHODS: The direct myocardial effects of the thiopental enantiomers were compared to those of rac-thiopental and propofol, using a crossover design with small incremental doses infused over 3 min, on separate days, into the left coronary arteries of conscious sheep. Hemodynamic and electrocardiographic measurements were acquired, and serial blood samples were collected during the studies for drug analyses. RESULTS: All three forms of thiopental and propofol produced significant hemodynamic effects consisting of dose-related and rapid-onset decreases in left ventricular dP/dtmax and stroke volume, and increases in left coronary blood flow and heart rate. Cardiac output, mean arterial blood pressure, and central venous pressure remained unaltered. The effects did not differ significantly among rac-thiopental, enantiopure R- or S-thiopental, or propofol. Arterial blood drug concentrations were consistently less than those associated with systemic effects. CONCLUSIONS: Although previous evidence indicates that R-thiopental could make a suitable single-enantiomer replacement for rac-thiopental, the current study did not find a significant difference in direct cardiac effects among the thiopental enantiomers, racemate, or propofol.     

Heart rate variability in sportive elderly: relationship with daily physical activity

PURPOSE: Aging is associated with decreased heart rate variability (HRV). As aerobic training is known to increase HRV, the purpose of this study was to evaluate the influence of long-term lifestyle on HRV in very old adults with regard to their usual physical activity. METHODS: Twenty-four older adults (mean 75.7 +/- 0.2 yr) were divided into two groups according to their sport activities assessed by the Modified Baecke Questionnaire for Older Adults. Sedentary subjects (SED) were compared to elderly regularly involved in sport activities (SP). The subjects were supine for 20 min and the last 5 min were used to determine HR and HRV indexes as the standard deviation of normal intervals (SDNN), the root-mean-square differences of successive normal R-R intervals (RMSSD), and the high-frequency (HF) and low-frequency (LF) power. Physical activity was evaluated during 1 wk by triaxial accelerometry and analyzed in terms of intensity and duration. RESULTS: Daily physical activity energy expenditure given by the accelerometer was significantly higher in SP than in SED (P < 0.05). SP spent more time per week in activity of intensity higher than 3 resting metabolic equivalents (METs), but total activity time was significantly higher for SED than for SP (P < 0.05). SP showed significantly (P < 0.05) lower resting heart rate than SED, higher global HRV (SDNN), and higher parasympathetic-related HRV indexes (RMSSD, HF, and HF/(LF+HF)) (P < 0.05). CONCLUSIONS: Our results indicate that in very old subjects a long-term sportive lifestyle, which increases total daily energy expenditure and physical activity intensity, is associated with higher global HRV and vagal-related indexes and thus may counteract the age-related decline in cardiac autonomic control better than a sedentary lifestyle.