Psychopathology in adolescent and young adult criminal offenders (15–21 years) in Sweden

Background This study examined rates of psychopathology among adolescent and young adult serious offenders referred to pre-sentence forensic psychiatric services and compared patterns of psychiatric morbidity with adult forensic referrals and age-matched general psychiatric inpatients. Methods In Sweden, criminal offenders can be referred for an extensive court-ordered pre-sentence inpatient forensic psychiatric examination (FPE). Data on all 3,058 of these offenders (90% male, mean age = 35.3 years) during 1997–2001 were obtained from the National Board of Forensic Medicine. We compared DSM-IV psychiatric diagnoses across age bands 15–17 years (N = 60), 18–21 years (N = 300) and 22 years and older (N = 2,698). Comparative data by age bands were also obtained for inpatient diagnoses among individuals admitted to general psychiatric hospitals. Results Compared with the adult forensic psychiatric examinees, those aged 15–17 years and 18–21 years had higher rates of depression, and childhood and developmental disorders but lower rates of psychosis, bipolar disorder, and substance use disorders. Compared with general psychiatric inpatients, offenders aged 15–17 years had higher prevalences of depression and attention-deficit or disruptive disorders and lower ones of alcohol and drug misuse disorders. Conclusions There are significant differences in patterns of psychiatric morbidity in adolescent and young adult offenders that come into contact with psychiatric services compared with older offenders and adolescent psychiatric inpatients. This suggests that the development of health services addressing the psychiatric needs of younger offenders needs to draw on information on their specific mental health needs.     

Adenocarcinoma of the gastroesophageal junction after bariatric surgery

BACKGROUND: The development of upper gastrointestinal malignancies after bariatric surgery has not been well characterized. Our objective was to review the experience of patients with distal esophageal cancer that was diagnosed after bariatric surgery. METHODS: A retrospective review was conducted to identify patients who had undergone bariatric surgery (1999 to 2006) and who later developed high-grade dysplasia or adenocarcinoma of the distal esophagus. RESULTS: Three patients (of 2,875 [0.1%]) developed esophageal cancer: 2 after Roux-en-Y gastric bypass and 1 after vertical banded gastroplasty. All three patients had complaints of reflux, and two were treated with esophagectomy. The third patient presented with invasive carcinoma and died 2 years after diagnosis. CONCLUSIONS: Our findings emphasize the importance of precise endoscopic evaluation before bariatric surgery in patients with gastroesophageal reflux disease (GERD), of the necessity for continuing postsurgical surveillance in patients with known Barrett's esophagitis, and of early evaluation in patients who develop new symptoms of GERD after bariatric surgery.     

The Effect of Transitioning to Medicare Part D Drug Coverage in Seniors Dually Eligible for Medicare and Medicaid

OBJECTIVES: To evaluate medication use, out‐of‐pocket spending, and medication switching during the transition period for patients dually eligible for Medicaid and Medicare (dual eligibles). DESIGN: Time‐trend analysis, using segmented linear regression. SETTING: Patient‐level pharmacy dispensing data from January 2005 to December 2006 from a large pharmacy chain with stores in 34 states. PARTICIPANTS: Dual eligibles aged 65 and older. MEASUREMENTS: Changes in utilization, patient copayments, and medication switching were analyzed using interrupted time trend analyses. Utilization and spending were evaluated for five study drugs: clopidogrel, proton pump inhibitors (PPIs), warfarin, and statins (essential drugs covered by Part D plans) and benzodiazepines (not covered through Part D but potentially covered through Medicaid). RESULTS: Drug use for 13,032 dual eligibles was evaluated. There was no significant effect of the transition to Medicare Part D on use of all study drugs, including the uncovered benzodiazepines. Cumulative reductions were seen in copayments for all covered drugs after implementation of Part D, ranging from 25% annually for PPIs to 53% for warfarin, but there was a larger increase in copayments, 91% annually, for benzodiazepines after the transition. The rate of switching medications was 3.0 times as great for the PPIs after implementation of Part D than before implementation, but there was no significant change in the other study drug classes. CONCLUSION: These findings in a single, large pharmacy chain indicate that the transition plan for dual eligibles led to less medication discontinuation and switching than many had expected. The substantially greater cost sharing for benzodiazepines highlights the importance of implementing a thoughtful transition plan when executing such a national policy.     

Coma caused by spontaneous otogenic pneumocephalus

We present the first case of spontaneous otogenic pneumocephalus presenting with a rapid deterioration in conscious level. This occurred in a 69-year-old woman who was subsequently treated with a subtemporal, extradural exploration and packing of the multiple defects in the mastoid air cells. The patient made a full neurological recovery within 10 weeks. Spontaneous otogenic pneumocephalus is a rare condition and was previously understood to present with subtle symptoms of headache, aphasia and cognitive deficits. This case, however, establishes how it can cause a rapid decline towards coma.     

Blood flow distribution in cerebral arteries

High-resolution phase–contrast magnetic resonance imaging can now assess flow in proximal and distal cerebral arteries. The aim of this study was to describe how total cerebral blood flow (tCBF) is distributed into the vascular tree with regard to age, sex and anatomic variations. Forty-nine healthy young (mean 25 years) and 45 elderly (mean 71 years) individuals were included. Blood flow rate (BFR) in 21 intra- and extracerebral arteries was measured. Total cerebral blood flow was defined as BFR in the internal carotid plus vertebral arteries and mean cerebral perfusion as tCBF/brain volume. Carotid/vertebral distribution was 72%/28% and was not related to age, sex, or brain volume. Total cerebral blood flow (717±123 mL/min) was distributed to each side as follows: middle cerebral artery (MCA), 21% distal MCA, 6% anterior cerebral artery (ACA), 12%, distal ACA, 4% ophthalmic artery, 2% posterior cerebral artery (PCA), 8% and 20% to basilar artery. Deviating distributions were observed in subjects with ‘fetal'' PCA. Blood flow rate in cerebral arteries decreased with increasing age (P<0.05) but not in extracerebral arteries. Mean cerebral perfusion was higher in women (women: 61±8; men: 55±6 mL/min/100 mL, P<0.001). The study describes a new method to outline the flow profile of the cerebral vascular tree, including reference values, and should be used for grading the collateral flow system.     

The Association Between Gastric Endoscopic Findings and Histologic Premalignant Lesions in the Iranian Rural Population

Atrophic gastritis, intestinal metaplasia, and gastric dysplasia are histologic premalignant lesions (PMLs). Correlation between the gastric endoscopic findings and histologic PMLs is not clear. This study was designed to determine the possible association of endoscopic findings and histologic PMLs.Over 28 months gastric endoscopic findings of consecutive rural patients with dyspepsia were categorized into 3 groups: 1—normal, 2—ulcerative with or without concurrent abnormality, 3—abnormal non-ulcerative. Biopsies of antrum and body were taken from all included patients and examined for the presence of histologic PMLs. Any mucosal abnormality was also biopsied.From 7340 evaluated patients, an overall of 1973 patients were included. 55.7% of patients were in group 1; 3.8% in group 2 and 40.5% in group 3. A within sex analysis showed that the majority of male patients were in PMLs subgroup (P < 0.001) likewise in groups 2 and 3 (P < 0.001). The prevalence of histologic PMLs in groups 2 and 3 was significantly higher than group 1 (P < 0:001) but the difference was not significant between groups 2 and 3 (P = 0.484). Mean (±SD) age of patient with PMLs was 50.25 ± 17.71 whereas in patients without PMLs was 41.16 ± 16.48 (P < 0.001).This study has showed that abnormal gastric endoscopic findings, male sex and increased age can be considered as risk factors of the formation of histologic PMLs. Until further investigations we propose that any abnormality on gastric mucosa (ulcerative or non-ulcerative) could be biopsied for the evaluation of probable histologic PMLs especially in old men.     

Structure–properties relationships in dental adhesives: Effect of initiator,matrix monomer structure,and nano-filler incorporation

Objectives

This is a confirmatory study to evaluate the effect of photoinitiator type and concentration, matrix monomer chemical structure, and nanoparticle incorporation on the physical and mechanical properties of an experimental dentin bonding agent.

Conservative two-step procedure including uterine artery embolization with embosphere and surgical myomectomy for the treatment of multiple fibroids: preliminary experience

Objective

To evaluate the feasibility and safety of combined uterine artery embolization (UAE) using embosphere and surgical myomectomy as an alternative to radical hysterectomy in premenopausal women with multiple fibroids.

Materials and methods

Mid-term clinical outcome (mean, 25 months) of 12 premenopausal women (mean age, 38 years) with multiple and large symptomatic fibroids who desired to retain their uterus and who were treated using combined UAE and surgical myomectomy were retrospectively analyzed. In all women, UAE alone was contraindicated because of large (>10 cm) or subserosal or submucosal fibroids and myomectomy alone was contraindicated because of too many (>10) fibroids.

Results

UAE and surgical myomectomy were successfully performed in all women. Myomectomy was performed using laparoscopy (n = 6), open laparotomy (n = 3), hysteroscopy (n = 2), or laparoscopy and hysteroscopy (n = 1). Mean serum hemoglobin level drop was 0.97 g/dL and no blood transfusion was needed. No immediate complications were observed and all women reported resumption of normal menses. During a mean follow-up period of 25 months (range, 14–37 months), complete resolution of initial symptoms along with decrease in uterine volume (mean, 48%) was observed in all women. No further hysterectomy was required in any woman.

Conclusion

In premenopausal women with multiple fibroids, the two-step procedure is safe and effective alternative to radical hysterectomy, which allows preserving the uterus. Further prospective studies, however, should be done to determine the actual benefit of this combined approach on the incidence of subsequent pregnancies.