The effectiveness of quetiapine versus conventional antipsychotics in improving cognitive and functional outcomes in standard treatment settings

OBJECTIVE: To examine the effectiveness of quetiapine versus conventional antipsychotics in improving cognitive and functional outcomes. METHOD: Forty stable outpatients with DSM-IV schizophrenia treated in public outpatient clinics were randomly assigned to continue taking conventional antipsychotic medications or switch to quetiapine for 6 months, beginning September 1998 and ending July 2000. Neurocognitive and functional measures were obtained at study entry, 3 months, and 6 months by raters blinded to treatment. Group differences were examined using repeated-measures analyses of covariance for mixed models. RESULTS: The mean (SD) dose of conventional antipsychotics in chlorpromazine equivalents was 348.00 (348.28) mg/day; the mean (SD) dose of quetiapine was 319.25 (142.55) mg/day. A cognitive function summary score improved in the quetiapine group relative to the group treated with conventional antipsychotics over the 6-month period (F = 5.80, df = 1,28.9; p <.023). Patients taking quetiapine did better with respect to both verbal fluency (initiation) and verbal memory. There were also statistically significant group differences with respect to quality of life favoring the quetiapine group (F = 4.87, df = 1,29; p <.04). Differences were not found with respect to adaptive functioning. CONCLUSION: Quetiapine improved cognition relative to conventional agents. After 6 months, groups differed by more than 1 standard deviation when baseline cognitive functioning was taken into account. No group differences were found with respect to improvements in community functioning. Improvements in adaptive functioning may lag behind improvements in cognition. Psychosocial programming may be necessary to translate gains in cognition into improvements in adaptive functioning.     

Computer graphics for digitally formatted images

The increasing use of digitally formatted imaging systems requires high-quality interactive gray-scale computer raster graphics systems for the management, display, and analog film recording of digital image and alphanumeric information. These systems are a combination of computer hardware and software and implement a set of graphics protocols. This paper describes a set of interactive graphics protocols that has been developed for clinical use.     

Parathyroid adenomas evaluated by Tl-201/Tc-99m pertechnetate subtraction scintigraphy and high-resolution ultrasonography

Thallium-201/technetium-99m pertechnetate subtraction scintigraphy of the parathyroid glands was performed in a prospective study of 33 patients who had undergone bilateral neck exploration for elevated serum calcium and serum parathyroid hormone levels. In 31 cases, the Tl-201/Tc-99m subtraction technique yielded an overall sensitivity of 81%, specificity of 99%, and accuracy of 94% for identifying solitary parathyroid adenomas. Tl-201/Tc-99m subtraction scintigraphy correctly identified 73% of parathyroid adenomas weighing less than 499 mg, 79% of those weighing 500-1,499 mg, and 100% of adenomas weighing more than 1,500 mg. In a subgroup of 24 patients with solitary parathyroid adenomas who underwent both scintigraphy and high-resolution sonography, the sensitivity, specificity, and accuracy of both procedures were similar.     

Multimodality treatment of upper extremity bone and soft tissue sarcomas

Management of soft tissue sarcomas requires a multidisciplinary approach with the help of a surgical-orthopedic oncologist, medical oncologist, radiation oncologist, pathologist, hand surgeon, and physiatrist/physical therapist. The indication and benefits of chemotherapy and radiation therapy for soft tissue sarcomas remain somewhat controversial.However, the encouraging results of studies using the most active chemotherapeutic agents gives credence to considering neoadjuvant chemoradiation therapy or postoperative adjuvant chemotherapy in this group of patients.     

Risk of Meningococcal Infection in College Students

Context  The number of meningococcal outbreaks on college campuses have been increasing in the past few years. However, no published studies have documented the incidence of invasive meningococcal infection in college students or whether the incidence is higher than in the general population of the same age. Objective  To compare the incidence of invasive meningococcal infection in Maryland college students with that of the general population of the same age. Design  Retrospective cohort study. Setting and Patients  Maryland residents with meningococcal infection from 1992-1997 identified from active, laboratory-based, statewide surveillance for invasive meningococcal disease. Main Outcome Measures  Incidence of invasive meningococcal infection. Results  Of 228 patients with invasive meningococcal infection, 67 were aged 16 to 30 years; 11 and 3 of these attended Maryland 4- and 2-year colleges, respectively. Of these, 12 (86%) had infection caused by Neisseria meningitidis serogroups included in the current meningococcal vaccine. The average annual incidence was 1.74 per 100,000 among students in 4-year schools vs 1.44 per 100,000 for the general population of the same age (P=.60). Among students in 4-year schools, the incidence was 3.24 per 100,000 in on-campus residents vs 0.96 per 100,000 in off-campus residents (relative risk, 3.4; 95% confidence interval, 1.0-11.6; P=.05). Conclusions  The incidence of meningococcal infection in college students is similar to the incidence in the general population of the same age, but college students residing on campus appear to be at higher risk than those residing off campus.      

老年胃癌患者围手术期并发症及其处理

目的 研究老年胃癌患者的临床特点,总结老年胃癌患者的年龄、术前各种合并症等对术后并发症发生的影响.方法 总结自2005年1月至2007年1月接受手术的181例胃癌患者的临床资料,其中老年患者(年龄大于65岁者)65例,回顾性分析老年胃癌患者的年龄、术前各种合并症与术后并发症发生的关系.结果 老年胃癌组术前合并症总发生率为83%,非老年胃癌组为59%;老年胃癌组中有52%存在2种或2种以上合并症,发生率最高的合并症为高血压,达40%;老年胃癌患者的根治率为86%,非老年胃癌组的根治率为93%;老年胃癌组术后并发症的发生率为37%,术前合并高血压、糖尿病、肺部疾病、低蛋白血症、贫血者术后并发症发生率较高.结论 老年胃癌患者手术治疗后的总并发症发生率和病死率与非老年胃癌患者相比无差异.     

Accommodative facility test results and academic success in Polish second graders.

BACKGROUND: Accommodative infacility, as commonly measured by accommodative flippers, has been implicated as a factor in academic underperformance. This study compares four areas of academics (reading, writing, math and gym) to accommodative flexibility scores. METHODS: Seventy-six elementary school children with a mean age was 8 years, 8 months were tested monocularly and binocularly with traditional accommodative flexibility flipper testing and with a new accommodative flexibility apparatus that allows control of visual acuteness, minification/magnification, and reaction time. These scores were then compared with academic scores using a number of failure criteria. The academic ratings were based on teacher responses for each student. RESULTS: Our data did not show any clear correlation or relationship between evaluations by reading, writing, math, or gym teachers and accommodative flexibility by either the traditional or new testing methods. CONCLUSION: Accommodative function, free of contaminating variables, does not appear to predict academic function any better than the traditional.     

Wallerian degeneration after cerebral infarction: evaluation with sequential MR imaging

The dynamic signal intensity changes at magnetic resonance (MR) imaging in active and chronic wallerian degeneration in the corticospinal tract were evaluated. Forty-three patients with wallerian degeneration seen on MR images after cerebral infarction were studied. When possible, patients with acute stroke were examined with MR imaging prospectively at the onset of symptoms and then at weekly intervals for several months. Focal infarction without distal axonal degeneration is demonstrated for the 1st month following onset of clinical symptoms. At 4 weeks, a well-defined band of hypointense signal appears on T2-weighted images in the topographic distribution of the corticospinal tract. After 10-14 weeks, the signal becomes permanently hyperintense. Over several years, accompanying ipsilateral brain stem shrinkage occurs. The dark signal intensity observed on T2-weighted images between 4 and 14 weeks is believed to result primarily from transitory increased lipid-protein ratio.