Histological changes over time around the site of sustained release naltrexone-poly(DL-lactide) implants in humans.

In order to assess the histological tissue changes over time around the site of implant, tissue biopsies were taken at 1 to 38 months post-implant from 54 (34 male) consenting human subjects who had received the Australian subcutaneous naltrexone-poly(DL-lactide) implant for heroin dependence. The implant consists of multiple tablets containing compressed naltrexone-poly[trans-3,6-dimethyl-1,4-dioxane-2,5-dione] (DL-lactide) loaded microspheres. Assessment of tissue samples by pathologists showed an early phase (up to 12 months post-implant) of inflammation, foreign body reaction, and fibrosis. This subsided gradually over the next 12 months until tissue returned to normal by 25+ months. Sufficient evidence was not available to conclude that the poly(DL-lactide) implant matrix was totally biodegradable within the study period. While implant material was not identified in most of the latter biopsies, its presence was noted in one biopsy at 26 months post-implant. Nevertheless the study results did demonstrate the implant's biocompatibility by the lack of inflammation, foreign body reaction, and fibrosis detected by 25+ months. It seems highly probable that surgical technique rather than the implant itself was associated with the additional finding of fat necrosis. Moderate fat necrosis was observed as a common feature of biopsies carried out during the first 6 months following implant. It subsided to mild levels over the next 18 months, and was notably absent by 25+ months. The results of the study indicated that the Australian naltrexone-poly(DL-lactide) implant is well tolerated and may have a role for use in the management of medical conditions such as heroin dependence.     

Effects of cognitive behavioral therapy on work outcomes in vocational rehabilitation for participants with schizophrenia spectrum disorders

Designed to help persons with schizophrenia to persist and perform better at job placements, the Indianapolis Vocational Intervention Program (IVIP) is a program of cognitive-behavioral group and individual interventions. While its feasibility has been previously demonstrated, it is unknown whether IVIP assists persons to achieve greater levels of participation in vocational rehabilitation and higher levels of job performance. In this study, 100 participants with schizophrenia or schizoaffective disorder were offered a six month job placement and randomized to receive IVIP (n = 50) or support services (n = 50) matched for treatment intensity. Number of hours worked was recorded weekly and job performance was assessed biweekly using the Work Behavior Inventory with raters blind to condition. t-tests revealed that participants in the IVIP group worked a significantly greater number of weeks than those in the support condition. Also, repeated measures ANOVA revealed the IVIP group worked more hours across that 26 week period as well. And with regards to work performance, repeated measures of the 56 participants who worked for at least two-thirds of the intervention revealed that participants in the IVIP group had generally better work performance than those in the support condition. Results suggest a connection between cognitive-behavioral interventions and higher levels of work performance in people with schizophrenia.     

Cytoskeletal rearrangement by oxidative stress

The cytoskeleton is susceptible to oxidative stress and this occurs prior to membrane blebbing and cell lysis. Vimentin intermediary filaments in rheumatoid synoviocytes are more susceptible than in normal synoviocytes and this may have pathological significance. They are however no more susceptible to heat shock than other cell types.     

Marital sex frequency and midcycle female testosterone

The purpose of the study was to attempt to replicate a finding of Persky et al. (1978) that midcycle peak values of testosterone (T) in women predicted differences in frequency of intercourse among married couples. Luteinizing hormone (LH), total testosterone (TT), and free testosterone (FT) values from 10 to 14 daily midcycle blood samples donated by 43 volunteering wives were analyzed against sexual activity patterns reported by the couples over a longer period of time. All couples were contracepting by means other than exogenous hormones or the rhythm method. Each morning through three menstrual cycles husbands and wives recorded independently and on separate forms answers to a series of questions concerning sexual activity in the previous 24 hr. Wives also recorded basal body temperatures (BBT). We designated midcycle values of TT and FT according to several definitions of midcycle. Total testosterone levels at the day of the BBT nadir and the day before the nadir correlated significantly with average intercourse frequency. Correlations with FT were statistically significant regardless of which midcycle measure was used; the day before the BBT nadir gave the highest correlation, 0.618, p = 0.01. Mean testosterone (TT or FT) values were not significantly related. We conclude that female midcycle total testosterone or free testosterone is indexing some unobserved event that affects the frequency of intercourse of couples. We speculate that this event affects the motivation of females, which influences the set point of the compromise frequency characteristic of couples.Research supported in part by NICHD Grant No. 1-R01-HDO7454-01.     

Aortic endograft infection: open surgical management with endograft preservation.

INTRODUCTION: We report successful management of aortic endograft infection without graft explantation or extra-anatomic bypass. REPORT: A 66 year-old male who had undergone endovascular repair of an aortic aneurysm presented with abdominal pain and raised inflammatory markers following embolisation of a type-2 'endoleak'. CT scanning revealed a left psoas fluid collection. Endograft infection was diagnosed. Following failure of CT-guided drainage and conservative management, surgical drainage with irrigation drain placement was undertaken with preservation of the endograft. There was no evidence of recurrent infection after follow-up at 30 months. DISCUSSION: Aortic endograft infection may be managed without endograft removal and extra-anatomic bypass.     

Learning to Observe Relationships and Coping

Milieu relationships provide the critical background presence to staff's attempts to motivate, regulate, and teach patients how to cope with stress. Forging a connection with hospitalized children and adolescents demands attention to how they respond to adults and engage with staff around milieu expectations. Assessment guides that deal with these issues are presented. Important aspects of children's relatedness are presented in the context of their working models of adults and the influence of these representations on their response to staff. Coping skills are explained with particular emphasis on behavioral coping strategies. Tied to the assessment process are interventions that emphasize staff's role in helping patients manage strong affects and avoid the use of nonproductive behavior regulation strategies.