Adolescent suicides with adjustment disorders or no psychiatric diagnosis

Detailed characteristics of adolescent suicides (aged 13–19 years) with adjustment disorders (AD) (N=11) or no psychiatric diagnosis (N=3) in a nationwide adolescent suicide population (N=53) from Finland are presented. The data were collected in a psychological autopsy study of all suicides in Finland (N=1397) during a 12-month period in 1987–1988. Data collection included thorough interviews with the victims' family members and professionals, and information from official records. All the suicides with AD or no diagnosis were males. Most of these victims used highly lethal suicide methods. Previous psychiatric treatment and previous suicide attempts were rare. They were seldom under the influence of alcohol when committing suicide. The process leading to suicide seemed to be of relatively short duration. According to informant reports, withdrawn or narcissistic individual characteristics predominated in many cases. Psychosocial stressors preceding suicide often involved interpersonal losses or conflicts. Talking of suicidal intentions prior to the act was common, indicating the need to take seriously all adolescents' expressions of intended suicide, even in the absence of explicit psychopathology.

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Zusammenfassung Es werden detaiilierte Beschreibungen von Selbst-morden im Jugendalter, verbunden mit Anpassungsstörungen (N=11) oder keiner psychiatrischen Diagnose (N=3) vorgestellt. Diese stammten aus der Gesamtheit aller jugendlichen Selbstmörder (N=53) aus Finnland. Die Daten wurden in einer psychologischen Obduktionsstudie aller Selbstmörder Finnlands (N=1397) während eines einjährigen Zeitraumes zwischen 1987 und 1988 gesammelt. Die Datenerhebung umfaßte ausgiebige Interviews mit den Familienmitgliedern, beteiligten Fachkräften und Informationen von offizieller Seite. Die Selbstmörder mit Anpassungstörungen oder keiner Diagnose waren alle männlich. Die meisten dieser Opfer benützten sehr letale Suizidmethoden. Vorangegangene psychiatrische Behandlungen und Selbstmordversuche waren selten. Sie standen nur selten unter dem Enfluß von Alkohol, als der Selbstmord vollzogen wurde. Der Prozeß, der zu dem Suizid führte, schien von relativ kurzer Dauer zu sein. Entsprechend den Angaben der Informanden prädominierten in vielen Fällen zurückgezogene oder narzißtische Persönlichkeitsmerkmale. Psychosoziale Stressoren, die dem Suizid vorangingen, umfaßten interpersonelle Verluste oder Konflikte. Häufig wurde über die Suizidabsichten vor der Tat gesprochen. Dies verdeutlicht die Notwendigkeit, alle Suizidäußerungen von Jugendlichen ernstzunehmen, selbst dann, wenn eine explizite Psychopathologie fehlt.

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Résumé Les caractéristiques détaillées de suicides d'adolescents (âgés de 13 à 19 ans) avec troubles avec l'adaptation (AD) (N=11) ou l'absence de diagnostic psychiatrique (N=3) sur une population de suicides d'adolescents s'étendant sur l'ensemble du pays (N=53), la Finlande sont présentées. Les faits ont été collectés dans le cadre d'une étude d'autopsie psychologique de tous les suicides en Finlande (N=1397) pendant une période de 12 mois 1987–1988. Le recueil des faits incluait des interviews avec les membres de la famille des victimes et les professionels ainsi que les informations provenant de documents officiels. Tous les suicides avec un trouble de l'adaptation ou sans diagnostic étaient masculins. La plupart de ces victimes utilisait des méthodes hautement mortelles. Les traitements psychiatriques précédents et les tentatives précédentes de suicides étaient rares. Ils étaient rarement sous l'influence de l'alcool quand ils ont commis les suicides. Le processus conduisant au suicide semblait être de durée relativement brève. Selon les rapports d'information, une attitude de retrait ou des caractéristiques individuelles de retrait prédominaient dans la majorité des cas. Les facteurs de stress psycho-sociaux précédent le suicide impliquaient souvent des pertes inter-personnelles ou des conflits. Parler du désir du suicide devant le passage à l'acte était habituel indiquant la nécessité de prendre au sérieux tous les adolescents exprimant le désir de suicide, même en l'absence d'une psychopathologie explicite.

     

Persistence of Mammary Artery Branches and Blood Supply to the Left Anterior Descending Artery

Background. Partial harvesting of the left internal mammary artery (LIMA) is a widespread technique used during minimally invasive coronary operations performed through a left anterior small thoracotomy. The influence of persisting LIMA branches was investigated to evaluate their effect on the blood flow of the left anterior descending artery.

Methods. Thirty patients, 15 with totally (group A) and 15 with partially (group B) harvested LIMAs, were evaluated. All the patients underwent postoperative angiography, during which a flow map of the LIMA was performed. The average peak velocity and the diastolic-to-systolic peak velocity ratio were recorded. The LIMA graft flow pattern was recorded in the proximal and distal thirds of the artery. Intramammary adenosine (12 to 14 μg) was injected and the average peak velocities before and after injection were calculated.

Results. The average peak velocity was similar in both groups in the proximal and distal thirds of the LIMA (25 ± 7 and 26 ± 5 cm/sec, respectively, in group A versus 27 ± 5 and 25 ± 5 cm/sec, respectively in group B; p = NS). The diastolic-to-systolic peak velocity ratio was similar proximally (0.78 ± 0.3 in group A versus 0.69 ± 0.3 cm/s in group B; p = NS), but not distally (1.72 ± 0.1 in group A versus 0.97 ± 0.3 in group B; p < 0.0005). The LIMA graft flow reserve was similar both proximally and distally (2.6 ± 0.6 and 2.5 ± 0.3 cm/s, respectively, in group A versus 2.6 ± 0.5 and 2.6 ± 0.3 cm/s, respectively, in group B; p = NS).

Conclusions. The persistence of LIMA branches does not influence the blood flow of the left anterior descending artery after acute adenosine-induced myocardial hyperemia. If a left anterior small thoracotomy is used in left anterior descending artery direct revascularization, complete LIMA harvesting is not mandatory and depends on the personal preference of the surgeon.     

Magnetic resonance in the staging of multiple myeloma]

The authors retrospectively reviewed the MR examinations of 46 patients with clinical and laboratory findings of monoclonal gammopathies (MG). All cases had been submitted to radiographic examination which had shown skeletal involvement in 22 cases and osteoporosis in 11, with rupture of the vertebral body in 3 patients. Scintigraphy had been performed on all patients and CT on 12; 36 patients were subsequently submitted to follow-up (at 6, 12 and 24 months). MR examinations were performed with dedicated coils and standard sequences for the subjects with skeletal localizations on X-ray images. The extant cases, with no radiographic evidence of skeletal involvement, were submitted to MRI of the spine, skull and pelvis. In agreement with clinical and laboratory findings and with follow-up results (in 36 patients), MRI diagnosed MG with no skeletal involvement in 13 cases, osteoporosis in 8 (with rupture of the vertebral body in 2), asymptomatic non-progressive myeloma in 4, solitary myeloma in 3, and multiple myeloma in 18 cases. The good identification of bone marrow and its multiplanarity make MRI the method of choice in the study of patients with suspected or known gammopathies. If compared with other modalities, MRI is more sensitive and accurate in depicting the tumor, its size and relationship to periskeletal tissues, and its possible multifocality. Moreover, the technique has proven to be a valid tool during the follow-up, showing tumor response to therapy.     

Evidence of tendinitis provoked by fluoroquinolone treatment: a case-control study.

OBJECTIVE: To investigate the association between the use of fluoroquinolone agents and the risk of tendinitis in a large population-based case-control study. METHODS: The study was performed by linking automated health databases from the Region of Lombardia, Italy. Cases were patients aged > or =18 years who had a hospital discharge diagnosis of non-traumatic tendinitis in 2002-3. For each case, up to five controls were randomly selected among those eligible for inclusion in the study. A conditional logistic regression model was used to estimate the odds ratio of tendinitis associated with the current, recent and past use of fluoroquinolones. Odds ratios were adjusted for exposure to other antibacterials and other drugs. RESULTS: 22,194 cases and 104,906 controls met the inclusion criteria. Current use of fluoroquinolones significantly increased the risk of tendon disorders as a whole (odds ratio [OR] = 1.7; 95% CI 1.4, 2.0), tendon rupture (OR = 1.3; 95% CI 1.0, 1.8) and rupture of the Achilles' tendon (OR = 4.1; 95% CI 1.8, 9.6). Concomitant use of corticosteroids and fluoroquinolones increased the risk of both tendon rupture (OR = 3.1; 95% CI 1.5, 6.3) and rupture of the Achilles' tendon (OR = 43.2; 95% CI 5.5, 341.1). DISCUSSION: Evidence that exposure to fluoroquinolones is associated with the sudden occurrence of tendinitis is supported by this large population-based study. We can estimate that a single case of rupture of the Achilles' tendon would occur for every 5958 persons treated with fluoroquinolones (95% CI 2148, 23,085). The corresponding number needed to harm is 979 (95% CI 122, 9172) for patients who concomitantly use corticosteroids and 1638 (95% CI 351, 8843) for those aged >60 years. CONCLUSION: Clinicians should be aware of this adverse effect, and the increased risk for fluoroquinolone-associated tendinitis in elderly patients with corticosteroid use must be considered when these agents are prescribed.     

Frontal white matter volume and delta EEG sources negatively correlate in awake subjects with mild cognitive impairment and Alzheimer's disease.

OBJECTIVE: A relationship between brain atrophy and delta rhythmicity (1.5-4 Hz) has been previously explored in Alzheimer's disease (AD) subjects [Fernandez A, Arrazola J, Maestu F, Amo C, Gil-Gregorio P, Wienbruch C, Ortiz T. Correlations of hippocampal atrophy and focal low-frequency magnetic activity in Alzheimer disease: volumetric MR imaging-magnetoencephalographic study. Am J Neuroradiol. 2003 24(3):481-487]. In this study, we tested the hypothesis that such a relationship does exist not only in AD patients but also across the continuum of subjects with mild cognitive impairment (MCI) and AD. METHODS: Resting, eyes-closed EEG data were recorded in 34 MCI and 65 AD subjects. EEG rhythms of interest were delta (2-4 Hz), theta (4-8 Hz), alpha 1 (8-10.5 Hz), alpha 2 (10.5-13 Hz), beta 1 (13-20 Hz), and beta 2 (20-30 Hz). EEG cortical sources were estimated by LORETA. Cortical EEG sources were correlated with MR-based measurements of lobar brain volume (white and gray matter). RESULTS: A negative correlation was observed between the frontal white matter and the amplitude of frontal delta sources (2-4 Hz) across MCI and AD subjects. CONCLUSIONS: These results confirmed for the first time the hypothesis that the sources of resting delta rhythms (2-4 Hz) are correlated with lobar brain volume across MCI and AD subjects. SIGNIFICANCE: The present findings support, at least at group level, the 'transition hypothesis' of brain structural and functional continuity between MCI and AD.     

The brain as a target for adrenocortical steroids: cognitive implications.

It is well established that a reciprocal control exists between the brain and glucocorticoid hormones. The brain regulates adrenocortical function via hypothalamic corticotrophin releasing hormone-41 (CRH-41), glucocorticoids act at specific receptors in the hippocampus, thus promoting negative feedback mechanisms. Because the hippocampus is a major site for memory processes, a role for excessive/long-lasting plasma glucocorticoid levels has been suggested in conditions of mental impairment. Major depression, Cushing's disease, and dementia of the Alzheimer type are disorders which share hyperactivity of the hypothalamo-pituitary-adrenal axis, as well as symptoms of cognitive decline. Although the mechanisms leading to hypercortisolemia appear to be different in each case, the neuropsychological features of these three disorders accord with the hypothesis of glucocorticoid-associated brain damage. It therefore is important to find pharmacological strategies that will avert or reduce these potential consequences on brain function.     

Free copper and resting temporal EEG rhythms correlate across healthy, mild cognitive impairment, and Alzheimer's disease subjects.

OBJECTIVE: The present study tested the hypothesis that the serum copper abnormalities were correlated with alterations of resting electroencephalographic (EEG) rhythms across the continuum of healthy elderly (Hold), mild cognitive impairment (MCI), and AD subjects. METHODS: Resting eyes-closed EEG rhythms delta (2-4Hz), theta (4-8Hz), alpha 1 (8-10.5Hz), alpha 2 (10.5-13Hz), beta 1 (13-20Hz), beta 2 (20-30Hz), and gamma (30-40Hz), estimated by LORETA, were recorded in 17 Hold, 19 MCI, 27 AD- (MMSE< or =20), and 27 AD+ (MMSE20) individuals and correlated with copper biological variables. RESULTS: Across the continuum of Hold, MCI and AD subjects, alpha sources in parietal, occipital, and temporal areas were decreased, while the magnitude of the delta and theta EEG sources in parietal, occipital, and temporal areas was increased. The fraction of serum copper unbound to ceruloplasmin positively correlated with temporal and frontal delta sources, regardless of the effects of age, gender, and education. CONCLUSIONS: These results sustain the hypothesis of a toxic component of serum copper that is correlated with functional loss of AD, as revealed by EEG indexes. SIGNIFICANCE: The present study represents the first demonstration that the fraction of serum copper unbound to ceruloplasmin is correlated with cortical delta rhythms across Hold, MCI, and AD subjects, thus unveiling possible relationships among the biological parameter, advanced neurodegenerative processes, and synchronization mechanisms regulating the relative amplitude of selective EEG rhythms.