Disasters, the environment, and public health: improving our response.

Natural and human-made disasters continue to adversely affect all areas of the world in both predictable and unpredictable ways. To highlight the importance of natural disasters, the United Nations declared the 1990s the International Decade for Natural Disaster Reduction. This paper considers the public health response to disasters. It highlights environmental health issues and approaches since disasters are extreme environmental events, and it reviews developments relating to capacity building, training, and collaboration. Although progress is noted, a comprehensive federal or academic approach is not evident in the United States and the proper linkage to environmental health is lacking. With the International Decade now half over, public health professionals and others involved with disaster management should reflect on progress made to date and goals for the future.     

Comparisons of maprotiline with imipramine in severe depression: a multicenter controlled trial.

The efficacy and safety of maprotiline (Ludiomil) was compared to imipramine in patients with manic-depressive illness, depressed type (DSM II 296.2). Three hundred forty-one patients from 16 different centers entered this four-week double-blind controlled trial, with 171 in the maprotiline and 170 in the imipramine group. Efficacy measurements included the Hamilton Depression Scale, the Self-Rating Depression Scale, and the Investigator's Overall Assessment of Effectiveness. Tolerability was monitored by collection of treatment-emergent signs and symptoms (TESS), blood pressure and pulse measurements, EKGs, and EEGs. Dosage was fixed for the first week at 50 mg t.i.d. and thereafter could be varied between 50 and 300 mg daily. Clinically and statistically significant reductions in symptomatology were noted in both drug groups for most efficacy parameters at each visit during therapy. Comparison between the drug groups revealed no difference in terms of the scales utilized. A trend toward fewer TESS in the maprotiline group was noted, especially for the side effects nausea, nervousness, and increased sweating.     

Virchow-Robin space: a path of spread in neurosarcoidosis

Three cases of documented sarcoid meningoencephalitis were reviewed. Computed tomography (CT) showed enhancing, perivascular, linear, and nodular areas along the subarachnoid space, extending deep into the white matter. In one case the perivascular granulomatous infiltration, which caused small vessel periangiitis, gave rise to a CT pattern closely resembling that of arteriovenous malformation or infarction with gyral enhancement. This infiltrative pattern might be seen in other chronic meningeal processes. The pathophysiology responsible for the unusual CT appearance and the differential diagnosis are discussed.     

Syringomyelia and its surgical treatment--an analysis of 75 patients.

A consecutive series of 75 patients with syringomyelia is presented, all of whom were treated by cranio-vertebral operations. Attention is drawn to the difficulty in assessing the results of treatment but 56 stabilised or showed modest improvement after surgery. Occluding the central canal appeared to have no greater influence on the progression of the disease than did simple decompression and did have a higher incidence of complications. Upper motor neurone weakness, joint position sense and central neck pain are the features most likely to improve and it is concluded that relieving the medullary compression resulting from a Chiari type 1 malformation, rather than influencing the syrinx, is the means by which this may occur. Simple decompression with preservation of the arachnoid membrane, combined with syringostomy in certain cases, is recommended.