Multisite, open-label, prospective trial of lamotrigine for geriatric bipolar depression: a preliminary report

Sajatovic M, Gildengers A, Al Jurdi RK, Gyulai L, Cassidy KA, Greenberg RL, Bruce ML, Mulsant BH, Ten Have T, Young RC. Multisite, open‐label, prospective trial of lamotrigine for geriatric bipolar depression: a preliminary report.
Bipolar Disord 2011: 13: 294–302. © 2011 The Authors.
Journal compilation © 2011 John Wiley & Sons A/S. Aims: This is a multisite, 12‐week, open‐label trial of lamotrigine augmentation in 57 older adults (≥ 60 years; mean ± SD age = 66.5 ± 6.7 years) with either type I or type II bipolar depression. Methods: Primary outcome measure was change from baseline on the Montgomery–Åsberg Depression Rating Scale (MADRS). Secondary outcome measures included Hamilton Depression Rating Scale (HAM‐D), Clinical Global Impression–Bipolar version (CGI‐BP), and the WHO‐Disability Assessment Schedule II (WHO‐DAS II). The Udvalg for Kliniske Undersøgelser (UKU) was used to assess side effects. Results: A total of 77.2% of the study subjects had bipolar I disorder. The mean (SD) lamotrigine dose was 150.9 (68.5) mg/day. There was significant improvement in the MADRS, HAM‐D, CGI‐BP, and in most domains on the WHO‐DAS II. For patients for whom final MADRS score was available: 31 (57.4%) met remission criteria and 35 (64.8%) met response criteria. There were 19/57 (33.3%) who dropped out of the study prematurely, with 6 dropouts due to adverse events (4 cases of rash, 1 manic switch, and 1 hyponatremia). Two cases of rash were possibly drug related and were resolved with drug discontinuation. The most common UKU adverse effects were reduced sleep duration (n = 14, 24.6%), weight loss (n = 12, 21.1%), increased dream activity (n = 12, 21.1%), polyuria/polydipsia (n = 11, 19.3%), weight gain (n = 9, 15.8%), diminished sexual desire (n = 9, 15.8%), increased sleep (n = 9, 15.8%), lassitude/fatigue (n = 8, 14%), and unsteady gait (n = 8, 14%). No significant changes in electrocardiogram or laboratory tests were observed. Conclusions: In bipolar depressed elders, lamotrigine was associated with improvement in depression, psychopathology, and functional status. There was a moderate number of adverse events, although relationship of adverse events (particularly falls) to study medication could not be clearly determined in this uncontrolled trial. Controlled studies are needed to further evaluate efficacy and tolerability of lamotrigine therapy in geriatric bipolar depression.     

Simulated septal deviations

Effects of simulated septal deviations on nasal airflow resistance were measured in two healthy young adults by computer-assisted rhinomanometry. Within the decongested bony cavum, simulated deviations, 30 x 5 x 5 mm perpendicular to the maxillary crest, elevated resistance only slightly, but severely when the mucosa was not decongested. Caval resistance was unaffected by simulated maxillary crest spurs, 30 x 5 x 5 mm, in either vascular state. Between inferior turbinate and anterior naris, 5-mm septal protrusions from floor to roof increased resistance severely, but when shortened by one third, their resistive effects were markedly decreased, especially when positioned near the roof. The cavum can accommodate large septal spurs, deviations, and congested mucosa with little effect on airflow resistance. By contrast, resistance of the anterior nasal airway beyond the inferior turbinate bone is acutely responsive to changes in mucosal congestion and to septal protrusions, especially when they are situated near the floor of the nose.     

A decade experience with infrainguinal revascularization in a dialysis-dependent patient population

OBJECTIVE: Although previous series have reported outcomes of lower extremity (LE) revascularization in patients with end-stage renal disease, the issue of LE bypass for limb salvage in this group has not been resolved. We herein present the largest series to date of a 10-year single-institution experience with LE bypass in patients with dialysis dependence. METHODS: With prospectively entered data from a university teaching hospital's vascular registry, we reviewed the records of all patients with dialysis dependence who underwent LE arterial bypass between January 1, 1990, and May 31, 1999. RESULTS: A total of 146 consecutive patients (177 limbs) underwent infrainguinal revascularization, of whom nearly all (92%) had diabetes and tissue loss (91%). The in-hospital mortality rate was 3% (five patients). The rates for perioperative congestive heart failure, myocardial infarction, arrhythmia, and wound infection were 2%, 3%, 5%, and 10%, respectively. The actuarial graft primary and secondary patency rates at 1 and 3 years were 84% and 85%, and 64% and 68%, respectively. The limb salvage rates were 80% and 80% at 1 and 3 years. The 1-year and 3-year cumulative survival rates were 60% and 18%, respectively. At 5 years, survival was poor with only 5% of the entire cohort of 146 patients still alive. Multivariate logistic regression analysis at 6 months identified age (odds ratio, 0.96, 0.91) and number of years on dialysis (odds ratio, 0.79, 0.74) as significant (P <.05) negative predictors of both limb salvage and survival, respectively. CONCLUSION: Infrainguinal arterial reconstruction can be performed on patients with dialysis dependence with acceptable rates of limb salvage given the high incidence rate of perioperative complications and poor longevity of this patient group. Advanced age and number of years on dialysis seem to correlate with poorer outcome.     

Triple central ray amputation for clear cell sarcoma of the hand

A 16-year-old girl presented for evaluation and management of a recurrent soft-tissue mass in her left hand after excision at another facility. She was given a diagnosis of clear cell sarcoma. She chose a limb salvage procedure over amputation. A triple central ray amputation of her index, middle, and ring fingers was performed. After 3 years, she has reasonable grasp function with her remaining fingers and has chosen not to use a prosthesis. Long-term follow-up is necessary for this tumor, as local recurrence and metastatic disease have been reported frequently.     

Chromatin-associated protein kinases in human normal and benign hyperplastic prostate

Nuclear phosphoproteins and protein kinases of human normal and benign hyperplastic prostate (BPH) were studied in an effort to delineate their properties and to identify any underlying differences therein. Chromatin-associated protein kinases active towards phosvitin, lysine-rich histone, and endogenous nonhistone proteins were characterized in human prostatic nuclei. The general properties of the human chromatin-associated prostatic protein kinases were similar to those of rat ventral prostate chromatin. Polyamines stimulated the phosphorylation of endogenous nonhistone proteins and phosvitin. Protein kinases active towards phosvitin and lysine-rich histones were unaltered in chromatin from BPH tissue as compared with the normal prostate. However, phosphorylation of chromatin-associated nonhistone proteins was markedly enhanced (average, 123%) in BPH tissue as compared with the normal tissue. The results indicate a change in the protein kinase reaction specifically involving chromatin-associated nonhistone proteins of BPH tissue as compared with normal human prostate.     

Avulsion fracture of the hamulus from clay gunshot sport: a case report

We report a case of hamulus (hook of hamate) fracture nonunion and secondary flexor digitorum profundus tendon rupture caused by repetitive wrist hyperextension sustained during clay shotgun shooting. The hyperextension caused avulsion of the hamulus by the pisohamate ligament. The hamulus was excised and a flexor digitorum profundus tendon transfer of the ring to small finger side to side was performed with satisfactory outcome.     

Pisiform ligament complex syndrome and pisotriquetral arthrosis

PLC syndrome is a spectrum that encompasses PLC instability and ends with PTA. Early recognition and treatment of PLC instability may disrupt its progression to PTA. The pisiform tracking test is a provocative maneuver that aids in diagnosing PLC syndrome. Pisiformectomy with preservation of the soft tissue confluence remains the treatment of choice for severe PLC syndrome that does not respond to nonoperative treatment.