Analysis of the symptoms of depression--a neural network approach

The purpose of this study is to determine the individual contribution, or importance number, of the symptoms to an analysis of depression, utilizing a neural network model. In addition, the presence of hopelessness and somatic complaints was examined, to determine their relevance to depression. Using Wave 1 data from Duke University's contribution in the Epidemiological Catchment Area (ECA) study, we created a mathematical model, a neural network, to map the relationship of nine symptoms of major depression, hopelessness and somatic complaints to the presence or absence of the formal diagnosis of depression, and performed a contribution analysis. The contribution analysis using the neural network revealed that the symptoms with the greatest impact on the occurrence of depression, or with the largest importance number for depression, were sadness, loss of interest, tiredness and sleeping trouble, in that order. The most frequently reported symptoms, though, were sadness, sleeping trouble, suicidal ideation, tiredness and poor concentration, in that order. Hopelessness and somatic symptoms were the lowest in their contribution to the diagnosis of depression. The study thus provides the hierarchy of the symptoms of depression and supports the DSM classification of major depression.     

Platinum distribution in malignant glioma following intraoperative intravenous infusion of carboplatin

The objective of this paper was to determine the time course and extent of platinum uptake into human malignant glioma tissue. An intraoperative, intravenous infusion of carboplatin was given to nine patients (seven glioblastoma and two anaplastic glioma) undergoing tumour excision. Carboplatin dosage was calculated individually to achieve a target systemic free carboplatin exposure. Tumour and peritumoural tissue was harvested at timed intervals following carboplatin administration. Plasma and tumour platinum concentrations were measured by graphite furnace flameless atomic absorption spectrophotometry. Histological examination was also performed on a piece of each tissue sample. The mean carboplatin dose administered was 783, SEM 56 mg (range 485-903). Plasma pharmacokinetics showed a typical elimination curve. The mean peak plasma platinum concentration was 44, SEM 5 micrograms/ml (range 27-74). The mean total elemental plasma platinum area under the curve (AUC) was 9.0, SEM 1.4 mg/ml/min. Platinum was detected in 61 tumour samples, the mean peak concentration being 13 SEM 2 micrograms/g (range 5-21). Platinum was also detected in peritumoural brain and necrotic tumour. No correlation was apparent between the degree of necrosis in each tumour specimen and tumour platinum concentration. Platinum concentrations achieved in tumour were similar to levels that would be cytotoxic for glioma cells in vitro. The results of this study have implications for future studies using capillary permeability modifying agents as adjuncts to brain tumour chemotherapy.     

Intracranial haemangioendothelioma mimicking a meningioma

A 33-year-old man presented with a history of fits and on initial investigation was suspected of having a left frontal parafalcine meningioma. Initial surgical procedure to excise the lesion had to be abandoned owing to the extreme vascularity of the lesion. Histology revealed it to be a haemangioendothelioma. At a second operation the tumour was completely removed. The histology of this rather uncommon tumour is discussed and the literature is reviewed.     

Cross infection on a combined paediatric plastic surgery and burns unit: a clinical and microbiological audit

To try and determine any presence of cross-infection between patients, prospective screening of 226 consecutive admissions on our burns unit was performed by taking nose, throat and wound swabs. Infected wounds were also swabbed and a correlation was sought between the organisms cultured on screening swabs and those responsible for infection. We did not find any evidence of cross- infection occurring between the burns patients and the other categories of patients on the ward. Screening swabs were useful in detecting carriers, who were found to be more of a risk to themselves than to other patients on the unit.     

Prosthetic reconstruction of the femur for primary bone sarcoma

The survival of patients and implants, complications and functional outcome were reviewed in 25 consecutive femoral endoprosthetic reconstructions for treatment of primary bone sarcoma. The diagnosis was chondrosarcoma in 11, osteosarcoma in 10, MFH in 3 and Ewing’s tumour in 1. Median follow up was 64 months (34 to 219) and median age at operation was 29 years (10 to 70). Twelve remained disease free at review. One had amputation for local recurrence and another was alive with metastases. 11 patients died at a median of 13 months (5 to 128); 8 from metastatic disease and 3 from other causes. Four implants were revised, at a median of 95 months (53 to 136); two for fractures of the stem and two for aseptic loosening. Three implants had radiological evidence of loosening at a median of 43 months (34 to 49). Fourteen patients had significant complications. The median functional score using the Musculoskeletal Tumour Society system was 68%. In our experience, prosthetic reconstruction of the femur does not compromise survival, although there is a significant complication rate.

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Résumé  La survie des patients et des implants, les complications et le résultat fonctionnel ont étéétudiés dans 25 reconstructions prothétiques fémorales consécutives au traitement de sarcomes primaires de 1’os. Le diagnoctic était : ostéosarcome dans 11 cas, chondrosarcome dans 10, MFH dans 3 et tumeur d’Ewing dans 1. La médiane de suivie était de 64 mois (34 à 219) et la valeur médiane de 1’age à 1’opération était de 29 ans (10 à 70). 12 patients sont sans métastase ni récidive à la revue. Un a eu une amputation pour récidive locale et un autre est vivant avec métastases. 11 patients sont morts avec une médiane de 13 mois (5 à 128): 8 de méastases et 3 d’autres causes. 4 implants ont été réopérés avec une médiane de 95 mois (53 à 136) : 2 pour rupture de la tige et 2 pour descellement aseptique. 3 implants montraient un descellement radiologique à une médiane de 43 mois (34 à 49). 14 patients avaient des complications notables. Le score fonctionnel moyen utilisant la cotation de la Musculoskeletal tumor Society était de 68%. La reconstruction prothétique du fémur ne compromet pas la survie bien qu’il y ait un taux élevé de complications.

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Accepted: 16 August 1999     

Potential preventive strategies and therapies in urinary tract infection

There are perhaps five strategies either presently advocated or under investigation for prevention of recurrent urinary tract infection (UTI): antibiotics, including natural peptides; functional foods; vaccines; probiotics; and miscellaneous, including avoidance of spermicides and maintenance of good hygiene. It is not possible to state the proportion of patients using antibiotics versus foods such as cranberry or using alternative approaches such as avoidance of spermicides. The majority of women who are referred to specialists will be prescribed long-term, low-dose antibiotics. However, given the magnitude of the problem, it is safe to state that large numbers of women are at least experimenting with alternative remedies such as drinking of cranberry juice or ingestion of herbal remedies with a view to enhancing their immune response. Vaccine development remains a long way from human use and has yet to be developed for organisms other than Escherichia coli. The use of probiotics to restore the normal vaginal flora and provide a competitive bacterial barrier to pathogens is close to becoming available as an alternative preventive approach. The next decade should see the introduction of new methods for reduction of the high incidence of UTI and better management of recurring urogenital infections.     

Preoperative ketorolac increases bleeding after tonsillectomy in children

Purpose

To compare the incidence of vomiting following codeine or ketorolac for tonsillectomy in children.

Methods

We had planned to enrol 240 patients, aged 2–12 yr undergoing elective tonsillectomy into a randomized, single-blind study in University Children’s Hospital. The study was terminated, after 64 patients because interim analysis of the data by a blinded non-study scientist concluded that the patients were at undue risk of excessive perioperative bleeding. After induction of anaesthesia by inhalation with N₂O/halothane or with propofol 2.5?3.5 mg· kg^?1 iv, the children were administered 150 μg· kg^?1 ondansetron and 50 μg · kg^?1 midazolam. Maintenance of anaesthesia was with N₂O and halothane in O₂. Subjects were administered either 1.5 mg · kg^?1 codeine im or 1 mg· kg^?1 ketorolac iv before the commencement of surgery. Intraoperative blood loss was measured with a Baxter Medi-Vac® Universal Critical Measurement Unit. Postoperative management of vomiting and pain was standardized. Vomiting was recorded for 24 hr after anaesthesia. Data were compared with ANOVA, Chi-Square analysis and Fisher Exact Test.

Results

Thirty-five subjects received ketorolac. Demographic data were similar. The incidence of vomiting during the postoperative period was 31% in the codeine-group and 40% in the ketorolac-group. Intraoperative blood losses was 1.3 ± 0.8 ml · kg^?1 after codeine and 2.2 ± 1.9 ml · kg^?1 after ketorolac (mean ± SD) P < 0.05. Five ketorolac-treated patients had bleeding which led to unscheduled admission to hospital, P < 0.05, Exact Test.

Conclusion

Preoperative ketorolac increases perioperative bleeding among children undergoing tonsillectomy without beneficial effects.     

Anti-Uz found in mother's serum and child's eluate

A saline-reactive antibody, anti-Uz, that reacted stronger with S+ than with S- red blood cells (RBCs) and failed to react with U- or ficin-treated RBCs has been previously reported. We describe an antibody of similar specificity in the postpartum serum of an untransfused woman and the eluate from her fourth child's cord RBCs. The mother's RBCs typed S-s+U+, He+(weak), and appeared to have normal glycophorin A and B content, as deter- mined by immunoblotting. The direct antiglobulin test (DAT) and the autocontrol were negative. Her serum reacted stronger with S + RBCs only in the antiglobulin phase, and failed to react with U- or ficin-treated RBCs. The antibody was adsorbed completely by S-s+U+ RBCs, proving that anti-S was not present. Monocyte monolayer assay results with S+s-U+ and S-s+U+ RBCs indicated that transfusion of incompatible blood would not result in significant hemolysis. The child's cord RBCs typed S-s+. The DAT was 3+ with anti-IgG, and an eluate prepared from these RBCs had the same reactivity as the maternal serum. The child showed no clinical signs of hemolytic disease of the newborn. In contrast to previous reports, these results suggest an immune form of anti-Uz.     

Guidelines for use access to compuuterized medical records

Computerization of the medical record allows the unique capability to provide differential access to various components of the record by users outsid of the immediate provider/patient health care setting Guidelines for designers, programmers, and users of computerizeid medical records have been defined in order to clarify which data elements or categories are appropriate for communication to various parties involved in utilizing patients information.