Tissue Injury-Inducing Potential of Unmodified ECT: Serial Measurement of Acute Phase Reactants

Eight subjects with acute functional psychoses receiving unmodified electroconvulsive therapy (ECT) at Ibadan were investigated for occult or subclinical internal tissue damage by serial measurements of eight acute phase reactants. Samples of venous blood were collected from each patient at pretreatment, two within treatment, and one at posttreatment. The acute phase proteins assayed were C-reactive protein (CRP), alpha-2-macroglobulin, ceruloplasmin, factor B, C-4 protein, C-3 protein, transferin, and alpha-1-antitrypsin. Except for CRP, the values of the proteins did not change during treatment. CRP values decreased posttreatment and were not detectable in the last sample in five subjects in whom values had been present pretreatment. Our data do not support fears of occult internal tissue damage during unmodified ECT. The consistent decrease in CRP levels posttreatment when patients no longer exhibited psychotic symptoms could not be explained by type of psychosis, intramuscular injections, or changes in drugs and diet; its significance is not known.     

Prevalence of tuberculin positivity and skin test anergy in HIV-1-seropositive and -seronegative intravenous drug users.

OBJECTIVES.--To identify differences in purified protein derivative (PPD) tuberculin positivity and skin test anergy rates by human immunodeficiency virus (HIV) serostatus, CD4+ lymphocyte count, and other risk factors in intravenous drug users (IVDUs); and to evaluate the appropriateness of the Centers for Disease Control (CDC)--recommended definition for a positive PPD tuberculin skin test result in HIV-1-seropositive patients. DESIGN.--Nested case-control and cross-sectional analyses. SETTING.--Community-based cohort of IVDUs. PATIENTS.--Two hundred sixty HIV-1-seropositive and -seronegative IVDUs, drawn from an unselected cohort, were skin-tested for sensitivity to PPD tuberculin, mumps, and Candida antigens using the Mantoux method. OUTCOME MEASURES.--Positivity to PPD tuberculin, skin test anergy. RESULTS.--Even using the CDC definition of an induration 5 mm or greater in diameter in HIV-1 seropositives, this group was substantially less likely to be PPD tuberculin positive than HIV-1 seronegatives (13.8% vs 25.2%; P = .02). In the HIV-1 seropositives the relative odds of being PPD positive varied depending on whether 10 mm or greater (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.2 to 0.7), 5 mm or greater (OR, 0.5; 95% CI, 0.2 to 0.9), or 2 mm or greater (OR, 0.7; 95% CI, 0.4 to 1.3) was used to define a positive test result. The mean diameter induration in the HIV-1-seropositive group was 2.6 mm vs 5.4 mm in the seronegative group (P = .005). Skin test anergy (to mumps and Candida) appeared to explain the differential. Anergy was substantially higher in the HIV-1 seropositive group and increased as the CD4+ lymphocyte count fell (chi 2 for linear trend, 24.5; P less than .0001). An inverse linear trend for PPD positivity and CD4+ lymphocyte count was also observed (chi 2 for trend, 6.1; P = .01). In multivariate analyses, being 35 years of age or older and being HIV-1 seronegative were significantly associated with PPD positivity, while history of previous police arrest was of borderline significance. Only HIV-1 seropositivity was significantly associated with anergy. CONCLUSIONS.--These findings show that CDC-recommended definition of an induration 5 mm or greater in diameter for PPD tuberculin positivity in HIV-1 seropositives significantly underestimates the "true" infection rate (using the PPD positivity rate in HIV-1 seronegatives as the criterion standard). A definition of 2 mm or greater would appear to be a better cutoff for reducing misclassification in HIV-1 seropositives. This study also confirms that delayed-type hypersensitivity is seriously depressed in HIV-1 seropositive IVDUs and that anergy testing is mandatory to properly assess a negative PPD test result.     

White-centered retinal hemorrhages: a sign of intracranial hemorrhage

White-centered retinal hemorrhages (so-called "Roth spots") were seen in an 11-year-old girl with spontaneous intraventricular and subarachnoid hemorrhage from a ruptured "berry" aneurysm without underlying systemic disorder.     

A brief assessment of psychosocial functioning of subjects with bipolar I disorder: the LIFE-RIFT. Longitudinal Interval Follow-up Evaluation-Range Impaired Functioning Tool

Those afflicted with bipolar disorder often suffer from substantial functional impairment both when in episode and when in remission. This study examined the psychometric properties of a brief assessment of psychosocial functioning, the Range of Impaired Functioning Tool (LIFE-RIFT), among subjects with bipolar I disorder. The study sample consisted of 163 subjects who presented with bipolar I disorder at intake into the NIMH Collaborative Depression Study (CDS). All LIFE-RIFT items come from the Longitudinal Interval Follow-up Evaluation (LIFE). Follow-up data that were used to examine the reliability and validity of the scale come from assessments of psychosocial functioning that were conducted 6, 12, 18, and 24 months after intake into the CDS. The results of factor analyses indicate that the scale items are measures of one construct, psychosocial functioning. The interrater agreement on the scale score was very good with an intraclass correlation coefficient was 0.94. The internal consistency reliability among the scale items was uniformly satisfactory over the four assessment periods, with coefficient alpha ranging from 0.78 to 0.84. Mixed-effect regression analyses showed that during mood episodes subjects were significantly more impaired than those in recovery. In conclusion, the psychometric properties of the LIFE-RIFT were examined in subjects with bipolar I disorder. The analyses from this longitudinal, observational study provide empirical support for the reliability and validity of the scale. The LIFE-RIFT provides a brief, inexpensive alternative to scales currently used to assess psychosocial functioning and can be easily added to semistructured assessments that are used in clinical and treatment outcome studies.     

Cystic fibrosis presenting as kwashiorkor in a Sri Lankan infant.

Growth failure is a common presentation of patients with pancreatic insufficient cystic fibrosis. However, full blown kwashiorkor is extremely rare. Cystic fibrosis is also considered to be rare in the South Asian population. This report describes a Sri Lankan infant with cystic fibrosis who presented with clinical features of severe kwashiorkor.     

Secondary traumatization among wives of PTSD and post-concussion casualties: distress, caregiver burden and psychological separation

This study has two aims. First, it assesses the implication of husbands' post-traumatic stress disorder (PTSD) and post-concussion syndrome (PC) on their wives' sense of burden and emotional distress. The second aim was to examine the implication of the women's separation-individuation on their adjustment. Sixty women participated in study: 20 women married to war veterans diagnosed as suffering to PTSD, 20 women married to war veterans suffering from PC, and 20 women married to healthy controls. Data was collected using self report questionnaires assessing psychiatric symptomatology, caregiver burden and psychological separation-individuation. Results indicate that women from both research groups suffer from higher levels of burden and distress than controls. The level of separation-individuation was found to be correlated to levels of burden and distress. The complex implications of living with a traumatized spouse are discussed.     

Spontaneous rupture of the liver upon revascularization during transplantation

Spontaneous rupture of the liver has been described in association with many benign and malignant conditions. We report, to our knowledge, the first case of spontaneous rupture of the liver upon revascularization, requiring total hepatectomy and portocaval shunt, followed by successful retransplantation. Routine pathological examination of the explanted liver failed to reveal the etiology of the rupture. However, electron microscopy demonstrated abnormal collagen in the hepatic arterial wall compatible with a collagen disorder such as Ehlers-Danlos type IV disease. We conclude that the donor liver had a previously undiagnosed collagen disorder. Review of the literature does not preclude the use of livers from donors with a history of connective tissue disorders. Based on our experience one should exercise caution when using livers from such donors. With a history of connective tissue disorder in an immediate family member, further tests should be performed in the donor to rule out a subclinical connective tissue disorder. In addition, a review of all patients reported thus far to have undergone total hepatectomy and portocaval shunt, followed by liver transplantation as a two-stage procedure is presented.