Delusional misidentification of inanimate objects: a literature review and neuropsychological analysis of cognitive deficits in two cases

Following a brief review of the literature on Delusions of Inanimate Doubles (DID), compared with other similar delusions, two cases are presented. Each completed a battery of tests designed to explore their cognitive abilities. In both cases, familiar and unfamiliar face-processing skills remained intact and word memory was unaffected. Their abilities to identify famous buildings and recognise unfamiliar houses were impaired. We propose that an extension of Ellis and Young's (1990) account of Capgras delusion can explain the cognitive impairments in case of DID. A comparison of the hypotheses of Staton et el. (1982), Ellis and Young (1990), and Van Lancker (1991) is also made. The last two have obvious similarities and seem to provide the best general approach. Finally, we caution the need to consider how a mood of suspiciousness may be needed to distort attribution processes that sustain delusional thinking.     

Pharmacotherapy quality improvement: use of a clinical rule-based application

Heritage's drug usage evaluation (DUE) program focuses on analyzing the dynamics of prescribing, dispensing, and medication usage data for insurers, managed care organizations (MCO), and others involved in the management of pharmacotherapy in the ambulatory care setting. The addition of a new clinical rules-based system (Athena) has increased the flexibility, scope, and speed of Heritage quality improvement products. Its integration into benchmarking, profiling, and disease management programs is described.     

Proliferative (mib1, mdm2) versus anti-proliferative (p53) markers in head and neck cancer. An Immunohistochemical study

Formalin fixed and paraffin embedded samples from 36 squamous cell carcinomas of the larynx and the oral cavity (pT₂N₀M₀, R₀) surrounded by non-tumorous mucosa were studied immunohistochemically using a panel of four different anti-p53 antibodies (CM1, PAbl801, D07, PAb240), a monoclonal anti-mdm2 antibody and MIB1, following wet autoclave antigen retrieval. P53 immunoreactivity was detected in 11/14 laryngeal and in 9/22 oral carcinomas. All p53 positive oral, and all but one laryngeal tumors revealed mdm2 positivity as well, whereas in p53 negative tumors 4/12 and 1/3 mdm2 immunopositive cases were demonstrated, respectively. MIB1 labeling indices of the tumors ranged between 18% – 64% in p53 positive cases, and 10% – 53% in p53 negative ones. The difference was not statistically significant. Close spatial coexpression of p53, mdm2 and MIB1 immunoreactivity was observed at the invasive front of the carcinomas and in the basal and suprabasal layers of the non-tumorous epithelium in all p53 positive cases. However, the MIB1 expression was similarly increased at the invasive margins in carcinomas lacking immunohistochemically detectable p53 alterations. Our results strongly suggest that p53 overexpression does not necessarily correspond to increased rate of proliferation, but rather to mdm2 overexpression and is largely dependent on the anatomical site in case of small and localized squamous cell carcinomas of the head and neck region.     

Decreased HER-2 tyrosine kinase expression in rectal mucosa of FAP patients following low-dose sulindac chemoprevention

As a part of the mechanisms of action in reversing FAP adenomas by the low-dose sulindac maintenance therapy (2 x 25 mg/patient per day), the extent of HER-2 proto-oncogene expression in the rectal mucosa seems to be of interest. Immunocytochemical analyses were performed in plasma and in rectal tissue of sulindac-treated FAP patients during an 18 months follow-up and compared with rectal tissue of patients with FAP, Crohn's disease, or rectal cancer or with healthy volunteers. HER-2 was significantly reduced and maintained in tissue under sulindac chemoprevention below base line levels of healthy individuals, but not in plasma. Therefore, a direct or indirect effect of sulindac as a tyrosine kinase inhibitor may be implicated. During NSAID treatment HER-2 protein expression as a prognostic tool seems to be of little clinical relevance.     

Angioplasty, stenting, atherectomy, and laser treatment after coronary artery bypass grafting

Saphenous vein grafts remain an essential part of coronary artery bypass surgery. However, their inferior long-term patency due to graft attrition often means recurrent ischemia or infarction. Repeat surgical revascularization carries a significantly higher morbidity and mortality and is frequently associated with less symptomatic improvement as compared with the initial surgery. Thus, nonsurgical alternatives are preferred in such a situation, particularly when the lesions are technically approachable and amenable to these transcatheter procedures. Traditionally, percutaneous transluminal coronary angioplasty has been the standard approach. However, there are certain shortcomings of this technique, principally its inadequacy in treating certain adverse lesion morphologies. Problems include an appreciable risk of coronary debris embolization and acute complications in old vein grafts, and the prohibitively high restenosis rate for stenoses situated at the ostium or the proximal and middle segments of grafts. Newer, second-generation intravascular techniques such as stents, atherectomy, and laser procedures have been introduced in an effort to overcome these problems. This review presents an update of the results of these new tools together with some suggestions on their clinical utility in a vein graft setting.     

Patient care contributions of clinical pharmacists in four ambulatory care clinics

This study investigates both cost-avoidance and improvement in the quality of care and patient outcome attributed to pharmacist intervention in four ambulatory care clinics. Four clinical pharmacists reported 199 interventions made in the pharmacotherapeutic management of 87 ambulatory clinic patients in 1 month. The majority of interventions were based on acceptable professional practices as ranked by peer reviewers. Positive impact of the interventions on patient outcome based on objective and subjective data was documented in 49% of the interventions. Forty-two percent of the interventions improved the process of care with no measurable impact on patient outcome. Cost avoidance was calculated according to interventions made at different steps of the drug use process. Net cost avoidance figures projected to 1 year amounted to $221,056.     

Reliability of hand-held dynamometry and its relationship with manual muscle testing in patients with osteoarthritis in the knee

Support for this study was provided by the Arthritis Health Professions Association, Arthritis Foundation, National Office, and NIH (NIAMS) Multipurpose Arthritis Center Grant No. AM 30692. The reliability of data gathered with hand-held dynamometers (HHD) and the relationship between HHD measurements and manual muscle tests (MMT) have been assessed only with healthy subjects and patients with neuromuscular disorders, not with homogeneous groups of patients with orthopaedic problems. In this study, HHD and MMT were used to measure the strength of knee extensor muscles of 43 patients with osteoarthritis. Test-retest reliability of HHD was determined, and the two testing systems were compared. The HHD measurements indicated that the knee extensor muscles were weak; the MMT grades indicated good strength. The HHD intraclass correlation coefficient for knee extensor strength measurements was 0.92. The HHD measurements increased as the MMT grades increased. The Kendall tau correlation coefficient between HHD measurements and MMT grades for the knee extensor muscles was 0.24. Hand-held dynamometry is less subjective than MMT, especially at the stronger grades. For the purpose of documenting progress of patients, HHD provides a reliable, quantitative method. The use of HHD with weak examiners, weak patients, and inadequate trunk stabilization is questionable. Hand-held dynamometry is useful for clinical and research settings where isokinetic testing is either unfeasible (ie., home care) or cost-prohibitive. J Orthop Sports Phys Ther 1992;16(3):145-149.