Steroid-refractory ulcerative colitis treated with corticosteroids,metronidazole and vancomycin: a case report

Background  

Increasing evidence elucidating the pathogenic mechanisms of ulcerative colitis (UC) has accumulated and the disease is widely assumed to be the consequence of genetic susceptibility and an abnormal immune response to commensal bacteria. However evidence regarding an infectious etiology in UC remains elusive.     

Anxiety in patients with epilepsy: systematic review and suggestions for clinical management

Up to 50 or 60% of patients with chronic epilepsy have various mood disorders including depression and anxiety. Whereas the relationship between epilepsy and depression has received much attention, less is known about anxiety disorders. It is now recognized that anxiety can have a profound influence on the quality of life of patients with epilepsy. The relationship between anxiety disorders and epilepsy is complex. It is necessary to distinguish between different manifestations of anxiety disorder: ictal, postictal, and interictal anxiety. Preexisting vulnerability factors, neurobiological factors, iatrogenic influences (antiepileptic drugs, epilepsy surgery), and psychosocial factors are all likely to play a role, but with considerable individual differences. Despite the high prevalence of anxiety disorders in patients with epilepsy, there are no systematic treatment studies or evidence-based guidelines for best treatment practice. Nevertheless, a practical approach based on the temporal relationship between anxiety and epileptic seizures allows clinicians to consider appropriate treatment strategies to reduce the psychiatric comorbidity in patients with epilepsy.     

Critical airway obstruction, superior vena cava syndrome, and spontaneous cardiac arrest in a child with acute leukemia

We report the unusual presentation of a previously healthy girl with sudden cardiopulmonary arrest caused by acute lymphoblastic leukemia and mediastinal involvement leading to acute tracheal and airway obstruction. Despite active resuscitation and mechanical ventilation, she developed severe cerebral edema as a result of cerebral asphyxia. She also had facial edema caused by superior vena cava obstruction, a high peripheral white cell count with blast differentials, and renal failure. Because of severe asphyxia leading to brain death and renal failure, chemotherapy was withheld. Her white cell count spontaneously reverted to reference range without chemotherapy. This report serves to alert clinicians of the oncological emergency of "superior mediastinal syndrome" causing airway and superior vena cava obstruction leading to death in this potentially curable disease.     

A randomized trial assessing the efficacy of peer counseling on exclusive breastfeeding in a predominantly Latina low-income community

OBJECTIVE: To assess the efficacy of peer counseling to promote exclusive breastfeeding (EBF) among low-income inner-city women in Hartford, Conn. DESIGN: Participants recruited prenatally were randomly assigned to either receive support for EBF from a peer counselor plus conventional breastfeeding support (peer counseling group [PC]) or only conventional breastfeeding support (control group [CG]) and followed through 3 months post partum. SETTING: Low-income predominantly Latina community. PARTICIPANTS: Expectant mothers, less than 32 weeks gestation and considering breastfeeding (N = 162).Intervention Exclusive breastfeeding peer counseling support offering 3 prenatal home visits, daily perinatal visits, 9 postpartum home visits, and telephone counseling as needed. MAIN OUTCOME MEASURES: Exclusive breastfeeding rates at hospital discharge, 1, 2, and 3 months post partum (n = 135). RESULTS: At hospital discharge, 24% in the CG compared with 9% in the PC had not initiated breastfeeding, with 56% and 41%, respectively, nonexclusively breastfeeding. At 3 months, 97% in the CG and 73% in the PC had not exclusively breastfed (relative risk [RR] = 1.33; 95% CI, 1.14-1.56) during the previous 24 hours. The likelihood of nonexclusive breastfeeding throughout the first 3 months was significantly higher for the CG than the PC (99% vs 79%; RR = 1.24; 95% CI, 1.09-1.41). Mothers in the CG were less likely than their PC counterparts to remain amenorrheic at 3 months (33% vs 52%; RR = 0.64; 95% CI, 0.43-0.95). The likelihood of having 1 or more diarrheal episode in infants was cut in half in the PC (18% vs 38%; RR = 2.15; 95% CI, 1.16-3.97). CONCLUSION: Well-structured, intensive breastfeeding support provided by hospital and community-based peer counselors is effective in improving exclusive breastfeeding rates among low-income, inner-city women in the United States.     

Callosal agenesis affects consistency of laterality in a paw preference task in BALB/cCF mice

We tested the hypothesis that the ontogenetic development of the corpus callosum (CC) affects the consistency of laterality in a paw preference task. Adult male mice (55 normal and 29 acallosal) of the BALB/cCF strain were initially tested (twice; inter-test interval: 72 h) in an unbiased setup in which both forepaws could easily perform a reaching movement. In a subsequent test, animals were placed in a biased setup that favored the use of the non-preferred paw. Acallosal and normal mice were strongly lateralized in the unbiased setup. Additionally, while normal mice did not present a populational bias favoring one of the paws, acallosal mice presented a significant bias favoring the left paw. In the biased setup, left- and right-pawed normal mice were equally consistent (approximately 65% of the animals, in both groups, used the preferred paw of the initial two tests, in spite of the bias). Conversely, while left-pawed acallosal mice were as consistent (65%) as normal mice, only 20% of right-pawed mice were consistent. These results suggest that the development of the CC affects consistency of laterality in a side-dependent manner. These results are discussed considering the role of the CC in the establishment of behavioral lateralization.     

Measuring Outcome in Psychogenic Nonepileptic Seizures: How Relevant Is Seizure Remission?

PURPOSE: To examine whether seizure remission is a comprehensive marker of outcome in psychogenic nonepileptic seizures (PNESs). METHODS: A postal questionnaire was returned by 147 patients with PNESs a mean of 4.2 years after diagnosis (mean age at follow-up, 38.1 years). The proportion of patients who were "unproductive" (receiving health-related state benefits) at follow-up was determined, with a comparison of markers of ongoing psychopathology (Global Severity Index, anxiety and depression scores of the Symptom Checklist 90, Somatization Index DSM of the SOMS-2) in three outcome groups: group 1, continuing seizures; group 2, seizures stopped but patients "unproductive;" and group 3, seizures stopped, patients "productive." RESULTS: Of the patients, 71.4% continued to have seizures, and 28.6% had achieved seizure remission; 60.0% of patients with continuing seizures and 42.7% of patients in remission were "unproductive" (difference, NS). Ongoing psychopathology was related to the factor "group membership" with higher values in groups 2 and 3 than in group 1 (GSI, p < 0.001; anxiety, p = 0.01; depression, p = 0.02; Somatization Index DSM, p < 0.001). Across all patients and in the subgroup with PNESs and additional epilepsy, differences were significant only between groups 2 and 3, not between groups 1 and 2. In patients with PNESs alone, differences were significant only between groups 1 and 2. CONCLUSIONS: Seizure remission is not a comprehensive measure of good medical or psychosocial outcome in PNESs. Nearly half the patients who become seizure free remain unproductive. Many of these patients continue to report symptoms of psychopathology. Seizure control should not be the only focus of treatment in clinical practice or outcome observation in research studies.     

Smaller corpus callosum subregions containing motor fibers in schizophrenia

Neuropsychological and neurophysiological studies provide evidence for abnormal interhemispheric communication in schizophrenia. These abnormalities may have a substrate in structural irregularities of the corpus callosum. This study investigated schizophrenia patients (n=27) and healthy comparison subjects (n=31). Global and regional measurements of the corpus callosum were acquired from one midsagittal SPGR slice. Eight subregions were approximately matched to fiber pathways from cortical regions. Overall effects of diagnosis [Wilks' Lambda F(8,46)=2.45, p=0.03] and diagnosis by age interaction [Wilks' Lambda F(8,46)=2.58, p=0.02] were found in a MANCOVA of the eight functionally specific subregions. Specifically, chronic schizophrenia was associated with a smaller rostral body [lower by 6.9%, F(1,53)=9.70, p=0.003] and anterior midbody [lower by 9.7%, F(1,53)=4.89, p=0.03] subregions. The rostral body and anterior midbody subregions of the corpus callosum primarily have premotor, supplementary motor, and motor cortical fibers transversing through them. Functional abnormalities of the associated cortical regions are reported in schizophrenia. These novel findings suggest that structural abnormalities of the corpus callosum exist in schizophrenia, with perhaps the motor-specific subregions affected more than others. Structural differences in the corpus callosum may be a substrate for interhemispheric functional dysconnectivity in schizophrenia.