Nuclear magnetic resonance (NMR) imaging of tumors in the posterior fossa

Nuclear magnetic resonance (NMR) images were obtained in 12 patients with mass lesions in the posterior fossa and the results compared with X-ray computed tomography (CT). Inversion recovery T1-weighted images demonstrated abnormalities in six of six intrinsic lesions and three of six extrinsic lesions. Spin echo T2-weighted images demonstrated abnormalities in two of two intrinsic lesions and four of five extrinsic lesions. Saturation recovery T1-weighted images were normal in two of two intrinsic lesions and two of four extrinsic lesions. Overall, NMR detected 11 of 12 lesions. Two intrinsic tumors detected by NMR were not detected by CT evaluation. Two small extrinsic tumors required CT gas cisternography for detection.     

Trends in use of antidepressants, lithium, and anticonvulsants in Kaiser Permanente-insured youths, 1994-2003

In view of the current controversy regarding the use of antidepressants in children and adolescents, we examined trends from 1994 to 2003 in the use of antidepressants, lithium, and anticonvulsants by enrollees, aged 5-17 years, of Kaiser Permanente in Northern California. We found that the use of antidepressants more than doubled from 9.4 per 1000 enrollees to 21.3 per 1000. Most of this increase is associated with selective serotonin reuptake inhibitors (SSRIs), which increased from 4.6 to 14.5 per 1000. The use of tricyclic antidepressants (TCAs) decreased markedly, while the increase of other newer antidepressants rose from 1.3 to 6.5 per 1000. The use of anticonvulsants nearly doubled, from 3.5 to 6.9 per 1000, while lithium use was relatively stable at a rate of nearly 1 per 1000. Use of SSRIs, newer antidepressants, and anticonvulsants increased in boys as well as girls in each of three age groups: 5-9, 10-14, and 15-17 years. An increasing percentage of the antidepressant users had a diagnosis of depression, and an increasing percentage of anticonvulsant users had a diagnosis of bipolar disorder. Although the safety and efficacy of antidepressants in youths needs to be more firmly established, these findings may reflect progress in the diagnosis and treatment of mental illness.     

Manganese distribution across the blood-brain barrier. IV. Evidence for brain influx through store-operated calcium channels

Manganese (Mn) is a required co-factor for many ubiquitous enzymes; however, chronic Mn overexposure can cause manganism, a parkinsonian-like syndrome. Previous studies showed Mn influx into brain is carrier-mediated, though the putative carrier(s) were not established. Studies conducted with cultured bovine brain microvascular endothelial cells (bBMECs), which comprise the blood-brain barrier, revealed (54)Mn (II) uptake positively correlated with pH, was temperature-dependent, and was sodium- and energy-independent. Brain (54)Mn uptake correlated inversely with calcium (Ca) concentration, but (45)Ca uptake was unaltered by high Mn concentration. Lanthanum (La), a non-selective inhibitor of several Ca channel types, as well as verapamil and amiloride, inhibitors of voltage-operated Ca channels, failed to inhibit Mn uptake into cells. Nickel (Ni), another non-selective inhibitor of several Ca channel types, inhibited Mn and Ca uptake into cells by 88 and 85%, respectively. Cyclopiazonic acid (CPA) and thapsigargin, which activate store-operated calcium channels (SOCCs), increased (54)Mn and (45)Ca uptake into cultured bBMECs. In situ brain perfusion studies were conducted in adult, male Sprague-Dawley rats to verify the cell culture results. Both nickel and verapamil produced a non-significant decrease in Mn and Ca influx. Lanthanum significantly increased Mn influx to 675 and 450% of control in parietal cortex and caudate, respectively, while producing no significant effect on Ca influx. Vanadate, which inhibits Ca-ATPase, inhibited Mn uptake into cultured blood-brain barrier cells, but not into perfused rat brain. Overall these results suggest that both Ca-dependent and Ca-independent mechanisms play a role in brain Mn influx. This work provides evidence that store-operated Ca channels, as well as another mechanism at the blood-brain barrier, likely play a role in carrier-mediated Mn influx into the brain.     

Clinical nurse specialist as leader of a bariatric program

Bariatric surgery is an appropriate intervention for the treatment of morbid obesity. Using the National Association of Clinical Nurse Specialist's "spheres of influence" model, the clinical nurse specialist (CNS) is able to lead in the development and maintenance of an effective hospital-based bariatric program. The three spheres include the patient/client, the nurse/nursing practice, and the organization. The CNS is vital in guiding the education and support for patients and hospital staff. S/he is also instrumental as a leader in developing an environment that is conducive to supporting the bariatric patient population. By employing the three spheres in the program, everyone involved will benefit and positive patient outcomes can be expected.     

Can we improve the assessment of discharge readiness?: A comparative study of observational and objective measures of depth of sedation in children

BACKGROUND: Current recommended discharge criteria might not be rigorous enough to detect residual sedation. This study evaluated the use of the Bispectral Index (BIS monitor), the University of Michigan Sedation Scale (UMSS; i.e., 0-4 observational scale), and a Modified Maintenance of Wakefulness Test (MMWT; visual observation of the time the child is able to stay awake) in assessing return to baseline status. METHODS: Twenty-nine children sedated for echocardiographic examination were studied. Nurses administered sedatives and monitored and discharged children according to institutional guidelines. Children were monitored with the BIS(R) throughout the study. Trained observers assigned UMSS scores every 10-15 min until revised discharge criteria were met (i.e., UMSS score of 0 or 1, MMWT duration >/= 20 min). The MMWT value was recorded at each observation following the procedure. Subsequently, blinded observers recorded average BIS values for the 5 min before each UMSS observation. RESULTS: There were moderate correlations between the BIS, MMWT, and UMSS scores (r = 0.68-0.78; P < 0.01). Revised criteria correctly identified children who were awake and alert (BIS value >/= 90) in 88% of the cases. Only 55% of the children had returned to baseline BIS values when discharged by the nurse, compared with 92% when revised criteria were met (P < 0.05). It took longer to meet revised criteria compared with standard criteria (75.3 +/- 76.2 min vs. 16.4 +/- 13.1 min; P = 0.001). CONCLUSIONS: The incorporation of specific, objective discharge criteria (i.e., UMSS score of 0 or 1, MMWT duration >/= 20 min) may ensure a status closer to baseline (BIS value >/= 90) compared with nursing judgment using standard criteria. However, such assurance may delay the discharge of sedated children.