Disorders of sexual impulse control in neuropsychiatric conditions

This article reviews hypersexuality in individuals with neuropsychiatric disorders and its psychopharmacologic treatment. A brief review of the neurology, neuroendocrinology, and neuropharmacology of sexual behavior is presented. Literature describing the occurrence and treatment of hypersexuality in individuals with neuropsychiatric disorders is reviewed along with literature which discusses the pharmacologic treatment of individuals with hypersexual disorders in nonneuropsychiatric populations. Finally, a clinical algorithm for approaching and treating such disorders in a neuropsychiatric population is presented.     

Pedicle marrow signal intensity changes in the lumbar spine: a manifestation of facet degenerative joint disease

Objective. Signal intensity changes in lumbar pedicles, similar to those described in vertebral body endplates adjacent to degenerated discs, have been described as an ancillary sign of spondylolysis on MRI. The purpose of this study was to determine whether pedicle marrow signal intensity changes also occur in association with facet degenerative joint disease. Design. Eighty-nine lumbar spine MRI examinations without spondylolysis were reviewed for marrow signal intensity changes in pedicles and vertebral bodies as well as for facet degenerative joint disease. Results. Five percent (46/890) of lumbar pedicles in 23 patients had marrow signal intensity changes. Ninety-one percent (42/46) of the abnormal pedicles had adjacent degenerative joint disease of the facets, while only 21% (189/890) of normal pedicles had adjacent facet degenerative joint disease (p<0.001). Eighty-nine percent (41/46) of the pedicles with marrow signal intensity changes had adjacent degenerative disc disease. Conclusions. Pedicle marrow signal intensity changes are not a specific sign of spondylolysis; they are commonly seen with adjacent facet degenerative joint disease in the absence of spondylolysis. Pedicle marrow signal intensity changes are probably a response to abnormal stresses related to abnormal motion or loading caused by the degenerative changes in the spinal segment. Received: 2 May 2000 Revision requested: 18 July 2000 Revision received: 25 August 2000 Accepted: 1 September 2000     

Setting apart the affected: the use of behavioral criteria in animal models of post traumatic stress disorder.

Post-traumatic stress disorder (PTSD) affects about 20-30% of exposed individuals. Clinical studies of PTSD generally employ stringent criteria for inclusion in study populations, and yet in animal studies the data collection and analysis are generally expressed as a function of exposed vs nonexposed populations, regardless of individual variation in response. Prior data support an approach to animal models analogous to inclusion criteria in clinical studies. This series of studies sought to assess prevalence rates of maladaptive vs adaptive responses determined according to a more stringent approach to the concept of inclusion/exclusion criteria (cutoff behavioral criteria-CBC), consisting of two successive behavioral tests (elevated plus maze and acoustic startle response tests). The rats were exposed to stressors in two different paradigms; exposure to a predator and underwater trauma. The prevalence rates of maladaptive responses to stress in these two distinct models dropped over time from 90% in the acute phase to 25% enduring/maladaptive response at 7 days, to remain constant over 30 days. As setting the affected individuals apart from the unaffected approximates clinical studies, it might also help to clarify some of the pending issues in PTSD research.     

Transvaginal repair of vesicovaginal fistula: surgical techniques to improve access and successful vaginal closure

This video demonstrates surgical techniques to improve closure of high vesicovaginal fistula using the vaginal approach and the Latzko procedure.     

Book

Abstract

Social Support and Health, Sheldon Cohen, PhD and S. Leonard Syme (eds). New York: Academic Press, 1985, 390 pages, $42     

Long-Term Outcomes of Augmentation Enterocystoplasty with a Catheterizable Channel in the Adult Neurogenic Population

Augmentation enterocystoplasty with a continent catheterizable stoma is a common approach to refractory neuropathic bladder, incontinence and end-stage bladder disease that aims to provide a large capacity, low-pressure reservoir and continent stoma. The goal is to not only to prevent renal deterioration, but also provide the patient with an improved quality of life. Several recent studies, reviewed in this chapter, have assessed the long-term outcomes of these procedures, demonstrating durable improvement in bladder capacity, bladder compliance, continence and quality of life. The long-term complications of the surgery include stomal complications such as stenosis and prolapse, channel related complications leading to difficult catheterization, bladder stones, recurrent urinary tract infections, bladder rupture, metabolic derangement and in very rare cases, malignant transformation. Successful surgery and good outcomes depend on proper patient selection, surgeon and center experience with the procedure, and close follow-up.