Mental disorders and nicotine dependence among pregnant women in the United States

OBJECTIVE: To investigate the association between mental disorders and cigarette use and nicotine dependence among pregnant women in the United States. METHODS: A face-to-face general population survey was conducted on participants in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. One thousand five hundred sixteen women reporting a pregnancy in the past year were captured. Primary outcomes were seven Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-defined mood and anxiety disorders and eight personality disorders, which were measured with the Alcohol Use Disorder and Associated Disabilities Interview Schedule. RESULTS: Among pregnant women, 21.7% reported cigarette use and 12.4% met the criteria for nicotine dependence. Among pregnant women with cigarette use, 45.1% met criteria for at least one mental disorder, and among those with nicotine dependence, 57.5% met criteria for at least one other mental disorder. After adjusting for demographics and comorbidity, nicotine dependence during pregnancy significantly predicted any mental disorder (odds ratio [OR] 3.3, 95% confidence interval [CI] 2.1-5.1), any mood disorder (OR 2.5, 95% CI 1.5-4.0), major depression (OR 2.07, 95% CI 1.3-3.4), dysthymia (OR 6.2, 95% CI 2.9-13.1), and panic disorder (OR 3.1, 95% CI 1.6-6.1) in the past year. No significant associations were found between nondependent cigarette use and mental disorders. CONCLUSION: Our results suggest an association between mental disorders and nicotine dependence among pregnant women in the United States. This association has far-reaching implications for both the mental and physical health of women and potentially for their children. LEVEL OF EVIDENCE: III.     

Pulmonary lymphangitic spread of carcinoma: appearance on CT scans

Chest computed tomography (CT), including high-resolution CT with thin (1.5-mm) sections was used to evaluate proved (pathologically or clinically) lymphangitic spread (LS) of tumor in 12 patients. These appearances were compared with thin-section scans obtained in 11 healthy subjects. Thin-section CT demonstrated findings consistent with thickening of the normal lung interstitium. In all patients, thin sections showed an increase in the number of peripheral lines (1-2 cm in length) that were diffuse in generalized disease and localized in focal disease. Normal peripheral arcades were not increased in number, but the limbs forming the arcades were thickened in all patients. A diffuse increase in linear and curvilinear structures (reticular pattern) was seen toward the center of the lung. Polygonal structures 1-2 cm in diameter were seen in seven patients with LS but not in healthy subjects. Fissures were thickened in nine patients. Selected 1.5-mm-thick CT sections are recommended through abnormal areas (seen at CT or on chest radiographs) or if these are normal at three levels (midapex, hilus, and 3 cm above the diaphragm) when scanning patients with tumors known to cause LS.     

The horse that was a zebra: primary lymphoma of bone mimicking shoulder strain in an elderly male

Primary malignant tumours of the extremities are rarely seen in chiropractic clinics. A case is presented of an eighty year old male who had complained of pain in the right shoulder of several days duration. History and clinical examination were consistent with mechanical joint pain. Following an appropriate course of conservative care the patient continued to improve until a re-injury occurred 3 months later. At that time, radiographs revealed an ill-defined moth-eaten lesion in the proximal humeral head. Subsequent evaluation demonstrated it to be a rare histologic sub-type of lymphoma. This case highlights several important issues ranging from clinical presentation to case management.     

The double puncture: an effective percutaneous technique for removing complex, multiple renal calculi

Percutaneous nephrostolithotomy, which can require a double puncture, is presently the method of choice in our institution for the removal of renal stones. Patients that underwent this procedure were evaluated to identify the possible reasons for the double puncture. Of 200 patients evaluated, 14 needed a second tract. The three variables that determined whether a second puncture was needed, in order of importance, were number and size of the stones, with second tracts needed in patients with multiple stones and staghorn calculi; anatomical variations of the renal collecting system itself, with bifid systems the most significant anatomic variation; and the dexterity of the radiologist in performing the puncture and the ability of the urologist to extract the stone. Second tracts were needed more frequently in patients who presented with stones in both the lower and middle poles of the collecting systems.     

Experience with the Amplatz retrievable vena caval filter. Work in progress

The Amplatz retrievable vena caval filter was designed in an attempt to decrease complications associated with the placement of Mobin-Uddin or Kimray-Greenfield filters. The design allows percutaneous retrieval, thus expanding application of the filter to situations requiring temporary prophylaxis against pulmonary embolism. Filters have been placed in 16 patients, nine (56%) for prophylactic purposes. All filters were easily inserted percutaneously. Complications occurred in three patients; these included complete thrombosis of the inferior vena cava below the filter, misplacement of one filter into the pericaval retroperitoneal tissue, and development of thrombus cranial to the filter. With the current introduction system, the possibility of filter misplacement has been essentially eliminated. No patient experienced symptoms suggestive of pulmonary embolism after filter insertion. One filter retrieval has been performed, with no complications.     

The role of MR imaging in evaluating metastatic spinal disease

Fifty-eight patients with suspected epidural metastases were evaluated with MR imaging. Six patients were examined on two separate occasions. MR was judged to be diagnostic in 60 of the 64 examinations. Twenty-two patients also underwent myelography. MR was as diagnostic as myelography in all cases of epidural metastases. In addition, MR offered several advantages over myelography in the evaluation of metastatic spinal disease, including demonstration of paravertebral tumor extension, identification of additional osseous metastatic lesions, and visualization of areas of spinal cord compression occurring between areas of myelographic blocks. We conclude that MR imaging is the examination of choice for evaluating suspected metastatic spinal disease.