Current issues in bipolar disorder: a critical review.

Although awareness on bipolar disorder has increased during the last decade, this condition remains characterized by a disabling burden, in terms of morbidity and functional impairment. This paper aims to review some critical issues in the current knowledge on Bipolar disorder. Although large European epidemiological studies are lacking, Bipolar disorder is characterized by a set of severe features, including an early age of onset, a chronic outcome and an important suicidal risk. A majority of bipolar patients also experience a comorbid Axis I condition, including substance abuse, anxiety disorder and attention-deficit hyperactivity disorder. This situation presents a therapeutic challenge, since antidepressants or methylphenidate may be associated with the risk of inducing mania. Recently, a large number of studies have provided evidence for the efficacy of new compounds in the treatment of both mania and bipolar depression, but also in long-term relapse prevention. Recent research has also allowed for the redefinition of the concept of mood stabilizer and for improving existing guidelines on the clinical management of Bipolar disorder.     

A novel recombinant soluble splice variant of Met is a potent antagonist of the hepatocyte growth factor/scatter factor-Met pathway

PURPOSE: The Met receptor tyrosine kinase and its ligand, hepatocyte growth factor/scatter factor (HGF/SF), are involved in a wide range of biological activities, including cell proliferation, motility, invasion, and angiogenesis. The HGF/SF-Met signaling pathway is frequently activated in a variety of cancers, and uncontrolled Met activation correlates with highly invasive tumors and poor prognosis. In this study, we investigated the inhibitory effect of a novel soluble splice variant of Met on the HGF/SF-Met pathway. EXPERIMENTAL DESIGN: Using our alternative splicing modeling platform LEADS, we have identified a novel splice variant of the Met receptor, which encodes a truncated soluble form of the receptor. This variant was produced as a recombinant Fc-fused protein named Cgen-241A and was tested in various cell-based assays representing different outcomes of the HGF/SF-Met pathway. RESULTS: Cgen-241A significantly inhibited HGF/SF-induced Met phosphorylation as well as cell proliferation and survival. In addition, Cgen-241A showed a profound inhibitory effect on cell scattering, invasion, and urokinase up-regulation. The inhibitory effects of Cgen-241A were shown in multiple human and nonhuman cell types, representing different modes of Met activation. Furthermore, Cgen-241A showed direct binding to HGF/SF. CONCLUSIONS: Taken together, our results indicate that Cgen-241A is a potent antagonist of the HGF/SF-Met pathway, underlining its potential as a therapeutic agent for the treatment of a wide variety of human malignancies that are dependent on this pathway.     

Uvulopalatopharyngoplasty: Evaluation of postoperative complications,sequelae, and results

A study of 71 patients with obstructive sleep apnea syndrome was performed to evaluate the effectiveness, complications, and late sequelae of uvulo-palatopharyngoplasty. Postoperative immediate complications were of minor importance. In 96% of the patients, the snoring was improved; it was completely resolved in 48%. The postoperative apnea index remained pathologic in all patients who underwent postoperative polysomnography, although mild improvement was noted. Seventy-four percent of our patients felt a subjective postoperative improvement which was not always confirmed by the polysomno-graphic examination. A record of improvement was obtained in 64% of the operated patients. Our results establish the beneficial effect of uvulopalatopharyn-goplasty, which is the recommended surgical procedure for obstructive sleep apnea syndrome.     

Mycobacterium tuberculosis cervical adenitis. Diagnosis and management

Cervical adenopathy as the sole presentation of tuberculosis is seen infrequently in the pediatric age group. Despite modern treatment and public health measures, tuberculous cervical adenitis persists, and its prompt diagnosis and treatment are important from both a clinical and preventive health perspective. The authors report five cases of children with ages ranging from 8 to 17 years, in whom cervical adenitis was the only presentation of infection with Mycobacterium tuberculosis. The clinical presentation and methods of diagnosis and treatment are described, and the difficulty of differentiation between infections with M. tuberculosis and non-tuberculous mycobacterial infections is stressed. Tuberculous cervical adenitis should be considered in cases of an elusive diagnosis of a cervical mass in the pediatric patient.     

Acoustic trauma-induced Meniere's syndrome

Eight male patients suffering from Menière's syndrome are presented. All patients sustained sudden or prolonged exposure to severe noise levels and suffer from acoustic trauma. The incidence of Menière's syndrome in our group of patients is significantly higher than in series reported in the normal population. Our presentation supports the implication of acoustic trauma as a possible cause of Menière's syndrome.     

Nasopharyngeal pressure gradients during non-phonetic activities of the velopharyngeal valve. Part I

The phonetic activity of the velopharyngeal valve has been the subject of electromyographic, radiological, ultrasonic, endoscopic, and of various acoustic and aeromechanical investigations. The subject of the present study was the non-phonetic activities of the velopharyngeal valve. Ten patients were assessed by nasendoscopic examinations of the velopharyngeal valve. The pressure gradients in the nasopharynx during these activities were recorded. Typical individual nasopharyngeal pressure patterns were revealed inducing a development of a special technique and tests for a further study of the non-phonetic activities of the velopharyngeal valve in correlation with its abnormality and pathological speech activities.     

von Willebrand factor-collagen binding activity is increased in newborns and infants

ABSTRACT. von Willebrand factor (vWF) antigen (vWF:Ag) and vWF-collagen binding activity (vWF:CBA) were measured in plasma by parallel quantitative ELISAs in normal newborns and infants ( n =71). The medians for vWF:Ag (IUjml) and vWF:CBA (Ujml), respectively, were 1.46 and 1.91 for 2-7 day-old (n = 43), 1.22 and 1.40 for 2-4 week-old (n = 14), 1.22 and 1.15 for 2-6-month-old (n = 14) infants and 0.98 and 1.08 (n = 36) in normal adults. Elevated levels of vWF:Ag, but particularly vWF:CBA were seen for up to 4 weeks of life reaching adult levels between 2 and 6 months of life. The elevated levels of the vWF parameters indicate that caution should be exercised when interpreting laboratory data and diagnosing von Willebrand disease in newborns and young infants and warrant the use of age-specific reference ranges. The efficient haemostasis observed during early neonatal life may in part be due to the increased ability of vWF to interact with collagen.     

Conservative surgical management of invasive differentiated thyroid cancer

The majority of well differentiated thyroid carcinoma are tumours of low grade malignancy. Laryngotracheal invasion by well differentiated thyroid carcinoma is an uncommon occurrence. The surgical management of patients with thyroid cancer invading the upper airway has primarily been by total laryngectomy. Other surgeons recommend in selected cases partial laryngeal and/or tracheal resection. A total of 122 patients with thyroid carcinoma were treated in our department between 1967 and 1982. Only seven patients with well differentiated tumours had airway invasion. In these seven patients we used a partial laryngeal and/or tracheal resection. In three of the patients with tracheal invasion a myoperichondrial flap was used for closing the tracheal defect. A partial resection of the larynx and trachea, and end to end anastomosis between the trachea and the remaining part of the larynx was performed in another four patients. The techniques used and a long-term follow-up are presented (Table I).