Reliability of life event information: a study on 83 psychiatric patients

Summary The reliability of life event information reported by a mixed group of 83 psychiatric patients was ascertained by comparing it with the reports of the same events as given by close relatives. The overall reliability was 86%, which appears satisfactory. Possible reasons for the results are discussed and suggestions offered to make life event studies more reliable.     

Discriminatory effect of anti-Pr-beta-hCG-TT antibodies on the neutralization of the biological activity of placental and pituitary gonadotropins.

In 2 test systems, serum from monkeys and human subjects immunized with an anti-human chorionic gonadotropin (hCG) vaccine, Pr-beta-hCG-TT, were analyzed for their capacities to neutralize hCG/luteinizing hormone (LH)-induced biological effects. hCG-induced ovulation was completely blocked by the monkey antiserum in mice, but the same amount of antiserum, and even 2-fold greater concentrations, did not reduce the number of ovulating animals when primed with ovine LH. Competency of both the immunized monkey and human sera to neutralize the hCG-induced testosterone production in Leydig cells was shown. All monkey and 7/12 human sera did not interfere with the human LH action on Leydig cells. 5 human sera, however, showed varying degrees of inhibition of human LH-induced sterodogesnesis by this sensitive Leydig cell bioassay. Nevertheless, these subjects maintained regular menstrual cycles, and serum progesterone levels during the luteal phase were consistent with ovulation. Normal hormone profiles were constructed from a subject whose serum had shown a fairly high degree of cross-reaction with human LH by the Leydig cell bioassay when estradiol, human LH, and progesterone levels were determined on different days throughout the menstrual cycle.     

The effectiveness in rhesus monkeys of an antifertility vaccine based on neutralization of chorionic gonadotropin

A model system, employing non-human primates, is needed to test the postulate that active immunization to achieve neutralization of the biological activity of chorionic gonadotropin could be used as a basis for fertility regulation in women. Adult female rhesus monkeys were actively immunized with the β-subunit of ovine LH (oLHβ) mixed with Freund's complete adjuvant. All monkeys developed circulating antibodies which bound iodinated oLH and human chorionic gonadotropin (hCG). The bound hCG was displaced by rhesus chorionic gonadotropin (rhCG). Antisera were also able to neutralize the biological activity of rhCG in the immature rat uterine weight assay. Serum progesterone levels and menstrual bleeding patterns indicated that normal ovulatory cycles continued to occur in most cases after immunization. Results of mating the animals reveal that the fertility of the immunized animals was significantly reduced.     

Spina bifida and unilateral focal destruction of the distal femoral epiphysis

Focal destruction of the postero-lateral distal femoral epiphysis was present on radiographs in two children with spina bifida and objective lower limb sensory loss. Each patient presented with painless swelling of the knee. In one patient the epiphysis showed sclerosis and fragmentation associated with a defect. In the second patient the destructive change was the dominant radiographic abnormality and simulated bone tumor. Computed tomography in this patient showed a bone fragment occupying the defect suggesting epiphyseal fracture. The lesion in each patient was believed to be traumatic in origin and to represent a stage in the development toward neuropathic arthropathy.     

Evaluating detection and diagnostic decision support systems for bioterrorism response

We evaluated the usefulness of detection systems and diagnostic decision support systems for bioterrorism response. We performed a systematic review by searching relevant databases (e.g., MEDLINE) and Web sites for reports of detection systems and diagnostic decision support systems that could be used during bioterrorism responses. We reviewed over 24,000 citations and identified 55 detection systems and 23 diagnostic decision support systems. Only 35 systems have been evaluated: 4 reported both sensitivity and specificity, 13 were compared to a reference standard, and 31 were evaluated for their timeliness. Most evaluations of detection systems and some evaluations of diagnostic systems for bioterrorism responses are critically deficient. Because false-positive and false-negative rates are unknown for most systems, decision making on the basis of these systems is seriously compromised. We describe a framework for the design of future evaluations of such systems.     

Diagnostic utility of squash (smear) technique in the inflammatory lesions of central nervous system

Smears of histologically verified inflammatory lesions of central nervous system (CNS) during 12 years were analysed to determine the diagnostic utility and accuracy of squash (smear) technique. Two hundred and sixteen (216) lesions were analysed. Smears could not be interpreted in 72 lesions (33.33%) as the tissue could not be spread or not representative. Tuberculosis was the commonest etiology (70.83%) followed by bacterial, fungal and parasitic infections. To conclude, smear technique is a useful modality in establishing diagnosis in inflammatory lesions of CNS, but its usefulness is limited by difficulties in spreading tissue.     

Celecoxib associated esophagitis: review of gastrointestinal side effects from cox-2 inhibitors

BACKGROUND: With the extensive use of COX-2 inhibitors to treat inflammatory and pain syndromes, gastrointestinal adverse effects are being increasingly observed. CASE REPORT: An 87-year-old white man with chronic peptic esophageal stricture presented to us with dysphagia and odynophagia. The patient was taking Celecoxib for 5 months for trigeminal neuralgia. An upper endoscopy revealed severe desquamative esophagitis. Celecoxib was discontinued and the patient was started on esomeprazole. The patient's symptoms improved in 1 month. Three months later, EGD revealed complete healing of the esophageal mucosa. DISCUSSION: Because recent studies have shown that COX-2 inhibitors are similar to NSAIDs with regards to absorption, in contrast to premarketing trials, extensive use of COX-2 inhibitors is likely to demonstrate gastrointestinal adverse effects similar to those caused by traditional NSAIDs. Our patient had severe esophagitis caused by Celecoxib and aggravated by reflux of achlorhydric gastric contents after dilatation of the stricture. SUMMARY: We report for the first time severe esophagitis caused by the COX-2 inhibitor Celecoxib.     

The Lazarus phenomenon

Even though Lazarus phenomenon is rare, it is probably under reported. There is no doubt that Lazarus phenomenon is a reality but so far the scientific explanations have been inadequate. So far the only plausible explanation at least in some cases is auto-PEEP and impaired venous return. In patients with PEA or asystole, dynamic hyperinflation should considered as a cause and a short period of apnoea (30-60 seconds) should be tried before stopping resuscitation. Since ROSC occurred within 10 minutes in most cases, patients should be passively monitored for at least 10 minutes after the cessation of CPR before confirming death.     

Comparison of Adalimumab and Etanercept for the Treatment of Moderate to Severe Psoriasis: An Indirect Comparison Using Individual Patient Data from Randomized Trials

Objectives

To compare outcomes between adalimumab and etanercept in the treatment of moderate to severe plaque psoriasis.