Clinical experience with a method for adjusting gentamicin dose from measured drug clearance

Gentamicin clearance was measured in 26 patients by a method which requires four blood samples. Clearance was used to calculate mean steady state serum concentrations [Css] with the aim of maintaining Css within the range 2.5-3.0 mg/l. All of the patients who failed to respond to antibiotic treatment had adequate Css and peak levels; all of these patients had serious underlying problems to explain their poor response. In contrast some patients responded satisfactorily despite being apparently underdosed. In two patients poor clinical response was associated with low Css levels despite adequate doses and peak levels; both patients responded to increased doses. In patients with stable renal function doses calculated from initial clearance measurements did result in Css within the desired range. In patients with unstable renal function measurement of clearance gave a better indication of the severity of renal impairment than measurement of serum creatinine or peak and trough levels but the bioassay used was too slow to allow adequate dose adjustment.     

Cyclothymic-depressive-anxious temperament pattern is related to suicide risk in 346 patients with major mood disorders

BackgroundSuicidal behavior is one of the most alarming signs not only in psychiatry, and current major depressive episode is the most frequent medical condition among suicide victims and attempters. The aim of the study was to investigate the relationship between the individual pattern of affective temperaments, non-typical symptoms of depression as measured with the Gotland Scale for Male Depression (GSMD), hopelessness and suicidal behavior in major mood disorder patients.MethodsParticipants were 346 adult inpatients (151 men and 195 women) with major mood disorders consecutively admitted to the Department of Psychiatry of the Sant'Andrea University Hospital in Rome, Italy. All the patients were administered the TEMPS-A, the GSMD, and the Beck Hopelessness Scale (BHS) and the Mini International Neuropsychiatric Interview (MINI).ResultsA Two Step Cluster Analysis procedure, performed to reveal natural groupings within patients' response set, indicated that there were 2-groups: a cyclothymic–depressive–anxious group and a hyperthymic group. More than 81% of the patients with prevailing cyclothymic–depressive–anxious temperament had mild to severe suicidal risk on the MINI vs. only around 42% of the patients with prevailing hyperthymic temperament. Sixty-four percent of patients with prevailing cyclothymic–depressive–anxious temperament had BHS scores of 9 or higher versus only 13% of patients with prevailing hyperthymic temperament. Also, patients with prevailing cyclothymic–depressive–anxious temperament more likely had higher GSMD than patients with prevailing hyperthymic temperament.LimitationsThe correlational nature of the study limits causal conclusions to be drawn.ConclusionsOur results indicate that affective temperament measure along with Gotland Scale for Male Depression could be useful tools in screening and identifying those affective disorder patients who are at higher risk of suicidal behavior.     

A study of affective temperaments in Hungary: internal consistency and concurrent validity of the TEMPS-A against the TCI and NEO-PI-R

BACKGROUND: TEMPS-A (Temperament Evaluation of the Memphis, Pisa, Paris and San Diego - Autoquestionnaire) is a new self-assessed temperament 110-item scale with depressive (D), cyclothymic (C), hyperthymic (H), irritable (I) and anxious (A) subscales. To date, it has been translated into 25 languages, and validated in 10. The present Hungarian version provides the most complete external validation across the Beck Depression Scale (BDI), Profile of Mood States (POMS), the BarOn Emotional Quotient Inventory (BarOn EQ-i), Temperament and Character Inventory (TCI), and the NEO Personality Inventory - Revised (NEO-PI-R). We were particularly interested in concurrent validation against the TCI and the NEO-PI-R, the most important of the new personality instruments. METHODS: 1132 clinically-well subjects (27% male) from the general population and university students (16-81 years) were administered the above scales and instruments. The data were tested with standard psychometric batteries. RESULTS: Factor analysis revealed 5 factors approximating the original D, C, I, H, and A subscales, which in their superfactor confirmed an Emotional (D, C, I, A) vs. Hyperthymic structure. Except for the D (a=0.65), the Cronbach alpha for the remainder temperaments ranged from 0.75-0.81. Dominant temperaments ranged from the I (2.7%) to the C (4.2%); the highest prevalence was observed among men with C=6% and H=5.4%. The BDI and POMS correlated significantly with the relevant subscales, as did the BarOn. Of the many significant possible correlations with the TCI, the most noteworthy were novelty seeking and harm avoidance with D, A, C, as well as C, and persistence with H. As for the NEO-PI-R, we were struck by the positive correlation of openness with C, and conscientiousness negatively with C; most other positive correlations such as neuroticism with all temperaments but the hyperthymic were expected and strongly supportive of concurrent validity. LIMITATIONS: Higher educational background of the subjects studied relative to that of the general population of Hungary. The distribution of the data may have in some instances deviated somewhat from the underlying assumptions for the standard psychometric tests for normality. We did not conduct test-retest reliability. CONCLUSIONS: The factorial structure of the TEMPS-A shows good reliability and internal consistency. Although the superstructure is reminiscent of neuroticism-extraversion, within it are embedded discernible classical affective temperaments. A provocative finding is the high prevalence of cyclothymia in Hungarian males (6%), which is rather unique when compared with the other 10 countries studied to date. This finding, coupled with high male hyperthymia (5.4%), may explain the high lifetime prevalence of bipolar disorders reported from Hungary. Inter alia, our psychometric data along with the foregoing epidemiologic considerations, are very much in line with the cyclothymic-bipolar spectrum model proposed by the senior author [Akiskal, H.S., Djenderedjian, A.H., Rosenthal, R.H., Khani, M.K., 1977. Cyclothymic disorder: validating criteria for inclusion in the bipolar affective group. Am. J. Psychiatry 134, 1227-1233].     

Affective temperaments: from neurobiological roots to clinical application

The Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) has grown to be a clinically important outcome measure in the diagnosis and the clinical course of mood disorders. However, temperaments, which represent the biologically stable core of personality, are not just antecedents of major affective disorders, but also serve as a reservoir of genetically advantageous traits for the survival of different cultures. The rapidly growing body of research in psychiatric and non-psychiatric fields even raises the question of temperament as a common root in psychiatric and somatic disorders, providing a new meaning for the construct of psychosomatic disorders. In this review we aim to summarize current knowledge on both the neurobiological background and clinical importance of affective temperaments including implications for future research.     

Oncologic outcome of stages II/III colon cancer treated via minilaparotomy

We analyzed clinicopathologic, surgical, and survival data on consecutive series of patients with stages II/III colon cancer for whom curative resection via minilaparotomy (skin incision, < or = 7 cm) was attempted between September 2002 and March 2009 to clarify the oncologic safety of this type of surgery. There were 64 men and 55 women; the median age was 70 years (range, 25-91 years). The median body mass index was 21.7 kg/ m2 (range, 15.1-28.9 kg/m2). The minilaparotomy approach was successful in 115 cases (96.6%). The cumulative 5-year disease-free and overall survival rates were 89.7% and 82.4%, respectively, in patients with stage II disease (n = 62) and were 68.4% and 82.4%, respectively, in patients with stage III disease (n = 57), all of which were compatible with those of the historical control patients who underwent conventional open surgery. Minilaparotomy approach for stages II/III colon cancer seems to be oncologically equivalent to conventional open surgery.     

Local airway heat and water vapour losses.

A previously developed time-dependent mathematical model of the heat and water vapour transport in the human respiratory tract for mouth breathing (Daviskas et al., J. Appl. Physiol. 69:362-372, 1990) was applied to calculate the local quantities of heat and water transfer. The results of the heat and water losses agreed with experimental data. The contribution of each airway to the conditioning of inspired air was found to depend on the inspired air conditions and the pattern of breathing as expected. The greater proportion of the total heat and water loss was calculated to occur within the upper airways. However, below the pharynx, the rate of water loss during hyperpnea was calculated at a much faster rate than in the resting state. The rate at which water is returned to the airways may not be adequate to keep the periciliary fluid isotonic. These findings support the proposal that the intrathoracic airways could become significantly dehydrated during hyperpnea. The use of calculated local heat and water transfer rates may help to predict the site of stimuli to exercise-induced asthma.