Scrotal fat necrosis after skiing

Fat necrosis in the scrotum is a rare lesion seen only before the age of puberty. The authors add one case of their own to three earlier reports. Common to most patients reported are the strict age limits between 9 and 12 years at the onset, exposure to cold, a tender mass in close connection with one or both testicles, and difficulties in differentiating this condition preoperatively from other forms of acute scrotum. Microscopic similarities with cold panniculitis are discussed. Offrint requests to: J. Viljanto     

The cochlear nerve in various forms of deafness

Operative specimens of cochlear nerve of 56 patients with profound deafness of varying origin were examined under the light microscope and the number of myelinated nerve fibers in each specimen was counted. The transverse fascicular area of each nerve was also determined. When the resulting neuron populations were evaluated with regard to the cochlear implant program the only truly unsuitable ears for artificial stimulation were found to be those with cholesteatoma involving the cochlear nerve and ears with local pathology in the internal auditory canal severe enough to cause atrophy of the cochlear nerve.     

Factors explaining recurrence in patients undergoing chemoimmunotherapy regimens for frequently recurring superficial bladder carcinoma

OBJECTIVES: To study the factors determining new recurrences in patients with frequently recurring superficial bladder tumors. METHODS: Of all 205 eligible patients, each received 5 weekly intravesical instillations of mitomycin C (MMC), with the first instillation given perioperatively. This was followed, according to randomization, by BCG instillations alone or by alternating instillations of interferon-alpha and BCG monthly for up to 1 year. Impact of 12 variables on time to first recurrence was retrospectively studied with the Cox multiple hazards regression and Kaplan-Meier analysis. RESULTS: Type of regimen was the most significant factor determining new recurrences, with preceding recurrence rate being the most important prognostic factor. Timing of the first MMC was the third significant predictor in the main multivariate analysis, with more than a two-fold relative risk for a new recurrence if the first MMC instillation was given later than on day 0. CONCLUSION: Preceding recurrence rate, most accurately reflects, in patients with frequently recurring tumors, the inherent risk for new recurrences. This risk can be considerably reduced by use of an effective chemoimmunotherapy regimen, and in addition, by inclusion of an early perioperative chemotherapy instillation in such a regimen.     

Childhood central nervous system viral infections and adult schizophrenia

OBJECTIVE: An earlier Finnish cohort study suggested that childhood viral CNS infections are associated with a fivefold increased odds of developing schizophrenia in adulthood. The authors sought to replicate this finding. METHOD: From the archives of the Department of Virology of the National Public Health Institute in Finland, 320 individuals born between 1960 and 1976 who had suffered virologically confirmed CNS infections before their 15th birthdays were identified. Of the infections, 202 had been caused by enteroviruses. The sample was followed up in the 1969-2000 records of the National Hospital Discharge Register of Finland to identify all cases of schizophrenia that emerged. RESULTS: The cumulative incidence of schizophrenia was 0.94% in the whole sample and 0.99% among individuals who had suffered enteroviral infections. These rates are comparable to that found in the general population. CONCLUSIONS: Childhood viral CNS infections were not associated with increased risk of schizophrenia.     

Do means matter?: Differences in characteristics of Finnish suicide completers using different methods

It is unclear whether suicides by different methods are distinguishable by their sociodemographic or clinical characteristics. We set out to investigate whether completed suicides by different methods show disparities in their sociodemographic and clinical characteristics. Within the National Suicide Prevention Project in Finland, all 1,397 suicides occurring April 1, 1987, through March 31, 1988, were investigated using the psychological autopsy method. Disparities were found in characteristics of suicide completers using different methods. Intoxication suicides were more often female and had a history of both previous attempts and psychiatric treatment, whereas suicides by shooting were the opposite in character. Victims using vehicle exhaust gas were most frequently younger males who had experienced a recent interpersonal loss or other adverse event and committed suicide while intoxicated with alcohol. Thus, typical characteristics associate with certain suicide methods, probably due to differences in availability and acceptability of the methods. Various restrictions on the availability of suicide methods are likely to exert their possible impact on somewhat different subpopulations at risk. In terms of suicide prevention, it seems reasonable to target availability restrictions for certain identifiable groups of potential suicide attempters. For instance, carefulness in the practice of prescribing of intoxicating substances to particular psychiatric patients seems justified.     

Health-related quality of life among patients with major depression

The study compared health-related quality of life in 165 patients with major depression and 165 randomly selected and with age- and gender-matched controls from a population sample. Health-related quality of life was measured with the self-report questionnaire (RAND-36), which consists of eight dimensions. Overall, perceived quality of life was broadly reduced among depressive outpatients, and as compared with the control group, significant impairment was observed for all eight dimensions of health-related quality of life. Accompanying somatic diseases causing disability had no additional impact on the reduction of quality of life in depressive patients. Depression per se impairs an individual's functioning ability in a number of ways. It has a significant effect not only on mental well-being but also on perceived physical functioning and bodily pain, and even on general health perceptions. Major depression seems to explain the broad decline in the quality of life among depressive patients.     

Serum insulin and leptin levels in valproate-associated obesity

PURPOSE: Weight gain is an important adverse effect of valproate (VPA) therapy, and it is associated with hyperinsulinemia and hyperandrogenism in women with epilepsy. Leptin is considered a signaling factor regulating body weight and energy metabolism. In human subjects, obesity is in general associated with elevated serum leptin levels, suggesting decreased sensitivity to leptin. The present study aimed at evaluating the role of insulin and leptin in VPA-related obesity. METHODS: Body mass index (BMI) was calculated, and serum insulin and leptin levels were measured in 81 patients with epilepsy taking VPA and in 51 healthy control subjects. RESULTS: Forty (49%) of the patients taking VPA and 25 (49%) of the control subjects were obese. The mean insulin levels were higher in VPA-treated patients than in the control subjects despite similar BMI values, when all subjects were included in the comparison. Both obese male and female patients taking VPA had higher serum insulin levels than the respective control subjects with similar BMI values. Serum insulin levels also were higher in lean male and lean female patients compared with the lean control subjects of same sex. Serum leptin levels did not differ between the VPA-treated patients and the control subjects. CONCLUSIONS: Both obese and lean patients taking VPA for epilepsy have hyperinsulinemia, suggesting development of insulin resistance. This may be one of the factors leading to weight gain during VPA treatment. However, the results of the present study do not suggest an independent role for leptin in the pathogenesis of VPA-related obesity.     

The association of preceding traumatic brain injury with mental disorders,alcoholism and criminality: the Northern Finland 1966 Birth Cohort Study

The purpose of this study was to test the hypothesis that traumatic brain injury (TBI) during childhood and adolescence is associated with psychiatric disorders, heavy alcohol use and criminal offenses in adulthood. We made use of an unselected, general population birth cohort (n=12058) in Northern Finland, which was followed up prospectively up to the age of 31. The data on TBIs of the cohort members were collected from the hospital case notes of the outpatient clinics of the hospitals in the region and from the Finnish Hospital Discharge Registers (FHDR). The data on mental disorders including alcohol diagnoses were also collected from the FHDR after a careful validation process. The Ministry of Justice provided information on criminal offenses for all subjects. The final number of subjects in our study was 5589 males and 5345 females. We found that after controlling for confounders, TBI during childhood or adolescence increased the risk of developing mental disorders two-fold (OR 2.1, 95% CI 1.1-3.6) and TBI was significantly related to later mental disorder with coexisting criminality in male cohort members (OR 4.1, 95% CI 1.2-13.6). The results support the TBI's association with psychiatric morbidity, which should not be overlooked when treating psychiatric patients, especially those with comorbid criminality.     

Depressive symptoms in adolescence as predictors of early adulthood depressive disorders and maladjustment

OBJECTIVE: The authors examined the association between self-reported depressive symptoms in adolescence and mental well-being in early adulthood. METHOD: A questionnaire assessing psychosocial well-being was given to a group of subjects (N=651) in their last 3 years of high school (mean age=16.8 years) and again when these subjects reached early adulthood (mean age=21.8 years). Diagnostic interview data were obtained from a subgroup of the young adults (N=245). Adolescents' depressive symptoms were analyzed in relation to their early adulthood mental health outcome data. RESULTS: Depressive symptoms in adolescence predicted early adulthood depressive disorders (major depression and dysthymia), comorbidity, psychosocial impairment, and problem drinking. CONCLUSIONS: Depressive symptoms in adolescence deserve attention as a potential risk for early adulthood mental disorders.