Vascular decompression surgery for severe tinnitus: Selection criteria and results

Seventy-four patients were operated on within a period of 10 years to treat incapacitating tinnitus; 72 underwent microvascular decompression (MVD) of the intracranial portion of the auditory nerve, and 2 underwent section of the eighth nerve close to the brain stem. Of those who underwent MVD, 2 had no change in symptoms and later also underwent section of the eighth nerve near the brain stem. Two patients did not return for follow-up. Of the 72 remaining patients, 13 (18.1%) experienced total relief from tinnitus, 16 (22.2%) showed marked improvement, 8 (11.1%) showed slight improvement, 33 (45.8%) had no improvement, and 2 (2.8%) became worse. The patients who experienced total relief and those who showed marked improvement had experienced their tinnitus for an average of 2.9 years and 2.7 years, respectively; those who showed slight improvement and those who had no improvement had experienced their tinnitus for a longer time before the operation (mean, 5.2 and 7.9 years, respectively). Of the 72 patients who were operated on and followed, 32 were women. Of these, 54.8% experienced total relief from tinnitus or marked improvement, while only 29.3% of the men showed such relief or improvement. Selection of the patients for operation was mainly based on patient history and, to some extent, on auditory test results (brainstem auditory evoked potentials [BAEP], acoustic middle ear reflexes, and audiometric data).     

Appraisal of caregiving, burden and psychological distress in relatives of psychiatric inpatients.

Appraisal of caregiving and its relationship to family burden and experienced mental health problems in the relatives were investigated as part of a multi-centre study of the quality of mental health services in Sweden performed in 1997. The sample was drawn from relatives of involuntarily and voluntarily admitted patients to acute psychiatric wards. The instrument used was a semi-structured questionnaire, interviewing relatives about the burden, experience of mental health problems and appraisal of the caregiving situation. The results showed a high proportion of relatives engaged in caregiving activities on a daily basis the month before the patient's admission to hospital and a high proportion of relatives appraising the caregiving activities negatively. The burden was more extensive if the relative and the patient were living together, had a longer duration of their relationship, if the relative was rendering caregiving on a daily basis and if the relative appraised caregiving negatively. The relatives' psychological distress was not related to their negative appraisal of caregiving, nor was patient characteristics, such as diagnosis and level of psychosocial functioning. The only factor found to influence the relatives' psychological distress was the duration of relationship to the patient. Interventions reducing psychological distress for relatives who have known the patients for more than 20 years, who live with the patient, who give care on a daily basis and who appraise their caregiving negatively are suggested.     

Concentrations of blood, serum and urine components in relation to number of amalgam tooth fillings in Swedish women

Abstract Altogether 1462 women aged 38, 46, 50, 54 and 60 yr were examined in 1968/69 in a combined medical and denial population study in Gothenburg, Sweden. Number of tooth surfaces restored with amalgam fillings was assessed. The examination was repealed in 1980/81 including a new dental examination. The results from a number of biochemical analyses of blood, serum and urine were analyzed for a possible statistical relationship to number of denial amalgam fillings. As emphasis has been put in the literature on special influence from amalgam on kidney function and on the immunological system, special attention was paid to variables which might reflect these functions in our analyses. When potential con-founders were taken into consideration, no significant correlations remained which seemed to be of clinical importance. Specifically, amalgam fillings were not found to be associated with impairment of the kidney function or the immunological status.     

Blood-Brain Barrier Equilibration of Codeine in Rats Studied with Microdialysis

Purpose. The purpose of the study was to investigate the distribution of codeine across the blood-brain barrier (BBB) in rats by micro-dialysis (MD). Methods. Rats were administered intravenous infusion of codeine in doses of (1) 10 mg/kg, (2) 20 mg/kg for 10 min, and (3) an exponential infusion for 2 h aiming at a plasma concentration of 2500 ng/ml, in a crossover design (n = 6). Microdialysis was used to determine codeine unbound concentrations in blood and brain extracellular fluid (ECF). Total brain tissue and plasma concentrations were also determined. Nalorphine was used as a calibrator for measurement of in vivo recovery. Results. Relative recovery and retrodialysis loss of codeine and nalorphine were similar both in vitro and in vivo. Codeine was rapidly transported into the brain ECF with identical influx and efflux clearance across the BBB. The AUC ratios of brain to blood were 0.99 ± 0.25 and 0.95 ± 0.16 for Dose 1 and 2, respectively. The C_ss ratio of brain to blood was 1.06 ± 0.12 for the exponential infusion. The half-lives were 25 ± 4 min, 22 ± 2 min in blood and 27 ± 5 min, 25 ± 5 min in brain for Dose 1 and Dose 2, respectively. Total brain tissue concentrations were 3.6 ± 1.2-fold higher than the unbound concentrations in brain. Codeine was demethylated to morphine with an unbound AUC_{bIood,morphine}/AUC_{blood,codeine} ratio of 7.7 ± 5.1% in blood. No morphine was detected in brain MD, but total concentrations were possible to measure. Conclusions. Codeine rapidly reached a distributional equilibrium with equal unbound concentrations in blood and brain. The brain transport of codeine did not show any dose-dependency.     

Immunological characterization of early fibrinogen degradation products. Radioimmunoassay of fragments released from the Aalpha-chain of fibrinogen.

Early plasmic degradation products of the Aα-chain of fibrinogen have been studied with a radioimmunological method and compared with a CNBr fragment, Hi2-DSK, of the same chain. Hi2-DSK is partly identical with some of the early degradation products. The same antigenic determinants are fully reactive in intact fibrinogen. A radioimmunoassay for determination of antigenic determinants in serum has been worked out. The Hi2-DSK immunoreactivity of normal serum corresponds on a molar basis to around 1% of that of fibrinogen in plasma.     

Steady-state plasma concentrations of alprenolol in man

Summary Plasma concentrations of alprenolol during one inter-dose interval and steady-state plasma concentrations have been determined in 30 patients treated for a prolonged period. The latter varied 25-fold between patients who received identical doses. Peak plasma concentrations were achieved at similar times in different patients, but only the level 5–7 h after administration was well correlated (r=0.997) with the steady-state concentration. The type of pharmacokinetic analysis described here is recommended for studies of the relationships between plasma concentration and effects of drugs with short half-lives.     

Aniseikonic body perception in pregnancy

Body perception through aniseikonic glasses (aniseikonic bosy perception, ABP), which produced perceptual distortion, was studied in 45 randomly selected women, pregnant for the first time. An association, between the existence of conflicts concerning reproductive functions on one hand and the experience of little distortion of the pelvic region on the other, was found. There was also indication in the body part, where the symptom is experienced. The results are interpreted in terms of psychological defence.