Patient outcomes in schizophrenia II: the impact of cognition.

BACKGROUND: Cognitive dysfunction is increasingly considered to be the strongest clinical predictor of poor long-term outcome in schizophrenia. Associations have been found between the severity of cognitive deficits and social dysfunction, impairments in independent living, occupational limitations, and disturbances in quality of life (QOL). METHODS: In this cross-sectional study, the relationships of cognitive deficits and treatment outcomes in terms of QOL, needs, and psychosocial functioning were examined in 60 outpatients with schizophrenia who had a duration of illness over 2 years and had been treated with either clozapine or olanzapine for at least 6 months. RESULTS: The present study suggests that cognitive functioning might be a predictor of work functioning/independent living outcome in stabilized patients with schizophrenia: deficits of visual memory and working memory were negatively associated with occupational functioning, and older patients lived independently and/or in a stable partnership more often. The patients' assessments of QOL and needs for care did not show any significant associations with cognitive functioning. DISCUSSION: These findings suggest that cognitive functioning is a key determinant of work functioning/independent living for stable outpatients with schizophrenia.     

Benzodiazepine receptor affinity and interaction of some N-(indol-3-ylglyoxylyl)amine derivatives.

Several derivatives, in which tryptamine, tyramine, and dopamine moieties are linked to the indole nucleus by an oxalyl bridge, were tested for their ability to displace the specific binding of [3H]flunitrazepam from bovine brain membranes. GABA ratio and in vivo tests for the most potent compounds showed they behave as inverse agonists at the benzodiazepine receptor (BzR). To better define the structure-activity relationship (SAR) of this kind of ligand, several phenylethylamine derivatives were synthesized to evaluate their affinity to BzR. Some of these derivatives (17, 21, 24, 26, and 30) were found to exhibit high affinity (Ki = 0.51-0.085 microM) for BzR and possessed a partial agonist activity, although their chemical structure is closely related to tryptamine 2-6, tyramine 7-11, and dopamine 12-16 derivatives. A different interaction of these ligands to the receptor site is hypothesized. Moreover, all the prepared 1-methyl derivatives exhibited very low binding affinity to BzR.     

The effects of vitamin D receptor polymorphism on secondary hyperparathyroidism and bone density after renal transplantation.

Immunosuppresive treatment and secondary hyperparathyroidism (SHPT) are considered among the most important pathogenetic factors for postrenal transplant bone disease. The aim of this study was to investigate the relationships among vitamin D receptor (VDR) gene polymorphism, parathyroid hormone (PTH) levels, and bone density in renal transplant recipients. We enrolled 69 patients (47 men and 22 women; mean age, 47 +/- 11 years) who had undergone kidney transplantation 51 +/- 5 months before. All patients underwent an evaluation of the main biochemical parameters of bone metabolism as well as bone densitometry. VDR alleles were typed by a polymerase chain reaction (PCR) assay based on a polymorphic BsmI restriction site. When the patients were categorized according to the VDR genotype (BB, Bb, and bb), serum creatinine, and the cumulative doses of immunosuppressive drugs were similar across the groups. PTH levels higher than 80 pg/ml were found in 53.6% of the patients, with the highest values being detected in the bb VDR genotype (p < 0.05). PTH was significantly correlated to urinary type I collagen cross-linked N-telopeptide (NTx) values. Bone density was low in the whole population; however, spinal bone density was lower in the bb subgroup (p < 0.02). In the whole population, only PTH (p < 0.05) and body mass index (BMI; p < 0.01) were independent predictors of spinal bone density. When grouping the patients by the VDR gene polymorphism, only PTH continued to be an independent predictor of spinal bone density in the bb allele subgroup (R2 adj. = 0.17). We can conclude that the VDR genotype polymorphism affects bone density of renal transplant recipients via its effects on the severity of SHPT.     

Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration.

OBJECTIVE: This study evaluated the clinical significance of pharyngeal retention to predict aspiration in patients with dysphagia. MATERIALS AND METHODS: At videofluoroscopy, pharyngeal retention was found in 108 (28%; 73 males, 35 females; mean age, 60 years) of 386 patients with a suspected deglutition disorder. Swallowing function was assessed videofluoroscopically. The amount of residual contrast material in the valleculae or piriform sinuses was graded as mild, moderate, or severe. The frequency, type, and grade of aspiration were assessed. RESULTS: Pharyngeal retention was caused by pharyngeal weakness or paresis in 103 (95%) of 108 patients. In 70 patients (65%) with pharyngeal retention, postdeglutitive overflow aspiration was found. Aspiration was more often found in patients who had additional functional abnormalities such as incomplete laryngeal closure or impaired epiglottic tilting (p < 0.05). Postdeglutitive aspiration was diagnosed in 25% patients with mild, in 29% with moderate, and in 89% with severe pharyngeal retention (p < 0.05). CONCLUSION: Postdeglutitive overflow aspiration is a frequent finding in patients with pharyngeal retention, and the risk of aspiration increases markedly with the amount of residue. Functional abnormalities other than pharyngeal weakness, such as impaired laryngeal closure, may contribute to aspiration.     

Modulation of uptake2 of3H-(±)-isoprenaline by isoprenaline-induced depolarization of rat salivary gland cells

Previous observations by Almgren and Jonason (1974) showed that propranolol is able to increase the extraneuronal accumulation of 3H-isoprenaline in rat salivary gland slices. The present experiments were carried out in order to test the hypothesis that 3H-isoprenaline, by acting on beta-adrenoceptors, might depolarize the gland cells and thereby hinder its own uptake2 and that this hindrance might be prevented by propranolol. After inhibition of catechol-O-methyltransferase the extraneuronal accumulation of the 3H-catecholamine in slices of rat salivary glands was determined subsequent to 20 min of exposure of the tissue to 0.5 to 5,000 nmol/l 3H-(+/-)-isoprenaline. Expressed as a tissue/medium ratio, accumulation decreased with increasing amine concentration, although all amine concentrations were well below those saturating uptake2. The 3H-isoprenaline-induced decrease of the tissue/medium ratio was antagonized by (-)-propranolol, and increasing concentrations of the antagonist were needed to antagonize the effect of increasing concentrations of 3H-isoprenaline. In parallel experiments K+-induced (60 mmol/l) depolarization reduced the tissue/medium ratio observed for 0.5 nmol/l 3H-(+/-)-isoprenaline. Gland slices were preloaded with 3H-(+/-)-isoprenaline and then washed out for 60 min with solution not containing labelled amine. When 500 nmol/l (+/-)-isoprenaline were present in the wash-out solution, the addition of 10 mumol/l (-)-propranolol impeded the efflux of 3H-isoprenaline. In parallel experiments, K+-induced (60 mmol/l) depolarization facilitated the efflux of 3H-isoprenaline [in the presence of 10 mumol/l (-)-propranolol]. The results support the working hypothesis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Scales in Parkinson’s disease

Journal of Neurology - The search for valid instruments to measure different domains of health disturbances becomes increasingly important for the assessment of Parkinson’s disease. The most...     

Correlation between the sites labelled by [3H]-8 hydroxy-2-(di-N-propylamino)tetralin and [3H]-imipramine in human platelets

The authors investigated the possible correlations between the binding parameters, maximum binding capacity (Bmax) and dissociation constant (Kd), of [³H]-8 hydroxy-2-(di-N-propylamino) tetralin and [³H]-imipramine in platelets of 13 healthy subjects. The in vitro pharmacological characterization was also carried out for a further comparison. The results, showing that the Bmax values were significantly and positively correlated, together with the findings of the displacement studies, suggest that in human platelets, [³H]-8 hydroxy-2-(di-N-propylamino)tetralin and [³H]-imipramine bind to the same protein.     

An uncommon cause of epistaxis: cartoid cavernous fistula

We report on an uncommon cause of epistaxis presenting to the emergency room. Epistaxis is not an uncommon presentation to emergency rooms across the world. The majority are easily controlled and have low mortality. We present a case of a carotid-cavernous fistula presenting with massive epistaxis culmination in cardiovascular collapse and death. Awareness of this entity will reduce the frequency of this condition resulting in major morbidity and mortality.