Personality and clinical predictors of recurrence of depression

OBJECTIVE: To help clinicians more accurately predict outcomes of treatment for depression, variables associated with recurrence of depression in the year after treatment were examined in a group of patients who completed treatment for an index episode of depression. METHODS: Forty-two depressed patients who participated in a double-blind pharmacological treatment study were followed for one year after treatment was discontinued. Length of treatment for the index episode was determined by clinicians and ranged from eight to 76 consecutive weeks. Eighteen patients who had a recurrent episode (43 percent) and 24 patients who did not (57 percent) were compared on sociodemographic and clinical variables, including scores on the Eysenck Personality Questionnaire (EPQ). RESULTS: A combination of three variables predicted recurrence of depression in 90 percent of cases. They were an elevated EPQ score on the neuroticism subscale, a short duration of treatment of the index episode, and a slow onset of response to treatment of the index episode. CONCLUSIONS: The findings suggest that personality traits, treatment duration, and variations in response to treatment might have an impact on long-term treatment outcome. Clinicians should consider these factors when making treatment decisions for depressed patients.     

Level of sustained entorhinal activity at study correlates with subsequent cued-recall performance: a functional magnetic resonance imaging study with high acquisition rate

Functional magnetic resonance imaging (fMRI) with high acquisition rate was performed during the intentional memorizing of words to specify which medial temporal lobe structure is important in determining what words are subsequently remembered in a cued-recall test and to characterize the time course of activation in that structure. Functional images of six healthy young subjects were analyzed by two subject- and voxel-wise statistics: First, to identify brain areas transiently engaged in encoding of words, brain activity during memorizing visually presented words and watching a fixation cross was compared by a Kolmogorov-Smirnov statistic (KS-test). Second, to identify brain areas whose activity correlates with memory encoding success, a Kendall's correlation was calculated between signal intensity at study and performance in a subsequent cued-recall test. Averaged signal intensities were plotted as a function of time to depict the time course of brain activity detected by both statistical tests. The level of slowly modulated, sustained activity in Brodmann area 28 (entorhinal cortex) did not respond transiently as study words appeared, but did correlate positively with subsequent test performance. More left than right activity in Brodmann area 45 (dorso-lateral prefrontal cortex) and bilateral activity in Brodmann area 44 (premotor cortex) exhibited transient hemodynamic responses that did not show any relation to subsequent memory performance. Thus, the study identified a novel pattern of slowly modulated brain activity in human entorhinal cortex that may represent a declarative memory encoding state whose level predicts whether experiences will be remembered or forgotten.     

Subtotal duodenal necrosis as a surgical complication (A case successfully treated with multiple-stage surgery)

A 53 year-old woman was admitted to our Department with serious sepsis, biliary-, fecal peritonitis, and subtotal duodenal necrosis following 5 previous operations. The first surgical intervention ceased the insufficiency of the small intestine anastomosis, and the marsupialization of Vater's papilla was achieved. After the sepsis and peritonitis ceased the authors performed a successful reconstruction. For two and a half years the patient has been free from complaints.     

Esophago-pericardial fistula caused by recurrent esophageal tumor

The esophago-pericardial fistula is a rare disease that causes a rather high mortality. Up to now less than 70 cases were published in the literature. The authors report an esophago-pericardial fistula caused by recurrent esophageal tumor one year after resection in the lower third esophagus for esophageal cancer. With conservative treatment the patient was kept alive for a month. No case report can be found in the literature of an esophago-pericardial fistula of the same etiology.     

Chylothorax after blunt chest trauma

An unusually lately discovered and successfully treated case with right sided chylothorax after blunt chest trauma is presented. Pathogenesis of chylothorax, diagnostic and treatment modalities are summarised.     

Single layer continuous absorbable sutures for gastrointestinal anastomosis

Authors evaluated the safety of single layer continuous sutured anastomosis technique with two different types of absorbable sutures in 252 anastomoses performed on 178 patients. In the prospective, randomized study 5 oesophagus, 26 stomach, 117 small intestine, 32 colonic, 29 pancreatic and 43 biliary anastomoses were performed. In 136 cases poliglecaprone 25 (Monocryl), in 116 cases glycomer 631 (Biosyn) were used. All procedures were carried out by the same surgeon. Anastomosis related complication was detected in 7 cases (2.8%), some kind of anastomosis insufficiency--including minor leakage--in 5 cases (2.0%), but reoperation only in one case (0.4%) was required. There was no anastomosis related death. Authors overview the advantages of the technique, which is safe, cheap, easy to carry out, physiological and least harmful to the blood supply, so they recommend its use in the gastrointestinal surgery as a standard procedure.     

Impossibility of intubation due to angioedema secondary to an angiotensin-converting enzyme inhibitor

Angioedema secondary to treatment of one year's duration with angiotensin converting enzyme inhibitor (ACEI) (lisinopril) in a 56-year-old man scheduled for elective cardiac surgery led unexpectedly to impossible intubation. Surgical access (tracheostomy) was required when airway control was threatened. We review the clinical course, etiology and treatment of angioedema secondary to ACEI therapy. This is a life threatening complication which, though rare, is becoming increasingly frequent with increased use of such drugs.