The balance of positive and negative affects in major depression: a further test of the States of Mind model.

The States of Mind (SOM) model provided a framework for assessing the balance between self-reported positive and negative affects in a sample of 39 outpatients with major depression and 43 healthy control subjects. The SOM model proposes that healthy functioning is characterized by an optimal balance of positive (P) and negative (N) cognitions or affects (P/(P + N) approximately 0.63), and that psychopathology is marked by deviations from the optimal balance. Research thus far has focused on the functional significance of cognitive rather than affective balance. Within this framework, we hypothesized that patients in untreated episodes of major depression would balance their positive and negative affects at the same level where depressed patients in other studies have balanced their positive and negative cognitions--namely, at P/(P + N) approximately 0.37. Points and confidence interval (CI) estimation procedures yielded results (mean = 0.35, 95% CI = 0.30 - 0.40) consistent with this hypothesis in a sample of 39 depressed male outpatients. Correlational analysis indicated that affect balance is inversely related to symptom severity as measured by self-report (Beck) and clinician-rating (Hamilton) scales.     

Combined neurosurgical-otolaryngologic operative approach to a massive nasoethmoidal encephalomeningocele

Frontal encephaloceles are uncommon yet challenging therapeutic problems that require careful planning and cooperation between the disciplines of neurosurgery and head and neck surgery. A case presentation is discussed together with the embryology, differential diagnosis, and surgical approach to the problem.     

The influence of epidural administration of fentanyl infusion on gastric emptying in labour

The effect of epidural infusions containing fentanyl on maternal gastric emptying in labour was examined using the rate of paracetamol absorption. Women were randomly allocated to receive one of two epidural infusions, bupivacaine 0.125% alone or bupivacaine 0.0625% with fentanyl 2.5 μgml⁻¹ at a rate of 10–12 mlh⁻¹. Paracetamol 1.5 g was given orally to women after either 30 ml of the infusion solution had been given (mean time 2.5 h, study A) or 40–50 ml (mean time 4.5 h, study B). Six venous blood samples were taken over the next 90 min for measurement of plasma paracetamol concentration. There were no significant differences in maximum plasma paracetamol concentration, time to maximum paracetamol concentration and area under the concentration–time curve between the two groups for study A. In study B the time to maximum plasma paracetamol concentration was significantly delayed in women receiving > 100 μg fentanyl compared with controls (p < 0.05). We conclude that the dose of fentanyl that may delay gastric emptying when given by epidural infusion is greater than 100 μg.     

Personality and sexual anomalies

Test properties of the Millon Clinical Multiaxial Inventory (MCMI) were examined in a sample of 419 sex offenders and controls in three different settings. The offender group included sexual aggressives, pedophiles, incest perpetrators and miscellaneous cases. Nineteen of the 20 scales of the MCMI had alpha reliability over 0.60 and for 13 scales it was over 0.80. The scales showed satisfactory discriminant validity from age but 9 scales showed a moderate influence of intelligence scores and education. Criminal history did not influence scale results. The scales unfortunately did show significant correlations with MMPI validity scales. Although the scales were not susceptible to naive lying, they were influenced by social desirability especially. Four factors were extracted in principal axes factor analysis that accounted for 91.2% of the total variance. The first factor explained 58.2% of the variance and was labeled general psychopathology. The other three factors suggested psychotic tendencies, extraversion and the bipolar dependency-antisocial tendencies. When the groups were compared, almost all scales significantly differentiated them. When the MMPI F-K Scale was forced to enter a stepwise discriminant analysis first, five scales still were significant; Narcissistic, Schizoid-Asocial, Alcohol Abuse, Paranoid, & Dependent-Submissive scales. The MCMI taps important dimensions in sex offenders but suffers from validity problems.     

Substance Misuse Among Women Attending Family Planning Clinics in a Rural Area in Britain: prevalence and associated problems

Objectives: Little research has been carried out focusing on women who misuse substances, although existing evidence suggests that they represent a distinctive group. The aims of the current study are to determine prevalence of tobacco, alcohol and other drug use in women attending family planning services in a rural area and to investigate preferred sources of help-seeking. Methods: A prospective study using a self-completed questionnaire assessing use of tobacco, alcohol, other drugs, associated problems and sources of help-seeking. The sample included women attending family planning clinics in a rural area of southern England. Results: Fifty-three percent were current smokers,thirty-five percent misused alcohol and fourteen and a half percent had used other drugs in the last year. Those using each of the substances were significantly more likely to be 21 years or under. Not all those using substances indicated problems and sources of help varied with the presence of problems. Conclusions: Women attending family planing clinics are a self-selected group with a high level of substance use compared to the general population. This suggests that they may have a lifestyle incorporating more risky behaviours, including unsafe sexual behaviour. Once problems have occurred due to substance use, help needs to be more accessible.     

Volume Flow Rate of Common Carotid Artery Measured by Doppler Method and Color Velocity Imaging Quantification (CVI-Q)

BACKGROUND: Common carotid artery (CCA) volume flow rate (VFR) is clinically useful for study of cerebrovascular disease. Color Velocity Imaging Quantification (CVI-Q; Philips Ultrasound International, Irvine, CA), previously reported as accurate and reliable, tracks the flow lumen over the cardiac cycle, as well as mean spatial velocity, which is multiplied by vessel area to obtain VFR. VFR can also be obtained by Doppler sampling for mean velocity, and vessel area based on static B-mode lumen diameter. We compared CCA VFR by CVI-Q and Doppler method (DM), since knowledge of how they compare is crucial when both are used clinically. METHOD: We prospectively studied patients having clinical carotid duplex exams and healthy controls. All had CCA VFR measured by both methods in the same exam session. RESULTS: Thirty-four studies were reviewed. CCA VFR by CVI-Q in those without ICA stenosis was 337 +/- 96 mL/m, and by DM 359 +/- 130 mL/m; P = .33. There was no difference between methods for 50-75% or 75-95% ICA stenosis. In 7 patients with ICA occlusion, and 3 with 95-99% stenosis, VFR was higher by DM than by CVI-Q (Occlusion: 125 vs 58 mL/m, P = .007; 95-99%: 152 vs 63 mL/m, P = .038). There was no statistically significant difference between methods for measurement of the ratio of VFR between right and left CCA. CONCLUSION: In patients with 0-95% ICA stenosis, VFR by CVI-Q and DM showed no difference. For 95-100% ICA stenosis the methods differ; with higher VFR by DM. Side-to-side VFR ratios remain constant, irrespective of VFR method, and can still provide clinically useful information.     

Choledochal duct cyst: resection with physiologic reconstruction.

BACKGROUND. The accepted surgical treatment of choledochal duct cyst is complete excision and enteric drainage through an intestinal conduit. Peptic ulceration and fat malabsorption have been reported after Roux-en-Y reconstruction. Such long-term complications may be avoided by a technique that simulates normal physiology. METHODS. Twenty-one patients have undergone resection of a choledochal duct cyst in the past 12 1/2 years. The pathologic duct is resected to the level of normal mucosa. A short segment of jejunum with a intussusception valve (1.5 to 2 cm) is interposed between the common hepatic duct and the duodenum. The medical records and all radiographs of each patient were reviewed. Eighteen children were reexamined or the parents were contacted by phone. RESULTS. Twenty of 21 patients recovered without major perioperative complications. Twelve of them are well and have no symptoms at 3 to 12+ years (mean, 6 years) after operation. Four children are currently well 6 to 19 months after operation. Three children were well when lost to follow-up. Two patients have radiographic evidence of incompetence of the interposition valve. One of these, who initially underwent operation at 9 months of age, was reexplored at 10 months and at 10 years for a stricture at the hepaticojejunal anastomosis. The other, a 7-year-old girl who was admitted with jaundice and pancreatitis, has had episodic abdominal pain for 7 years after operation but is well. CONCLUSIONS. The valved jejunal interposition hepaticoduodenostomy offers superior biliary reconstruction after excision of a choledochal duct cyst. Normal physiology is simulated, with bile draining directly into the duodenum. A short conduit prevents stasis, and biliary reflux is minimized with the addition of an intussusception valve.     

Tubular adenoma of the main pancreatic duct.

We report a case of tubular adenoma of the duct of Wirsung with focal villous changes. To our knowledge, this is the 13th reported case of this uncommon neoplasm and the first with a primarily tubular histologic pattern. The patient presented with abdominal pain and diarrhea and was found on endoscopic retrograde cholangiopancreaticography to have a mass in the head of the pancreas, which was confirmed by endoscopic ultrasound. Clinical and pathological features of the 12 previously reported cases are reviewed. Intraoperative testing failed to rule out adenocarcinoma which, in addition to difficulties presented by local anatomic relationships of the tumor, supports wide surgical resection as the preferred surgical solution.     

The onset of ablation of the evoked adductor pollicis muscle twitch in children: a clinical perspective

The time to loss of the adductor pollicis muscle response to ulnar nerve stimulation at 1 Hz (twitch) after succinylcholine, 1.5 mg.kg-1 intravenously (IV), or vecuronium, 0.1 mg.kg-1 (IV), administration was assessed visually in 134 children, age 2-13 yr, during clinically determined, deep halothane, enflurane and isoflurane anaesthesia. The overall time to twitch ablation and duration of succinylcholine's action is in agreement with published times obtained under controlled experimental conditions; the onset time following vecuronium is comparable to those observed during a similar anaesthetic background measured under controlled experimental conditions. Twitch ablation after succinylcholine was achieved in half the time needed following vecuronium regardless of anaesthetic agent. Succinylcholine's and vecuronium's onset time as well as succinylcholine's duration is adequately assessed by the outlined, simple clinical means. The choice of inhalation agent does not affect the time to visible twitch ablation in a clinically relevant manner; nor does it make an appreciable difference, in clinical terms, in succinylcholine's duration of action.