The impact of lower urinary tract symptoms on general health status and on the use of prostatectomy

Our objective was to determine the extent to which lower urinary tract symptoms affect the general health status of men and contribute to the decision to undergo surgery. A cross-sectional population survey using postal questionnaires was conducted in the North West Thames health region, followed by a prospective cohort study of men undergoing prostatectomy (North West Thames and Oxford regions). The subjects in the first survey were 221 men aged 55 and over with previously reported mild, moderate or severe urinary symptoms; subjects in the second study were 388 men undergoing prostatectomy. Main outcome measures were selfreported symptom severity, bothersomeness and general health status (Nottingham Health Profilie, Part 1). The response rate among eligible responders in the population survey was 85.7%. Increasing symptom severity was associated with worsening NHP scores for energy, emotional reactions, sleep and physical mobility (p<0.01). Increasing bother-someness of symptoms was associated with emotional reactions, sleep and pain (p<0.05). Men undergoing surgery reported worse health status than men in the population with the same severity of symptoms as regards emotional reactions, energy and pain. For a given level of symptom severity, the impact of those symptoms on aspects of a man's general health status may be the determinant of seeking and undergoing surgery. Greater understanding of the factors that affect a man's response to his symptoms is needed in interpreting the decision to seek and accept treatment.     

Foreign body aspiration in children. The diagnostic value of signs,symptoms and pre-operative examination

One hundred and fifteen patients, between 6 months and 12 years of age, had bronchoscopy on suspicion of foreign body aspiration. The histories of these patients were studied to examine the diagnostic value of signs, symptoms and examinations, and to determine the time that passed between aspiration and removal of the foreign body. The sensitivity of the symptoms choking and coughing was fairly high (81 and 78%), but the specificity was poor. The sensitivity of a chest radiograph was 82%, the specificity 44%. The sensitivity of radiographs on inspiration and expiration was 80%, the specificity 55%. The patients had been referred with the initial diagnosis foreign body aspiration (80), pneumonia (34), or subglottic laryngitis (1). In 85 patients a foreign body was identified and extracted. The other 30 patients had respiratory tract infections. The initial diagnosis of foreign body aspiration was correct in 61 out of 85 patients. In these cases, the period between aspiration and extraction of the foreign body was a mean 6 days, compared with 55 days, if the initial diagnosis was pneumonia or sub-glottic laryngitis. We conclude that the diagnosis of foreign body aspiration is too often missed, and that, apart from bronchoscopy, diagnostic tools are of little value.     

Health-related quality of life under six months' treatment of migraine—an open clinic-based longitudinal study

Health-related quality of life (HQL) assessment in the clinical setting have distinguished subjective perceptions (e.g. well-being), signssymptoms of the disease, and functional capacity as three major components. The impact of short-term treatment for migraine attacks on these variables was evaluated in an open prospective 6-month study at the Gothenburg Migraine Clinic. Socio-economic factors, subjective symptoms, and general well-beingquality of life were evaluated by self-administered questionnaires in 99 patients with migraine with or without aura in accordance with the classification of the International Headache Society. Short-term treatment comprising conventional therapy or subcutaneous sumatriptan reduced number of days per month with migraine and absenteeism from work, migraine-associated symptoms, but did not significantly improve general well-being between attacks. Future assessment of the patients' HQL in accordance with this approach would enable us to consider all the advantages and disadvantages of current therapies of particular interest in the field of migraine.     

Augmentation strategies in geriatric depression

Approximately 30–40% of elderly patients with major depression have inadequate response to an initial therapeutic trial of antidepressant medication. In these cases augmentation of the antidepressant has been recommended as one way of improving the rate of response. This article reviews the literature on augmentation strategies in treatment-resistant geriatric depression. Successful augmentation with lithium, triiodothyronine, stimulants, carbamazepine, valproate and a tricyclic–serotonin reuptake inhibitor combination have been described. However, there have been no controlled trials and, with the exception of two open prospective studies of lithium potentiation, the literature consists entirely of case reports and retrospective case series. As a result, it is difficult to draw conclusions about the efficacy of these strategies in late life, especially since treatment failures seldom get reported. Side-effects may limit the usefulness of some augmentation regimens in old age—up to 25% of patients treated with lithium or carbamazepine discontinued these medications because of adverse events. There is a need for controlled studies to better determine the clinical utility of augmentation strategies in physically well depressed elderly, as well as those with depression complicating medical illness, dementia and other neurological disorders.     

The treatment of diffuse lewy body disease: A pilot study

Single case studies may provide useful information and generate hypotheses for later testing in group studies. The effect of anti-Parkinsonian medication is reported in five individual cases of diffuse Lewy body disease. The problems caused by the variability in congnitive function and psychiatric symptoms in these cases are outlined together with suggested strategies for future research.     

Psychosocial stress and symptoms of menopause: a comparative study of menopause clinic patients and non-patients

In much of the literature to date, the definition of climacteric symptoms has been based largely upon women who present for medical treatment of symptoms. It is already well recognised that patients (of all ages and both sexes) presenting for medical treatment tend to report themselves as suffering from more life stresses and from more neurotic symptoms than people in the general population. Life stress and adequacy of coping may thus be important factors in the incidence of symptomatology at the climacteric, as at any other time of life. This study therefore investigated the proposal that post-menopausal women who present for treatment at menopause clinics suffer from more life stresses and more neurotic symptoms than post-menopausal women in the general pupolation.

It was found that patients did indeed suffer from more psychosocial stress, measured in terms of life events, clinical depression and anxiety scales and a rating scale based on a clinician's judgements of ongoing psychosocial stress, vulnerability and adequacy of coping. Patients also suffered from significantly more symptoms than non-patients, not only psychological, but also hypothalamic and metabolic symptoms. However, the incidence of hot flushes and vaginal atrophy was the same in both groups. The stress/coping rating was the measure which correlated most highly with the psychological symptoms reported by subjects as symptoms of menopause. Life events and clinical stress measures were more consistently related in the non-patient group, indicating possible intervening variables (such as hormone imbalance) in this relationship in the patient group.     

Testing genetic models for multiple symptoms: An application to the genetic analysis of liability to depression

A model is presented which allows for the contribution of genes and environment to categorical data on multiple symptoms. The model distinguishes between parameters needed to express the relationship between a latent trait and observed responses and the parameters required to represent the causes of variation in the latent trait. The regression of the latent trait on covariates may also be specified. The model is applied to symptoms of depression in 1983 pairs of adult female monozygotic and dizygotic twins. A model which allows only for polygenic variation in the latent trait is supported as well as the mixed model, which also allows for the effects of a major gene. The likelihood is significantly lower when all genetic effects are ascribed to a single gene. Practical limitations of the method are discussed.This research is supported by Grants AG04954, AA06781, GM32782, GM30250, and MH40828 from the National Institutes of Health. We are indebted to Dr. Greg Carey for his incisive discussion.     

Neurobehavioral phenotype in carriers of the fragile X premutation

There have been contradictory findings in the fragile X (fraX) literature about possible neurocognitive and psychological symptoms due to the fraX premutation (pM). The purpose of the present study was to investigate the relationship between CGG repeat length and neurobehavioral functioning in carriers of the fraX pM. Eighty‐five female carriers of the pM with allele sizes ranging from 59–166 were administered a comprehensive IQ test (WAIS‐III) and completed a questionnaire designed to measure psychopathology (Symptom Checklist (SCL)‐90‐R). No relationship between allele size and cognition was identified. A significant negative relationship between allele size and age was found, as well as a positive relationship between allele size and depression. Follow‐up analyses separating small and large allele sizes (below and above 100 CGG repeats) indicated that individuals with larger allele sizes scored significantly higher on the Interpersonal Sensitivity and Depression subscales of the SCL‐90‐R. Despite the limitation of few individuals with high CGG repeat lengths, our findings suggest that females with larger premutated alleles (≥ 100 repeats) display some clinical manifestations of fraX syndrome. © 2001 Wiley‐Liss, Inc.     

Adjunct effect of loratadine in the treatment of acute sinusitis in patients with allergic rhinitis

H₁-blockers are often added to the standard treatment of acute sinusitis, but this is not supported by a controlled study. A multicentric, randomized, double-blind, placebo-controlled, parallel-group study was done in 139 allergic patients (15–65 years) to assess the adjunct efficacy of loratadine in acute exacerbation of rhinosinusitis. Sinusitis was diagnosed by symptoms and confirmed by rhinoscopy and sinus radiograph. Allergy was characterized by skin tests, RAST, and history. Patients were treated with antibiotics (14 days), oral corticosteroids (10 days), and loratadine (10 mg OD) or placebo (28 days). Treatment efficacy was assessed over 28 days by symptom scores quoted daily by patients. Physicians also rated total symptom scores at entry and at day 28. At entry, both groups had similar symptoms. Placebo-treated patients improved significantly, but patients who received loratadine had a significantly greater improvement in sneezing ( P =0.003) after 14 days, and in nasal obstruction ( P =0.002) after 28 days. Physicians found that patients receiving loratadine were significantly improved compared to placebo patients ( P =0. 0125). Loratadine in addition to standard therapy was found to improve the control of some symptoms of sinusitis.