Psychopathology during long-term lithium treatment of patients with major affective disorders. A prospective study

Thirty-seven patients with major affective disorders according to DSM-III and on continuous lithium treatment were followed during a 7-year period. Outcome was assessed by use of the Comprehensive Psychopathological Rating Scale and by the need for additional psychotropic medication and for hospital and outpatient care. Anamnestic variables and patient's attitudes to their lithium medication were also included in the analysis of outcome, as were laboratory data, including lithium parameters. An increase in psychopathology was demonstrated in a significant number of patients and was attributed mainly to an increase in the depressive symptoms, with a significant increase in the rated scores for fatiguability, pessimistic thoughts, reduced sleep, and inner tension. Suicidal thoughts were common, but no suicide attempts were made. A significant number of patients complained of failing memory, but no significant progression was demonstrated during the 7-year study period. The increase in the depressive symptoms was closely correlated with the number of hospital admissions for depressive recurrence and with the number of days in hospital. The following factors showed a significant relationship with the increase in depressive symptoms: serum lithium levels, large increase in the elimination half-life of lithium, low level of social functioning, low TSH values, and need of concomitant administration of antidepressants and benzodiazepines.     

Base anatomique d'un nouveau concept de stabilité du carpe

Résumé Le concept de stabilité du carpe repose sur l'anatomie et la biomécanique. Celles-ci nous permettent de constater que le lunatum est le centre de deux axes fonctionnels: l'un longitudinal, mécanique, l'autre transverse, dynamique. Le lunatum est fermement stabilisé au radius et au complexe ligamentaire cubital par le V proximal: il devient ainsi un élément porteur; il est de plus fermement uni aux os voisins, le scaphoideum et le triquetrum, avec lesquels il forme une unité fonctionnelle intercalaire différenciée. Le guidage de cette unité est assuré par le V distal et le ligament radio-triquetrum dorsal.

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Summary Based on anatomical and biomechanical evidence, we conclude that the stability of the carpus relies on the lunate bone which is the centre of the longitudinal as well as the transverse functional axis. The lunate is firmly stabilised proximally to the radius and the radio-ulnar ligament complex by the proximal V-ligament, and so becomes a weight bearing structure. It is anchored by strong ligaments to the scaphoid on one side and the triquetrum on the other, thus forming a 3-bone intercalary system, which is in turn guided by the palmar distal V-ligament and the dorsal radio-triquetral ligament.

     

Adult adjustment of persons with severe/profound mental disabilities: A longitudinal study

The parents of 14 individuals with severe/profound mental disabilities were interviewed one and three years after their children graduated or aged out of high school. Two categories of information were sought concerning the adult adjustment of these individuals. General status variables included marital status, place of residence, agencies contacted concerning employment opportunities, financial resources, leisure activities, means of transportation, sources of help in resolving problems, and amount of postsecondary training. Employment variables included location of employment, wages, number of hours worked per week, and job benefits received. Results indicated that three years after exiting high school, all participants were very dependent upon others for housing, transportation, and financial assistance. Ten of the 14 individuals were employed 3 years after exiting high school, all in sheltered workshops.     

Dynamic properties of vestibular reflexes in the decerebrate cat

Summary Vestibulocollic (VCR) and vestibulo-ocular (VOR) reflexes were studied during angular rotation in the horizontal plane in precollicular decerebrate cats. Angular position was modulated by sinusoids or sums of sinusoids with frequencies ranging from 0.05 to 5 Hz.Reflex motor output was measured by recording electromyographic (EMG) activity of the lateral rectus and dorsal neck muscles and discharge of abducens motoneurons. Measured with respect to input angular acceleration VCR motor output displayed a second order lag at low frequencies, bringing mean EMG phase (–136 °) and gain slope (–35 dB/ decade) close to those of an angular position signal at 0.2 Hz. At higher frequencies the lag was counteracted by a second order lead bringing mean phase (–52 °) and gain slope (–5.6 dB/decade) back close to those of an angular acceleration signal at 3 Hz. By contrast, mean phase (–113 ° to –105 °) and gain slope (–21 to –28 dB/decade) of the VOR motor output remained close to those of an angular velocity signal across the entire frequency range.The data suggest that neural pathways producing the VCR receive selective input from irregular type horizontal semicircular canal afferents which provide one lag and one lead in the overall transfer function while the other lag and lead are produced by central pathways.Transaction of the medial longitudinal fasciculus (MLF), which eliminates all of the most direct (three neuron) arcs of the horizontal VCR, did not cause any detectable change in the horizontal VCR at either low or high frequencies. Reductions in overall gain occurred in some cases but these could be attributed to damage to axons outside the MLF. Less direct pathways, probably including vestibulo-reticulospinal pathways, are thus able to produce both the low-frequency, phase-lagging and high-frequency, phase-leading components of the horizontal VCR.Supported in part by NIH grants EY 02249, EY 00100, and NS 02619Recipient of NIH Fellowship NS 06030     

Causes of Stability of Aggression from Early Childhood to Adolescence: A Longitudinal Genetic Analysis in Dutch Twins

This study investigated the contribution of genetic and environmental influences on the stability of aggressive behavior from early childhood to adolescence. Two developmental models, the simplex model and the common factor model, were tested to study the underlying processes of stability and change. Measures of aggressive behavior (AGG) were obtained from maternal CBCL data as part of a large ongoing longitudinal study of the Netherlands Twin Registers (NTR) and included data from 6488 three-year-old twin pairs, 5475 seven-year-old twin pairs, 2983 ten-year-old twin pairs, and 1509 twelve-year-old twin pairs. AGG showed moderate to high stability during childhood. The stability coefficients ranged from 0.41 to 0.77 across varying intervals. Averaged across boys and girls, genetic factors accounted for approximately 65% of the total stability. Longitudinal genetic analysis indicated a simplex model for genetic effects, which suggests a dynamic development process consisting of transmission of existing genetic effects interacting with new genetic influences. This is especially true at age 7, when the influence of new genetic factors was large. Shared environmental factors accounted for approximately 25% of phenotypic stability, and it seemed that a stable set of the same shared environmental factors underlay the development of AGG. Nonshared environmental factors, when important, are age specific. Sex-specific differences for stability were identified. For boys, genetic influences were greater, whereas for girls shared environmental factors were more important. These data support the idea that both genetic and environmental influences play a role in the stability of AGG from age 3 to 12.     

前路椎体次全切在治疗颈椎后纵韧带骨化中的应用

目的：探讨颈前路椎体次全切治疗颈椎后纵韧带骨化的手术减压范围。方法：采用前路椎体次全切植骨融合术治疗颈椎后纵韧带骨化56例，其中完全切除骨化者47例，用“漂浮法”处理者9例，并针对不同个体及病变特点采用不同的减压范围。结果：54例获得3个月-6a随访，平均28个月。植骨均于术后3-5个月内获得骨性融合。JOA评分由术前8．5分提高到术后14．1，平均改善率74％，优良率80．2％。结论：行椎体次全切术治疗颈椎后纵韧带骨化时应针对不同个体及病变特点采用不同的足够的减压范围，可以减少并发症，并获得较佳的疗效。     

Transvaginal sonography and rectal endoscopic sonography for the assessment of pelvic endometriosis: a preliminary comparison

BACKGROUND: Endometriosis and possible rectal involvement are difficult to assess by physical examination. Previous studies have shown the diagnostic value of magnetic resonance imaging and rectal endoscopic sonography (RES) in this setting, but not that of transvaginal sonography (TVS). The aims of this study were to compare the accuracy of TVS and RES for the diagnosis of pelvic endometriosis, and to compare the results with histological findings. PATIENTS AND METHODS: In a prospective study, 30 consecutive patients referred with clinical signs of endometriosis underwent TVS and RES; the images were interpreted blindly with regard to physical findings. RESULTS: Endometriosis was confirmed histologically in 28 (93%) of the 30 patients. Endometriomas were also present in 67% of cases. For the diagnosis of uterosacral endometriosis, the sensitivity, specificity, and positive and negative predictive values of TVS and RES were 75 and 75%, 83 and 67, 95 and 90%, and 45 and 40% respectively. For the diagnosis of rectosigmoid endometriosis, the sensitivity, specificity, and positive and negative predictive values of TVS and RES were 95 and 82%, 100 and 88%, 100 and 95%, and 89 and 64% respectively. CONCLUSION: Despite the large proportion of our patients who had intestinal endometriosis, representing a possible source of bias, our results suggest that TVS is as efficient as RES for detecting posterior pelvic endometriosis and should therefore be used as the first-line examination.     

腕关节关节囊内韧带的解剖观察及其创伤学意义

本文描绘了腕关节关节囊内韧带的解剖,其中首次描述了中腕关节的韧带连结,即大、小多角骨,头状骨至舟状骨的韧带和钩骨至三角骨的韧带.本文还论述了与这些韧带连结方式密切相关的腕骨生理运动特点及维持腕关节稳定性的因素.文章还讨论了与腕关节关节囊内韧带有关的腕部创伤学特点.     

胸椎椎间孔外韧带的解剖学观测

目的　对T1~12椎间孔外口区域的韧带进行解剖学研究并探讨其临床意义。 方法　对10具成人尸体标本的240个T1~12椎间孔进行解剖观测。鉴别所有出现的韧带，观察并记录T1~12椎间孔外口区域椎间孔外韧带的数量、形态、分布、起止位置和毗邻，并用游标卡尺分别测量每条韧带的长度、宽度和厚度。 结果　在229个胸椎椎间孔外口区域共发现564个椎间孔韧带，另11个椎间孔外口区域未发现韧带，椎间孔外韧带的出现率为95.42%。韧带有2种类型，放射型占24.11%（136个），横跨型占75.89%（428个）。放射型韧带在T1及T9~12节段较为常见，而在T2~8节段则相对较少。其中有43.44%（245个）韧带分布于椎间孔外口区域的前部，39.89%（225个）分布于后部，11.35%（64个）分布于上部，5.32%（30个）分布于下部。 结论　胸椎椎间孔外口区域存在2种类型的韧带；其中放射型韧带可能是一种脊神经抗牵拉的结构，对脊神经起到固定和保护作用，横跨型韧带可能是胸椎压缩性骨折后肋间神经痛的潜在原因之一。     

The affinity of IgG antibodies to gag p24 and p17 in HIV-1-infected patients correlates with disease progression.

The affinity of anti-gag antibody was studied for up to 9 years (1984-1993) in sera from 15 HIV-1+ patients with haemophilia. On the basis of their 1993 clinical status patients were divided into two groups: (i) patients who remained asymptomatic (n = 9); and (ii) those who progressed to AIDS between late 1987 and 1993. The affinity constants of antibody for p24 and p17 were determined by a double isotope fluid-phase radioimmunoassay; and the relationships between antibody affinity and titre, patient clinical course, CD4 cell counts and p24 antigenaemia were analysed. The affinity of p24- and p17-specific antibody was up to 100 times greater in asymptomatic patients than in patients who progressed to AIDS. Patients who developed AIDS either lost or failed to develop high-affinity antibodies early in the infection. Asymptomatic patients maintained high-affinity antibodies for several years; however, in some of these patients the affinity of anti-p24 and p17 antibodies subsequently fell later in the study period. The presence of low-affinity antibody and progressive reduction in the titre of specific antibody were earlier predictors of disease onset than CD4 cell counts. The failure to either develop or maintain high affinity gag-specific antibody suggests an early impairment of T helper function in individuals who progressed to AIDS. The presence of antibody of high affinity could be essential in controlling virus replication and the onset of AIDS.