The validity of the letter memory test as a measure of memory malingering: robustness to coaching.

The letter memory test (LMT) is a computerized forced-choice test of malingering detection including two face valid difficulty manipulations: increase in target stimulus length and increase of response foils. Prior research suggests the LMT shows promise as a malingering detection measure. In the present study, the utility of the LMT in the identification of malingering was further explored, using a counterbalanced design in a simulated malingering sample. Prior work was extended by assessing the robustness of the LMT to coaching and assessing the effectiveness of an additional scoring method, utilizing the face valid difficulty manipulations. Results were consistent with prior research on the LMT, with the standard cutoff score yielding high indices of accuracy. The LMT showed no order effects and was superior to the 15-item test in accuracy indices. Both the standard LMT score and the proposed score based on difficulty manipulations were relatively robust to coaching. Overall, findings indicate the LMT is a viable contender among measures of memory malingering.     

Heart Transplantation in a 68-Year-Old Patient with Senile Systemic Amyloidosis

Senile systemic amyloidosis (SSA) results from deposition, predominantly in the heart, of amyloid fibrils derived from wild-type transthyretin (T TR) molecules. Cardiac autopsies indicate that SSA progressively increases in subjects 80 years of age and older. However, only a few cases of patients with SSA and cardiac failure have been recognized by cardiac biopsies during life. Here, we report a case of heart transplantation in a 68-year-old male patient with SSA. After cardiopulmonary resuscitation in October 1998, he underwent complete evaluation. Myocardial biopsies revealed the presence of amyloid deposition. Immunohistochemical staining of the amyloid indicated T TR. Genomic DNA analysis of the T TR exons did not result in any identification of a mutation. In 2001, heart transplantation was performed because progressive heart failure occurred. At the 1-year follow-up, no amyloid deposits were found in the donor heart. At the 2-year follow-up, the patient's physical and mental health was excellent. We conclude that heart transplantation can be an effective treatment in progressive heart failure due to SSA.     

Systemic amyloidosis: diagnosis before treatment.

Familial amyloidotic polyneuropathy is a systemic amyloidosis with a dismal prognosis for which a surgical treatment exists. Awareness of the clinical characteristics of the disease is critical for early genetic diagnosis and timely referral for liver transplantation. In this report we describe the history of a 49-year-old man in whom non-AA amyloidotic infiltration of the heart and the intestinal tract was diagnosed. Initially, inappropriate identification of the etiology of the disease led to maltreatment.     

An Early Onset Rehabilitation Program for Children and Adolescents after Traumatic Brain Injury (TBI): Methods and First Results

Survived traumatic brain injuries (TBI) are one of the most serious challenges to the patient's future life. Recent literature increasingly questions the long believed protective effects of functional cerebral plasticity in children. Although TBI in children and adolescents is frequent, they are less frequently admitted to rehabilitation centers as in-patients than adults. This emphasizes the role of out-patient treatment. The progressing study described here aims to achieve a contribution to a comprehensive approach in TBI-rehabilitation for youngsters. A two-stage multimethodal program, starting with stimulation in coma while the patient is on the intensive care unit, and neuropsychological therapy after regaining consciousness is to be evaluated in a controlled, prospective and randomized study. After including nearly 50 % of the planned sample (100 persons), some preliminary results can be mentioned with all applicable caution. The effectiveness of the applied therapy can be stated here with respect to the posttraumatic development of intellectual abilities in the 6- and 12 months follow ups. Moreover, in the control group development of psychopathological alterations was found to a considerable degree and also lower ratings in a quality of life questionnaire, compared to the experimental group. It is expected to prove these differences statistically, after the total sample has been included, and thus equal distributions have been achieved in all predictive variables.     

Sensitivity of normal and malignant cells to shock waves

We examined the cytotoxic effect of shock waves for primary (embryonic chick kidney and thigh muscle) and permanently growing normal and malignant cells (human, rat, and mouse) in suspension. To avoid the influence of different media, the cells were suspended in phosphate buffered saline and shock wave treated. In all cases the acute cytotoxic effect (measured by flow cytometry) was a function of the applied shock waves. The investigated cells differed in their LD 50 values which, however, do not reveal a general difference in sensitivity to shock waves for normal and malignant cells.     

Survival and differentiation of adult neuronal progenitor cells transplanted to the adult brain.

The dentate gyrus of the hippocampus is one of the few areas of the adult brain that undergoes neurogenesis. In the present study, cells capable of proliferation and neurogenesis were isolated and cultured from the adult rat hippocampus. In defined medium containing basic fibroblast growth factor (FGF-2), cells can survive, proliferate, and express neuronal and glial markers. Cells have been maintained in culture for 1 year through multiple passages. These cultured adult cells were labeled in vitro with bromodeoxyuridine and adenovirus expressing beta-galactosidase and were transplanted to the adult rat hippocampus. Surviving cells were evident through 3 months postimplantation with no evidence of tumor formation. Within 2 months postgrafting, labeled cells were found in the dentate gyrus, where they differentiated into neurons only in the intact region of the granule cell layer. Our results indicate that FGF-2 responsive progenitors can be isolated from the adult hippocampus and that these cells retain the capacity to generate mature neurons when grafted into the adult rat brain.     

High prevalence of undiagnosed coeliac disease in adults: a Swedish population-based study

OBJECTIVE: To determine the prevalence of coeliac disease in a population-based sample of Swedish adults. DESIGN: Population-based cross-sectional study. SETTING: Northern Sweden. SUBJECTS: A total of 1894 adults (76%) out of 2500 invited, randomly selected from the population register after stratification for age and sex. MAIN OUTCOME MEASURES: Prevalence of biopsy verified coeliac disease, symptoms of undiagnosed cases, and results of antiendomysium and antigliadin serum antibody tests. RESULTS: Coeliac disease was confirmed by intestinal biopsy showing enteropathy in 10 individuals (seven women and three men), corresponding to a prevalence of 5.3 per 1000 (95% CI = 2.5-9.7). The majority of cases (eight out of 10) had not been diagnosed prior to the screening, although many had symptoms compatible with coeliac disease. All individuals with antiendomysium antibody positivity who were subjected to a small intestinal biopsy had enteropathy. Furthermore, all of them also had elevated levels of antigliadin antibodies type IgA and/or IgG. CONCLUSIONS: Coeliac disease is common, albeit mostly undiagnosed, in Swedish adults. It is likely that the situation is no better in other countries. This highlights the importance of keeping coeliac disease in mind, and of promptly investigating individuals with unexplained, even mild, symptoms compatible with the disease. Serological markers, e.g. antigliadin and antiendomysium antibodies, are useful tools within this active case-finding strategy, although the final diagnosis should be based on an intestinal biopsy demonstrating enteropathy.