Intramuscular ziprasidone treatment of acute psychotic agitation in elderly patients with schizophrenia.

OBJECTIVE: Intramuscular (i.m.) ziprasidone treatment has been shown to be effective and well tolerated in reducing the symptoms of acute psychosis in adults. Few data are available as to safety in the elderly. The growing utilization of health services by elderly psychiatric patients warrants an evaluation in this population. METHOD: Consecutive elderly patients (60 years of and older) admitted to a psychogeriatric ward in a large, university-affiliated tertiary psychiatric center were treated by i.m. ziprasidone for acute psychotic agitation. Patients received three days of flexible-dose i.m. ziprasidone. After an initial dose of 10-20 mg, a subsequent dose of 10-20 mg could be given after 12 hours if needed (maximum daily dose: 40 mg). RESULTS: All treatment emergent side effects and adverse events along with the investigators' assessments of severity were systematically recorded as the primary outcome. The Brief Psychiatric Rating Scale (BPRS) and the Behavioral Activity Rating Scale (BARS) were the secondary outcomes. Twenty-one patients, six male and 15 female, mean age 71.4 +/- 1.3 years (range: 60-81 years) were enrolled. All had completed the three days i.m. ziprasidone treatment. There was one adverse event in a patient with untreated benign prostatic hypertrophy who developed urinary retention. Two side effects of mild severity that resolved spontaneously were observed: blurred vision and sedation. The BPRS decreased by 26.8 points after three days of treatment (p = 0.001). The BARS score, reflecting agitation, decreased significantly after each injection, reaching maximal decrease of 2.14 points at completion of study (p = 0.001). CONCLUSION: Intramuscular ziprasidone in this series of elderly patients suggests acceptable safety and efficacy in the management of acute psychotic agitation among elderly patients with schizophrenia.     

Spectrally opponent inputs to the human luminance pathway: slow +M and −L cone inputs revealed by intense long-wavelength adaptation

The nature of the inputs to achromatic luminance flicker perception was explored psychophysically by measuring middle- (M-) and long-wavelength-sensitive (L-) cone modulation sensitivities, M- and L-cone phase delays, and spectral sensitivities as a function of temporal frequency. Under intense long-wavelength adaptation, the existence of multiple luminance inputs was revealed by substantial frequency-dependent changes in all three types of measure. Fast (f) and slow (s) M-cone input signals of the same polarity (+sM and +fM) sum at low frequencies, but then destructively interfere near 16 Hz because of the delay between them. In contrast, fast and slow L-cone input signals of opposite polarity (−sL and +fL) cancel at low frequencies, but then constructively interfere near 16 Hz. Although these slow, spectrally opponent luminance inputs (+sM and −sL) would usually be characterized as chromatic, and the fast, non-opponent inputs (+fM and +fL) as achromatic, both contribute to flicker photometric nulls without producing visible colour variation. Although its output produces an achromatic percept, the luminance channel has slow, spectrally opponent inputs in addition to the expected non-opponent ones. Consequently, it is not possible in general to silence this channel with pairs of 'equiluminant' alternating stimuli, since stimuli equated for the non-opponent luminance mechanism (+fM and +fL) may still generate spectrally opponent signals (+sM and +sL).     

Gender Trends in Emergency Medicine Publications

Background In recent years, the number of women entering the field of emergency medicine (EM) has increased.
Objectives To determine if authorship in EM publications has increased in parallel with this trend.
Methods The gender of first and last authors of EM articles in Academic Emergency Medicine , American Journal of Emergency Medicine , Annals of Emergency Medicine , and Journal of Emergency Medicine were examined. The authors reviewed articles from 1985, 1995, and 2005 for American Journal of Emergency Medicine , Annals of Emergency Medicine , and Journal of Emergency Medicine and from 1999 and 2005 for Academic Emergency Medicine . The primary outcomes were the proportions of female authors.
Results A total of 2,016 articles were reviewed. Overall, 18% of first and last authors were female. Respectively, for 1985, 1995, 1999, and 2005, the proportions of female first authors were 9%, 15%, 19%, and 24%; the proportions of female last authors were 9%, 18%, 19%, and 22%. The trend of increases in female authorship was statistically significant.
Conclusions Although female authorship remains a minority in EM publications, it has increased significantly in parallel with increases in female participation in EM.     

Closed flexible intramedullary nailing of adolescent femoral shaft fractures

Twenty-five femoral shaft fractures in twenty-three patients aged 10-16 years with open epiphyses and treated with flexible intramedullary nailing were studied retrospectively. Clinical and roentgenographic follow-up averaged 28 months. Hospitalization, which included patients with multiple injuries, averaged 11.7 days. Patients ambulated without assist devices as early as 2 weeks postoperatively (average of 7.7 weeks). All fractures healed with no leg length inequality--21 with anatomic alignment and full range of motion of the hip and knee. Three patients sustained intraoperative extension of the fracture resulting in healing with angular or rotatory malalignment. One patient with associated knee ligamentous injury had less than full knee flexion at follow-up. All patients had normal gait (except one patient with residual hemiplegia) and were able to participate in full activities including athletics. Early ambulation and functional recovery with low morbidity and cost suggest that this procedure should be considered for the treatment of femoral shaft fractures in this age group.     

Postural stability by computerized posturography in minor head trauma

Mild head injuries are very common among young children. Often, these injuries are followed by a variety of subjective complaints termed posttraumatic syndrome. Posturography (balance test) was performed immediately after the trauma in 21 children who had sustained mild head injury. Significant difference in performance was observed in head-injured children in all subparts of the test as compared with a control group. We conclude that posturography may serve as a simple cost-effective method in qualifying the posttraumatic imbalance.     

Computed tomography and plain radiography in experimental fracture healing

We evaluated the relative contribution of plain radiographs and computed tomography to the assessment of fracture healing under experimental circumstances. In 15 sheep, we performed midshaft femoral osteotomies and internal fixation of the resultant segmental fractures. Radiographs were obtained preoperatively and immediately postoperatively. Animals were sacrificed at 3 weeks, 6 weeks, 12 weeks, 24 weeks, and 36 weeks after surgery, and the femoral specimens radiographed. After removal of the internal fixation devices, computed tomographic scans of the specimens were performed.By 3 weeks, callus was visible, but at 6 weeks, a trabecular pattern in the callus was seen on plain films but not on computed tomography. There was progressive organization of the callus on both studies. At 24 weeks, computed tomography demonstrated fracture lines not seen due to overlying callus on plain films and also more accurately showed incomplete union. By 36 weeks, healing was essentially complete according to both modalities, although there still were small gaps in the callus detectable on computed tomography but not on plain films.Computed tomography may be of value in the evaluation of fractures of long bones in those cases in which clinical examination and plain radiographs fail to give adequate information as to the status of healing.     

Dislocation of the second through fifth carpometacarpal joints

We report a case of dislocation of the second through fifth carpometacarpal joints and review the mechanism of injury and radiographic findings in such injuries.     

Food allergy as a risk factor for asthma morbidity in adults.

BACKGROUND: The objective of this study was to evaluate the relationship between food allergy and asthma morbidity in adults. METHODS: We interviewed a cohort of persistent asthmatics from an inner-city clinic. Allergies to food were assessed by patient report of convincing symptoms of acute allergic reactions. Outcome variables included health resource utilization and medication use. RESULTS: The prevalence of allergy to fish, peanut, tree-nut, shellfish, and seed allergies were 3%, 3%, 3%, 13%, and 1%. Patients with allergies to > 1 food had increased asthma hospitalizations, ED visits, and use of oral steroids (p < 0.05 for all comparisons). Specifically, allergy to fish was associated with a greater risk of health resource utilization and increased frequency of oral steroid use (p < or = 0.03 for all comparisons). CONCLUSIONS: Self-reported allergy to foods was associated with worse outcomes, suggesting that food allergy may be a risk factor for increased asthma morbidity in adults.