Do supine oblique views provide better imaging of the cervicothoracic junction than swimmer's views?

OBJECTIVE: To determine whether a swimmer's view or supine (trauma) oblique views are more likely to visualise the lower cervical spine when a lateral view fails to show the cervicothoracic junction. DESIGN: A prospective study comparing two 20 week periods. In the first phase the swimmer's view was performed as an additional view when the cervicothoracic junction was not demonstrated. In the second phase paired supine oblique views replaced the swimmer's view. RESULTS: 230 patients were included in the first phase, of whom 60 required swimmer's views. In the second phase 62 of 197 patients required supine oblique views. Radiology analysis of 53 pairs of supine oblique views showed that the vertebral bodies were adequately demonstrated at the cervicothoracic junction in only 20 patients (38%) compared with 22 in the swimmer's group (37%). The facet joints and posterior elements were, however, clearly seen in 37 (70%) of the supine oblique patients compared with 22 (37%) of the swimmer's group (p < 0.001, chi2 test). Exposure dose calculations showed a substantial reduction for a pair of supine oblique views (1.6 mGy) over a single swimmer's view (7.2 mGy). CONCLUSIONS: In injured patients for whom the standard three view series fails to demonstrate the cervicothoracic junction, swimmer's views and supine oblique views show the alignment of the vertebral bodies with equal frequency. However, supine oblique films are safer, expose patients to less radiation, and are more often successful in demonstrating the posterior elements.

Comparison between acute and delayed onset major depression after spinal cord injury.

Sixty patients with spinal cord injury were examined to assess major depression during the in-hospital period and at 3- and 6-month follow-up. Thirteen patients had depression during the initial in-hospital evaluation (acute onset depression) and eight had depression first diagnosed at either 3- or 6-month follow-up (delayed onset depression). Acute onset depression was related to the severity of impairment and premorbid history of psychiatric disorder, suggesting a psychological reaction to impairment or premorbid vulnerability as a possible mechanism for developing depression. Delayed onset depression was not related to severity of physical impairment but was associated with more rostral spinal injury, suggesting the possibility that neurophysiological response to injury more proximal to the brain may play a role in delayed onset depression. These data also suggest that the etiology and pathophysiology of these two types of depression may be different.

Depression following myocardial infarction: a one year longitudinal study.

OBJECTIVE: The purpose of this study was to examine the course and clinical correlates of depression during the first year after myocardial infarction. METHOD: A group of seventy patients hospitalized for the treatment of myocardial infarction (MI) were assessed for the presence of mood disorders during their hospital admission and at three, six, nine, and twelve months follow-up. Patients were evaluated and diagnosed using the Present State Examination and DSM-III criteria. Impairment in activities of daily living was measured by the Johns Hopkins Functioning Inventory and impairment in social functioning was measured by the Social Functioning Examination. RESULTS: A total of twenty-four patients met DSM-III criteria for major depression at some time during the study (18 in the acute stage, 6 during follow-up). There were two patients with minor depression (dysthymia) at intake and six developed minor depression during the follow-up period. The median duration of major depression was 4.5 months. Patients with depression at intake had greater impairment in activities of daily living than non-depressed patients. Depressions lasting more than six months were more likely to be anxious depressions than those lasting less than six months. After the acute MI period, there was a consistent relationship between the existence of depression and impaired social functioning. CONCLUSIONS: This is a pilot study and needs further replication due to the low rate of follow-up participation. However, these data suggest that there may be two types of depression following MI: an acute depression associated with greater functional impairment, and a prolonged depression that may be associated with inadequate social support.

Prospective longitudinal study of depression following spinal cord injury.

A group of 60 patients with spinal cord injury was examined to assess mood disorders during the rehabilitation hospital admission and 6 months of follow-up. During the initial evaluations, 13 patients (22%) had major depression and 5 patients (8%) had minor depression. The development of mood disorders during the hospital admission appeared to be related to heterogeneous etiological factors, including previous psychiatric history and severity of impairment in activities of daily living. During the first 3 months after SCI, about half of the depressions resolved. Nonrecovery from depression may be related to lack of adequate social support.

Secondary mania following traumatic brain injury.

OBJECTIVE: In this study patients were examined during the first year after traumatic brain injury to determine the presence of secondary mania. METHOD: A consecutive series of 66 patients with closed-head injury were evaluated in the hospital and at 3-, 6-, and 12-month follow-ups. The patients were examined with a semistructured psychiatric interview and scales for measurement of impairment in activities of daily living, intellectual function, and social functioning. Patients fulfilling the DSM-III-R criteria for mania were compared to patients with major depression and to patients without affective disturbances in regard to their background characteristics, impairment variables, and lesion locations. RESULTS: Six patients (9%) met the criteria for mania at some point during follow-up. The presence of temporal basal polar lesions was significantly associated with secondary mania even when the effect of other lesion locations was taken into account. Secondary mania was not found to be associated with the severity of brain injury, degree of physical or cognitive impairment, level of social functioning, or previous family or personal history of psychiatric disorder. The duration of mania, however, appeared to be brief, lasting approximately 2 months. CONCLUSIONS: The 9% frequency of secondary mania in these patients with traumatic brain injury is significantly greater than that seen in other brain-injured populations (e.g., patients with stroke). The major correlate was the presence of a temporal basal polar lesion.

Depression following traumatic brain injury: a 1 year longitudinal study.

A group of 66 patients hospitalized for the treatment of closed head injury, were assessed for the presence of mood disorders during their hospital admission and at 3, 6 and 12 months follow-up. A total 28 patients met DSM-III-R diagnostic criteria for major depression at some time during the study (17 in the acute stage, 11 during follow-up). The mean duration of major depression was 4.7 months. However, there appeared to be a group of transiently depressed patients (41%) who where depressed inhospital but were no longer depressed at 3 months follow-up. Throughout the follow-up period, major depression showed a strong relationship with poor social functioning. There was not, however, a consistent relationship between depression and quantitative measures of either physical or cognitive impairment. Location of the brain lesion was associated with the development of major depression only in the acute stage. Transient depressive syndromes were associated with left dorsolateral frontal and/or left basal ganglia lesions.

Comparison between acute- and delayed-onset depression following traumatic brain injury.

Sixty-six patients admitted for the treatment of acute closed head injury were assessed for the presence of mood disorders during the in-hospital period and at 3-, 6-, and 12-month follow-ups. Diagnosis was made using a structured psychiatric interview and DSM-III criteria. A total of 28 patients had major depression at some time during the study: 17 had acute-onset depression and 11 had delayed-onset depression. Acute-onset depressions are related to lesion location and may have their etiology in biological responses of the injured brain, whereas delayed depressions may be mediated by psychosocial factors, suggesting psychological reaction as a possible mechanism.

Depression in patients with acute traumatic brain injury.

OBJECTIVE: This study was undertaken to examine patients with closed head injuries for the presence of depressive disorders. METHOD: A consecutive series of 66 patients with closed head injuries but no significant spinal cord or other organ system injury were examined by means of a semistructured psychiatric interview. The Hamilton Rating Scale for Depression as well as scales measuring impairment in activities of daily living, intellectual functioning, and social functioning were administered. The patients' CT scans were also examined. RESULTS: Seventeen patients had major depression and two had minor depression. The presence of left dorsolateral frontal lesions and/or left basal ganglia lesions and, to a lesser extent, parietal-occipital and right hemisphere lesions was associated with an increased probability of developing major depression. Compared to the nondepressed group, the group with major depression had a higher frequency of previous psychiatric disorder and showed evidence of poorer social functioning. CONCLUSIONS: Major depression occurs in about one-quarter of patients after traumatic brain injury. This is the same frequency as in other major disorders such as stroke. Major depression appears to be provoked by one or more factors that include poor premorbid social functioning and previous psychiatric disorder or injury to certain critical brain locations.

Vertebral metastases and an equivocal bone scan: value of magnetic resonance imaging.

To assess the value of magnetic resonance imaging (MRI) in the investigation of patients with suspected but nonproven vertebral metastases 45 consecutive patients referred in a 6 month period with known primary malignancy and back pain in whom an isotope bone scan was reported as equivocal were studied. All patients had abnormal isotope uptake localized to the spine. Twelve patients were shown to have bony metastases on plain X-ray. In the remainder, where X-rays showed normal or benign appearance, MRI of the spine was offered. Twenty-four patients underwent MRI examination which showed vertebral metastases in 11 cases. Magnetic resonance imaging is shown to be a useful, noninvasive, complementary investigation for evaluation of patients known to have malignant disease and suspected of having vertebral metastases on bone scintigraphy.

Depression following myocardial infarction.

OBJECTIVE: Although many investigators have studied mood disorders following myocardial infarction, the prevalence, severity, and persistence of depression have been disputed, and standard rating scales and criteria for depressive disorders have infrequently been utilized. The authors' goal was to determine how frequently depressive disorders occur after myocardial infarction, and to investigate predisposing factors for such disorders. METHOD: Structured clinical interviews were administered to 129 inpatients within ten days of myocardial infarction. Patients were also evaluated using standardized rating scales for depression, social function, cognition, and physical impairment. DSM-III diagnoses were derived from the structured interview. RESULTS: Major depressive syndromes were present in 19 percent (n = 25) of the patients and were associated with prior history of mood disorder, female sex, large infarcts, and functional physical impairment. CONCLUSION: Major depression is common in the acute post-myocardial infarction period. Such disorders confer significant psychiatric morbidity and, if sustained, require psychiatric intervention.

Specificity of affective and autonomic symptoms of depression in Parkinson's disease.

Previous investigators have suggested that numerous symptoms used to diagnose depression, such as sleep or appetite disturbance, are non-specific in medically ill patients, and alternative diagnostic criteria should be developed. In the study this hypothesis was tested in Parkinson's disease (PD) by comparing patients with PD who reported a depressive mood with patients having PD but without a depressive mood. Depressed patients showed a significantly higher frequency of both autonomic and affective symptoms of depression. Depressed patients with PD reported a significantly higher frequency of worrying, brooding, loss of interest, hopelessness, suicidal tendencies, social withdrawal, self-depreciation, ideas of reference, anxiety symptoms, loss of appetite, initial and middle insomnia, and loss of libido when compared with non-depressed patients. No significant between-group differences, however, were observed in the frequency of anergia, motor retardation, and early morning awakening.

The surgical management of extravalvular aortic root infection.

Fifteen patients with extravalvular aortic root infection and associated infective endocarditis underwent urgent operation for this condition at Glasgow Royal Infirmary between 1977 and 1983. Four patients (26.7%) subsequently died between 1 and 68 months after operation. All patients underwent aortic valve replacement, with debridement or suture closure of abscess cavities as indicated. Three patients also required insertion of permanent pacing systems for complete heart block. Three other patients required further surgical intervention. Aortic valve rereplacement was done on two occasions in 1 patient and repair of a periprosthetic leak in the second patient; the third required one additional procedure to close an aorto-right atrial fistula postoperatively. Ten out of 11 survivors are in New York Heart Association Class I, and the remaining patient is in Class II. Aggressive surgical therapy without the need for complicated reconstructive procedures of the aortic root is effective in the management of extravalvular aortic root infections.

The endoscopic and histological features of peptic duodenitis.

This study attempts to compare the endoscopic features of duodenitis with the histological characteristics. During a 12 month period, 98 patients undergoing fibreoptic oesophago-gastro-duodenoscopy had the endoscopic appearances of the duodenum classified on a three point scale of increasing severity of duodenitis. Multiple duodenal biopsies were then taken and the histological features of the severity of duodenitis graded from 0 to 4 plus by an independent observer. The histological criteria included an assessment of neutrophil infiltration, villous bluting, gastric metaplasia and chronic inflammation. Routine endoscopic assessment alone was unsatisfactory for diagnosing and grading the severity of duodenitis and multiple target biopsies are required for histological examinations.