Determinants of Pouch-Related Symptoms, a Common Outcome of Patients With Adenomatous Polyposis Undergoing Ileoanal Pouch Surgery.

INTRODUCTION: Total proctocolectomy with ileal pouch anal anastomosis (IPAA) is performed in patients with adenomatous polyposis syndromes (APSs). Data regarding pouch outcomes in APS are scarce. The purposes of this study were to determine the prevalence of pouch-related symptoms in patients with APS and to identify the contributing factors. METHODS: This is a prospective cohort study. Demographic, surgical, and clinical data were collected. Endoscopy was performed, and biopsies from the terminal ileum, pouch, and cuff were obtained in all patients and reviewed by a dedicated pathologist. RESULTS: Fifty-one patients with APS after IPAA were followed. Twenty patients (39.2%) had pouch-related symptoms. Single-stage IPAA had better outcomes than 2-stage IPAA: fewer daily bowel movements (42.9% vs 13.8% with ≤5 daily bowel movement, P = 0.02), more solid consistency (52.4% vs 6.9%, P < 0.001), and less abdominal pain (19% vs 48.3%, P = 0.034). Younger age at IPAA (<20) was also associated with better outcomes: fewer daily bowel movement (58.3% vs 17.9% with ≤5 daily bowel movement, P = 0.011), less watery consistency (8.3% vs 53.8%, P = 0.005), and abdominal pain (8.3% vs 43.6%, P = 0.037). Eighteen patients (35.3%) had endoscopic signs of inflammation, and 22 patients (43.1%) had histologic signs of pouchitis. However, no correlation was found between symptoms and endoscopic or histologic findings. The median pouchitis disease activity index was low (2, interquartile range 1-4) and did not correlate with clinical symptoms. DISCUSSION: Pouch-related symptoms are common in patients with APS after IPAA. One-stage IPAA and younger age at surgery are associated with better clinical outcomes. However, symptoms do not correlate well with endoscopic or histologic findings or with pouchitis disease activity index and might be attributed to a functional pouch disorder.

Low serum cholesterol in violent but not in non-violent suicide attempters.

Many previous studies have suggested that low or lowered serum cholesterol levels may increase the risk of mortality not due to somatic disease: principally, suicide and violent death. Because violent death is rare, some studies have investigated afterwards the relation between cholesterol levels and either suicide attempts in psychiatric populations or violence in criminally violent populations. However, none of these studies have compared cholesterol levels in violent and non-violent suicide attempters. The blood of 25 consecutive drug-free patients following a violent suicide attempt and of 27 patients following a non-violent suicide attempt by drug overdose was drawn in the 24 h following admission. Patients with a diagnosis of alcohol abuse and with cholesterol-lowering therapy were excluded. Age, sex, body mass index, psychiatric diagnosis and the physical conditions of the suicide attempt were investigated. Thirty-two healthy subjects were used as a control group. There were no differences between the groups in age, frequency of psychiatric diagnoses or body mass index. There was more women in the group of non-violent suicide attempters than in that of violent suicide attempters (P<0.001). In analyses controlling for sex and age, the serum cholesterol concentration was 30% lower (F(2,82)=15.8; P<0.0001) in the group of violent suicide attempters (147+/-54 mg/dl) than in the group of non-violent suicide attempters (209+/-38 mg/dl) or control subjects (213+/-46 mg/dl). Our results showed that low serum cholesterol level is associated with the violence of the suicide attempt and not with the suicide attempt itself. Further investigations are necessary to determine the usefulness of this easily accessible parameter as a potential risk indicator for violent acts such as violent suicidal behavior in susceptible individuals.

Decreased platelet serotonin transporter sites and increased platelet inositol triphosphate levels in patients with unipolar depression: effects of clomipramine and fluoxetine.

BACKGROUND: The central serotonergic system has been implicated in the pathophysiology of depression and in the mechanism of the action of antidepressant drugs. The human platelet has been proposed as a peripheral model of central serotonergic neurons. METHODS: Six peripheral serotonergic parameters were determined simultaneously in 27 patients with unipolar depression before and after 2, 4, and 12 weeks of clomipramine or fluoxetine treatment according to the psychiatrist. RESULTS: In patients with depression versus matched control subjects, platelet [3H]paroxetine binding sites were found to be significantly decreased (2.10 +/- 0.70 versus 3.88 +/- 0.77 fmol/10(9) platelets; P = .0001), platelet serotonin (5-HT) content was found to be significantly decreased (1.90 +/- 1.52 versus 2.74 +/- 1.12 nmol/10(9) platelets; P = .001), and platelet inositol triphosphate levels were found to be significantly increased (2.85 +/- 0.70 versus 1.85 +/- 0.77 fmol/10(9) platelets; P = .0001). No significant difference between patients and control subjects was found for platelet [3H]-lysergic acid diethylamide ([3H]LSD) binding sites, aggregation tests with 5-HT or adenosine diphosphate and plasma 5-HT levels. Treatment with both clomipramine and fluoxetine gradually further reduced the density of platelet [3H]paroxetine binding sites and induced a dramatic decrease in platelet and plasma 5-HT levels. With clomipramine, the decreased blood 5-HT levels are associated with increased platelet [3H]LSD binding sites and aggregation responses. After 12 weeks, nonresponders to both treatments had platelet inositol triphosphate levels that were still increased (2.81 +/- 0.75 fmol/10(9) platelets) when responders levels were not different from those of control subjects (1.41 +/- 0.45 versus 1.70 +/- 0.25 fmol/10(9) platelets). CONCLUSIONS: Drug-free patients with depression had simultaneously decreased 5-HT transporter (5-HTT) sites and overstimulated phosphoinositide signaling systems. Clomipramine and fluoxetine treatments, which further decreased the density of 5-HTT sites, allowed platelet inositol triphosphate levels to return to normal values only in responders.

Plasma serotonin level after 1 day of fluoxetine treatment: a biological predictor for antidepressant response?

RATIONALE: Antidepressant treatments present a delayed onset of action. OBJECTIVE: The present study investigated whether plasma or serum serotonin, 5-hydroxytryptamine (5-HT), could predict clinical improvement. METHODS: Biological parameters were determined after a 4-week drug-free period (day 0) and 1, 14 and 28 days after the beginning of the treatment with fluoxetine 20 mg daily in depressed patients. Clinical evaluations were assessed on days 0, 14 and 28. RESULTS: One day after a single dose, the mean values of plasma 5-HT (5.4 +/- 2.6 nmol/l) and serum 5-HT (484 +/- 215 nmol/l) were not statistically different from basal mean values (4.5 +/- 2.5 nmol/l and 523 +/- 263 nmol/l, respectively). The repeated treatment significantly reduced serum 5-HT to 34% (P = 0.002) and 17% (P = 0.0004) of pretreatment values after 14 and 28 days of treatment, respectively; plasma 5-HT was also reduced significantly to 28% and 15% of pretreatment values (P < 0.05 in both cases). At day 28, four of the eight patients responded by showing a reduction in MADRS score of at least 50% of the baseline score. No correlation was found between pretreatment values of serum or plasma 5-HT and clinical evolution, even if a tendency (P < 0.07) to lower serum 5-HT pretreatment values was observed in responders. Plasma 5-HT after 1 day of treatment was significantly different between responders and non-responders: the plasma 5-HT concentration in responders was 3.4 +/- 1.7 nmol/l versus 7.4 +/- 1.6 nmol/l in non-responders (P = 0.02). Moreover, plasma 5-HT levels after 1 day of treatment were positively correlated to the final MADRS score (r = +0.89, n = 8, P = 0.003) and inversely correlated to its change from the initial score (r = -0.76, n = 8, P = 0.02). CONCLUSION: These preliminary data show that fluoxetine and norfluoxetine might influence 5-HT peripheral venous blood parameters and that plasma 5-HT after 1 day of treatment might be a biological predictor for antidepressant response.

Passive care and active rehabilitation in a patient with failed back surgery syndrome.

OBJECTIVE: To describe the results of chiropractic care combined with rehabilitative exercise protocol for a 41-yr-old male patient suffering from failed back surgery syndrome. CLINICAL FEATURES: A 41-yr-old man, who herniated his L4-L5 disc 4 yr before presentation and had undergone two surgeries to relieve his symptoms, sought chiropractic care for complaints of chronic, severe low back pain and leg pain with sensorimotor deficits. INTERVENTION AND OUTCOME: A 16-wk treatment protocol coupled passive chiropractic care (including adjustment, electric stimulation, stretching, massage and moist hot packs), with active rehabilitative exercise (including pelvic stabilization, muscle strengthening, proprioceptive training and movement training). Outcome measures included weekly assessment of the patient's active thoracolumbar flexion and extension by a goniometer. The Low Back Pain and Disability Questionnaire (Revised Oswestry) and visual analogue pain scale were administered weekly. In addition, daily activities such as ability to walk without a cane and hours of painfree sleep per night were noted each visit. After 16 wk of care, thoracolumbar ranges of motion were restored to normal, pain was reduced from "severe" to "moderate" and ability to perform daily activities was increased. The patient no longer required a cane to walk and was able to walk up to 7 miles without difficulty. Sleep increased from 5 to 7-9 hours per night. The patient halted use of pain medications, except for occasional days when he felt a significant increase in pain. CONCLUSION: A multifactorial treatment approach using passive care plus active rehabilitative exercises can be effective in the treatment of chronic low back pain associated with failed back surgery syndrome. Chiropractors who are trained in rehabilitation techniques will be well prepared to provide comprehensive care to such patients.

Two-color imaging by the use of patterned optical filters bonded to focal-plane-array detectors.

Two-color imaging by the use of a patterned optical filter directly bonded to a HgCdTe focal-plane array is demonstrated. The optical filter is spatially patterned, by multilayer lithographic techniques, to provide multicolor response in the midwavelength infrared by the use of a single substrate.

[SPECT and depressive pseudo-dementia. A case report]. / SPECT et pseudo démence dépressive. A propos d'un cas.

The SPECT (Single Photon Emission Computed Tomography), a new advance in medical imagery, allows the measure of cerebral blood flow and could be of interest in studying mental disorders. We report here a case of pseudo-dementia for which a SPECT has been performed before and after treatment. Mrs V., a 49 years old female, has been suffering from a dementia-like syndrome for several months. She is divorced, has two children, lives with a boy-friend, and has been working in a factory for 25 years. The first psychiatric disorders began three years ago with a gradual apragmatism and muteness. A neuroleptic treatment gave no result. One year later, without any reason, Mrs V. recovered a normal way of life. Nevertheless, from time to time, she had some periods of subexcitation. Few months later, she relapsed in her previous state of apragmatism and muteness. During a new hospitalization, neuroleptic treatment is tried again without any success. Mrs V. is then referred to us for medical screening of a dementia syndrome. In the Unit, it is difficult to communicate with her; she looks sad or amimic and has motor stereotypies (like rubbing her feet continuously against the floor). She has polidypsia and glutonny. Neurologic examination is normal, as well as EEG, X Scan, Nuclear Magnetic Resonance. The Folstein Mini Mental State score is 9/30.(ABSTRACT TRUNCATED AT 250 WORDS)

Properties of mixed composition Si/ZnSe and ZnSe/LaF(3) infrared optical thin films.

The behavior of codeposited thin films of ZnSe/LaF(3) and Si/ZnSe has been investigated. Mixed ZnSe/LaF(3) films are polycrystalline with intermediate compositions with moderately high compressive stress (1500-2000 kg/cm(2)). Mixed Si/ZnSe films are amorphous with intermediate compositions with low compressive stress (<1000kg/cm(2)). Optical properties of the ZnSe/LaFcm(3) system vary monotonically with composition, but those of the Si/ZnSe system do not, which is explained by the possible chemical reaction of the two species.

Codeposition of continuous composition rugate filters.

Rugate filters are optical thin film interference structures with sinusoidal refractive index profiles. Two-wavelength reflection filters have been fabricated by codeposition of SiO(2) and TiO(2). Composition modulation was monitored and controlled using quartz crystal rate controllers. The resulting filters exhibited two well-defined stopbands. Microscopic examination revealed that the structure is glasslike without pronounced thin film microstructure.

Patterned infrared spectral filter directly deposited onto cooled substrates.

A method for depositing patterned infrared thin film spectral filters directly onto substrates at low temperatures (200 degrees C) is described. Energetic deposition methods (ion-assisted and laser-assisted) were used to avoid heating the substrates, while a multilayer photoresist lift-off technique was applied to pattern the structures. The process produced durable films capable of surviving harsh processing conditions. This is a promising method for depositing patterned coatings directly onto infrared focal plane detector arrays.

Narrow-band optical filter through phase conjugation by nondegenerate four-wave mixing in sodium vapor.

An ultrahigh-Q, tunable optical filter with a FWHM bandwidth of 41 MHz is demonstrated. The filtering is produced by nondegenerate phase conjugation through four-wave mixing in atomic-sodium vapor. The filter is observed to have a maximum quantum efficiency of 4 x 10(-3). However, degenerate phase-conjugation experiments in sodium suggest that a quantum efficiency of greater than unity can be attained on a cw basis.