Dexamethasone suppression test and onset of poststroke depression in patients with ischemic infarction.

BACKGROUND: Studies documenting abnormal results in the 1.0-mg dexamethasone suppression test (DST) and the prevalence of depression in stroke patients are usually accomplished between 1 and 6 months poststroke. One study, however, reported that 27% of patients met DSM-III criteria for major depression and 20% for minor depression 1 to 3 weeks poststroke even though previous research has indicated that the prevalence of poststroke depression was greatest at approximately 6 months. Therefore, we decided to assess DST abnormalities and depression within the first month of stroke. METHOD: Twelve patients with single, computed tomography (CT)-verified, ischemic infarctions were administered the DST at 1 and 3 weeks poststroke. Each patient also received a complete psychiatric evaluation, including a special clinical interview and the 17-item Hamilton Rating Scale for Depression (HAM-D). 3 to 4 weeks poststroke. RESULTS: DST results were abnormal in 75% of the patients at 1 week poststroke and 50% of the patients at 3 weeks poststroke. Those patients whose HAM-D scores revealed more depressive symptoms at 3 to 4 weeks were more likely to evidence abnormal DST results (cortisol nonsuppression). None of the patients, however, met either DSM-III or modified criteria for clinical depression at 3 to 4 weeks. CONCLUSION: Poststroke depression appears to have a delayed clinical onset. Abnormal DST results at 3 weeks poststroke may serve as a potential marker for those patients at risk for developing poststroke depression.

Neuroleptic malignant syndrome after haloperidol therapy.

A well documented case of neuroleptic malignant syndrome is reported. The patient had unusual, life-threatening complications, consisting of cardiac arrhythmia, followed by cardiac arrest, dysphagia persisting for eight weeks and leading to aspiration pneumonia, seizures, and myoclonus following treatment with haloperidol. An 18-month outpatient follow-up has failed to reveal any residual neurologic or cardiovascular damage.

How the brain integrates affective and propositional language into a unified behavioral function. Hypothesis based on clinicoanatomic evidence.

Recent publications suggest that the right hemisphere dominates in modulating the affective components of language. Disorders of language form right-sided focal brain lesions have been called "aprosodias" and can be classified in a manner similar to the aphasias. We describe a patient with motor aprosodia who subsequently died and underwent neuropathologic examination. From the neuropathologic findings and recent observations concerning the neurology of depression, we hypothesize that the motor integration of propositional and affective language takes place in the brainstem, whereas their higher-order integration takes place via the callosal connections between Wernicke's area on the left and its homologue on the right. Direct application of these functional and anatomic relations can help clinicians to properly interpret the often incongruous and disparate behavioral and language responses encountered in brain-damaged patients.

Graft adherence to de-epithelialized surfaces: a comparative study.

Graft adherence may be divided into two distinct phases: Phase I, which is fibrin dependent and Phase II, which begins after 72 hours with fibro-vascular ingrowth or vascular anastomosis with the graft material. Adherence values for autograft, homograft, heterograft, silicone membrane and a modified collagen membrane were evaluated during the fibrin-dependent Phase I period at 5 and 72 hours on dermal, fascial and granulating surfaces on rats. Modified collagen membrane demonstrated a superior adherence at both times tested on dermal and fascial surfaces, while autograft and homograft were significantly more adherent on granulating surfaces at 72 hours. The inert silicone membrane was consistently the least adherent. Granulating surfaces produced the highest adherence values at 5 hours and fascial surfaces at 72 hours. The higher values found with collagen indicate that future research directed toward the production of a synthetic wound dressing or skin should be directed toward biologically derived materials, rather than inert materials. The data supports the concept of the role of fibrin as the bonding factor in Phase I adherence and implies that collagen, rather than elastin, is primarily responsible for early graft adherence.

Modified collagen membrane as a skin substitute: preliminary studies.

Modified collagen membrane when compared to autograft, homograft, heterograft and silicone polymer membrane, demonstrated a superior adherence on split and full-thickness surfaces, but proved to be an inferior covering for granulating surfaces. Water vapor transport was found to be adequate and adaptable to modification. It was found to be permeable to most commonly used topical antibiotics, and no significant antigenicity could be demonstrated. In a controlled animal burn study, modified collagen membrane proved superior to homograft and heterograft in regard to mortality, time to grafting, bacteriology and autograft take. These studies provide a background for further laboratory and clinical studies now in progress.