Impulsivity in disorders of food and drug misuse.

BACKGROUND: Evidence suggests some overlap between the pathological use of food and drugs, yet how impulsivity compares across these different clinical disorders remains unclear. Substance use disorders are commonly characterized by elevated impulsivity, and impulsivity subtypes may show commonalities and differences in various conditions. We hypothesized that obese subjects with binge-eating disorder (BED) and abstinent alcohol-dependent cohorts would have relatively more impulsive profiles compared to obese subjects without BED. We also predicted decision impulsivity impairment in obesity with and without BED. METHOD: Thirty obese subjects with BED, 30 without BED and 30 abstinent alcohol-dependent subjects and age- and gender-matched controls were tested on delay discounting (preference for a smaller immediate reward over a larger delayed reward), reflection impulsivity (rapid decision making prior to evidence accumulation) and motor response inhibition (action cancellation of a prepotent response). RESULTS: All three groups had greater delay discounting relative to healthy volunteers. Both obese subjects without BED and alcohol-dependent subjects had impaired motor response inhibition. Only obese subjects without BED had impaired integration of available information to optimize outcomes over later trials with a cost condition. CONCLUSIONS: Delay discounting appears to be a common core impairment across disorders of food and drug intake. Unexpectedly, obese subjects without BED showed greater impulsivity than obese subjects with BED. We highlight the dissociability and heterogeneity of impulsivity subtypes and add to the understanding of neurocognitive profiles across disorders involving food and drugs. Our results have therapeutic implications suggesting that disorder-specific patterns of impulsivity could be targeted.

Clinical efficacy of a new variant of a foam-based NWPT system.

OBJECTIVE: To evaluate the clinical efficacy of a new variant of a foam-based negative wound pressure wound therapy (NPWT) system. METHOD: A newly available polyurethane foam-based NPWT system (RENASYS-F, Smith & Nephew) was used to treat 18 patients in a prospective, multi-centre study. The patients had a variety of wound types including pressure ulcers, diabetic foot ulcers, traumatic and surgical wounds. RESULTS: The mean patient age was 48.3 years (range 25-72). Mean treatment duration was 14.6 days (range 5-29). At the end of therapy, 83% (15) wounds had progressed sufficiently, leading to a change in treatment from NPWT. Median reductions in wound area, depth and volume of 31.3%, 45.5% and 74.2% respectively were observed over the course of therapy. This equated to a weekly reduction in area, depth and volume of 12.9%, 20.0% and 32.1% respectively. Exudate level (p = 0.013) and wound malodour (p = 0.03) were significantly reduced between the onset and the end of NPWT. The percentage cover of 'beefy' red granulation tissue in the wound bed was significantly increased (p < 0.001) and non-viable tissue significantly reduced (p = 0.008) between the onset and the end of NPWT. CONCLUSION: These data demonstrate that an alternative foam-based NPWT system (RENASYS-F) is able to address the common treatment goals associated with application of NPWT including reduction in wound dimensions, reduction in exudate levels and an improvement in wound bed quality.

Sclerosing mediastinitis: a report on 18 cases.

BACKGROUND: Sclerosing mediastinitis is a rare condition which causes dense fibrosis of the mediastinum. Few large studies have been reported to date. The clinical and pathological features of cases have been studied in a specialist referral centre in the UK. METHODS: The pathological files of the Royal Brompton Hospital were examined and 18 cases of sclerosing mediastinitis were identified between 1970 and 1993. The clinical notes were obtained and the pathological specimens analysed. RESULTS: There were 12 men and six women of age range 9-64 years. Twelve patients presented with shortness of breath, six had haemoptysis, three had hoarseness, four had pleuritic chest pain, three general weakness, two had dysphagia, and one was asymptomatic. Nine patients had a previous history of pulmonary tuberculosis. Two had auto-immune disease--one rheumatoid arthritis and the other systemic lupus erythematosus. There were three cases of previous malignancy--two undifferentiated carcinoma of the lung and the other Hodgkin's disease. Serological tests revealed only one positive reaction to Histoplasma. The erythrocyte sedimentation rate and serum immunoglobulins were raised in nine patients. Diagnosis was usually by thoracotomy with biopsy. All cases had fibrosis and chronic inflammation with no active granulomas. No infective organisms or positive cultures were obtained in any case. Ten of the 18 cases are alive up to 15 years after diagnosis, with only two deaths and six lost to follow up. CONCLUSIONS: Sclerosing mediastinitis is a slowly progressive condition associated with previous tuberculosis, mediastinal malignancy, and autoimmune disease. The outlook is excellent for those cases without underlying malignancy.

Carpopedal spasm: an unusual reaction to fluorescein?

Fluorescein angiography is a routine procedure in ophthalmology. There can, however, be some harmful side-effects from fluorescein injections. It is important that all personnel involved in using this investigative procedure should be aware at all times of the possible side-effects and be ready to detect and control any adverse reaction. A case presentation is given of a 40-year-old man who had an unusual reaction to fluorescein resulting in carpopedal spasm.

Specular microscopy at Southampton Eye Hospital.

There is nothing significantly new in the technique of specular microscopy. The equipment has improved and the methods of cell counting have been automated using computer technology. This paper gives an account of how the old practice is still being used effectively in assessing the endothelial cell population, their shape and shape variability.