Neuropsychological deficits in drug naïve, non-depressed obsessive-compulsive disorder patients.

There are several studies that compared neuropsychological performance of OCD patients with healthy controls. However, there are hardly any studies which have used drug-naïve as well as non-depressed OCD subjects in their studies. The present study compared eighteen drug-naïve non-depressed OCD patients with similar number of age, education and sex matched healthy controls on neuropsychological tests. The tests used are block design, object assembly, Visuospatial Working Memory Test, Verbal Working Memory Test, Complex Figure Test, Stroop Test and Wisconsin Card Sorting Test. In addition to usual significance testing, Effect Sizes were calculated. In addition, correlation was done between neuropsychological test variables and clinical variables. The results did not show any significant correlation between any of the clinical variables and neuropsychological test variables. On the other hand, patients showed significant deficits mainly in executive functions and organizational strategy with respect to visuospatial functions. The observed deficits can be attributed to both dorsolateral prefrontal cortex and orbitofrontal cortex involvement.

Evaluation of functional outcomes in congenital hydrocephalus.

AIM: The long term outcomes of congenital hydrocephalus are still not clearly known despite it being a common clinical condition. Several clinical, radiological factors were correlated to predict the functional outcomes. This study aimed to correlate the clinical, radiological parameters with the regional functional outcomes of the brain. MATERIALS AND METHODS: Children with congenital hydrocephalus were divided into Group A with hydrocephalus alone and Group B hydrocephalus with spina bifida. Ventriculoperitoneal shunt surgery was performed by the same surgeon. CT scans and neuropsychological assessments were performed before and serially after the shunt. The clinical and the radiological findings were correlated with the developmental levels during the follow-up. RESULTS: There were 25 children in Group A and 15 children in Group B; 72% in Group A and 93% in Group B were less than 6 months of age at the time of treatment. Forty percent in Group A and 92% in Group B had the signs of hydrocephalus at admission. Cerebrospinal fluid (CSF) diversion results in the reduction in ventricular dilatation and corresponding increase in the cortical mantle thickness. The ventricular size and the cortical mantle thickness were measured serially and correlated with the development in the neuropsychological function. In this study, 80% in Group B reached near normal development in comparison to 33% in Group A. We have noticed a significant correlation in the increase in the regional cortical mantle thickness with corresponding improvement in the functional development. This clearly ratifies the improvement in the frontal and parietal areas having their distinctive effect on the functional development of the child. CONCLUSION: Early CSF diversion and timely intervention seems to benefit functional recovery. It is interesting to note that reconstitution of cortical mantle in different areas of the brain showing corresponding improvement in their respective areas. Large ventricles (head circumference more than 50 cm) recurrent subdural collections and repeated shunt obstructions have a bad influence on the long-term outcome. Unlike the previous belief the children with myelomeningocele can have equal benefit in terms of neuropsychological development after the shunt surgery.

"Mini-open" repair of acute tendo Achilles ruptures--the solution?

BACKGROUND: The standard surgical exposure for repair of acute tendo Achilles rupture gives favourable results, but such extensive exposure increases the possibility of peritendinous adhesion, wound breakdown and infections which increases morbidity and impairs functional outcome. Open repair also increases post-operative hospital stay and hence encroaches on valuable bed space availability. To evade this mini-open technique was developed which provide anatomic apposition of the tendon ends and minimal damage to epitendon. METHODS: We describe a retrospective case series of 21 patients who were treated with mini-open technique as a day case, between 2004 and 2007 operated by a single surgeon. They were followed up for a year. Both the Leppilahti score and the American Orthopaedic Foot and Ankle Society for the Ankle Hind foot Clinical Rating System (AOFAS) were calculated. The patients (8 males and 13 females) had a mean age of 43.4 years. Post-operatively the leg was placed in an air cast boot with 3 heel wedges allowing 30 degrees of plantar flexion. The foot is brought into plantigrade position by 6 weeks with serial removal of heel wedges followed by a rehabilitative training programme. RESULTS: There was one superficial infection which settled on oral antibiotics, no re-rupture or sural nerve involvement was noted in this series. All patients returned to previous work and sports activities. All patients scored above 90 in the American Orthopaedic Foot and Ankle Hind foot Clinical Rating System and on the Leppilahti Scoring System. Mini-open procedure is an excellent alternative to open exposures reducing the inpatient post-operative stay. All patients were discharged home on the same day of the procedure. CONCLUSION: Our pilot study has helped us to implement a standardised pathway by which patients have benefitted with improved rehabilitation and return to their pre-injury status.

Passage of peritoneal fluid into lumbar epidural catheter during pelvic exenteration.

Migration of an epidural catheter into either paravertebral tissues or pleural cavity has already been described. Up to now, no case of passage of peritoneal fluid into the epidural space has been reported. Here we report such an event in a patient submitted to pelvic exenteration, and discuss its diagnosis and management.

A case of relapsing Salmonella osteomyelitis in a thalassaemia trait patient.

We report a case of chronic relapsing osteomyelitis caused by Salmonella Stanley in a beta-thalassaemia trait patient who is otherwise normal. The importance of obtaining definitive bacteriological diagnosis and timely intervention to treat bone infection effectively is emphasised here.

Cognitive deficits in children of alcoholics: At risk before the first sip!

BACKGROUND: High family loading for alcoholism, early onset of alcohol use and childhood disinhibitory behaviors, persisting into adulthood, increase the susceptibility to alcoholism. At the psychophysiology level, reduced amplitude of the P300 component of the Evoked Response Potential is associated with externalizing psychopathology in children. Children of alcoholics have reduced P300 amplitudes. Preliminary data suggests a developmental lag phenomenon in the maturation of the P300. AIMS: The study compares the amplitude and topography of the P300 generated in response to a visual task, between subjects at high risk (HR) and those at low risk (LR) for alcoholism and its relation to externalizing behaviors. RESULTS: HR subjects have lower P300 amplitudes over frontal brain areas. Differences are greater in young, tending to converge with increasing age. There is a strong association between this reduced brain activation and an excess of externalizing behaviors in HR individuals. CONCLUSION: A maturational lag in brain development causing central nervous system disinhibition and externalizing behaviors may underlie the susceptibility to alcoholism.

Are we overusing blood transfusing after elective joint replacement?--a simple method to reduce the use of a scarce resource.

OBJECTIVES: To determine the proportion of patients who received a blood transfusion after joint replacement, and to devise a simple method to ensure patients were transfused based on strict clinical and haematological need. DESIGN: Prospective audit over 2 years. PATIENTS AND METHODS: The study group was 151 patients who underwent total hip and knee arthroplasty in a typical district general hospital (Kettering) over a 2-year period. They were divided into three consecutive groups. Current practice was audited (producing the first group of 62 patients) and transfusion rates were compared to regional figures. Local guidelines were drawn up. A form was introduced on which the indications for any transfusion had to be documented prior to transfusion of the blood. This was designed to encourage transfusion only on strong clinical grounds or an haemoglobin (Hb) level < 8 g/dl. Transfusion practice was then re-audited (producing the second group of 44 patients) to assess whether practice had improved. A year later, all relevant staff were reminded by letter of the guidelines. The process was then re-audited (producing the third group of 45 patients) again to determine whether practice remained improved or not. RESULTS: In the first audit (current practice) of 62 patients, the overall transfusion rate was 71%, with a higher rate in the hip replacement group (84%) ordered mainly by anaesthetic staff. Ward staff were reluctant not to transfuse patients whose Hb level fell below 10 g/dl. In the second audit, the transfusion rate fell by nearly 50% to 37%, with almost identical figures for knee and hip replacement. In the third audit of 45 patients, a year later, the transfusion rate was 40% overall. CONCLUSIONS: Patients were being transfused routinely, generally without good clinical evidence of benefit to the patient. The audit process was successful in instituting change for the better in blood transfusion practice for elective joint replacement. The improved practice can be largely maintained provided staff are regularly reminded of appropriate guidelines and encouraged to transfuse for clinical need only. For absolute adherence to guidelines, we would recommend a compulsory form system be introduced for transfusion in the per-operative period, to ensure blood transfusion is only given when absolutely necessary.

Frontal deficits in alcoholism: an ERP study.

Alcoholism is a major health problem afflicting people all over the world. Understanding the neural substrates of this addictive disorder may provide the basis for effective interventions. So-called "executive processes" play a role in cognitive functions like attention and working memory, and appear to be disrupted in alcoholism (Noel et al., 2001). Event related potentials (ERPs) provide an excellent, minimally invasive technique for exploring these neural deficits. The current study used the P300 in number sequencing task (modified version of the Petries & Milner, 1982) requiring working memory to compare a group of patients with alcoholism and frontal lobe lesions to patients with subcortical lesions and normal controls to assess the relationship of alcoholism to frontal lobe damage. The ERP paradigm was a Number Sequencing task. Electrophysiological results indicate that the frontal lesion group had significant P300 amplitude reduction and a similar trend for alcohol dependent group but not the subcortical group compared to the normal controls.

Spectral EEG effects of electroconvulsive shock stimulus parameters: the development of a rationale for the optimization of the ECT stimulus.

BACKGROUND: Electroconvulsive therapy (ECT) stimulus parameters, such as pulse amplitude, pulse width, pulse frequency, and stimulus duration, differently influence seizure threshold and, possibly, other neurobiological effects of ECT. We examined the influence of these parameters on the EEG power spectrum in an animal model. METHODS: Adult, male, Wistar rats (n=54) were randomized to receive one of five differently constituted (approximately) 30-mC electroconvulsive shock (ECS) stimuli administered once on alternate days for a total of three ECS. A single-lead, unipolar EEG recording was obtained before, during, and immediately after each ECS seizure. EEG power was computed in eight frequency bands from 2 to 40 Hz. Greater ictal EEG power, greater postictal EEG suppression, and greater interictal EEG power, especially in lower frequency bands, were a priori defined as proxies of seizure efficacy. RESULTS: Motor and EEG seizure duration and a proxy for seizure generalization did not differ significantly across the five stimulus groups. Despite equivalent charge, the five stimuli varied widely in their effects on the EEG proxies of seizure efficacy. The narrow (0.6 milliseconds) pulse width, high (100 Hz) pulse frequency combination was best associated with EEG proxies of seizure efficacy; with this combination, a longer stimulus train duration appeared superior to a greater pulse amplitude. The wide (2 milliseconds) pulse and low (30 Hz) frequency combination was least associated with EEG proxies of efficacy. Stimulus "on" time, number of pulses delivered, and the rate of delivery of charge were not associated with the EEG proxies; the former finding questions the validity of dosing ECT in units of charge. CONCLUSIONS: These findings suggest a rationale for optimizing stimulus parameter choices during ECT and provide a framework for the evaluation of electrical aspects of the ECT stimulus.

EEG alpha coherence and psychopathological dimensions of schizophrenia.

The aim of this study was to evaluate the correlation between psychopathological dimensions in recent-onset neuroleptic-naive schizophrenic patients and EEG alpha coherence in the resting state. 37 neuroleptic-naive recent-onset schizophrenic patients were assessed on the Scale for the Assessment of Negative Symptoms and the Scale for the Assessment of Positive Symptoms, and psychopathological dimension scores on reality distortion, psychomotor poverty and disorganization were calculated. EEG alpha coherence was computed across 14 intra-hemispheric and 8 interhemispheric electrode pairs in the resting eyes closed and eyes open conditions. The relationship between the psychopathological dimension scores and coherence values was assessed using Pearson's product moment correlation with Bonferroni correction for levels of significance. Significant associations between higher psychomotor poverty scores and lower inter-hemispheric coherence values were found across the central and parietal regions in the eyes closed condition and across central regions in the eyes open condition. Reality distortion and disorganization dimensions were not significantly correlated with intra- or inter-hemispheric coherences in both eyes closed and eyes open conditions. However there was a trend for an inverse correlation between disorganization dimension and intra-hemispheric coherence across left frontal, left temporo-parietal and right parieto-occipital regions in the eyes open condition. These findings suggest a possible differential pattern in the extent of brain involvement across the three psychopathological dimensions of schizophrenia in neurolepticnaive patients with recent-onset illness.

Mast cell mediation of muscle and pulmonary injury following hindlimb ischemia-reperfusion.

We have observed extensive mast cell degranulation in the reperfused hindlimb muscle of the mouse, accompanied by pathological changes within the muscle. As quantitated by the tissue:blood (125)I permeability ratio, both the hindlimbs and lungs exhibited a significant increment in permeability during hindlimb reperfusion. In lungs of the same mice, mast cell-derived chymase mMCP-1 coats alveolar macrophages, an event noted by us in acid-induced direct lung injury. Mast cells in the lung contain mMCP-1, whereas those in the muscle do not. Neither extensive muscle injury nor an increased pulmonary permeability index occurs in the mast cell-deficient W/W(v) mice. We conclude that the mast cell is a key mediator in both local ischemia-reperfusion injury (I-R) of muscle and consequent remote lung injury.

The presence of v-abl-transformed V3 mast cells in the lungs augments pulmonary vascular permeability to acid aspiration.

Acid aspiration causes pulmonary vascular permeability and PMN sequestration. By increasing pulmonary mast cells through adoptive transfer of v-abl-transformed mast cells (V3MCs) into BALB/c mice, we now show that the greater mast cell number in the lung is associated with increased pulmonary injury.

Apert syndrome variant with overlapping features of Crouzon syndrome.

A rare variant of Apert syndrome having overlapping features of Crouzon syndrome is described. The salient features of the two syndromes are briefly discussed and overlapping features are highlighted. A possible genetic explanation for the same is mentioned.

Free radical-induced generation of isoprostanes in vivo. Evidence for the formation of D-ring and E-ring isoprostanes.

We recently reported the discovery that a series of novel prostaglandin (PG)F2-like compounds (F2-isoprostanes) are produced in vivo independent of the cyclooxygenase as products of free radical-catalyzed lipid peroxidation. F2-isoprostanes are initially formed in situ from arachidonic acid esterified to phospholipids and then released preformed. We have now investigated whether PGD2/E2-like isoprostanes are also produced by rearrangement of the PGG2-like intermediates involved in isoprostane formation. Using a variety of approaches utilizing mass spectrometry, compelling evidence was obtained for the presence of D2/E2-isoprostane-containing phosphospholipids in the liver (85 +/- 33 ng/g of liver) and free D2/E2-isoprostanes in the circulation (215 +/- 90 pg/ml) of rats treated with CCl4 to induce lipid peroxidation. In untreated rats, levels of D2/E2-isoprostanes esterified in liver phospholipids were much lower (0.90 +/- 0.10 ng/g), and free compounds could not be detected in the circulation (< 5 pg/ml). Interestingly, one of the E2-isoprostanes that would be expected to be formed in abundance, 8-epi-PGE2, was found to be a potent renal vasoconstrictor, and these effects could be abrogated by SQ29548, a thromboxane receptor antagonist. Further understanding of the biological consequences of the formation of these novel compounds and factors that influence their formation may provide valuable insights into the pathophysiology of oxidant injury.

Interhemispheric electroencephalographic coherence as a biological marker in alcoholism.

Electroencephalographic coherence scores in 21 teetotaler first-degree relatives of alcoholics, 27 subjects with alcohol dependence and 21 healthy subjects without a family history of alcohol abuse were compared. The relatives had significantly higher coherence scores in the frontal and parietal leads than the alcoholics and in the frontal and centroparietal leads than in the healthy subjects. This might represent a trait marker of resilience in subjects at high risk for the development of alcoholism.

Chirality, charge, and chain branching effects on dithiocarbamate-induced mobilization of cadmium from intracellular deposits in mice.

The effects of three major structural features on the intracellular cadmium mobilizing potency of dithiocarbamates have been examined. These features, the chirality of the groups, the total ionic charge of the chelating agent, and the extent of chain branching, would be expected to affect the pharmacological properties of these chelating agents but to have little effect on the stability constants of the cadmium complexes involved. A total of 25 compounds (including 21 new ones) was prepared and used in animal studies designed to evaluate these effects. These included a series of amphipathic dithiocarbamates of the general type R1N(R2)CS2-Na+, where R1 is a relatively nonpolar organic group and R2 is derived from a reducing hexose. All of the factors examined influenced the potency of dithiocarbamates in the mobilization of cadmium from intracellular deposits. The compounds with R2 = galactose or mannose and R1 = benzyl were both more effective than the corresponding glucose derivatives in inducing the removal of cadmium from the liver and the whole body. Increases in the net negative charge of the chelating agent uniformly decreased the observed potency in the mobilization of hepatic and renal cadmium deposits. The replacement of a normal alkyl group by a branched-chain group of the same molecular weight also led to an increase in potency for the two pairs of compounds examined. Dithiocarbamates which are not amphipathic because of the presence of similar polar substituents for both R1 and R2, such as sodium diarabitylamine carbodithioate, were relatively ineffective as agents for the mobilization of intracellular cadmium.(ABSTRACT TRUNCATED AT 250 WORDS)

Preliminary findings on skin conductance measures in schizophrenics & normal individuals in India.

Skin conductance measures were investigated during response paradigms, in 18 non medicated schizophrenics and 22 normal individuals. Basal, tonic and phasic skin conductance indices were studied in four experimental series consisting of auditory and visual stimuli differing in signal status. No differences were seen in skin conductance basal levels, tonic levels, phasic response or in the incidence of nonresponse in schizophrenics as compared to normal individuals.