No benefit of antidepressants in inpatient treatment of depression. A longitudinal, quasi-experimental field study.

RATIONALE: Antidepressants (AD) are mostly considered indispensable for the treatment of major depression. The vast majority of depressive inpatients are treated with AD. However, there is a growing body of studies indicating that the effectiveness of AD is greatly overestimated due to methodological issues with the AD efficacy studies (e.g., publication bias, unintentional unblinding, confusion between withdrawal symptoms and relapse). OBJECTIVES: The benefit of the additional use of AD in the inpatient treatment of depression with intensive cognitive-behavioral therapy (CBT) has been investigated in a naturalistic design. METHODS: Depressiveness was assessed using the Beck Depression Inventory (BDI-II) during a preliminary interview (T0), at admission (T1), at discharge (T2), and at a 6-month follow-up (T3). Two study phases were compared: During Phase A, AD were recommended in accordance with the German guideline. In Phase B, AD were no longer recommended, and they were only prescribed upon explicit request from patients. In phase A (N = 574), 60.3% of all patients were taking AD at discharge. In Phase B (N = 424), 27.9% of patients were on AD at discharge. Apart from the difference in AD usage, the two treatment conditions were similar, and the samples did not significantly differ in terms of age, sex, diagnoses, history of suicide attempts, comorbid anxiety disorders, and unemployment. RESULTS: In both study phases, BDI-II scores were strongly decreased at T2 and T3, respectively, compared with T1. The BDI-II scores of the two phases did not differ at any of the measurement time points. Depression changes were similar in both phases. In sequential multiple regression analyses with the total sample, AD were no significant predictors for the reduction of depression at either T2 or T3. CONCLUSIONS: The inpatient CBT was effective in depression. The effectiveness of CBT is not improved by the additional use of AD. The current prescribing practices of AD should be questioned.

Survivorship and long-term outcome of a consecutive series of 200 Scandinavian Total Ankle Replacement (STAR) implants.

AIMS: We report the long-term clinical and radiological outcomes of a consecutive series of 200 total ankle arthroplasties (TAAs, 184 patients) at a single centre using the Scandinavian Total Ankle Replacement (STAR) implants. PATIENTS AND METHODS: Between November 1993 and February 2000, 200 consecutive STAR prostheses were implanted in 184 patients by a single surgeon. Demographic and clinical data were collected prospectively and the last available status was recorded for further survival analysis. All surviving patients underwent regular clinical and radiological review. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scoring system. The principal endpoint of the study was failure of the implant requiring revision of one or all of the components. Kaplan-Meier survival curves were generated with 95% confidence intervals and the rate of failure calculated for each year. RESULTS: A total of 84 patients (87 ankles) were alive by the end of this study. Of the surviving 84 patients (87 ankles; rheumatoid arthritis (RA), n = 40; OA, n = 47), 45 were women and 39 were men, with a mean age of 54 years (18 to 72 years) at the time of surgery. A total of 32 implants failed (16%), requiring revision surgery. The mean time to revision was 80 months (2 to 257). The implant survival at 15.8 years, using revision as an endpoint, was 76.16% (95% confidence interval (CI) 64.41 to 87.91). We found a steady but low decrease in survival over the study period. The mean AOFAS score improved from 28 (10 to 52) preoperatively to 61 (20 to 90) at long-term follow-up. CONCLUSION: STAR prostheses in the United Kingdom have now been largely superseded by newer design TAAs, potentially with improved characteristics and surgical techniques. The long-term survivorship for the STAR prosthesis can provide a benchmark for these later designs of ankle arthroplasty.

Intraosseous epidermoid cysts of the hand skeleton: a series of eight patients.

This paper reviews the clinical and radiographic features and treatment results in eight patients with intraosseous epidermoid cysts in the terminal phalanx of a finger seen over a period of 26 years. Data on age, sex, occupation, diagnostic findings, history of injury in six cases, treatment and follow-up were obtained by reviewing medical records and the histopathological findings using the hospital database. The most frequent symptoms of pressure pain, tenderness, redness and swelling occurred at a median time of 12 years after trauma. Male patients were mainly affected (7:1). In four the intraosseous epidermoid cysts were confused with other osteolytic diseases before surgery. Magnetic resonance imaging is recommended in any case of an osteolytic, expanding lesion, particularly in cases that are clinically and radiologically not obviously an intraosseous epidermoid cyst.

Low Ca2+ buffering in hypoglossal motoneurons of mutant SOD1 (G93A) mice.

Mutations in the Cu/Zn superoxide dismutase (SOD1) gene are associated with amyotrophic lateral sclerosis (ALS), a fatal neurodegenerative disorder characterized by a selective degeneration of brainstem and spinal motoneurons. The pathomechanism of degeneration is still incompletely understood, but includes a disruption in cellular Ca2+ homeostasis. Here we report a quantitative microfluorometric analysis of the Ca2+ homeostasis in vulnerable hypoglossal motoneurons of neonatal mutant (G93A) SOD1 transgenic mice, a mouse model of human ALS. Ca2+ transient decay times (tau = 0.3 s), extrusion rates (gamma = 92 s(-1)) and exceptionally low intrinsic Ca2+ binding ratios (kappaS = 30) were found to be in the same range as compared to non-transgenic animals. Together with the previous observation of high Ca2+ binding ratios in ALS-resistant neurons (e.g. oculomotor), this supports the assumption that low Ca2+ buffering in vulnerable motoneurons represents a significant risk factor for degeneration. On the other hand, alterations in buffering properties by expression of mutant SOD1 are unlikely to be involved in disease initiation.

Childbirth customs in Orthodox Jewish traditions.

OBJECTIVE: To describe cultural beliefs of Orthodox Jewish families regarding childbirth in order to help family physicians enhance the quality and sensitivity of their care. QUALITY OF EVIDENCE: These findings were based on a review of the literature searched in MEDLINE (1966 to present), HEALTHSTAR (1975 to present), EMBASE (1988 to present), and Social Science Abstracts (1984 to present). Interviews with several members of the Orthodox Jewish community in Edmonton, Alta, and Vancouver, BC, were conducted to determine the accuracy of the information presented and the relevance of the paper to the current state of health care delivery from the recipients' point of view. MAIN MESSAGE: Customs and practices surrounding childbirth in the Orthodox Jewish tradition differ in several practical respects from expectations and practices within the Canadian health care system. The information presented was deemed relevant and accurate by those interviewed, and the subject matter was considered to be important for improving communication between patients and physicians. Improved communication and recognition of these differences can improve the quality of health care provided to these patients. CONCLUSIONS: Misunderstandings rooted in different cultural views of childbirth and the events surrounding it can adversely affect health care provided to women in the Orthodox Jewish community in Canada. A basic understanding of the cultural foundations of potential misunderstandings will help Canadian physicians provide effective health care to Orthodox Jewish women.

Childbirth customs in Vietnamese traditions.

OBJECTIVE: To examine and understand how differences in the cultural backgrounds of Canadian physicians and their Vietnamese patients can affect the quality and efficacy of prenatal and postnatal treatment. QUALITY OF EVIDENCE: The information in this paper is based on a review of the literature, supplemented by interviews with members of the Vietnamese community in Edmonton, Alta. The literature was searched with MEDLINE (1966 to present), HEALTHSTAR (1975 to present), EMBASE (1988 to present), and Social Sciences Abstracts (1984 to present). Emphasis was placed on articles and other texts that dealt with Vietnamese customs surrounding childbirth, but information on health and health care customs was also considered. Interviews focused on the accuracy of information obtained from the research and the correlation of those data with personal experiences of Vietnamese community members. MAIN MESSAGE: Information in the texts used to research this paper suggests that traditional Vietnamese beliefs and practices surrounding birth are very different from the biomedical view of the Canadian medical system. The experiences and beliefs of the members of the Vietnamese community support this finding. Such cultural differences could contribute to misunderstandings between physicians and patients and could affect the quality and efficacy of health care provided. CONCLUSIONS: A sensitive and open approach to the patient's belief system and open and frank communication are necessary to ensure effective prenatal and postnatal treatment for recent Vietnamese immigrants and refugees. Education and awareness of cultural differences are necessary for physicians to provide the best and most effective health care possible.

PIP: A review of the literature dating back to 1966, supplemented by interviews with members of the Vietnamese community in Edmonton, Alberta, was conducted to examine and understand how differences in the cultural backgrounds of Canadian physicians and their Vietnamese patients can affect the quality and efficacy of prenatal and postnatal treatment. The available data suggest that traditional Vietnamese beliefs and practices regarding birth are very different from the biomedical view held by the Canadian medical system. The experiences and beliefs of the Vietnamese respondents support this finding. Such cultural differences could contribute to misunderstandings between physicians and patients, and affect the quality and efficacy of health care provided. A sensitive and open approach to the patient's belief system, and open and frank communication are needed to ensure effective prenatal and postnatal treatment for recent Vietnamese immigrants and refugees.

[Evaluation of a complex trace element composition and bioutilization using isotope technics and total body measurement]. / Komplex nyomelem készítmény biológiai hasznosulásának tanulmányozása izotópos nyomjelzéstechnika és egésztest-mérés alkalmazásával.

Modified mineral and trace element solutions were prepared containing Zn-65, Co-57, Mn-54, Fe-59, Mo-99 and Ni-63 isotopes which were physico-chemically identical to the original solution. Bioutilization examinations were carried out on animals receiving their normal feeding, after p. os application of complex trace element composition (CTEC) namely whole-body retention studies, bioassays, scintigraphic and excretion examinations in altogether 180 Wistar rats, 6 Beagle and 2 mongrel dogs using whole body counter, gamma and beta counters, gamma camera and metabolic cages. Extremely high whole body retention was measured in case of iron (8-30%), high utilizations in case of zinc (4-5%), cobalt (4-6%), molybdenum (3-4%) and manganese (2-4%) and a lower value in case of nickel. Bioassay and scintigraphic evaluations showed marked liver-, kidney-, and muscle and moderated blood uptakes. The way of excretion was mainly (more than 90%) via the faeces in case of zinc, manganese, iron and nickel, although cobalt excreted in 8% and molybdenum in 52% via the urinary tract. Our results show, that isotope technique combined with whole body counting and excretion studies in an available method for trace element bioutilization studies.

Mobilization of radioactive strontium from mouse and rat using dicarboxylic acid derivatives of cryptand (2.2).

To date, there has been no effective therapy to counter incorporated radionuclides of strontium. In an endeavour to solve this problem, we have synthesized and evaluated various N,N'-disubstituted derivatives of 1,4,10,13-tetraoxa-7,16-diaza-cyclooctadecane(crypt and 2.2) for their ability to mobilize 85Sr2+. These ligands are water soluble and have a relatively low acute i.v. toxicity, as demonstrated by their evaluation in rat and mouse. The di-sodium-calcium complex and tetra-sodium salt of the cryptand (2.2) dimalonate have exerted a remarkable decorporation effectiveness for 85Sr2+ in extracellular space. The tetra-potassium salt of the cryptand (2.2) dimalonate has a moderate effect, while no mobilization activity can be detected with the cryptand (2.2) that does not have a side chain substituent. Animals were initially given 85SrCl2 either i.p. or into the lung, then the compounds were administered 30-60 min later using an alternative route. The degree of decorporation achieved a 80-95% of the initial body burden (ibb) compared with the control values of 20-30%. The agents are resorbed easily from the lung, and the radiostrontium deposition in bone was inhibited strongly by a decorporation agent. The success of the treatment, however, is dependent upon the speed with which decorporation therapy commences.

Adenylate cyclase-the more membrane associated, the less radiosensitive.

A dose dependent but not parallel decreases were observed both in SH content and catalytic activity of "free" catalytic subunit after irradiation (0-3200 Gy), while SH groups of membrane-associated adenylate cyclase were insensitive (under 3200 Gy). An initial "radioactivation" of membrane-associated enzyme was found under 800 Gy, then an inhibition above 1600 Gy. The SH alkylating agent, N-ethylmaleimide resulted in a complete inactivation, both of membrane associated form of adenylate cyclase and "free" catalytic subunit with similar inactivation profiles. These data indicate that in the radiosensitivity or "radioprotection" of adenylate cyclase, its membrane association/integration might play a more important role than the SH groups themselves.

Radiation response of E. coli after combined treatment with misonidazole and WR-2721 at various oxygen concentrations.

It has been reported that the aminothiol compound WR-2721 is a promising radioprotective agent and in combination with misonidazole (MISO) seems to be of therapeutic benefit. Since the radiomodification is oxygen-dependent, the actual oxygen status of cells and the surrounding media is an important factor influencing their effectiveness. Escherichia coli B/r radioresponse was studied either alone or in combination with these compounds at various oxygen concentrations ranging from anoxia to high oxygen content. WR-2721 had a protective effect under anoxic conditions and gave overall protection when oxygen was present. The maximum protection was seen at 3.2% O2 in N2 (PF 2.08). In combination with MISO the hypoxic sensitization of MISO was completely abolished by WR-2721, resulting in radioprotection under hypoxic conditions as well. Under euoxic conditions MISO was able to reduce the protective effect of WR-2721 by about 21%. According to our results MISO and WR-2721 influence each other in their radiomodifying effect in either fixation or repair of the radiation-induced damage.

Alterations in monoamine oxidase activity of the mouse brain and liver after mixed neutron-gamma irradiation.

Monoamine oxidase (MAO) plays an important role in the metabolism of neuro-transmitter biogenic amines. Its activity was determined in mouse brain and liver after exposure to different kinds of ionizing radiation and after pretreatment with a radioprotective agent. After a lethal dose of mixed neutron-gamma irradiation the MAO activity decreased in the brain and increased in the liver. In contrast, after a lethal dose of 60Co-gamma irradiation enzyme activity was considerably increased in the brain while in the liver it increased like after mixed neutron-gamma irradiation. AET (S2-aminoethyl-isothiuronium-Br X HBr), when administered in a radio-protective dose, inhibited MAO activity in the brain, while it increased in the liver. Even more marked changes of enzyme activity were observed in both brain and liver after AET pretreatment and mixed neutron-gamma irradiation. On the basis of the results it is suggested that different kinds of ionizing radiation lead to different types of lipid peroxidation in the lipid environment surrounding MAO, an event leading to altered enzyme activity. AET itself inhibited MAO in the brain and increased the activity in the liver but did not prevent the alterations caused by ionizing radiation in enzyme activity.

[Absorption and distribution of 1-(2,5-dichlorophenoxy)-3-tert-butylaminopropen-2-ol in aerosols]. / Resorption und Verteilung von 1-(2,5-Dichlorphenoxy)-3-tert-butylaminopropen-2-ol in Aerosolen.

The absorption and distribution of the slightly water-soluble, carbon-14-labelled 1-(2,5-dichlorophenoxy)-3-tert-butylaminopropen-2-ol hydrochloride (1) from sprays and suspension aerosols have been studied in mice. It was found that the blood level and the organ concentrations achieved with suspension aerosols were higher than those obtained with sprays.

[Absorption and distribution of benzyloxyamine-containing aerosols (author's transl)]. / Resorption und Verteilung Benzyloxyamin enthaltender Aerosole.

The study of the blood levels and tissue concentrations in mice to which 14C-benzyloxyamine hydrochloride was applied in the form of a spray and of a suspensoid aerosol evidenced the good abosrption of this pharmacon. Maximum blood levels were observed 0.5 hour after administration of the spray. When the aerosol was given, the blood levels increased progressively and reached maximum values at the end of the experiment, 4 hours after application. The concentrations found in the lung, stomach, kidney and liver were, in general, higher on suspensoid aerosol application (maximum values being reached after 1--2 hours) than on spray administration.