Primary placement of a titanium motility post in a porous polyethylene orbital implant: animal model with quantitative assessment of fibrovascular ingrowth and vascular density.

PURPOSE: To determine whether a Medpor porous polyethylene orbital implant, at the time of initial orbital implant surgery, will tolerate the insertion of a titanium screw on the anterior surface of the implant. METHODS: Twelve New Zealand white rabbits were enucleated and implanted with a porous polyethylene orbital implant. At the time of enucleation, the porous polyethylene orbital implants were drilled, and titanium motility coupling posts were inserted. The motility coupling posts were inserted at two projection heights (2 or 4 mm) and either covered within Tenon capsule/conjunctiva (eight implants) or left exposed (four implants). Rabbits were killed at 6 or 12 weeks. Clinical tissue tolerance, histologic response to the motility coupling post, and vascular density of the porous polyethylene orbital implant were evaluated. RESULTS: The motility coupling posts were well tolerated, and extrusion or migration of the motility coupling post did not occur. The average percentage cross-sectional area of the implant occupied by fibrovascular tissue at 6 and 12 weeks was 76.3% and 97.5%, respectively. In comparing the vascular density (number of vessels per square millimeter) in the porous polyethylene orbital implant within a 1-mm zone immediately surrounding the motility coupling post, no significant difference between this zone and the vascular density found within its entire corresponding annulus was found at either 6 or 12 weeks. CONCLUSIONS: During the 6- and 12-week observation periods, all implanted motility coupling posts demonstrated favorable tissue tolerance and stable interfaces with surrounding tissues. The extent of fibrovascular tissue ingrowth and vascular density verify that initial screw insertion does not adversely affect the healing process after porous polyethylene orbital implant implantation. Thus, primary placement of the motility coupling post may obviate the need for a secondary surgical procedure.

Hypnosis and suggestion-based approaches to smoking cessation: an examination of the evidence.

This article reviews 59 studies of hypnosis and smoking cessation as to whether the research empirically supports hypnosis as a treatment. Whereas hypnotic procedures generally yield higher rates of abstinence relative to wait-list and no-treatment conditions, hypnotic interventions are generally comparable to a variety of nonhypnotic treatments. The evidence for whether hypnosis yields outcomes superior to placebos is mixed. In short, hypnosis cannot be considered a specific and efficacious treatment for smoking cessation. Furthermore, in many cases, it is impossible to rule out cognitive/behavioral and educational interventions as the source of positive treatment gains associated with hypnotic treatments. Hypnosis cannot, as yet, be regarded as a well-established treatment for smoking cessation. Nevertheless, it seems justified to classify hypnosis as a "possibly efficacious" treatment for smoking cessation.

Hypnosis, context effects, and the recall of early autobiographical memories.

This study found that attempts to recall earliest memories were strongly influenced by the testing context. It showed that a brief 3-minute self-hypnosis experience, coupled with the insinuation that hypnosis improves memory, resulted in earlier autobiographical memory reports (M = 29.5 months) than instructions for relaxation (M = 37.9 months) or counting/visualization (M = 48.9 months). Inquiries about earliest memories across 5 age ranges showed that the hypnotic context resulted in a higher proportion of participants reporting a memory at or before 12, 24, 36, 48, and 60 months of age. Nearly 40% of the "hypnotized" participants reported a memory for an event that reportedly occurred at or before 12 months of age. A brief discussion of context effects and demand characteristics associated with hypnosis and memory follows.

Hypnotizability, the dissociative experiences scale, HGSHS: A amnesia, and automatic writing: is there an association?

The present study examined whether participants (N = 112) selected on the basis of high and low dissociative ability (Dissociative Experiences Scale [DES]; Bernstein & Putnam, 1986), high and low/simulating hypnotizability (Harvard Group Scale of Hypnotic Susceptibility, Form A [HGSHS:A]; Shor & Orne, 1962), and past performance on the HGSHS:A amnesia item differentially passed an automatic writing suggestion administered during a follow-up experiment. Results from a loglinear analysis supported a single main effect for hypnotizability. Low hypnotizable, simulating participants were more than six times as likely to pass the automatic writing suggestion than high hypnotizable participants. Results found dissociation status and past performance on an ostensibly dissociative suggestion (i.e., amnesia) to be independent of passing the automatic writing suggestion. Findings are discussed in light of other research regarding the relation between the DES and hypnotizability.

Removal of an infected silicone rod frontalis sling without recurrence of ptosis.

We examined a child with congenital ptosis. She underwent a bilateral silicone rod frontalis sling operation. One of the slings became infected and necessitated removal. We noticed no recurrence of her ptosis after sling removal. Removal of a frontalis sling does not invariably lead to recurrence of ptosis. We hypothesize that a scar tract formed in the plane of tissue from which the sling was removed. This band of scar tissue can act as a frontalis sling to elevate the eyelid.

"Normal pressure" pseudotumor cerebri.

We present a case report of a patient with clinical features suggestive of pseudotumor cerebri (PTC), without a documented elevated measurement of intracranial pressure (ICP). Chart review was done of one patient's clinical course over a 28-month period. The patient was treated for PTC even though she never had a documented elevated ICP. Her signs and symptoms, including headache, disc edema, and visual field loss, all showed improvement with standard PTC therapy, which ultimately included optic nerve sheath fenestration (ONSF). Her presenting symptoms of clinical depression were also relieved with this treatment. PTC may present without an elevated ICP as defined by current standards. Some patients may be more susceptible to lower levels of ICP and develop this syndrome, and it may be responsive to standard PTC therapy. Further investigation may warrant that clinical depression be included as another minor symptom of PTC.

Lack of a precursor-product relationship between histamine and its metabolites in brain after histidine loading.

Levels of histamine and its major metabolites in brain, tele-methylhistamine (t-MH) and tele-methylimidazoleacetic acid (t-MIAA), were measured in rat brains up to 12 h after intraperitoneal administration of L-histidine (His), the precursor of histamine. Compared with saline-treated controls, mean levels of histamine were elevated at 1 h (+102%) after a 500 mg/kg dose; levels of t-MH did not increase. Following a 1,000 mg/kg dose, mean histamine levels were increased for up to 7 h, peaked at 3 h, and returned to control levels within 12 h. In contrast, levels of t-MH showed a small increase only after 3 h; levels of t-MIAA remained unchanged after either dose. Failure of most newly formed histamine to undergo methylation, its major route of metabolism in brain, suggested that histamine was metabolized by another mechanism possibly following nonspecific decarboxylation. To test this hypothesis, other rats were injected with alpha-fluoromethylhistidine (alpha-FMHis; 75 mg/kg, i.p.), an irreversible inhibitor of specific histidine decarboxylase. Six hours after rats received alpha-FMHis, the mean brain histamine level was reduced 30% compared with saline-treated controls. Rats given His (1,000 mg/kg) 3 h after alpha-FMHis (75 mg/kg) and examined 3 h later had a higher (+112%) mean level of histamine than rats given alpha-FMHis, followed by saline. Levels of t-MH and t-MIAA did not increase. These results imply that high doses of His distort the simple precursor-product relationship between histamine and its methylated metabolites in brain. The possibility that some His may undergo nonspecific decarboxylation in brain after His loading is discussed. These findings, and other actions of His independent of histamine, raise questions about the validity of using His loading as a specific probe of brain histaminergic function.

pros-Methylimidazoleacetic acid in cerebrospinal fluid of patients with chronic schizophrenia: relationships to ratings of symptoms, ventricular brain ratios, and rates of urine excretion.

Concentrations of pros-methylimidazoleacetic acid (p-MIAA) were measured in cerebrospinal fluid of 30 patients with chronic schizophrenia. Levels of p-MIAA correlated negatively with mean scores of the Psychiatric Symptom Assessment Scale for positive symptoms (r = -0.48), but not negative symptoms, and with ventricular brain ratios (r = -0.48). Patients with abnormal ventricular enlargements had much lower concentrations of p-MIAA than those with normal ventricles. These results suggest that processes that reduce accumulation of p-MIAA in CSF may be associated with increased severity of symptoms among patients with chronic schizophrenia.

The relationship between urine excretion and biogenic amines and their metabolites in cerebrospinal fluid of schizophrenic patients.

Concentrations of norepinephrine and metabolites of biogenic amines were measured in lumbar cerebrospinal fluid of 30 patients with chronic schizophrenia, nine of whom were polyuric. The mean level of norepinephrine was two-fold higher (p < or = 0.025) in polyuric patients than in patients whose excretion of urine was within the normal range. CSF levels of histamine's primary metabolite, tele-methylhistamine, an index of brain histaminergic activity, were positively correlated (p < 0.005) with daily urine volume. These results are consistent with the known influence of norepinephrine and histamine on fluid regulation and suggest that norepinephrine and histamine may be involved in psychogenic polydipsia-polyuria in schizophrenic patients.

Bone formation in hydroxyapatite orbital implants.

PURPOSE: We examined the histopathologic features of two hydroxyapatite orbital implants that were removed from two patients. METHODS: Two surgically removed hydroxyapatite orbital implants were decalcified and processed for routine light microscopic examination. RESULTS: Both implants demonstrated fibrovascular ingrowth and foci of bone formation. CONCLUSION: Bone may form in hydroxyapatite orbital implants.

Nasopharyngeal carcinoma. A study examining Asian patients treated in the United States.

From 1972 to 1991, 126 Asian patients with nasopharyngeal carcinoma underwent definitive radiation therapy for locoregional disease: 86 men, 40 women. Median age was 50. All patients received external-beam irradiation with cobalt 60 or 4-18 MV x-rays. Local recurrence, regional recurrence, and distant metastases were 22%, 11%, and 23%, respectively. Local recurrence progressively increased with increasing T stage, but doses in those who recurred did not differ from the group as a whole. Regional recurrence was not associated with T or N stage or dose. Patients with N2 disease had the highest distant metastatic rate. The 5- and 10-year overall survival rates were 54% and 38%, respectively. Of age, gender, and histology, only age less than 50 was found to be favorably prognostic. No severe long-term complications were observed, and acute reactions were acceptable. Our survival results are comparable with results found both in Asia and North America. Nonetheless, altered fractionation techniques and/or other radiation modalities should be further explored to improve locoregional control.

Release of glutamate from striatum of freely moving rats by pros-methylimidazoleacetic acid.

The effect of pros-methylimidazoleacetic acid (p-MIAA) was measured on the release of glutamate and aspartate from cerebral cortex, hippocampus, and striatum of freely moving rats, and on the uptake of 14C by striatal slices incubated in the presence of L-[14C]-glutamate. Twenty-four hours after implantation of a dialysis fiber, striatum, hippocampus, or cerebral cortex spontaneously released both glutamate and aspartate in the micromolar range. p-MIAA (1 microM to 1 mM), added to the dialysis perfusate, elicited a concentration-dependent increase of glutamate release from striatum with a maximal increase of about threefold. This effect did not occur in hippocampus or cortex. In none of these regions did p-MIAA increase aspartate release significantly. The p-MIAA effect was not mimicked by its isomer tele-methyl-imidazoleacetic acid. p-MIAA did not influence the uptake of glutamate by striatal slices. The glutamate-releasing action of p-MIAA may affect striatal function and explain the positive correlation between levels of p-MIAA in CSF and the severity of Parkinson's disease.

Histamine metabolites in cerebrospinal fluid of patients with chronic schizophrenia: their relationships to levels of other aminergic transmitters and ratings of symptoms.

Levels of the histamine metabolites, tele-methylhistamine (t-MH) and tele-methylimidazoleacetic acid (t-MIAA), and metabolites of other aminergic transmitters and of norepinephrine were measured in cerebrospinal fluid of 36 inpatients with chronic schizophrenia and eight controls. The mean t-MH level from controls was nearly identical to the levels seen previously in healthy volunteers. Compared with controls, the mean level of t-MH in the schizophrenic patients was 2.6-fold higher (p = 0.006); 21 of the patients had levels exceeding the range of controls. There was no significant difference (p > 0.05) in levels of other analytes, although the levels of t-MH correlated significantly with those of t-MIAA, homovanillic acid, 3,4-dihydroxyphenylacetic acid, norepinephrine, 3-methoxy-4-hydroxyphenylglycol and 5-hydroxyindoleacetic acid. The difference in levels of t-MH were not attributable to medication, since those taking (n = 10) or withdrawn from (n = 26) neuroleptic drugs had nearly the same mean levels of t-MH; each group had higher levels than controls (ANOVA: p < 0.05). Patients with or without tardive dyskinesia showed no significant differences in means of any analyte. Only levels of t-MH among those with schizophrenia correlated with positive symptom scores on the Psychiatric Symptom Assessment Scale (rs = 0.45, p < 0.02). The elevated levels of t-MH in cerebrospinal fluid, which represent histamine that was released and metabolized, suggest increased central histaminergic activity in patients with chronic schizophrenia.

Reasoning abilities in Psy.D. and Ph.D. clinical graduate students: a preliminary study.

Clinical students in regionally representative Psy.D. and Ph.D. programs responded to a questionnaire that assessed everyday reasoning and psychological knowledge. Ph.D.s scored higher on the Methodology Reasoning test and the Conditional Probability test, while there were no differences on the Verbal or Statistical Reasoning tests or the Psychology questions. Calibration curves indicated that Psy.D.s tended to be somewhat more overconfident in their responses than Ph.D.s. Similarities and differences between the performance of the Psy.D.s and Ph.D.s are discussed, as well as the limitations and implications of the study.

Measurement of histamine metabolites in brain and cerebrospinal fluid provides insights into histaminergic activity.

Measurements of the concentrations of histamine's metabolites, tele-methylhistamine (t-MH) and tele-methylimidazoleacetic acid (t-MIAA), in brain have been used to evaluate histamine turnover in brains of animals, and the same measurements in CSF have been used to infer histaminergic activity in brains of man. In regions of rat brain, half-lives of histamine are shorter than those of dopamine, 5-hydroxytryptamine and norepinephrine. Studies of human CSF suggest that brain histaminergic activity increases with age and is higher in females than in males.

Clinical and research attitudes of Psy.D. and Ph.D. clinical graduate students.

A survey of 137 Psy.D. and Ph.D. clinical graduate students out of 561 at 4 Ph.D. schools and 4 Psy.D. schools indicated that these Ph.D. students found knowledge of statistics and research design to be more useful than the 98 Psy.D. students. A need to replicate and to ascertain the basis for such differences was discussed.