The relationships of impulsivity and cardiovascular responses: the role of gender and task type.

The present study was conducted to assess the relationships of impulsivity with both baseline cardiovascular levels and reactivity during two laboratory stressors in both female and male young adults. Heart rate (HR), blood pressure (BP), and heart rate variability (HRV) were measured at rest and during a reaction time and speech task in one hundred and one undergraduate students. Impulsivity was measured using the Barratt Impulsiveness Scale-11 and Block's Ego-Undercontrol Scale. Males and females responded similarly to both laboratory tasks and also did not differ on the impulsivity scales. For males, higher scores on impulsivity were associated with higher systolic BP levels at rest but decreased systolic BP and HR reactivity during the preparation of the speech task; females showed no relationships of resting cardiovascular levels with impulsivity, but more impulsive females did show decreased HR response during speech preparation. No significant relationships were found between impulsivity and either HRV levels or reactivity. It is speculated that tasks involving a degree of planning may be important to find relationships between impulsivity and cardiovascular reactivity, especially in males.

Designing your health benefit plan.

A health care benefit plan should meet the needs and expectations of your organization and its insureds. Each organization is unique, so a health care benefit plan shouldn't be "off the shelf" but be uniquely tailored for your organization. Analyze current demographic, utilization and other data to determine which services members and their families are using and what type of services may be needed in the future.

Term delivery following conservative treatment for villoglandular papillary adenocarcinoma of the uterine cervix: report of a case and analysis of the literature.

BACKGROUND: Villoglandularpapillary adenocarcinoma (VPA) of the cervix is often indolent, and surgical treatment has a favorable outlook. Risk factors include depth of invasion, lymphovascular invasion, and the presence of other histologic types of cancer. CASE: An amputation of the cervical portio was required to satisfactorily resect a 2.5-cm ectocervical lesion in a 28-year-old nulligravida. A diagnosis of pure VPA with a depth of invasion less than 2 mm was established. During a subsequent pregnancy, second trimester ultrasound showed extreme effacement of her cervix and an abdominal cerclage was placed. The pregnancy continued until delivery of a healthy infant at 36 weeks. CONCLUSIONS: In cases of tumor invasion less than 3 mm, and in the absence of lymphovascular space involvement, extrauterine spread of pure VPA has not been described. When conservative treatment is planned, amputation of the cervical portio may be better suited than conization to the achievement of an adequate margin of resection. Cervical cerclage may be needed to offset the extensive cervical surgery.

In vitro fertilization following conservative management of stage 3 serous borderline tumor of the ovary.

Among patients with advanced stage serous borderline tumors of the ovary, those with micropapillary architecture or invasive implants have the greatest risk of malignant transformation. In the absence of these patterns, consideration can be given to preservation of reproductive function. A 28-year-old, nulliparous patient presented with symptoms mimicking advanced ovarian cancer. Histology showed a serous borderline tumor with a hierarchical branching pattern. Surgery was able to remove all visible disease but still preserve the uterus and a portion of one ovary. She subsequently underwent in vitro fertilization and delivered a full-term infant.

Mechanisms of maintenance of tropical freshwater fish communities in the face of disturbance.

Community resistance to, and resilience from, perturbation will determine the trajectory of recovery from disturbance. Although selective timber extraction is considered a severe disturbance, fish communities from headwater streams around Danum Valley Field Centre, Sabah, Malaysia, showed few long-term changes in species composition or abundance. However, some species showed short-term (< 18 months) absence or decrease in abundance. These observations suggested that both resistance and resilience were important in maintaining long-term fish community structure. Resistance to perturbation was tested by monitoring fish communities before and after the creation of log-debris dams, while resilience was investigated by following the time-course of recolonization following complete removal of all fish. High community resistance was generally shown although the response was site-specific, dependent on the composition of the starting community, the size of the stream and physical habitat changes. High resilience was demonstrated in all recolonization experiments with strong correlations between pre- and post-defaunation communities, although there was a significant difference between pool and riffle habitats in the time-course of recovery. These differences can be explained by the movement characteristics of the species found in the different habitats. Resilience appeared to be a more predictable characteristic of the community than resistance and the implications of this for ensuring the long-term persistence of fish in the area are discussed.

Issues in the monopharmacotherapy and polypharmacotherapy of obsessive-compulsive disorder.

Polypharmacotherapy is again becoming common place in clinical practice. Obsessive-compulsive disorder (OCD) as a single primary diagnosis is responsive exclusively to the serotonin reuptake inhibitors (SRIs) and this fact forms the major evidence supporting a central role for 5-HT (serotonin) in the pathogenesis of the disorder. Presently, the highly potent serotonin reuptake inhibitors clomipramine, fluoxetine, fluvoxamine, and paroxetine are the only agents approved by the Food and Drug Administration (FDA) for OCD, but there is evidence that other SRIs, such as sertraline, are also effective. Because OCD is often treatment refractory and highly comorbid with other psychiatric disorders, the use of polypharmacotherapy can be justified. Other serotonergic medications such as lithium, buspirone, trazodone, or fenfluramine may be useful as adjuvant treatments in treatment-refractory OCD and adjuvant antipsychotics are useful in tic disorders, personality disorders, and psychotic disorders. The usefulness of polypharmacotherapy should be tempered by adverse effects including the serotonin syndrome, withdrawal phenomena, extrapyramidal side effects, and drug-drug interactions.

A prediction model for identifying alcohol withdrawal seizures.

A retrospective review of alcohol withdrawal seizures was performed at a private chemical-dependence treatment facility to help identify patients who were at high risk for having a seizure. Patients were identified by two means: controlled substance records were reviewed to determine patients having received intramuscular phenobarbital, and patient charts were reviewed for all patients with a discharge diagnosis of a seizure disorder. Two thousand and one patient records were reviewed; alcohol withdrawal seizure patients were identified. Twenty-eight randomly selected nonseizure patient records served as controls. The statistical test consisted of a discriminant function analysis. The data yielded a statistically significant predictive model for alcohol withdrawal seizures based on six interdependent patient variables which will be helpful in treating future patients undergoing alcohol withdrawal.

Cardiovascular effects of imipramine, fluvoxamine, and placebo in depressed outpatients.

BACKGROUND: The data presented represent cardiovascular parameters collected from one site of a larger, multicenter, double-blind, placebo-controlled, 6-week outpatient efficacy study of the serotonin uptake inhibitor fluvoxamine in depressed outpatients. METHOD: In this smaller study, we compared fluvoxamine (N = 17) to the prototypic antidepressant, imipramine (N = 14), and to placebo (N = 15). Specific parameters investigated were drug effects on postural pulse and blood pressure changes and ECG parameters including PR, QRS, and QTc intervals and ventricular heart rate. RESULTS: Fluvoxamine had few effects on measured parameters. Imipramine produced statistically significant changes on all measures; placebo had no effects on cardiac measures. CONCLUSION: Our data support that fluvoxamine, in a sample of healthy depressed outpatients, has little effect on cardiovascular function. Further study and clinical experience with this drug will be necessary before the full extent of its cardiac profile is known.

Effect of fluvoxamine, imipramine and placebo on catecholamine function in depressed outpatients.

Many of the specific serotonin reuptake inhibitors appear to have some effect on noradrenergic function. Fluvoxamine is one of the newer agents and its specificity has not been fully assessed. Depressed patients participating in a study comparing the efficacy of fluvoxamine with imipramine and placebo collected 24 hour urine samples (N = 38) and had plasma samples drawn (N = 38) prior to and after 6 weeks of double blind treatment. Urine samples were analyzed for 24 hour output of MHPG, VMA, NMN, MN and HVA. Plasma samples were analyzed for NE levels. Imipramine treatment produced a reduction in urinary MHPG, an increase in the ratio of NMN to MHPG plus VMA, and a trend towards an increase in plasma NE which was significantly different than the effects seen in the fluvoxamine and placebo groups. There was an additional finding in the imipramine group of a significant correlation between percentage change in plasma NE and clinical improvement. Fluvoxamine treatment, on the other hand, produced no clear effect on any measure of noradrenergic function and the antidepressant efficacy of fluvoxamine was unrelated to any noradrenergic variable. These findings lend support to the hypothesis that fluvoxamine does not have significant effects on noradrenergic function.

Silastic joint arthroplasty of the great toe. A review of 228 implants using the double-stemmed implant.

Various operations have been advocated in the treatment of hallux valgus (bunions) and other painful conditions affecting the great toe, e.g., osteoarthritis, rheumatoid arthritis, and deformity. Resection arthroplasty using a double-stemmed silicone implant has proved a satisfactory method. A retrospective review of 228 implants followed over a period of eight years (average, four years) showed complete patient acceptance in 89%.

Prediction of response to antipsychotics.

This review surveys the literature in the area of predictors of response to antipsychotic drugs. Four general categories are presented and discussed: diagnosis as a predictor, clinical predictors, biological predictors, and pharmacological predictors. No single consistent predictor of response could be discerned; it appears that a variety of factors affect outcome and that several variables must be considered simultaneously. Based on the findings of this review, suggestions for improvements in clinical research design are made.