Extensor tendon rupture after internal fixation of a distal radius fracture using a dorsally placed AO/ASIF titanium pi plate. Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation.

Extensor tenosynovitis has been reported as a complication of the Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) pi plate. The authors present a case of extensor tendon rupture after internal fixation with a pi plate after one of the screws in the distal limb loosened. This mechanism of extensor tendon rupture has not been reported previously. With appropriate prevention, monitoring, and intervention this complication could have been avoided. Schnur DP, Chang B. Extensor tendon rupture after internal fixation of a distal radius fracture using a dorsally placed AO/ASIF titanium pi plate.

The orienting response in schizophrenia and mania.

We examined skin conductance (SCR) and finger pulse amplitude response (PULSE) in 53 schizophrenic, 30 manic, and 28 control subjects to provide information on orienting response (OR) dysfunction in severe psychiatric disorders. SCR and PULSE to neutral and task-relevant tones were measured in acutely ill inpatients and normal control subjects on two occasions separated by a 3-week interval. There were no significant group differences in proportions of SCR and PULSE non-responders to neutral tones. PULSE frequency to task-relevant tones in both the schizophrenic and manic patients was lower than that for the control subjects in both OR sessions, but did not differ significantly between patient groups. Although PULSE frequency was inversely related to neuroleptic dose in the schizophrenia sample, reanalysis of unmedicated patients did not change our results. OR frequency to task-relevant but not to neutral tones exhibited test-retest reliability. Certain aspects of OR dysfunction may overlap in schizophrenia and bipolar disorder. Our failure to demonstrate excessive OR non-responding to neutral tones in schizophrenia patients is inconsistent with many previous studies but may be due to a high proportion of OR non-responders among the control subjects.

Hillside study of risk and early detection in schizophrenia.

BACKGROUND: The Hillside Study of Risk and Early Detection in Schizophrenia is a prospective study of young probands (ages 14-28) and their at-risk siblings (ages 14-24). A major goal is the identification of early predictors of illness that will facilitate intervention. The project design and pilot study are discussed. METHOD: Fifteen adolescents were compared to 14 typical age-of-onset adults, all undergoing their first hospitalisation for schizophrenia. RESULTS: There were no differences between adolescents and adults on any of the measures administered (i.e. attention, eye tracking, neurocognitive or clinical). In addition, for the sample overall, no association was found between neurocognitive functions and clinical state, either at admission or after treatment. CONCLUSIONS: Individuals with adolescent onset of schizophrenia are considered to be representative of schizophrenia in general. Furthermore, neurocognitive deficits and clinical symptoms are concluded to be two independent classes of risk indicators.

Prefrontal cortex glucose metabolism and startle eyeblink modification abnormalities in unmedicated schizophrenia patients.

Attentional modulation of the startle reflex was studied in 16 unmedicated schizophrenia patients and 15 control individuals during the 18F-2-deoxyglucose uptake period for positron emission tomography. In a task involving attended, ignored, and novel tones that served as prepulses, control individuals showed greater prepulse inhibition (PPI) at 120 ms and greater prepulse facilitation at 4,500 ms during attended than during ignored prepulses; the amount of PPI and facilitation during novel prepulses was intermediate. In contrast, patients failed to show differential PPI at 120 ms and tended to show greater facilitation at 4,500 ms during novel prepulses. For control individuals, greater PPI was associated with higher relative metabolic activity rates in prefrontal (Brodmann Areas 8, 9, and 10 bilaterally) and lower in visual cortex. Patients showed this relationship only for Area 10 on the left. Patients also had low metabolism in superior, middle, and inferior prefrontal cortex. Consistent with animal models, our results demonstrate the importance of the functional integrity of prefrontal cortex to PPI modulation.

Dorsal striatal size, shape, and metabolic rate in never-medicated and previously medicated schizophrenics performing a verbal learning task.

BACKGROUND: Magnetic resonance imaging and positron emission tomography were used to study the size and metabolic rate of the caudate and the putamen in 18 patients with schizophrenia (n=16) or schizo-affective disorder (n=2) and 24 age- and sex-matched control subjects. METHODS: The patients were either never medicated (n=7) or drug free (n=11) for a median of 3 weeks. During uptake of fludeoxyglucose F 18, all patients performed a serial verbal learning test. Positron emission tomographic and magnetic resonance imaging scans were coregistered, and the caudate and the putamen were traced on the magnetic resonance image. RESULTS: The striatum had a significantly lower relative metabolic rate in schizophrenics than in controls. Never-medicated patients had lower metabolic rates in the right putamen (ventral part of the dorsal striatum) than previously medicated patients. The caudate was significantly smaller in never-medicated patients than in controls and largest in previously medicated patients. Patients with higher relative metabolic rates in the putamen scored higher on the Abnormal Involuntary Movements Scale. CONCLUSIONS: The findings are consistent with reports of striatal enlargement in previously medicated patients and size increases after neuroleptic treatment. Never-medicated patients, in contrast, had ventral striatal structures that were smaller and less active than those observed in controls and previously medicated patients.

Reduction mammaplasty: an outcome study.

Outcome studies of the value of reduction mammaplasties have only recently appeared in the literature. Medical directors of insurance companies and managed care plans have been reluctant to pay for reduction mammaplasties, citing the uncertainty of the medical necessity of the procedure. They have defended their position by stating that the medical literature is devoid of studies documenting that reduction mammaplasty is medically beneficial to the patient. For this reason, reduction mammaplasty is often excluded from health care benefit plans. Because of the need for outcome studies for this procedure, the charts of 363 consecutive patients who had reduction mammaplasty at the Mayo Clinic from January of 1986 to December of 1993 were reviewed. Questionnaires were sent to all these patients asking them to evaluate their outcome, and 328 responded (90.4 percent response rate). Of the respondents, 94.2 percent believed that the procedure was completely or very successful, and only 1.5 percent believed that it was not very successful or completely unsuccessful. The symptoms most frequently reported by patients preoperatively were as follows: uncomfortable feeling about their body, 97.0 percent: inability to find clothes that fit, 95.7 percent; pain in bra-strap groove, 92.4 percent; shoulder pain, 86.0 percent; inability to run, 79.3 percent; upper back pain, 79.0 percent; inability to participate in sports, 77.4 percent; neck pain, 70.7 percent; lower back pain, 64.0 percent; and intertrigo, 61.0 percent. The symptoms least frequently reported by patients preoperatively were as follows: pain or numbness in the hands, 22.6 percent; headaches, 30.2 percent; arm pain, 35.4 percent; and breast pain, 58.2 percent. These symptoms were either relieved or partially relieved in 88 percent or more of the patients. Of the 328 patients, 97.3 percent responded that they definitely or probably would have the procedure again, and only 1.2 percent definitely or probably would not have the operation again. Evaluation of medical treatment used to relieve symptoms showed a marked decrease in the need for such measures after reduction mammaplasty. Study of the charges for the procedure revealed that the setting of practice parameters for the procedure and the use of an ambulatory surgery center significantly decreased the charges for the procedure. This outcome study supports the hypothesis that reduction mammaplasty is an effective procedure and the treatment of choice for symptomatic mammary hyperplasia.

Temporal stability of polydipsia-hyponatremia.

We evaluated temporal stability and outcome predictors associated with polydipsia-hyponatremia (PH). Severity of PH was measured on two occasions separated by at least 1 year in 25 chronic psychiatric inpatients (24 with schizophrenia). Three-quarters of the sample had clinically evident PH on follow-up. Follow-up PH severity was significantly related to intake severity and hospitalization length. Our findings suggest that PH may be a persistent condition with specific outcome predictors.

Attention and clinical symptoms in schizophrenia.

Attentional deficits, long established to characterize patients with schizophrenia spectrum disorders, have traditionally been regarded as part of the disorder's clinical syndrome. In this paper we provide evidence to indicate that: a) impaired attention is a dimension of schizophrenia that is independent of clinical state, and b) that attention does not appear to respond to the medication (i.e. standard neuroleptics) most typically used to treat clinical symptoms. Since intact attention and other cognitive processes appear critical to successful functioning in the community after hospital discharge, these findings have major implications for treatment.

Regional cerebral blood flow in mood disorders: IV. Comparison of mania and depression.

Cortical regional cerebral blood flow (rCBF) was assessed in minimally medicated, relatively young adults in episodes of either acute mania (n = 11) or major depression (n = 11) and in matched normal control subjects (n = 11), using the 133xenon inhalation method, under eyes-closed, resting conditions. The three groups were equivalent in global CBF. Both patient groups showed significant reductions of rCBF in anterior cortical areas and reduction of the normal anteroposterior gradient. In addition, there was evidence of abnormal, albeit similar, patterns of flow lateralization on a regional basis in both clinical groups compared with normal subjects. An exploratory analysis revealed preliminary evidence of rCBF differences between the clinical groups, localized to the inferior frontal cortex. Otherwise, the evidence in this study suggests that young adult manic and depressed patients are predominantly similar in cortical rCBF parameters.

Differing patterns of electrodermal and finger pulse responsivity in schizophrenia and depression.

Non-response of the autonomic orienting response (OR), as indexed jointly by deficient skin conductance (SCR) and finger pulse amplitude responding (FPAR), has been shown to occur with excessive frequency in the schizophrenic population. The present study is an attempt to replicate earlier evidence that SCR-OR and FPAR-OR, when measured in concert, could distinguish schizophrenic from depressed patients (Bernstein et al. 1988). This issue is critical of the question of diagnostic specificity of OR non-responding, since reduced SCR has been found repeatedly in depression as well as in schizophrenia. We examined SCR and FPAR concurrently in 69 schizophrenic, 45 depressed, and 67 normal subjects. SCR non-responding was more frequent in both schizophrenics and depressives than in normal controls, while only the schizophrenics displayed excessive FPAR non-responding. Moreover, among SCR non-responders, concordant OR non-responding--defined as non-responding indexed simultaneously in both the SCR and FPAR components--was most common in the schizophrenic sample. These findings support our previous conclusion that OR non-responding in depression, may have distinct peripheral origins. Our results also suggest that measuring multiple biochemically distinct components of the OR may be more sound methodologically than obtaining a single channel recording.

The relationship of the skin conductance and finger pulse amplitude components of the orienting response to season of birth in schizophrenia and depression.

Schizophrenia is said to be associated with a modest excess of winter births. We examined relations of season of birth (SOB) to the skin conductance response (SCR) and finger pulse amplitude response (FPAR) components of the orienting response (OR) in 83 schizophrenic patients, 59 depressed patients, and 81 normal controls. SCR-OR nonresponding was more prevalent among depressed patients regardless of SOB, whereas only winter-born schizophrenics showed significantly more frequent electrodermal nonresponding than controls. However, this latter relation was not confirmed with log linear analysis. No other relations of SOB to SCR-OR or FPAR-OR nonresponding were significant. Our data do not support the view that nonresponding in the SCR or FPAR components of the OR is associated with winter birth either in schizophrenia or depression.

Dichotic-listening measures of brain laterality in mania.

Dichotic syllable and complex tone tests were used to compare performance asymmetries in manic patients (n = 35) with normal controls (n = 26) and to determine whether there were changes in laterality with remission of the manic state. Relationships of performance asymmetries to treatment outcome and symptom features were also examined. Compared with normal controls, manic patients showed overall poorer accuracy, particularly for complex tones presented to the left ear, and they failed to show the normal left-ear (right-hemisphere) advantage for complex tones. Abnormal laterality for complex tones was present in patients who later responded to treatment but not in nonresponders. In the euthymic state, patients showed improved left-ear accuracy for complex tones and more normal perceptual asymmetry. These findings suggest that mania is associated with a decrement in right-hemisphere processing of complex tonal information.

Regional cerebral blood flow in mood disorders, III. Treatment and clinical response.

BACKGROUND: Global and regional deficits in cerebral blood flow and glucose metabolism have been reported in major depression, but there is limited information on the effects of somatic treatment and clinical recovery on these abnormalities. METHODS: We assessed cortical blood flow with the xenon 133 technique in depressed patients prior to a course of electroconvulsive therapy (ECT), 30 minutes before and 50 minutes after a single treatment, and during the week following ECT. Acute (preictal and postictal) effects of a single treatment also were studied in manic patients. RESULTS: In the depressed and manic groups, larger blood flow reductions in the acute period, both globally and in particular patterns of brain regions, were associated with a superior clinical outcome following the treatment course. In depressed patients, similar patterns were observed for the blood flow changes over a full treatment course. Blood flow reductions in anterior cortical regions were strongly associated with a positive clinical response in both depression and mania. CONCLUSIONS: The findings indicated that cerebral blood flow abnormalities in major depression were not reversed by successful treatment with ECT. Rather, particularly in responders, ECT resulted in additional perfusion reductions. The therapeutic properties of ECT are related to reduced functional brain activity in specific neural regions.

Abnormal growth of cultured skin fibroblasts associated with poor premorbid history in schizophrenic patients.

The relations of abnormal growth of cultured skin fibroblasts, as manifest in prolonged doubling time, and a history of impaired childhood premorbid functioning, separately for social and school (instrumental) functioning were examined in 22 schizophrenic patients. Prolonged doubling time (> 2 weeks) was significantly associated with poorer childhood social functioning, even after controlling for variance due to age, sex, race, and age at onset of illness. Doubling time was not associated with school performance scores. The findings indicate that the cellular or molecular process(es) underlying abnormal growth of skin fibroblasts may be involved in, or associated with, aberrant biological processes that contribute to early dyssocial behavior in schizophrenic patients.

Decreased adhesiveness and altered cellular distribution of fibronectin in fibroblasts from schizophrenic patients.

Relative to those from normal subjects, cultured skin fibroblasts from schizophrenic patients have been found to show abnormal growth characteristics and morphology. This study compared skin fibroblasts from 10 drug-free schizophrenic patients and 10 normal control subjects on cell adhesiveness to the substratum. Relative to fibroblasts from normal controls, those from patients showed significantly decreased cell adhesiveness, with no overlap in distribution between the groups. Since fibronectin, a major cell surface molecule, is known to be involved in the fibroblast adhesion to substratum, its extracellular and intracellular distribution was determined by immunocytochemical analysis. Both extracellular and intracellular levels of fibronectin were significantly lower, and the distribution was altered in fibroblasts from the patients.

Serum antibodies to nicotinic acetylcholine receptors in schizophrenic patients.

Although elevated serum levels of antibodies to the nicotinic acetylcholine receptor (nAChR) have been reported in neuroleptic treated patients with tardive dyskinesia, such antibodies have not been determined in comparable nondyskinetic patients. Using a toxin-binding inhibition assay, we examined serum anti-nAChR antibody levels in 17 DSM-III-R chronic schizophrenic patients, seven of whom had persistent tardive dyskinesia, and 10 normal controls. On the average, anti-nAChR antibody levels were significantly higher in schizophrenic patients than in normal controls, but but not differ between patients with and without tardive dyskinesia and was not related to age, sex, or duration of illness in patients.

Electroconvulsive therapy of acute manic episodes: a review of 50 years' experience.

OBJECTIVE: The most common indication for electroconvulsive therapy (ECT) is major depression. It is less recognized that ECT is effective also in the treatment of acute mania. This article aims to provide a comprehensive and critical review of the literature on the use of ECT for manic patients. METHOD: All published papers in the English language on the use of ECT in acute mania that could be found were reviewed with regard to efficacy, frequency and number of treatments, bilateral versus unilateral electrode placement, predictors of antimanic response, stability of therapeutic response, cognitive consequences, and other relevant issues. RESULTS: The evidence indicates that ECT is associated with remission or marked clinical improvement in 80% of manic patients and that it is an effective treatment for patients whose manic episodes have responded poorly to pharmacotherapy. Manic patients do not require a high frequency or prolonged course of treatments to respond to ECT. The seizure threshold appears to be lower in manic patients than in depressed patients. The issues of relapse following response to ECT, cognitive consequences of ECT, and the relative merits of unilateral versus bilateral ECT in manic patients require further study. CONCLUSIONS: ECT is an effective and safe treatment for acute mania. Remission of mania following ECT reflects a primary therapeutic effect rather than a secondary consequence of an ECT-induced organic brain syndrome.

Computer-assisted molecular modeling: indispensable tools for molecular pharmacology.

Ball-and-stick mechanical models, typically associated with chemists, have been helpful in understanding structural problems and the relationship between structure and biologic activity. With progress in computer speed, graphics performance, and software innovation, molecules of biological interest can be subjected to rigorous calculations. Computational chemistry and biology are rooted in the belief that theoretical physics can be used to calculate accurate molecular structures. Although in its infancy, computer-assisted molecular modeling is gaining attention and acceptability as an increasing number of researchers turn their attention toward rational molecular design. The trend to use theoretical methods can be traced to the greater availability of computer graphics work-stations, decreasing computer costs, faster central processing units, more robust algorithms, and "user-friendly" software codes. Every major pharmaceutical company has invested in these resources to reduce the time it takes to design and develop pharmaceutical agents. Because of the vast financial and manpower investments needed to introduce a single drug, medicinal chemists and pharmacologists are interested in understanding and predicting drug action at the molecular level. Although drug action is still poorly understood, molecular modeling should reduce some of the labor in the development of pharmaceutical agents.

Birth weight and CT scan findings in chronic schizophrenic patients.

The relations of birth weight to CT scan measures of lateral ventricular size, third ventricular size, frontal cortical sulcal prominence, and parieto-occipital cortical sulcal prominence were examined in 24 chronic schizophrenic patients. In contrast to the inverse correlation between birth weight and ventricular size found among offspring of schizophrenic parents in the Danish High-Risk Study, and the predictions of the subsequent hypothesis, no significant relations between birth weight and CT scan measures were observed in this study.