Can response to partial sleep deprivation in depressed patients be predicted by regional changes of cerebral blood flow?

The possible predictive value of regional cerebral perfusion patterns with respect to the response to partial sleep deprivation (PSD) was evaluated in 15 major depressive patients (mean age = 54.9 years, mean Hamilton depression score = 21.6). Patients were studied with single photon emission computed tomography with technetium-99 m-D,L-hexamethyl-propylene amine oxime. Scans were performed on the morning before and after (at 08.00 h) PSD. Responders to PSD had significantly higher perfusion in the right orbitofrontal cortex than did non-responders before PSD. Multiple regression analysis indicated that right orbitofrontal/basal cingulate perfusion (r = -0.77, P < 0.001) before PSD, and left inferior temporal perfusion (r = 0.59, P = 0.01) after PSD, were fairly accurate predictors of change in Hamilton depression scores. Thus, it appears that the orbitofrontal cortex and the cingulate are involved in PSD and may serve as predictors of therapeutic response.

Spinal computed tomography scanning in the evaluation of metastatic disease.

Twenty patients with known metastatic cancer or high-risk primary cancer developed new lesions on Tc 99m bone scans and had normal plain radiographs. Spinal computed tomography (CT) was performed on all new bone-scan-positive lesions in minimal examination time. Fifteen patients had extensive metastatic vertebral disease and received local radiotherapy. One patient with new metastatic vertebral disease on CT was treated only with chemotherapy and developed acute spinal cord compression. Four patients had discogenic disease or degenerative disease but no evidence of metastases. Radionuclide bone scans are more sensitive but less specific than plain radiographs in detecting early bone metastases. Early and accurate diagnosis of metastasis is particularly important in the axial spine to prevent epidural compression and fracture. Spinal CT is valuable for identifying the presence and extent of vertebral metastases, as well as the presence of benign disease in cancer patients.

Morbidity in long-term survivors of small cell carcinoma of the lung.

The follow-up of eight patients who were alive and disease-free for at least 12 months following completion of therapy for small cell carcinoma of the lung (SCC) is presented. One patient is alive and well. Five patients (62%), including two with acute leukemia, died of second malignancies. One patient died with late recurrence of SCC, and one patient died of an unexplained neurologic degenerative disease with dementia. It is concluded that patients with apparent cure of SCC are at high risk for serious disorders including second malignancies.

Frequency specificity of simultaneously recorded early and middle latency auditory evoked potentials.

Early and middle latency auditory evoked potentials were recorded simultaneously with a 2-channel wide-band recording technique. Latency and amplitude distributions of components V, Na and Pa were determined in 20 normal hearing adults for 3 different stimuli (click, plop, 500 Hz tone burst) presented at 70, 30 and 20 dB HL. Normative latency data of the middle latency components are presented. The detectability and amplitude of the Na-Pa complex were considerably larger than those of wave V at 20 and 30 dB HL for the two low frequency stimuli. Ten ears exhibiting high frequency sensorineural hearing loss were examined. In these cases, only click-evoked Na and Pa, but not wave V, were observed down to 20 dB HL. Also, the click latency-intensity function of Na-Pa was found to be similar to the normal low frequency latency functions. The results consistently suggested that the low frequency contributions to wave V cancel in phase because of short duration, whereas the duration of the Na-Pa complex allows for a positive superimposition of all frequency bands. Since these differences in frequency specificity of the EAEP and the MAEP affect latency, care is advised for the interpretation of inter-peak latencies.