Very long-term amnesia in association with temporal lobe epilepsy: evidence for multiple-stage consolidation processes

The temporal fractionation of long-term retention remains a relatively uncharted area in human memory research, and in particular there is little in the way of neuropsychological data that address this issue. We describe a patient with temporal lobe epilepsy who complained of amnesia for important events that had occurred in the previous 3-24 months, but who reported that her short-term and medium-term memory were normal. She displayed normal performance on traditional tests of short-term and long-term retention, performing at a very similar level to that of age- and sex-matched healthy control subjects on immediate and half-hour delayed recall measures. Forty days later, however, she showed a dense amnesia for recall of such information, whereas control subjects could readily recall much of the original stimuli. She also showed evidence of memory loss for news events that had occurred over the previous few years. MRI scanning and EEG brain mapping indicated left temporal lobe pathology, with a possible epileptogenic focus in the left anterior hippocampus. These data provide empirical evidence for the existence of a distinct very long-term consolidation process in human episodic memory and point to its neural correlates in the temporal lobe. Transfer of information into a permanent long-term memory store may entail multiple-stage consolidation processes rather than a single-stage, unitary consolidation process.

The best of both worlds--'resposables'

Managed care has brought about changes in the way surgical departments function. Minimally invasive surgeries are common, but costly for the surgical department. The use of reusable or resposable instruments can help keep costs down.

Long-term perceptual priming in transient global amnesia

This paper addresses the question as to whether long-term perceptual priming can occur during transient global amnesia. A patient who displayed the classical features of transient global amnesia was assessed during the episode and again 7 days later. During the episode, she was administered a task that required the perceptual identification of fragmented pictures over a number of learning trials. Seven days later, after recovery from the episode, she was required to identify the same fragmented pictures together with a new set of pictures that she had never seen before. She was significantly better at identifying the old pictures than the new pictures, in spite of having amnesia for the period of the attack. Matched control subjects who had never seen either set of pictures before, were also tested and performed at a similar level on the old and the new pictures. Our findings extend the clinical domain of implicit memory phenomena and parallel similar observations in chronic amnesia (Cave & Squire, 1992). We provide the first demonstration of a residual capacity for long-term perceptual priming during an acute episode of apparent total loss of memory.

Psychological and cardiovascular predictors of anaesthesia induction, operative and post-operative complications in minor gynaecological surgery

This study aimed to clarify the pre-operative-personality-post-operative-recovery association by considering anaesthetic variables. Additionally, the work investigated the relationships between psychological and cardiovascular functioning and anaesthetic induction difficulties and operative problems. Two minor gynaecological procedures were evaluated (dilatation and curettage, laparoscopy) which differ greatly in anaesthetic and operative techniques. Psychological factors predicted cardiovascular responding immediately prior to the induction of anaesthesia, and combinations of cardiovascular and psychological variables were associated with anaesthetic induction, operative and post-operative problems. Health locus of control and worry concerning the various stages of the operation emerged as the most consistent psychological predictors of peri-operative outcome in both procedures.

Blockade of digestion by famotidine pretreatment does not interfere with the opioid-enhancing effect of ingested amniotic fluid

Ingestion of placenta or amniotic fluid by rats has been shown to enhance ongoing opioid-mediated antinociception, but does not, by itself, produce antinociception. This enhancement is produced by an active substance(s) in placenta and amniotic fluid that we have termed POEF for placental opioid-enhancing factor. Previous research has shown that enhancement requires mediation by the gastrointestinal system: gastric vagotomy blocks enhancement produced by ingested placenta; amniotic fluid injected SC or IP does not produce enhancement. The present study was designed to distinguish between two possible explanations for the blockade of the POEF effect produced by gastric vagotomy: that afferent information arising in vagal gastric receptors conveys the critical information to the CNS, or that disruption of vagal efferent action on digestion blocks the manufacture or activation of the POEF molecule in the gut. Famotidine is an H2-histamine receptor antagonist that reduces gastric acid and pepsin secretion to an extent at least as great as gastric vagotomy. Rats treated with either famotidine or a vehicle were fed placenta or a control substance, then stimulated with vaginal/cervical probing to produce antinociception that is partly opioid mediated. Famotidine did not block POEF enhancement of vaginal/cervical stimulation-induced analgesia in a tail flick latency test. These results suggest that enhancement by POEF does not require normal digestive processes or other processes inhibited by famotidine.

Transforms of the computerized patient record data model: from transactions to analytical processing

The design of Computerized Patient Record databases needs to be different depending on whether the focus of the database is transaction processing or analytical processing. Transaction processing includes the operational use of databases for single patient update during clinical encounters. Analytical processing includes cross-patient querying for research or clinical management. These different design needs are defined. A case study is presented for the methodology that transforms transaction databases to analytical ones. The resulting analytical design is argued to be successfully evaluated according to specific criteria of useability and maintainability. This methodology is easily replicated in any relational database environment.

Management consultancy. Shopping around

The NHS spends millions on management consultants but often has little idea of who to hire or how to get the best out of them. Philip Abbott shows how the health service can learn a few tricks from the private sector.

Improving the efficiency of patient recruitment with an automated telephone screening system in a client-server environment

An automated telephone screening system was implemented at the Baltimore VA Hospital on a Local Area Network (LAN) to evaluate older adults for the GRECC research program. Using the system for decision support, a registered nurse (RN) placed 117 phone calls to older adults in the Baltimore community over a 3 month period. The modular design of the system allowed tracking of inclusion and exclusion criteria which was shared by clinicians and researchers. The design goal of the telephone screening system was to reduce time and personnel costs and increase the effectiveness of screening for recruitment for a major research project. Effectiveness is defined as avoiding under--or over--screening. Using the telephone system, it is estimated the research team saved over $6,000.00 in unnecessary medical evaluation in a 3 months period. As the system develops, the process by which older adults are assessed for research programs in the Geriatrics Service at the Baltimore VAMC will provide additional cost efficiencies.

Placental opioid-enhancing factor (POEF): generalizability of effects

A substance in amniotic fluid and placenta (POEF for Placental Opioid-Enhancing Factor) has been shown to enhance opiate- or opioid-mediated analgesia in rats. Recent studies have only touched on the generalizability of the phenomenon. The present studies further tested the generalizability of the POEF effect: they examined sex specificity of the mechanism; whether POEF activity exists in afterbirth material of species other than the rat; whether POEF activity exists in tissue other than afterbirth material; whether POEF activity could be demonstrated after injection rather than ingestion of afterbirth material; and whether POEF enhances all opioid-mediated phenomena. We found that (a) POEF is effective in male rats as well as in female rats; (b) POEF activity exists in human and dolphin afterbirth material; (c) ingestion of pregnant-rat liver does not produce enhancement of opioid-mediated analgesia; (d) POEF does not seem to be effective when amniotic fluid is injected either IP or SC; and (e) POEF does not modify morphine-induced hyperthermia.

Amniotic fluid ingestion before vaginal/cervical stimulation produces a dose-dependent enhancement of analgesia and blocks pseudopregnancy

A substance in amniotic fluid (AF) and placenta has been shown to enhance analgesia produced by morphine, late pregnancy, footshock, and vaginal/cervical stimulation (VS). When morphine-induced analgesia was assessed previously, the degree of enhancement by ingestion of AF or placenta was found to be a function of the amount of analgesia being generated. We have extended these results to include the analgesia produced by VS. Analgesia induced by 75, 125, 175, or 225 g of vaginal/cervical pressure was measured in rats pretreated with 0.25 ml (by orogastric infusion) of either AF or saline. AF infusion enhanced the analgesia produced by 125 g VS, but did not affect the analgesia produced by 75, 175, or 225 g VS. Unexpectedly, we also found that infusion of AF shortly before the application of VS prevents VS-induced pseudopregnancy (PsP). Whereas the incidence of PsP following 75, 125, or 175 g VS was less than 19% and not statistically different for AF and saline pretreatments, the incidence of PsP after 225 g VS was 44% in saline-pretreated rats, but only 10% in AF-pretreated rats. Protection from the induction of pseudopregnancy, which could be caused by mechanical stimulation of the cervical area during delivery, may be an additional benefit of parturitional ingestion of placenta and amniotic fluid (placentophagia).

Midazolam-droperidol premedication for cardiac surgery. A comparison with papaveretum and hyoscine

A combination of midazolam and droperidol given intramuscularly was compared with papaveretum and hyoscine for premedication of patients about to undergo cardiac surgery. Midazolam and droperidol proved to be a very satisfactory combination, producing superior sedation and anxiolysis with good cardiovascular stability.

Loss of heterozygosity for genes on 11p and the clinical course of patients with lung carcinoma

Forty-five primary human lung carcinomas were evaluated for the loss of heterozygosity for genes on the short end of chromosome 11. Of 40 evaluable heterozygous cases, loss of the 11p genes c-H-ras and insulin was documented in nine cases (22%). The clinical parameters investigated for each patient included the disease stage at presentation, the presence of metastatic disease in either bronchial or mediastinal lymph nodes, and the presence of positive parietal pleural margins in the surgically resected specimen. There were no differences found with respect to these indicators when patients exhibiting the loss of heterozygosity were compared with those who did not have such genetic loss. In addition, when the clinical courses of the two patient groups were compared, there was no difference in survival. We conclude that the loss of heterozygosity for c-H-ras and insulin on 11p is a common finding in primary non-small cell human lung carcinomas but does not confer a more aggressive phenotype on these tumors. Although this genetic lesion may be important in the initial transformation of the cells to carcinoma, the available data for lung carcinoma are insufficient to prove causality.

Intractable neck pain

A retrospective survey of 1,661 patients seen over a 10-year period at a pain clinic yielded 55 patients with intractable neck pain as the presenting complaint. In 89% there was an industrial or motor vehicle accident as the precipitating event, 78% were involved in legal proceedings relating to the accident, and in 87% the pain radiated to neighboring structures. Diagnostically, 36% had no physical signs, and cervical radiographs were normal for 46%. There was a high incidence of previous psychiatric treatment (53%) and major intrafamily problems (60%). Treatment mainly by psychotherapy or tricyclic antidepressants resulted in some benefit for 56% of patients. Legal compensation and change in occupation were not major factors influencing the outcome of treatment.

Amniotic-fluid ingestion by parturient rats enhances pregnancy-mediated analgesia

Amniotic fluid and placenta contain a substance (POEF, for Placental Opioid-Enhancing Factor) that, when ingested, enhances opioid-mediated analgesia in nonpregnant rats; ingestion of the substance by rats not experiencing opioid-mediated analgesia, however, does not produce analgesia. It is highly likely that periparturitional analgesia-enhancement is a significant benefit of ingestion of the afterbirth (placentophagia) during delivery. Here we report that prepartum ingestion of amniotic fluid (via orogastric infusion) does indeed enhance the endogenous-opioid-mediated analgesia evident at the end of pregnancy and during delivery; that the degree of enhancement is greater with 0.75 ml than with 0.25 ml; and that the prepartum enhancement of analgesia can be blocked with the opioid antagonist naloxone.

Anxiety, depression, and somatization in DSM-III hypochondriasis

To assess the severity of distress and of somatization in hypochondriasis, the authors administered several validated self-rating scales of depression, anxiety, somatic symptoms, and anger/hostility to 21 psychiatric outpatients with the DSM-III diagnosis of hypochondriasis and to matched groups of other nonpsychotic psychiatric patients, family practice patients, and employees. Anxiety and somatic symptoms were highest in hypochondriacal patients; depression and anger/hostility did not differ from those of other psychiatric patients but were higher than in the other groups. The findings do not support the theory that hypochondriasis is a defense against anxiety or that it is a masked depression or depressive equivalent. The findings are consistent with the view that the interaction of severe anxiety and severe somatic symptoms is a common feature of the psychopathology of hypochondriasis.

Dose-dependent enhancement of morphine-induced analgesia by ingestion of amniotic fluid and placenta

Ingestion of amniotic fluid and placenta by rats has been shown to enhance opioid-mediated analgesia. The present studies were designed to examine the effect of several doses and volumes of placenta and amniotic fluid on tail-flick latency in rats treated with 3 mg/kg morphine. The optimal dose of amniotic fluid was found to be 0.25 ml, although 0.50 and 1.0 ml also produced significant enhancement. Doses of 0.125 and 2 ml of amniotic fluid were ineffective, as was a dose of 0.25 ml diluted to 2 ml with saline. The optimal dose of placenta was found to be 1 placenta, although the resulting enhancement was not significantly greater than that produced by 025, 0.50, 2.0 or 4.0 placentas. Doses smaller than 0.25 placenta or larger than 4.0 placentas were ineffective. The most effective doses of amniotic fluid and placenta correspond to the amounts delivered with each pup during parturition.

Infrapatellar contracture syndrome. An unrecognized cause of knee stiffness with patella entrapment and patella infera

Infrapatellar Contracture Syndrome (IPCS) is an infrequently recognized cause of posttraumatic knee morbidity. Unique to this group of patients is the combination of restricted knee extension and flexion associated with patella entrapment. IPCS can occur primarily as an exaggerated pathologic fibrous hyperplasia of the anterior soft tissues of the knee beyond that associated with normal healing. It can also occur secondarily to prolonged immobility and lack of extension associated with knee surgery, particularly intraarticular ACL reconstruction. IPCS follows a predictable natural history which is divided into three stages. Symptoms, diagnostic findings, and recommended treatment are determined by the stage at presentation. Once beyond its early presentation, IPCS is best treated by an anterior intraarticular and extraarticular capsular debridement and release, followed by extensive rehabilitation. The authors review 28 consecutive cases of IPCS. At followup 3 months to 4 years postoperation, the patients had averaged 2.3 additional surgical procedures following their index procedure or injury. The average increase in extension at followup was 12 degrees with the average increase flexion 35 degrees. Eighty percent of patients demonstrated signs and symptoms consistent with patellofemoral arthrosis; 16% of the patients demonstrated patella infera. The authors conclude that prevention or early detection and aggressive treatment are the only ways of avoiding complication in these problem cases.

Fears, beliefs, and attitudes in DSM-III hypochondriasis

In order to explore fears, beliefs, and attitudes of patients with DSM-III hypochondriasis, the authors administered the self-rated Illness Attitude Scales to 21 patients with hypochondriasis, matched family practice patients, nonpatient employees, and nonhypochondriacal psychiatric patients. Hypochondriacal patients reported more fears of and false beliefs about disease; they attended more to bodily sensations, had more fears about death, and distrusted physicians' judgments more, yet sought more medical care than other subjects. They did not take better precautions about their health. The self-report of overt attitudes suggests a characteristic syndrome, consistent with the DSM-III description of hypochondriasis. Two of the subscales of the Illness Attitude Scales yielded characteristic responses in hypochondriasis.

Ingestion of amniotic fluid enhances opiate analgesia in rats

Placenta ingestion has recently been shown to enhance opiate-mediated analgesia produced by morphine injection, footshock, or vaginal/cervical stimulation. The enhancement of the effect of endogenous opiates (especially analgesia) may be one of the principal benefits to mammalian mothers of placentophagia at delivery. During labor and delivery, however, mothers also ingest amniotic fluid (AF) which, unlike placenta, becomes available during, or even before expulsion of the infant. The present experiments were undertaken to determine whether AF ingestion, too, enhances analgesia; if so, whether the effect requires ingestion of, or merely exposure to, AF; whether the effect can be produced by AF delivered directly to the stomach by tube; and whether the enhancement, if it exists, can be blocked by administering an opiate antagonist. Nulliparous Long-Evans rats were tested for analgesia using tail-flick latency. We found that rats that ingested AF after receiving a morphine injection showed significantly more analgesia than did rats that ingested a control substance; AF ingestion, alone, did not produce analgesia; ingestion of AF, rather than just smelling and seeing it, was necessary to produce analgesia enhancement; AF produced enhancement when oropharyngeal factors were eliminated by delivering it through an orogastric tube; and treatment of the rats with naltrexone blocked the enhancement of morphine-induced analgesia that results from AF ingestion.

Hypochondriacal beliefs and attitudes in family practice and psychiatric patients

Beliefs and attitudes which can be responsible for hypochondriacal behavior were explored by administering the Illness Attitude Scales and two distress scales to patients attending a family practice clinic, nonpsychotic psychiatric outpatients and a random group of employees. Family practice patients were more distressed, had more hypochondriacal concerns and had more bodily preoccupations than employees and took more precautions about their health. Psychiatric patients were more distressed and had more fears about illness and death than family practice patients, yet took fewer precautions about their health. The findings appear to have implications for treatment.