Age-related differences in the symptomatic expression of major depression

Hamilton Rating Scale for Depression and Beck Depression Inventory results were examined in a consecutive series of 174 female and 83 male patients, ranging in age from 18 to 81 years, admitted to a psychiatric hospital with a diagnosis of major depression. Items on the two scales were examined to determine the relationship between age and the symptomatic expression of major depression. Overall scores on the Hamilton scale revealed no relationship with age, but scores for males on the Beck Depression Inventory were negatively associated with age. In addition, the most prevalent types of depressive symptoms showed significant correlations with age. Items related to low self-esteem, such as guilt, sense of failure, self-accusations, and thoughts of suicide, showed a negative relationship with age for both males and females. It is possible that psychological maturation or other age-related factors reduce vulnerability to low self-esteem during episodes of clinical depression; however, selection bias or a cohort effect cannot be ruled out with the current methodology.

Intestinal anaphylaxis: radiation-induced suppression

The gastrointestinal tract is highly sensitive to ionizing radiation. Some of the most radiosensitive cells in this system are mast cells and epithelium. This article describes experiments that test the hypothesis that irradiation suppresses mucosal immune responses in which mast cells and epithelium are involved. The hypothesis was tested by examining the impact of ionizing radiation on anaphylactically mediated Cl- secretion in jejunum of rats sensitized by Trichinella spiralis infection and challenged with antigen derived from the parasite. Antigen-induced Cl- secretion was measured electrophysiologically in vitro. Rats were immunized by inoculation with 3 x 10(3) T. spiralis larvae and, 30-50 days later, exposed to total abdominal irradiation from a cobalt-60 gamma source. Doses were 5, 7, and 9 Gy. At 1, 3, 5, 7, 14, and 21 days postirradiation (DPI), jejunal segments were assessed for immune responsiveness. (Duration of suppression to antigenic challenge was directly related to radiation dose). Recovery of response to antigenic challenge after irradiation with 5 Gy was complete by 5 DPI. At 7 Gy, responsiveness was totally suppressed from 1 to 5 DPI, was partially expressed from 5 to 14 DPI, and was completely restored by 21 DPI. A dose of 9 Gy completely suppressed immune responsiveness throughout the 21-day period. Full responsiveness of jejunum to exogenous Cl- secretagogues at 1-5 DPI indicates that the immunosuppressive effect of radiation was not due to a breakdown in the secretory process at the epithelium level.(ABSTRACT TRUNCATED AT 250 WORDS)

Hartnup disease presenting in an adult

A young woman presented with pellagra. Her symptoms were precipitated by prolonged lactation and increased activity. Dietary intake of niacin was within recommended guidelines. Chromatography of urinary amino acids was diagnostic of Hartnup disease, an inherited disorder usually presenting in childhood. Her symptoms resolved with oral nicotinamide.

Modulation of host response to Escherichia coli o157:H7 infection by anti-CD18 antibody in rabbits

BACKGROUND/AIMS

Escherichia coli O157:H7 infection induces diarrhea, severe colitis, and colonic electrolyte transport abnormalities characterized by decreased Na absorption and Cl secretion. The aim of this study was to examine the role of the host inflammatory response in inducing distal colonic transport changes during infection with E. coli O157:H7.

METHODS

New Zealand white rabbits aged 10 days were infected with E. coli O157:H7 strain EDL933 (plasmid+, verotoxin 1+, verotoxin 2+). Studies were performed daily from day 1 to day 5 postinfection and compared with uninfected controls (10 days old). Distal colonic ion transport was studied in vitro under short-circuited conditions in Ussing chambers, and tissue inflammation was assessed by mucosal myeloperoxidase activities and mucosal neutrophil (polymorphonuclear neutrophil [PMN]) counts. In a second study, PMN infiltration was inhibited by an anti-CD18 (leukocyte adhesion molecule) monoclonal antibody, IB4, and histology and transport were studied on day 5 postinfection.

RESULTS

Infection with O157:H7 induced diarrhea and inhibition of Na absorption by day 3. CI secretion occurred on day 5, coincident with tissue infiltration with PMN. Pretreatment with IB4 prevented histological damage and tissue infiltration with PMN, and it inhibited the transport abnormalities induced by infection alone.

CONCLUSIONS

Infection with O157:H7 reduces Na absorption and stimulates Cl secretion in the distal colon. Disruption of the epithelium and changes in colonic electrolyte transport during enterohemorrhagic E. coli are mediated by the host inflammatory response.

Kangaroo care

Kangaroo Care--skin-to-skin contact between parent and baby--is becoming a popular adjunct to the routine, technology-driven care provided to premature babies in neonatal intensive care units (NICUs) across the country. Research suggests that Kangaroo Care is safe and that it is therapeutic for the infant and parent alike. The purpose of this article is to review the Kangaroo Care Program at Brigham and Women's Hospital and to illustrate how it meets the needs of parents of premature infants.

Instructions in learning skills: an integrated approach

The transition from school to university education and a medical school environment can be difficult even for the very best students. However, little appears to be done to assist students in making this transition and in developing study skills during the early stages of their training. This article outlines a scheme which has been called supplemental instruction. Although developed for medical students in the United States, it is particularly well suited to developing essential study skills in first-year medical students in the United Kingdom. The scheme has been successfully introduced into some degree and diploma subjects in this country, with improvement in course grades and lower attrition rates, but has yet to be introduced into medical education. Evaluation data for non-medical courses show that student participation in supplemental instruction significantly improves overall course marks and could be of significant value in the medical curriculum.

Primary gastric adenosarcoma

We describe the first case, to our knowledge, of a primary gastric adenosarcoma surgically resected from a 46-year-old white man. This biphasic neoplasm, well described in the female genital tract, was composed of cytologically benign tubular and cystic glands widely dispersed within a sarcomatous stromal component. Immunohistochemically, the epithelial elements were positive for cytokeratin, while the stromal elements were positive for vimentin and desmin. The clinical and pathologic features of pelvic adenosarcomas are described and compared with the tumor of the stomach. Although accurate prediction of the biologic behavior of this gastric neoplasm is difficult, the high mitotic rate in the sarcomatous component and the infiltration of the gastric serosal surface by the tumor were considered to be ominous prognostic features.

Effects of the nursing Mutual Participation Model of Care on parental stress in the pediatric intensive care unit--a replication

The pediatric intensive care unit (PICU) hospitalization of a child is stressful for parents. Helping parents to decrease their stress is warranted so that they can function in a vital role that is therapeutic to them and their critically ill child. Although many interventions have been recommended to help parents decrease their stress, only the Nursing Mutual Participation Model of Care (NMPMC) has been tested in the clinical setting. This article reports a study that expands on Curley's original work by investigating the effects of the NMPMC on parental stress when implemented by PICU staff nurses. Fifty-six parents participated in the study, which used a quasi-experimental design. Sequential sampling placed the first 31 subjects into the control group and the next 25 subjects in the experimental group. The experimental group received care from staff nurses instructed in the NMPMC. The dependent measure was the Parental Stressor Scale:Pediatric Intensive Care Unit (PSS:PICU) administered within 24 to 48 hours of PICU admission, every 48 hours thereafter, and 24 hours after PICU discharge. The results indicated that parents in the experimental group perceived less stress than the control group, specifically the stress related to alterations in parental role in the PICU setting. Implications for nursing care are discussed.

Long-term treatment with gabapentin for partial epilepsy

Gabapentin was studied as an open-label 'add-on' antiepileptic drug in 35 patients with partial seizures. Follow-up at 6 months, 12 months, 18 months, and 24 months is reported. There was a trend toward improvement in simple (SPS) and complex partial seizures with it reaching significance for SPS at 12 and 24 months and for the weighted combination of seizures at 3 months. Five of nine patients were subsequently successfully converted to gabapentin monotherapy. Of those five, one is now seizure free and three are significantly improved since baseline. One remains with unchanged seizure frequency compared to baseline, but is experiencing less toxicity than at that time. This long-term observation suggests that the short-term effect demonstrated in blinded studies continues and that indeed some patients with refractory epilepsy can be maintained on gabapentin alone. Based on these findings, double-blind monotherapy trials of this drug are presently being conducted.

Force-length properties and functional demands of cat gastrocnemius, soleus and plantaris muscles

The purpose of this study was to measure isometric force-length properties of cat soleus, gastrocnemius and plantaris muscle-tendon units, and to relate these properties to the functional demands of these muscles during everyday locomotor activities. Isometric force-length properties were determined using an in situ preparation, where forces were measured using buckle-type tendon transducers, and muscle-tendon unit lengths were quantified through ankle and knee joint configurations. Functional demands of the muscles were assessed using direct muscle force measurements in freely moving animals. Force-length properties and functional demands were determined for soleus, gastrocnemius and plantaris muscles simultaneously in each animal. The results suggest that isometric force-length properties of cat soleus, gastrocnemius and plantaris muscles, as well as the region of the force-length relation that is used during everyday locomotor tasks, match the functional demands.

Hemimaxillectomy for the treatment of oral tumors in 69 dogs

Hemimaxillectomy was performed in 69 dogs for the treatment of benign or malignant maxillary tumors. Eighteen dogs with ameloblastomas had a median disease-free interval of 21.5 months (range, 1 to 76 months), with a 72% 1-year survival time. There was recurrence in three dogs, with metastasis after malignant transformation in one of them. Based on calculated survival curves, seven dogs with squamous cell carcinoma had a median survival time of 19.2 months (range, 2 to 24 months), with a 57% 1-year survival time. There was local recurrence in two dogs. Twenty-three dogs with melanoma had a median survival time of 9.1 months (range, 1 to 46 months), and a 27% 1-year survival time. Twelve dogs died or were euthanatized because of recurrence or metastases. Fifteen dogs with fibrosarcoma had a median survival time of 12.2 months. Eight dogs died or were euthanatized because of recurrence or metastases. Six dogs with osteosarcoma had a median survival time of 4.6 months (range, 1 to 12.5 months), with a 17% 1-year survival time. Five dogs died or were euthanatized for recurrence or metastases. Tumor size or location and type of partial maxillectomy performed did not affect survival.

Increases in depressive symptomatology in the rural elderly: results from a cross-sectional and longitudinal study

Depressive symptomatology was examined in a large sample of noninstitutionalized older adults using the Center for Epidemiological Studies-Depression scale (CES-D). Both cross-sectional and longitudinal data showed age-related increases in mean CES-D scores and increases in the percentage of respondents scoring at or above the cutoff score of 16. Variables collected at baseline in the longitudinal study from 2,032 participants 65 years of age and older were significant predictors of depressive symptomatology 3 and 6 years later. Baseline CES-D scores accounted for the largest proportion of the variance.

A modified anaesthetic induction chamber for rats

The anaesthetic induction chamber for rats described in this paper has been designed for use in conjunction with a controlled delivery of halothane/O2 mixture and an anaesthetic scavenger system. Using this system rapid induction of anaesthesia is achieved using low levels of anaesthetic vapour without risk to the operator.

Modulation of leukocyte adhesion in rat mesenteric venules by aspirin and salicylate

Erythrocyte velocity, vessel diameter, leukocyte rolling velocity, and number of adherent and emigrated leukocytes were measured in postcapillary venules both before and during superfusion of rat mesentery with either aspirin or sodium salicylate. In some experiments, animals were treated with either a leukotriene (LT)-synthesis inhibitor (L-663,536), an LTD4 antagonist (MK-571), an LTB4 antagonist (SC-41930), misoprostol, or prostaglandin (PG) I2, then the aspirin protocol was repeated. Superfusion of aspirin but not sodium salicylate resulted in increased leukocyte adherence and a reduced leukocyte rolling velocity but did not affect leukocyte emigration. Aspirin-induced leukocyte adhesion was effectively prevented by the LT-synthesis inhibitor and LTB4 antagonist but not by the LTD4 antagonist. Misoprostol and PGI2 also prevented the aspirin-induced adhesion responses. Superfusion of the mesentery with either platelet-activating factor (PAF) or LTB4 enhanced leukocyte adherence and emigration while reducing leukocyte rolling velocity. Sodium salicylate prevented all of the adhesion responses elicited by LTB4. Although salicylate did not affect the PAF-induced leukocyte adherence and rolling responses, it completely prevented the increased leukocyte emigration. These results indicate that aspirin promotes, whereas sodium salicylate inhibits, leukocyte-endothelial cell adhesive interactions at therapeutically relevant concentrations.

Reduction of airborne allergenic urinary proteins from laboratory rats

Allergy and asthma caused by proteins of laboratory animals, particularly rats and mice, are the most important occupational health hazards for the scientists and technicians who work with such animals. The influence of different cage litters, cage design, and stock density on measured rat urinary aeroallergen (RUA) concentrations has been examined in a room housing male rats, to determine practical means to reduce allergen concentration in animal laboratories. Eight hour static air samples were taken at 2 1/min and the RUA concentrations measured by radioallergosorbent test (RAST) inhibition. High RUA concentrations occurred when the animals were housed on wood based, contact litter (geometric mean (GM) sawdust 7.79 micrograms/m3; woodchip 6.16 micrograms/m3). The use of noncontact absorbent pads was associated with a significant decrease in RUA concentrations (GM 2.47 micrograms/m3; p less than 0.0001). Rat urinary aeroallergen concentrations fell more than fourfold when the animals were housed on woodbased, contact litter in filter top cages rather than conventional open top cages (GM filter top 0.33 micrograms/m3; open top 1.43 micrograms/m3; p less than 0.0001). The number of rats (stock density) strongly influenced the RUA concentration and a linear relation was found between the log(e) allergen concentration and stock density under these study conditions. The measurement of airborne particle size on cleaning out days showed that all litter types generated similar sized particles: more than 80% of the RUA was carried on particles larger than 8 microns in diameter for all litter types. The findings suggest that the exposure of animal husbandry personnel to RUA may be substantially reduced by the avoidance of contact litter, the use of filter top cages (where suitable), and by keeping stock density to a minimum.

Extubation and reintubation in the NICU: identifying opportunities to improve care

An investigation was conducted to determine the overall incidence and reasons for extubation and reintubation in a NICU population in order to establish a baseline for ongoing quality assessment and evaluation monitoring. The investigators sought to identify factors associated with accidental extubation for which action plans to improve care could be developed.

Increases in soluble CD8 antigen in plasma, and CD8+ and CD8+CD38+ cells in human immunodeficiency virus type-1 infection

Increases in plasma levels of soluble CD8 (SCD8) antigen and expansion of the CD8+ CD38+ lymphocyte compartment were early immunologic alterations frequently observed prior to detection of antibodies against human immunodeficiency virus type 1 (HIV-1) and diminution of CD4+ cells in subjects at risk to develop AIDS. These increases identified in the 49 seronegative homosexual men were manifest in all 164 homosexual subjects and 45 intravenous drug users (IVDU) positive for HIV-1 antibodies (HIV-1+), 19 patients with ARC, and 29 AIDS patients. Augmentation of plasma sCD8 antigen correlated with increases in both CD8+ and CD8+ CD38+ cells in HIV-1(-) homosexual men (r = 0.35, P less than 0.013; r = 0.48, P less than 0.0005; respectively) and the 258 HIV-1+ subjects (r = 0.25, P less than 0.0003; r = 0.33, P less than 0.0001, respectively). In vitro examination of unstimulated peripheral blood lymphocytes from HIV-1+ homosexuals and IVDU confirmed the fivefold higher constitutive levels of cellular release of sCD8 antigen in these subjects compared to heterosexual controls. Inclusion of radiolabeled amino acids during the 3-day culture period in the presence or absence of phytohemagglutinin resulted in negligible levels of radioactivity associated with the sCD8 antigen indicative of a lack of de novo synthesis. Throughout clinical progression to AIDS, sCD8 antigen levels continued to escalate relative to the numbers of CD8+ cells bearing CD38+ antigen. The data confirm the interrelationship between sCD8+ antigen and CD8+ and CD8+ CD38+ cells.

Indomethacin-induced leukocyte adhesion in mesenteric venules: role of lipoxygenase products

Although the pathogenetic mechanisms underlying indomethacin-induced mucosal injury remain undefined, the results from recent studies suggest that leukocyte adherence in gastric microvessels may be an important component of this injury process. The objective of this study was to determine whether clinically relevant plasma concentrations of indomethacin promote leukocyte-endothelial cell adhesive interactions in postcapillary venules. Erythrocyte velocity, vessel diameter, leukocyte rolling velocity, and the number of adherent (stationary for greater than or equal to 30 s) and emigrated leukocytes were measured in rat mesenteric venules. Repeat measurements of all parameters were obtained within 20 min after addition of either 2.5 or 25 micrograms/ml indomethacin to the mesenteric superfusate. In some experiments, rats were pretreated with either a leukotriene (LT) synthesis inhibitor (L 663,536), an LTD4 (MK-571) or LTB4 (SC 41930) receptor antagonist, misoprostol, or prostacyclin (PGI2). Indomethacin alone increased the number of adherent leukocytes, reduced both leukocyte rolling velocity and venular shear rate, but did not promote leukocyte emigration. L 663,536 and SC 41930 prevented all of the adhesive and hemodynamic alterations induced by indomethacin; misoprostol and PGI2, but not MK-571, exerted similar beneficial effects. These results indicate that indomethacin promotes leukocyte adherence in postcapillary venules through an LTB4-dependent mechanism.

Increases in depressive symptomatology in the rural elderly: Results from a cross-sectional and longitudinal study

Depressive symptomatology was examined in a large sample of noninstitutionalized older adults using the Center for Epidemiological Studies-Depression scale (CES-D). Both cross-sectional and longitudinal data showed age-related increases in mean CES-D scores and increases in the percentage of respondents scoring at or above the cutoff score of 16. Variables collected at baseline in the longitudinal study from 2,032 participants 65 years of age and older were significant predictors of depressive symptomatology 3 and 6 years later. Baseline CES-D scores accounted for the largest proportion of the variance.

Lead poisoning from art restoration and pottery work: unusual exposure source and household risk

Two cases of lead poisoning following exposures in the arts and crafts environment are presented. The first illustrates the impact of an unusual exposure source experienced by a female art conservator while restoring an antique Peruvian tapestry from the Chancay Period (A.D. 1000-1500). The second demonstrates the extension to the artist's family members of a lead hazard associated with pottery work. Noted were a wide spectrum of clinical and biochemical abnormalities, ranging from severe neurological and gastrointestinal symptoms to subtle alterations in the biosynthetic pathway of heme. Marked elevation of the blood lead level (up to 130 mcg/100 mL) was found in the most severe case of lead poisoning. The cases illustrate the need for industrial hygiene measures in this type of work in order to prevent lead intoxication, both in the adult artist and children in the household. However, in some instances of increased lead absorption in persons with lead-related hobbies, sources other than those associated with arts and crafts should be investigated. This alternative is illustrated by a third case, in which firearms training was the more likely source of excessive exposure. Multiple occupational factors must occasionally be considered in evaluating increased lead absorption.