A thirty-year retrospective study of hospitalization among severely mentally ill patients

This study examines the effects of deinstitutionalization policies on psychiatric hospitalization rates over a thirty-year period. It is based on a retrospective study of successive hospitalizations in severely disabled patients. The data indicate that in any five-year period these patients still spend over 20% of their time in hospital. For patients who have stayed for a total of more than one year every five years in hospital, the average length of stay has been decreasing far less rapidly in the last fifteen years than it had previously. Patients who were first admitted after 1971 spent proportionally as much time in hospital as those whose first stay was earlier. These results show that the groups primarily affected by deinstitutionalization are those who were first hospitalized prior to the 1970s and those who are the heaviest hospital users. However, the data from the patients admitted since the seventies seem to reveal that the process of change may have reached its limits.

{A pro-active approach to community intervention in the rural setting}

This paper reports an evaluation study of a pilot project held in a "CLSC" (Local Community Health Centre) located in a rural community. The intervention design is based on multidisciplinary teams created to meet specific local community needs. Mental health intervention is part of a community-based approach open to all kinds of requests for support. Practitioners in the field give support not only to the individual with a mental health problem, but also to existing self-help networks in the community. The intervention is also designed to change the relationship between a professional, seen as the one who provides services, and a client, defined as a consumer. The term "client" gains a wider meaning, and collaborative work with informal self-help networks induces a closer relationship between the community and the practitioner. The practitioner is more open to local community values and adjusts his or her practice to match variable contexts. The evaluation study has expanded knowledge of this type of intervention design, on its impact upon service demand, intervention modalities, and service management and organization. This project was coupled with a similar project in an urban environment and was financed by the Health and Social Services Ministry in Québec.

[Surgical approach of the petrous vertical segment and upper cervical internal carotid]

The main obstacle to successful management of aneurysms involving the high cervical internal carotid artery (ICA) is to obtain an adequate exposure. In this report we describe our experience in 5 patients presenting carotid aneurysms at the skull base, intermediately below the carotid foramen. Exposure is achieved in two stages. The cervical stage consists in resection of the styloid processes and muscles followed by anterior displacement of the mandibular condyle. This exposes the vertical segment of the petrous ICA. The petrous stage consists in partial petrectomy exposing the jugular bulb and the third segment of the facial nerve. Using this route, the vertical intrapetrous segment of the ICA can be drilled away without damaging the middle ear. In our series, no vascular complications occurred. Damage involving the facial glossopharyngeal and vagal nerves is discussed. This approach appears to be a suitable alternative to the conventional infratemporal approach which sacrifices the middle ear.

A latent variable causal model of the quality of life and community tenure of psychotic patients

Services are intended to maintain patients in the community while improving the quality of their lives. The purpose of this study was to determine the extent to which psychiatric patients' diagnoses, levels of autonomy, objective living conditions and degree of service utilization are associated with their perceived quality of life and, in turn, community tenure. A latent variable causal model was developed and tested using data from 152 schizophrenic and affective psychotic patients. Information was obtained using a semistructured interview, a quality of life scale, ratings on the Global Assessment Scale and patient hospital records. Results indicate that greater autonomy is significantly associated with greater perceived quality of life and that greater quality-of-life ratings are associated with greater community tenure.

Coxiella burnetii infection of pseudoaneurysm of an aortic bypass graft with contiguous vertebral osteomyelitis

We report the case of a 67-year-old man who had an infection of a pseudoaneurysm of an aortic graft with contiguous vertebral osteomyelitis. The infectious organism was identified as Coxiella burnetii, a strict intracellular pathogen causing Q fever infection in humans. The patient was treated successfully with removal of the infected material in conjunction with extraanatomic bypass and specific antibiotic therapy. He is doing well after more than 3 years, with no evidence of recurrent periaortic infection on successive computed tomographic scans. We suspect that C. burnetii vascular graft infections could be underdiagnosed, because this cause is not frequently evoked. We suggest that extending the etiologic search to C. burnetii could decrease the number of undocumented vascular graft infections.

Extension of a cerebellar cystic astrocytoma into the cervical canal, demonstrated by magnetic resonance imaging

One characteristic feature of ependymomas of the fourth ventricle is a tendency to extend through the foramina, specifically the foramina of Luschka and Magendie, the foramen magnum and the aqueduct of Sylvius. The authors report a case of pilocytic astrocytoma of the cerebellum that mimicked such extension into the upper cervical canal. This finding was revealed by magnetic resonance imaging and confirmed at surgery.

Multiple B-cell epitopes in a recombinant GRA2 secreted antigen of Toxoplasma gondii

Two cDNA clones encoding the GRA2 (G.P.28.5) secreted antigen of Toxoplasma gondii were expressed in Escherichia coli as glutathione-S-transferase fusion polypeptides. A high level of expression was obtained for the first clone expressing the 59C-terminal amino acids of GRA2. The other one was an open-reading-frame of 212 amino acids containing the entire GRA2 cDNA. By ELISA, IgG antibodies directed against the 59aa recombinant polypeptide were detected in 33/44 (75%) sera from patients chronically infected with T. gondii and in 19/23 (82.6%) sera derived from patients with acute, primary toxoplasmosis. 10 of the 11 "chronic" sera which were negative by the 59aa ELISA were tested in a immunoblot against the 212aa open-reading-frame of GRA2: 8/10 were positive. A peptide representing the 15 C-terminal amino acids of GRA2 has been shown to contain the epitope recognized by a mouse monoclonal antibody (TG17-179). The reactivity of human sera with the 59aa recombinant polypeptide was inhibited to varying degrees when the sera were co-incubated with this peptide. Twelve chronic sera showed a range of inhibition from 8 to 100% and twelve acute sera an inhibition range of 15 to 90%. This suggests that the 15aa C-terminal peptide contains an epitope recognized in both the acute and chronic phases of infection and that other major epitope(s) exist in the 59aa C-terminal region of GRA2. As a conclusion, the recombinant GRA2 protein appears to contain at least three B-cell epitopes.

ACE inhibition with perindopril and atherogenesis-induced structural and functional changes in minipig arteries

The effects of angiotensin-converting-enzyme (ACE) inhibition on atherosclerosis-induced changes in arterial function are unknown, as well as whether they are coupled to improvements of structural alterations in the arterial wall. An atherogenic (A) diet and the ACE inhibitor perindopril (P) were given concomitantly for 4 months to seven adult Pitman-Moore minipigs (7 months of age; A+P animals), which were compared with seven A and seven control (C) animals. Perindopril, at a daily dose of 4 mg PO that is commonly used in the clinical setting, induced a continuous 70% inhibition of serum ACE activity. At the end of the study, the atherosclerosis-induced impairment of arterial flow was investigated via the hemodynamics and vascular rheology of hindlimb arteries in non-barbiturate-anesthetized pigs. Structural alterations were evaluated from the histopathology of lesions in the arterial tree (abdominal aorta, left interventricular coronary artery [LIVCA], and brachiocephalic trunk [BCT]), with particular attention given to the analysis of the structure and composition of aortic elastic fibers. Atherosclerosis impaired the function of both capacitance and resistance arteries. Blood pressure (BP) rose significantly because of increased hindlimb peripheral resistance (HPR) and aortic input impedance (Zc), although blood flow was not affected. Altered aortic stress and elastic responses revealed that the stiffness of the aorta was markedly increased because of increased wall tension and reduced viscoelasticity, the viscous component being blunted in the arterial wall. Perindopril significantly opposed these alterations by reducing BP, HPR, and Zc and by returning parietal stiffness values to C values by increasing aortic compliance. ACE inhibition prevented the alteration of both stress and elastic responses. Major fibroproliferative fatty lesions were observed in the aorta and LIVCA, while moderate fibrosclerotic lesions were found in the BCT. Computerized densitometric analysis of orcein-stained elastin showed that elastic laminae fragmentation was prominent in the abdominal aorta, less in the LIVCA, and moderate in the BCT. Furthermore, the elastin content was reduced in the atherosclerotic aorta, although this loss of elastin was not associated with changes in the biochemical nature of alkali-insoluble elastin. Perindopril significantly prevented the development of atherosclerosis in the abdominal aorta, LIVCA, and BCT by decreasing the cross-sectional area of lesions as well as the number of lipid-laden cells in the abdominal aorta and LIVCA. In the abdominal aorta, ACE inhibition significantly prevented the alteration of elastic laminae by specifically preventing elastolytic fragmentation of dense elastic laminae, but it didn ot modify elastin content.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects of angiotensin-converting enzyme inhibition with perindopril on hemodynamics, arterial structure, and wall rheology in the hindquarters of atherosclerotic mini-pigs

The effects of ACE inhibition with perindopril on the atherosclerosis-induced impairment of arterial flow were investigated via histopathologic studies, hemodynamics, and vascular rheology of hindlimb arteries in 7 adult Pitman-Moore mini-pigs (7 months of age) fed for 4 months with an atherogenic diet and perindopril (at the daily oral dose of 4 mg, which induced a continuous 70% inhibition of serum ACE activity), versus 7 atherogenic and 7 control animals. Major fibroproliferative fatty lesions with medial intimalization were observed in the abdominal aorta. Atherosclerosis impaired the function of both capacitance and resistance hindlimb arteries. In atherogenic mini-pigs, blood pressure (BP) increased significantly due to increased hindlimb peripheral resistance (HPR) and aortic input impedance, although aortic blood flow was not affected. Altered aortic wall rheology revealed that the stiffness of the aorta was markedly increased due to increased wall tension and reduced viscoelasticity, the viscous component being reduced in the arterial wall. Perindopril significantly opposed these alterations by reducing BP, HPR and input impedance and by returning parietal stiffness to control values by increasing aortic compliance. Angiotensin converting enzyme (ACE) inhibition significantly prevented the development of atherosclerosis in the abdominal aorta by decreasing the cross-sectional area of lesions and the presence of lipid-laden cells, as well as by preventing alteration and fragmentation of elastic laminae. In conclusion, ACE inhibition with perindopril showed a significant preventive action on atherosclerosis-induced deleterious effects on vascular wall function and structure in mini-pig arteries.

Tailgut remnant--or teratoma?

The tailgut is the distalmost portion of the embryonic gut, located caudal to the cloacal membrane. Up to the sixth week of development, it is in close proximity to the distal end of the notochord and the neural tube. It completely regresses by the seventh week, but some caudal duplication-like cysts have been attributed to its remnants. We report a full-term male born with a large heterogeneous sacral mass. Severe bony abnormalities of the coccyx, sacrum and lower lumbar vertebrae were present, but the infant was neurologically intact. At surgery, the upper cystic structures within the mass were found to communicate with the dura, while the solid component, whose surface resembled intestinal mucosal folds, was closely related to the perirectal tissues. The mass was completely resected and the dura oversewn. Since this complex mass contained all three cell lines in an aberrant location, it satisfies the definition of a sacrococcygeal teratoma. However, its unique architecture suggests a malformative, rather than tumoral origin. The macroscopic appearance of this lesion reflects the embryonic relationship between the tailgut, the neural tube and the notochord.

Molecular structure of a Toxoplasma gondii dense granule antigen (GRA 5) associated with the parasitophorous vacuole membrane

The P21 antigen of Toxoplasma gondii, defined by the monoclonal antibody TG17-113, has been described as a dense granule component, secreted in the parasitophorous vacuole during host cell invasion. The present work reports the cloning of the gene encoding the P21 antigen, for which we propose the name GRA 5. A cDNA library was screened with a rat antiserum raised against an HPLC fraction enriched in the P21 antigen. cDNA clones encoding GRA 5 were selected by antibody selection on the recombinant proteins. All these clones were incomplete at the 5' end. The 5' fragment of the longest cDNA clone isolated by this first screening was used as a probe in secondary screenings of cDNA and genomic DNA libraries. A genomic fragment containing the P21 gene and nearly full-length cDNAs have been isolated and sequenced. The gene encoding GRA 5 is 834 bp long and does not contain any intron. The deduced amino acid sequence of an open reading frame encoding 133 amino acids perfectly matched that of 5 peptides microsequenced from the native antigen. A N-terminal hydrophobic region was found to possess the characteristics of a signal peptide of 25 amino acids. A second hydrophobic domain, bordered by two hydrophilic regions strongly suggests a transmembrane region. This molecular structure is supported by ultrastructural studies showing the association of the P21 antigen with the parasitophorous vacuole membrane.

Influence of electrical stimulation on enzymatic activity of old rat muscles during hindlimb suspension

1. The purpose of this study was to determine the effects of electrical stimulation on the muscles of older rats (21-24 months old) during suspension hypokinesia/hypodynamia. The rats' hindlimbs were suspended for three weeks, after which the activities of three enzymes were measured in the extensor digitorum longus, the medial gastrocnemius and the soleus muscles. 2. The activity of phosphofructokinase decreased in the soleus muscle and in the white part of the medial gastrocnemius muscle. Malate dehydrogenase and beta-hydroxyacyl-CoA-dehydrogenase showed decreased activity in the red part of the medial gastrocnemius muscle. 3. When electrical stimulation was applied, the activity of the glycolytic enzyme phosphofructokinase increased substantially in all studied muscles. The activity of the malate dehydrogenase and beta-hydroxyacyl-CoA-dehydrogenase enzymes was not influenced by electrical stimulation in the majority of the studied muscles. 4. These results suggest that our electrical stimulation model not only prevents loss of phosphofructokinase activity of aged muscles but increases the activity of anaerobic glycolysis metabolism without affecting the oxidative and fatty acid pathways.

Leptomeningeal gliomatosis: MR findings

We report a case of primary diffuse leptomeningeal gliomatosis documented by MR. The radiological findings guided the surgical biopsy toward the area involved. Pathological examination confirmed the diagnosis. The patient could consequently benefit from treatment, i.e., radiation therapy, which was followed by clinical relief.

Molecular characterization of a dense granule antigen (Gra 2) associated with the network of the parasitophorous vacuole in Toxoplasma gondii

The monoclonal antibody (mAb) TG17.179 recognizes an excreted-secreted antigen (ESA) of 28.5 kDa named Gra 2, which is stored in the dense granules of Toxoplasma cells and secreted into the parasitophorous vacuole after host cell invasion. Screening of an expression cDNA library with TG17.179 led to the isolation of several clones, the longest one (clone L) being of 1030 bp. Clone L cDNA was found to be homologous to a previously described composite cDNA encoding a P28 protein of Toxoplasma gondii. Characterization of one genomic clone indicates that the complete GRA 2 gene is about 1.3 kb in length, including an intron of 241 bp. Northern blot and primer extension analyses confirmed the size of the mature messenger (1.1 kb). Amino acid partial sequencing of the native antigen purified by HPLC and metabolic radiolabelings of ESAs perfectly matched the primary amino acid structure deduced from the clone L cDNA. This primary translation product consists of an 185 amino acid polypeptide (19.8 kDa) including a 23 amino acid signal sequence. The presence of many serine and threonine residues may indicate an O-glycosylation. The predicted mature polypeptide shows an internal helical domain with 2 amphipathic alpha-helices. These might be involved in the association of Gra 2 with the membranous network within the parasitophorous vacuole.

Pure motor hemiparesis in a case of vertebrobasilar arterial ectasia

A case of pure motor hemiparesis due to a pontine lacunar infarct is reported. Infarction was related to vertebrobasilar ectasia identified on CT, MRI and MR angiography. MR studies provide accurate information on anatomical location, residual lumen, partial thrombosis, mass effect on brain stem and CSF pathways and vascular complications.

Amino acid sequence requirements for the epitope recognized by a monoclonal antibody reacting with the secreted antigen GP28.5 of Toxoplasma gondii

We have characterized in detail, the epitope of the secreted antigen GP28.5 recognized by the mouse monoclonal antibody TG 17-179 using synthetic peptides and a truncated recombinant fusion protein. The screening of a T. gondii expression library with TG17-179 mAb led to the isolation of cDNAs clones, all encoding for the C-terminal region of GP28.5 and with one encoding for only the five last C-terminal residues. Competitive ELISA with longer peptides revealed that the immunoreactivity was retained for peptides of eight residues or longer, and lost when the peptide was reduced to the six last C-terminal residues or less. Experiments with the octapeptide lacking the carboxy-terminal glutamine residue showed it to be 64-fold less active. Moreover, neither addition of residues in the carboxy-end nor substitution of COOH function changed the immunoreactivity of the epitope. Competition experiments between TG17-179 mAb and sera from infected individuals demonstrates that the epitope defined by a mouse monoclonal probe is also a major epitope for human polyclonal antibodies. These results describe the sequence requirements within a probably linear epitope and give rise to some general question concerning experimental test for epitope mapping.

Profiles of alcoholics according to the SCL-90-R: a confirmative study

The Symptom Checklist-90-Revised (SCL-90-R) has often been used in studies of alcoholic populations. Based on findings reported in the literature and data gathered on 712 alcoholics in treatment, this paper investigates the general trends in the responses of alcoholics to the SCL-90-R. On global measures as well as on each of the symptom scales, the scores of alcoholic groups reveal a symptomatology two to five times as severe as that observed in the general population. The Psychoticism dimension shows the most marked divergence with the general population. In almost each of the study groups, the Depression Scale registers the highest scores, followed by Obsessive-Compulsive, Interpersonal Sensitivity, and Anxiety.

[Community services and quality of life: a study of the impact in a remote region]

This longitudinal study with a matched comparison group was conducted in Abitibi, an area in North-West Quebec. Its goal was to observe the impact of community support services on the quality of life of long term psychiatric patients living in a remote area. A cohort of 47 subjects, living in a small town with a comprehensive network of community support services, was compared with a similar group living in a neighbouring city with only outpatient services. The satisfaction with life domains scale developed by Andrews and Withey and adapted by Baker and Intagliata was used at four times during the study. According to the results, the subjective perception of the quality of life in the two groups is comparable, even though the objective conditions are less favorable for the group participating in the community support program. The highest ratings were given to the place of residence, the neighborhood and its commodities; the lowest ratings were given to their love life and financial situation. One can observe a stability of the measures of quality of life over time and for the two groups. The perceptions of the sample living in a remote area are much more favorable than the ones of a comparable group living in the Montreal area. These results are discussed in a double perspective: the role of community support services in the daily life of people who are having severe and persistent problems of mental health, and the interest of measures of quality of life.

[Inhibitors of angiotensin-converting enzyme and processus of intima proliferation in atherosclerosis]

The renin angiotensin system is a negative feed-back system of blood pressure control. A number of concordant experimental and clinical results indicate that the angiotensin family has a trophic effect on the vessel wall. These properties of the angiotensins favorise the proliferation of the cells which make up the vessel wall and also amplify the vascular dysfunction in the absence of the inhibitory regulations. Angiotensin converting enzyme inhibitors could be a valuable therapeutic method of counteracting these deleterious effects on the composition and function of the vessel wall.