1
|
Cole K, Glass D, Bence T, Pisaniello D, Knott P, Rowett S, Johnson S. Prevention of the Occupational Silicosis Epidemic in Australia: What Do Those Who Assess Workplace Health Risk Think Should Be Done Now? Ann Work Expo Health 2022; 67:281-287. [PMID: 36111348 PMCID: PMC9923037 DOI: 10.1093/annweh/wxac064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/15/2022] Open
Abstract
An Australian National Dust Disease Taskforce was established to address the re-emergence of occupational lung disease, in particular silicosis. Exposure to respirable crystalline silica (RCS) occurs in various industries in Australia. We asked occupational hygienists about their practical experiences and perspectives on RCS exposure and regulatory action. A total of 105 members of the Australian Institute of Occupational Hygienists completed an anonymous questionnaire, which addressed individual characteristics, experience, perceived level of employer awareness, effectiveness of current regulation, and recommendations for improvement, across three main industrial sectors. Based on professional experience, 71% were concerned about the potential for RCS over-exposure. Barriers to adequate exposure control included lack of management commitment and financial resources. The employment of specialist occupational hygiene inspectors was considered to be the most effective regulatory strategy. Given the large number of exposed workers in the construction industry, with only a moderate awareness, there is the potential for significant cost shifting of the burden of occupational lung disease from employers on to individuals and the public health system. A nationally consistent approach to RCS exposure control across all industrial sectors is now recommended, with an increased focus on measuring and controlling exposure.
Collapse
Affiliation(s)
- Kate Cole
- Australian Institute of Occupational Hygienists Inc, Suite 11, 99-101 Western Avenue, Westmeadows, VIC 3049, Australia,Cole Health Pty Ltd, PO Box 605, Balmain, NSW 2041, Australia
| | - Deborah Glass
- Australian Institute of Occupational Hygienists Inc, Suite 11, 99-101 Western Avenue, Westmeadows, VIC 3049, Australia,School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Tracey Bence
- Australian Institute of Occupational Hygienists Inc, Suite 11, 99-101 Western Avenue, Westmeadows, VIC 3049, Australia,Chevron Australia, 250 St Georges Terrace, Perth, WA 6000, Australia
| | - Dino Pisaniello
- Author to whom correspondence should be addressed. Tel: +61-8-83133571; fax: +61-8-83134955; e-mail:
| | - Peter Knott
- Australian Institute of Occupational Hygienists Inc, Suite 11, 99-101 Western Avenue, Westmeadows, VIC 3049, Australia,GCG Health Safety Hygiene, U4 46-50 Belmore Road, Lorn, NSW 2320, Australia
| | - Shelley Rowett
- Australian Institute of Occupational Hygienists Inc, Suite 11, 99-101 Western Avenue, Westmeadows, VIC 3049, Australia,Mining and Quarrying OHS Committee, Level 2/220 Victoria Square, Adelaide, SA 5000, Australia
| | - Sharann Johnson
- Australian Institute of Occupational Hygienists Inc, Suite 11, 99-101 Western Avenue, Westmeadows, VIC 3049, Australia,Callander and Johnson Consultancy Services Pty Ltd, PO Box 304, Caulfield East, VIC 3145, Australia
| |
Collapse
|
2
|
Lavoué J, Joseph L, Knott P, Davies H, Labrèche F, Clerc F, Mater G, Kirkham T. Expostats: A Bayesian Toolkit to Aid the Interpretation of Occupational Exposure Measurements. Ann Work Expo Health 2020; 63:267-279. [PMID: 30551169 DOI: 10.1093/annweh/wxy100] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/01/2018] [Accepted: 11/13/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Interpretation of exposure measurements has evolved into a framework based on the lognormal distribution. Most available practical tools are based on traditional frequentist statistical procedures that do not satisfactorily account for censored data and are not amenable to simple probabilistic risk statements. Bayesian methods offer promising solutions to these challenges. Such methods have been proposed in the literature but are not widely and freely available to practitioners. METHODS A set of computer applications were developed aimed at answering typical inferential questions that are important to occupational health practitioners: Is a group of workers compliant with an occupational exposure limit? Are some individuals within this group likely to experience substantially higher exposure than its average member? How does an intervention influence the distribution of exposures? These questions were addressed using Bayesian models, simultaneously accounting for left, right, and interval-censored data with multiple censoring points. The models are estimated using the JAGS Gibbs sampler called through the R statistical package. RESULTS The Expostats toolkit is freely available from www.expostats.ca as four tools accessible through a Web application, an offline standalone application or algorithms. The tools include a variety of calculations and graphical outputs useful according to current practices in analysis and interpretation of exposure measurements collected by occupational hygienists. Tool1 and its simplified version Tool1 Express focus on inferences from data from a similarly exposed group. Tool2 evaluates within- and between-worker components of variability, as well as the probability that an individual worker might be overexposed. Tool3 compares exposure data across groups, e.g. evaluates the effect of an intervention. Uncertainty management includes the calculation of credible intervals and produces probabilistic statements about the exposure metrics (e.g. probability that over 5% of exposures are above a limit). DISCUSSION Expostats is the first freely available toolkit that leverages the flexibility of Bayesian analysis to perform an extensive list of calculations recommended in several international guidelines on the practice of occupational hygiene.
Collapse
Affiliation(s)
- Jérôme Lavoué
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, chemin de la Côte Ste-Catherine, Montréal, Québec, Canada.,University of Montreal hospital research center, Montréal, Québec, H2X, Canada
| | - Lawrence Joseph
- Division of clinical epidemiology, McGill University Health Centre, Montreal, Québec, Canada
| | - Peter Knott
- GCG Health Safety Hygiene, Hendra, QLD , Australia
| | - Hugh Davies
- School of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - France Labrèche
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, chemin de la Côte Ste-Catherine, Montréal, Québec, Canada.,Institut de recherche Robert-Sauvé en santé et en sécurité du travail, De Maisonneuve Ouest, Montréal, Québec H3A3C2, Canada
| | - Frédéric Clerc
- Institut National de Recherche et de Sécurité pour la prévention des accidents du travail et des maladies professionnelles (INRS), Paris, France
| | - Gautier Mater
- Institut National de Recherche et de Sécurité pour la prévention des accidents du travail et des maladies professionnelles (INRS), Paris, France
| | - Tracy Kirkham
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Abstract
PURPOSE Little is known about the natural history of spinal deformities in Coffin-Lowry syndrome (CLS). Our goal was to evaluate the spinal deformity progression and clinical impact. METHODS In this institutional review board-approved study, we performed a multinational retrospective review of six male CLS patients, aged 13 to 22 years at final follow-up, for a mean of 7.25 years (3 to 13). RESULTS All showed delayed skeletal maturity. Three had calcifications of their lower cervical ligamentum flavum, all experienced neural axis abnormalities, including lower extremity weakness, numbness and tingling and in one, quadriparesis. Only two were ambulatory at final follow-up.All had significant spinal abnormalities, including severe progressive thoracic lordosis, thoracolumbar kyphosis and scoliosis. All had undergone spinal fusion or were being evaluated for surgery. CONCLUSION CLS is a rare X-linked mutation in the RSK2 gene, affecting between 1/50 000 to 100 000 people. There are two reports in the literature of patients with calcifications of their ligamentum flavum. Both had neural axis abnormalities and one had acute onset quadriplegia. Analysis of their ligamentum flavum found abundant central calcifications. Despite our small cohort we found 50% had calcifications and 100% had neurologic consequences associated with those calcifications. There was a 100% rate of deformity progression.They all exhibited delay in skeletal maturity, which mandates longer follow-up and has implications for surgical planning.From our cohort and literature review, the natural history of CLS supports frequent patient evaluation and a lower threshold for correction of spinal deformities. Aiming to avoid spinal cord compression and improve or avoid neurological deterioration. LEVEL OF EVIDENCE IV - retrospective study.
Collapse
Affiliation(s)
- M. Welborn
- Orthopaedic Surgery Department, Shriners Hospital for Children, Portland, Oregon, USA,Correspondence should be sent to M. Welborn, Shriners Hospital Portland, 3031 SW Sam Jackson Park Road, Portland, Oregon 97239, United States. E-mail:
| | - S. Farrell
- Orthopaedic Surgery Department, Shriners Hospital for Children, Portland, Oregon, USA
| | - P. Knott
- Orthopaedic Department, Rosalind Franklin University, Chicago, Illinois, USA
| | - E. Mayekar
- Orthopaedic Department, University of Illinois Chicago, Chicago, Illinois, USA
| | - S. Mardjetko
- Orthopaedic Department, Illinois Bone and Joint Institute, Rush University, Chicago, Illinois, USA
| |
Collapse
|
4
|
Tamplen M, Tamplen J, Torrecillas V, Seth R, Ricceri S, Hemmat S, Heaton C, Ryan W, Knott P. Does a Standalone Cancer Center Improve Head and Neck Microsurgical Outcomes? J Reconstr Microsurg 2017; 33:252-256. [DOI: 10.1055/s-0036-1597757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Matthew Tamplen
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Jesse Tamplen
- Lean Transformation Office, University of California San Francisco, San Francisco, California
| | - Vanessa Torrecillas
- George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
| | - Rahul Seth
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Santo Ricceri
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Shirin Hemmat
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Chase Heaton
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - William Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - P. Knott
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| |
Collapse
|
5
|
Negrini S, De Mauroy JC, Grivas TB, Knott P, Kotwicki T, Maruyama T, O'Brien JP, Rigo M, Zaina F. Actual evidence in the medical approach to adolescents with idiopathic scoliosis. Eur J Phys Rehabil Med 2014; 50:87-92. [PMID: 24622050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Idiopathic scoliosis (IS) is a three-dimensional deformity of the spine and trunk. The most common form involve adolescents. The prevalence is 2-3% of the population, with 1 out of 6 patients requiring treatment of which 25% progress to surgery. Physical and rehabilitation medicine (PRM) plays a primary role in the so-called conservative treatment of adolescents with IS, since all the therapeutic tools used (exercises and braces) fall into the PRM domain. According to a Cochrane systematic review there is evidence in favor of bracing, even if it is of low quality. Recently, a controlled prospective trial including a randomised arm gave more strength to this conclusion. Another Cochrane review shows that there is evidence in favor of exercises as an adjunctive treatment, but of low quality. Three meta-analysis have been published on bracing: one shows that bracing does not reduce surgery rates, but studies with bracing plus exercises were not included and had the highest effectiveness; another shows that full time is better than part-time bracing; the last focuses on observational studies following the Scoliosis Research Society (SRS) criteria and shows that not all full time rigid bracing are the same: some have the highest effectiveness, others have less than elastic and nighttime bracing. Two very important RCTs failed in recruitment, showing that in the field of bracing for scoliosis RCTs are not accepted by the patients. Consensuses by the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) show that there is no agreement among experts either on the best braces or on their biomechanical action, and that compliance is a matter of clinical more than patients' behavior (there is strong agreement on the management criteria to achieve best results with bracing). A systematic review of all the existing studies shows effectiveness of exercises, and that auto-correction is their main goal. A systematic review shows that there are no studies on manual treatment. The SOSORT Guidelines offer the actual standard of conservative care.
Collapse
Affiliation(s)
- S Negrini
- Physical and Rehabilitation Medicine Department of Clinical and Experimental Sciences University of Brescia, Brescia, Italy -
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Knott P, Anderson C, Werner M, Wilson H, Speers D. The effects of scoliosis bracing on parent and child perception of adolescent’s quality of life. Scoliosis 2013. [PMCID: PMC3675410 DOI: 10.1186/1748-7161-8-s1-o56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Knott P, Musto J, Thompson S, Mardjetko S. The relationship between scoliosis and balance in a population of adolescents with AIS. Scoliosis 2013. [PMCID: PMC3675345 DOI: 10.1186/1748-7161-8-s1-o5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
8
|
Knott P, Techy F, Cotter T, Jansen L, Kove P, Loving J, Poletis K, Mardjetlko S. Retrospective analysis of immediate in-brace correction of scoliosis attainable in patients with AIS: a SOSORT initiative. Scoliosis 2013. [PMCID: PMC3675390 DOI: 10.1186/1748-7161-8-s1-o49] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
9
|
Knott P, Thompson S, Mardjetko S. A descriptive study of lateral spondylolisthesis in patients with adult scoliosis. Scoliosis 2012. [PMCID: PMC3304942 DOI: 10.1186/1748-7161-7-s1-p13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
10
|
Knott P, Smith K, Mack L, Peters L, Patel N, Thompson S, Mardjetko S. A comparison of static vs dynamic surface topography measurements in the evaluation of scoliosis. Scoliosis 2012. [PMCID: PMC3304844 DOI: 10.1186/1748-7161-7-s1-p12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
11
|
Siljander M, Knott P, Thompson S, Mardjetko S. The effect of patient positioning during radiographs on the resulting Cobb angle measurements. Scoliosis 2012. [PMCID: PMC3304917 DOI: 10.1186/1748-7161-7-s1-o12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
12
|
Egbor M, Knott P, Bhide A. Red-cell and platelet alloimmunisation in pregnancy. Best Pract Res Clin Obstet Gynaecol 2012; 26:119-32. [DOI: 10.1016/j.bpobgyn.2011.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 09/20/2011] [Accepted: 10/11/2011] [Indexed: 10/14/2022]
|
13
|
Knott P, Mardjetko S, Tager D, Hund R, Thompson S. The influence of body mass index (BMI) on the reproducibility of surface topography measurements. Scoliosis 2012. [PMCID: PMC3305309 DOI: 10.1186/1748-7161-7-s1-o18] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
14
|
Knott P, Mardjetko S, Thompson S. A comparison of authomatic vs. manual detection of anatomical landmarks during surface topography evaluation using the formtric 4D system. Scoliosis 2012. [PMCID: PMC3305249 DOI: 10.1186/1748-7161-7-s1-o19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
15
|
Hart DJ, Fairweather-Tait SJ, Broadley MR, Dickinson SJ, Foot I, Knott P, McGrath SP, Mowat H, Norman K, Scott PR, Stroud JL, Tucker M, White PJ, Zhao FJ, Hurst R. Selenium concentration and speciation in biofortified flour and bread: Retention of selenium during grain biofortification, processing and production of Se-enriched food. Food Chem 2010; 126:1771-8. [PMID: 25213956 DOI: 10.1016/j.foodchem.2010.12.079] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 11/16/2010] [Accepted: 12/16/2010] [Indexed: 11/19/2022]
Abstract
The retention and speciation of selenium in flour and bread was determined following experimental applications of selenium fertilisers to a high-yielding UK wheat crop. Flour and bread were produced using standard commercial practices. Total selenium was measured using inductively coupled plasma-mass spectrometry (ICP-MS) and the profile of selenium species in the flour and bread were determined using high performance liquid chromatography (HPLC) ICP-MS. The selenium concentration of flour ranged from 30ng/g in white flour and 35ng/g in wholemeal flour from untreated plots up to >1800ng/g in white and >2200ng/g in wholemeal flour processed from grain treated with selenium (as selenate) at the highest application rate of 100g/ha. The relationship between the amount of selenium applied to the crop and the amount of selenium in flour and bread was approximately linear, indicating minimal loss of Se during grain processing and bread production. On average, application of selenium at 10g/ha increased total selenium in white and wholemeal bread by 155 and 185ng/g, respectively, equivalent to 6.4 and 7.1μg selenium per average slice of white and wholemeal bread, respectively. Selenomethionine accounted for 65-87% of total extractable selenium species in Se-enriched flour and bread; selenocysteine, Se-methylselenocysteine selenite and selenate were also detected. Controlled agronomic biofortification of wheat crops for flour and bread production could provide an appropriate strategy to increase the intake of bioavailable selenium.
Collapse
Affiliation(s)
- D J Hart
- Institute of Food Research, Norwich Research Park, Colney, Norwich NR4 7UA, UK
| | | | - M R Broadley
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, Leicestershire LE12 5RD, UK
| | - S J Dickinson
- Premier Foods, Rank Hovis, Solent Mills, Western Docks, Southampton SO15 1BS, UK
| | - I Foot
- Limagrain UK Ltd., Woolpit Business Park, Windmill Avenue, Woolpit, Bury St. Edmunds, Suffolk IP30 0RA, UK
| | - P Knott
- Marks and Spencer plc, Waterside House, 35 North Wharf Road, London W2 1NW, UK
| | - S P McGrath
- Rothamsted Research, Harpenden, Hertfordshire AL5 2JQ, UK
| | - H Mowat
- Marks and Spencer plc, Waterside House, 35 North Wharf Road, London W2 1NW, UK
| | - K Norman
- Velcourt R&D, The Stables, Red House Farm, Woodwalton, Huntingdon, Cambridgeshire PE28 5YL, UK
| | - P R Scott
- Carr's Fertilisers, Old Croft, Stanwix, Carlisle CA3 9BA, UK
| | - J L Stroud
- Rothamsted Research, Harpenden, Hertfordshire AL5 2JQ, UK
| | - M Tucker
- Yara (UK) Ltd., Immingham Docks, NE Lincolnshire DN4U 2NS, UK
| | - P J White
- Scottish Crop Research Institute, Invergowrie, Dundee DD2 5DA, UK
| | - F J Zhao
- Rothamsted Research, Harpenden, Hertfordshire AL5 2JQ, UK
| | - R Hurst
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
| |
Collapse
|
16
|
Knott P, Mardjetko S, Lamborne D, Stemer J, Strasburg A. The influence of examiner experience on the reliability of surface topography measurements in patients with AIS. Scoliosis 2009. [PMCID: PMC2793439 DOI: 10.1186/1748-7161-4-s2-o14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
17
|
Snyder SM, Quintana H, Sexson SB, Knott P, Haque AFM, Reynolds DA. Blinded, multi-center validation of EEG and rating scales in identifying ADHD within a clinical sample. Psychiatry Res 2008; 159:346-58. [PMID: 18423617 DOI: 10.1016/j.psychres.2007.05.006] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 01/24/2007] [Accepted: 05/09/2007] [Indexed: 11/26/2022]
Abstract
Previous validation studies of attention deficit/hyperactivity disorder (ADHD) assessment by rating scales or EEG have provided Class-IV evidence per standards of the American Academy of Neurology. To investigate clinical applications, we collected Class-I evidence, namely from a blinded, prospective, multi-center study of a representative clinical sample categorized with a clinical standard. Participating males (101) and females (58) aged 6 to 18 had presented to one of four psychiatric and pediatric clinics because of the suspected presence of attention and behavior problems. DSM-IV diagnosis was performed by clinicians assisted with a semi-structured clinical interview. EEG (theta/beta ratio) and ratings scales (Conners Rating Scales-Revised and ADHD Rating Scales-IV) were collected separately in a blinded protocol. ADHD prevalence in the clinical sample was 61%, whereas the remainder had other childhood/adolescent disorders or no diagnosis. Comorbidities were observed in 66% of ADHD patients and included mood, anxiety, disruptive, and learning disorders at rates similar to previous findings. EEG identified ADHD with 87% sensitivity and 94% specificity. Rating scales provided sensitivity of 38-79% and specificity of 13-61%. While parent or teacher identification of ADHD by rating scales was reduced in accuracy when applied to a diverse clinical sample, theta/beta ratio changes remained consistent with the clinician's ADHD diagnosis. Because theta/beta ratio changes do not identify comorbidities or alternative diagnoses, the results do not support the use of EEG as a stand-alone diagnostic and should be limited to the interpretation that EEG may complement a clinical evaluation for ADHD.
Collapse
Affiliation(s)
- Steven M Snyder
- Department of Psychology, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX 76107, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Affiliation(s)
- Matthew R Lewin
- Division of Emergency Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.
| | | | | |
Collapse
|
19
|
Knott P. A novel means of assessing pediatric craniofacial integrity: high-frequency ultrasound. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-5998(03)01158-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
20
|
Knott P. The impact of fiducial distribution on headset registration in image-guided sinus surgery. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-5998(03)00985-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
21
|
Abstract
The red cell alloantibody, anti-U, is uncommon but is a recognised cause of haemolytic disease of the fetus and newborn. We describe six pregnancies complicated by the presence of maternal anti-U, and review nine other well-documented cases. In these 15 cases severe haemolytic disease occurred only with titres of > or = 1/512, and titres as high as 1/4000 were not necessarily associated with significant haemolysis. We recommend that an anti-U titre of > or = 1/128 or more at > or = 17 weeks of gestation is an indication for assessment of haemolysis in the fetus. Amniocentesis is the preferred initial investigation.
Collapse
Affiliation(s)
- G Smith
- Haematology Department, Guy's Hospital, London, UK
| | | | | | | | | |
Collapse
|
22
|
Hagan P, Knott P. Diagnosing and treating polycystic ovary syndrome. Practitioner 1998; 242:98-100, 103, 105-6. [PMID: 10476555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
|
23
|
Halperin JM, Newcorn JH, Koda VH, Pick L, McKay KE, Knott P. Noradrenergic mechanisms in ADHD children with and without reading disabilities: a replication and extension. J Am Acad Child Adolesc Psychiatry 1997; 36:1688-97. [PMID: 9401330 DOI: 10.1097/00004583-199712000-00017] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine noradrenergic (NA) function in children with attention-deficit hyperactivity disorder (ADHD) by replicating and expanding upon a previous finding that ADHD children with and without reading disabilities (RD) differ in plasma levels of the NA metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG). METHOD Plasma levels of MHPG were compared in ADHD children who were subdivided on the basis of the presence or absence of RD. Subsequently, this replication sample was combined with a previously studied sample to further explore the relationship between plasma MHPG levels and measures of cognitive function in children with ADHD. RESULTS Plasma levels of MHPG were significantly lower in ADHD children without RD, compared with those with RD, replicating a published finding. Analyses in the combined sample indicated that, among children with ADHD, plasma MHPG levels were inversely associated with measures of academic achievement and verbal processing, but not parent or teacher ratings of behavior or continuous performance test measures of attention and impulsivity. CONCLUSIONS These data indicate that children with ADHD are not homogeneous with regard to NA function and that neurochemical variation is closely associated with differences in clinical characteristics of the children.
Collapse
Affiliation(s)
- J M Halperin
- Psychology Department, Queens College, City University of New York, Flushing 11367, USA
| | | | | | | | | | | |
Collapse
|
24
|
Trestman RL, Yehuda R, Coccaro E, Horvath T, Knott P, Gabriel S, Siever LJ. Diurnal neuroendocrine and autonomic function in acute and remitted depressed male patients. Biol Psychiatry 1995; 37:448-56. [PMID: 7786958 DOI: 10.1016/0006-3223(94)00184-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study evaluated diurnal data gathered hourly (1000 to 1800 hours) in males during acute depression and during remission of depression and in age-range/gender-matched normal controls. Mean, peak, variability, and time-course of the noradrenergic metabolite, plasma 3-methoxy, 4-hydroxyphenylglycol [MHPG]), plasma cortisol, and autonomic (mean arterial blood pressure [MAP] and heart rate) variables were examined. Compared to controls, acutely depressed, but not remitted depressed, patients had 1) an earlier plasma MHPG peak, 2) a greater intragroup variability of plasma MHPG, 3) a higher plasma cortisol concentration, 4) a lower MAP, and 5) tended to increase MAP more slowly than did the normal controls. The time course of diurnal heart rate also differed in acutely depressed patients from controls: acutely depressed patients started higher and converged by midday to normal levels. These diurnal data lend limited support to the dysregulation hypotheses of depression that suggest normal circadian rhythmicities are altered or disrupted in acute depression and that peripheral manifestations of central dysregulation normalize in remission of depression.
Collapse
Affiliation(s)
- R L Trestman
- Psychiatry Service, Bronx VA Medical Center, N.Y. 10468, USA
| | | | | | | | | | | | | |
Collapse
|
25
|
Amin F, Seeman TE, Mohs RC, Davidson M, Knott P, Berkman LF, Albert M, Blazer D. Plasma homovanillic acid and performance on motor and cognitive tasks in community-dwelling elderly: MacArthur studies of successful aging. Neuropsychopharmacology 1994; 10:29-35. [PMID: 8179792 DOI: 10.1038/npp.1994.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To investigate the dopaminergic correlates of the aging-related motor and cognitive deficits, the dopamine metabolite homovanillic acid (HVA) in plasma was studied in a community-dwelling elderly cohort (n = 141). The results showed that hand-signature time (HST), a measure of bradykinesia, correlated negatively with plasma HVA (r = -0.24, p < .007). Similarities task performance showed a trend-level positive correlation with plasma HVA (r = 0.15, p = .08). Because plasma HVA is derived from several sources including central dopaminergic neurons and both central and peripheral noradrenergic neurons, the noradrenergic metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG) in plasma was also measured to indirectly estimate the relationships, with HVA originating from noradrenergic metabolism. Plasma MHPG significantly correlated with similarities scores (r = 0.34, p < .001) but not with HST. The results suggested that the association of HVA with prolonged HST may be related to central dopamine metabolism, but its association with similarities scores may be due to noradrenergic metabolism. The results raise the possibility that prolonged HST may be an indicator of preclinical brain dopamine loss in the elderly.
Collapse
Affiliation(s)
- F Amin
- Psychiatry Service, Bronx VA Medical Center, New York 10468
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Trestman RL, Coccaro EF, Lawrence T, Knott P, Gabriel SM, Siever LJ. The stability of plasma growth hormone and MHPG responses to repeated clonidine challenge in normal males. Psychoneuroendocrinology 1994; 19:13-20. [PMID: 9210208 DOI: 10.1016/0306-4530(94)90055-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Clonidine is a centrally acting alpha 2-adrenergic agonist used in many psychiatric studies to assess adrenergic functioning. The short- and long-term stability of plasma growth hormone (GH) and plasma 3-methoxy-4-hydroxy phenylglycol (MHPG) responses to clonidine (2 micrograms/kg IV) over a 60-min period were assessed in subsets of 13 male normal controls on 2 consecutive days (Study A; n = 11) and on 2 days separated by several months (Study B; n = 11). In Study A, no significant differences between consecutive days were found in either baseline plasma GH or MHPG or their responses to clonidine. The 60 minute plasma GH responses between consecutive days were highly correlated (r = 0.75, n = II, p < .001), while the 60 min plasma MHPG responses were not. In Study B, no significant differences in baseline plasma GH or MHPG, or their responses to clonidine challenge, were found between the 2 test days. However, neither the plasma GH responses nor the plasma MHPG responses to clonidine at 60 min correlated significantly between the 2 study days separated by several months. Both in Study-A and in Study B, 8 of 11 subjects had a stable GH response to clonidine across both study days when defined dichotomously (blunted < 4 ng/ml; otherwise, not blunted). These results suggest that the plasma GH response and plasma MHPG response to clonidine are unaffected by repeat clonidine challenge separated by 24 h, and that the plasma GH response to clonidine may be more stable over time than the plasma MHPG response to clonidine.
Collapse
Affiliation(s)
- R L Trestman
- Psychiatry Service, Bronx VA Medical Center, NY 10468, USA
| | | | | | | | | | | |
Collapse
|
27
|
Kahn RS, Davidson M, Knott P, Stern RG, Apter S, Davis KL. Effect of neuroleptic medication on cerebrospinal fluid monoamine metabolite concentrations in schizophrenia. Serotonin-dopamine interactions as a target for treatment. Arch Gen Psychiatry 1993; 50:599-605. [PMID: 7688208 DOI: 10.1001/archpsyc.1993.01820200009001] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This study examined the effect of neuroleptic treatment on indexes of dopamine and serotonin function in schizophrenic patients. We hypothesized that neuroleptic treatment would be effective by changing dopamine and serotonin function and/or by altering their interaction. DESIGN Lumbar cerebrospinal fluid (CSF) concentrations of the metabolites of dopamine (homovanillic acid, [HVA]) and serotonin (5-hydroxyindoleacetic acid, [5-HIAA]) were measured after a minimum drug-free period of two weeks and again after five weeks of treatment with haloperidol, 20 mg/d orally. Psychiatric symptoms were rated within one day of CSF sampling. PATIENTS Sixteen schizophrenic and three schizoaffective male inpatients. RESULTS Neuroleptic treatment significantly raised HVA concentrations and significantly increased the ratio between HVA and 5-HIAA. The increase in HVA was not related to symptomatic improvement, whereas the increase in the HVA/5-HIAA ratio was significantly correlated with reduction in overall symptomatology. CONCLUSIONS These findings suggest that the increase in HVA is relative to 5-HIAA, and not the absolute increase in HVA, that is related to symptomatic improvement. This, in turn, suggests that changing dopamine function relative to serotonin function, rather than changing dopamine per se, is associated with the therapeutic effect of haloperidol. Exploring serotonin-dopamine interactions in schizophrenia may be more informative than examining each system in isolation.
Collapse
Affiliation(s)
- R S Kahn
- Department of Psychiatry, Mount Sinai School of Medicine/Bronx Veterans Affairs Hospital, New York, NY
| | | | | | | | | | | |
Collapse
|
28
|
Trestman RL, Coccaro EF, Apovian M, Bernstein D, Lawrence T, Knott P, Horvath TB, Siever LJ. Norepinephrine responses to postural and isometric stressors in acute and remitted depression. Psychiatry Res 1993; 47:291-3. [PMID: 8372165 DOI: 10.1016/0165-1781(93)90086-v] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
29
|
Davidson M, Kahn RS, Stern RG, Hirschowitz J, Apter S, Knott P, Davis KL. Treatment with clozapine and its effect on plasma homovanillic acid and norepinephrine concentrations in schizophrenia. Psychiatry Res 1993; 46:151-63. [PMID: 8483974 DOI: 10.1016/0165-1781(93)90017-b] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Measurement of plasma concentrations of the dopamine metabolite, homovanillic acid (pHVA), is an indirect tool to assess changes in dopamine turnover. Levels of pHVA have been reported to decrease during treatment with conventional antidopaminergic, neuroleptics, with the decrement correlating with symptomatic improvement in schizophrenic symptoms. Clozapine, an atypical neuroleptic, is the only drug proved to be effective in treatment-refractory patients. However, the mechanism mediating this unique efficacy has not been fully elucidated. This study examined the effect of clozapine on pHVA concentrations in schizophrenic patients. Since clozapine potently binds to alpha 2-adrenergic receptors, plasma norepinephrine (pNE) concentrations were also measured. Twenty-eight treatment-refractory schizophrenic patients (24 men, 4 women) were treated with clozapine (up to 600 mg/day) for 5 weeks, after a minimum 1-week drug-free period. Symptomatology and pHVA and pNE concentrations were measured at the last drug-free day and weekly for 5 weeks. Fourteen patients responded to clozapine treatment, while an equal number did not. Mean pHVA concentrations did not significantly change during treatment with clozapine. Although clozapine tended to lower pHVA concentrations in treatment responders, the effect was small and not significant. Clozapine treatment significantly raised pNE concentrations, but this did not differentiate responders from nonresponders to clozapine. These findings suggest that clozapine's effect on DA turnover is small and that clozapine may be effective in treatment-refractory schizophrenia by mechanisms other than, or in addition to, dopamine receptor blockade. However, since about one-third of NE is metabolized into HVA, the clozapine-induced increase in pNE may have overshadowed a possible lowering effect of clozapine on pHVA.
Collapse
Affiliation(s)
- M Davidson
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029
| | | | | | | | | | | | | |
Collapse
|
30
|
Siever LJ, Amin F, Coccaro EF, Trestman R, Silverman J, Horvath TB, Mahon TR, Knott P, Altstiel L, Davidson M. CSF homovanillic acid in schizotypal personality disorder. Am J Psychiatry 1993; 150:149-51. [PMID: 8417559 DOI: 10.1176/ajp.150.1.149] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
CSF concentrations of homovanillic acid (HVA) were measured in 10 patients with schizotypal personality disorder and 14 patients with other personality disorders. The patients with schizotypal personality disorder had higher CSF HVA concentrations than the patients with other personality disorders. Furthermore, the psychotic-like schizotypal symptoms correlated positively with the CSF HVA concentrations. These results suggest a central dopaminergic dysfunction associated with the psychotic-like symptoms of schizotypal personality disorder.
Collapse
Affiliation(s)
- L J Siever
- Psychiatry Service, VA Medical Center, Bronx, NY 10468
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Abstract
In view of the abundant anatomical and functional interactions between serotonin and dopamine systems, this study examined the effect of the serotonin agonist, m-chlorophenylpiperazine (mCPP) on plasma concentrations of the dopamine metabolite, homovanillic acid. Plasma prolactin levels, body temperature, and mCPP blood level were also measured. mCPP (0.35 mg/kg) and placebo were administered orally to 10 healthy men in a randomized double-blind design. Variables were measured for 210 min after administration of capsules. mCPP raised prolactin and temperature as compared to placebo, but did not affect plasma homovanillic acid concentrations. Results suggest that mCPP does not alter dopamine function.
Collapse
Affiliation(s)
- R S Kahn
- Department of Psychiatry, Mount Sinai School of Medicine, Bronx Veterans Administration Hospital, Bronx, New York
| | | | | | | | | | | |
Collapse
|
32
|
Trestman RL, Lawrence TL, Coccaro EF, Harvey P, Bernstein D, Lawrence EK, Condello V, Mahon T, Yang RK, Knott P. Noradrenergic responses to clonidine in acute and remitted depressed male patients. Psychiatry Res 1992; 43:199-213. [PMID: 1332095 DOI: 10.1016/0165-1781(92)90053-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To investigate noradrenergic function in depression, plasma 3-methoxy-4-hydroxyphenylglycol (MHPG), plasma norepinephrine (NE), mean arterial pressure (MAP), and heart rate responses to intravenous clonidine (2 micrograms/kg), an alpha 2-adrenergic agonist, were measured in 27 acutely depressed patients, 18 remitted depressed patients, and 27 normal control subjects; a placebo infusion was administered to a subgroup. Clonidine compared with placebo, over a 150-minute time course, decreased plasma NE, MAP, and heart rate, but not plasma MHPG, in the control subjects. Plasma MHPG, plasma NE, MAP, and heart rate at baseline or in response to clonidine and placebo over 150 minutes did not indicate any group differences. The only significant plasma MHPG response to clonidine in the normal control subjects occurred 60 minutes after the infusion. A significantly diminished plasma MHPG response to clonidine at 60 minutes was found in the acutely depressed group compared with the normal control subjects. These results suggest that peripheral inhibitory noradrenergic responses to clonidine are normal in depressed patients, while plasma MHPG responses to clonidine, which have a limited central contribution, appear to be a weak reflection of central noradrenergic function and appear insufficiently robust for a meaningful evaluation of hypothetical group differences in central inhibitory alpha 2-adrenergic activity in this population.
Collapse
|
33
|
Knott P, Wilkinson L. Standard-setting--a measure of care. Nurs Times 1992; 88:28-30. [PMID: 1574406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
34
|
Kaufmann H, Oribe E, Miller M, Knott P, Wiltshire-Clement M, Yahr MD. Hypotension-induced vasopressin release distinguishes between pure autonomic failure and multiple system atrophy with autonomic failure. Neurology 1992; 42:590-3. [PMID: 1549219 DOI: 10.1212/wnl.42.3.590] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
To investigate whether activation of afferent and central baroreceptor pathways could differentiate between pure autonomic failure (PAF) and multiple system atrophy with autonomic failure (MSA), we determined the effect of upright tilt on circulating levels of vasopressin in patients with PAF and patients with MSA. We also studied 14 normal subjects, nine of whom developed acute hypotension due to vasovagal syncope. In patients with PAF and in normal subjects with vasovagal syncope, upright tilt induced marked hypotension and a pronounced increase in the plasma concentration of vasopressin (1.1 +/- 0.3 to 38.0 +/- 8.0 pmol/l in PAF and 1.0 +/- 0.2 to 27.4 +/- 7.2 pmol/l in vasovagal syncope, p less than 0.005 for both). In patients with MSA, upright tilt also elicited profound hypotension but circulating levels of vasopressin increased little (0.5 +/- 0.1 to 1.5 +/- 0.3 pmol/l, p less than 0.05). During upright tilt, the plasma concentration of norepinephrine significantly increased in normal subjects but did not increase in patients with autonomic failure. Our results indicate that afferent and central baroreceptor pathways involved in vasopressin release are normal in patients with PAF but are impaired in patients with MSA. Thus, measurement of baroreceptor-mediated vasopressin release appears to provide a clear marker to differentiate between patients with PAF and patients with MSA.
Collapse
Affiliation(s)
- H Kaufmann
- Department of Neurology, Mount Sinai School of Medicine, New York, NY
| | | | | | | | | | | |
Collapse
|
35
|
Davidson M, Kahn RS, Stern RG, Harvey PD, Keefe R, Knott P, Apter S, Webster L, Davis KL. MEASUREMENTS OF PLASMA HOMOVANILLIC ACID IN SCHIZOPHRENIC PATIENTS. Clin Neuropharmacol 1992; 15 Suppl 1 Pt A:521A-522A. [PMID: 1354058 DOI: 10.1097/00002826-199201001-00271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- M Davidson
- Bronx Veterans Administration Medical Center, NY
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Davidson M, Kahn RS, Knott P, Kaminsky R, Cooper M, DuMont K, Apter S, Davis KL. Effects of neuroleptic treatment on symptoms of schizophrenia and plasma homovanillic acid concentrations. Arch Gen Psychiatry 1991; 48:910-3. [PMID: 1929760 DOI: 10.1001/archpsyc.1991.01810340042005] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Measurement of plasma concentrations of the dopamine metabolite, homovanillic acid, is an indirect tool to assess changes in dopamine turnover in schizophrenic patients. Plasma homovanillic acid concentrations have been reported to decrease during neuroleptic treatment, with the decrement correlating with symptomatic improvement in symptoms of schizophrenia. The present study tested the hypothesis that neuroleptic drugs decrease plasma homovanillic acid concentrations in those schizophrenic patients who improve with administration of neuroleptic drugs but not in patients who fail to display a treatment response. Twenty schizophrenic men who remained drug free for at least 2 weeks were treated with 20 mg/d of haloperidol for 5 weeks. Symptoms and plasma homovanillic acid concentrations were assessed on the last drug-free day and weekly for 5 weeks. Mean plasma homovanillic acid concentrations decreased in the group of patients who responded to neuroleptic treatment and did not change in the group of patients who did not improve. These findings suggest that there may be a qualitative distinction between responders and nonresponders to dopamine antagonists.
Collapse
Affiliation(s)
- M Davidson
- Department of Psychiatry, Mount Sinai School of Medicine/Bronx Veterans Affairs Hospital, New York, NY 10029
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
OBJECTIVE To assess the relation between the indication for fetal blood sampling and pregnancy loss following the procedure. DESIGN Retrospective study. SETTING The tertiary referral Fetal Medicine Units at Guy's and University College Hospitals, London. SUBJECTS Women undergoing diagnostic fetal blood sampling in four groups: (1) 94 having prenatal diagnosis with normal ultrasound findings; (2) 94 with a structural fetal abnormality; (3) 30 having fetal assessment and (4) 35 with non-immune hydrops. INTERVENTIONS Freehand ultrasound guided fetal blood sampling from umbilical cord, intrahepatic vein or fetal heart. MAIN OUTCOME MEASURES Pregnancy losses were divided into those within 2 weeks and those 2 weeks after the procedure, obstetric accidents and neonatal deaths. RESULTS The 253 patients had fetal blood sampled on 268 occasions. Fifty-one pregnancies were terminated. Overall, 51 of the remaining 202 desired continuing pregnancies were lost, of which 19 (9%) were lost within 2 weeks of the procedure. After exclusion of the pregnancies that were terminated, the procedure-related losses within 2 weeks of sampling were 1 in 76 (1%), 5 in 76 (7%), 4 in 29 (14%) and 9 in 36 (25%) in groups 1, 2, 3 and 4 respectively. CONCLUSIONS The risk of fetal blood sampling is increased in abnormal pregnancies, reflecting the underlying pathology and this must be taken into account when counselling patients before the procedure.
Collapse
|
38
|
Khan RS, Amin F, Powchik P, Knott P, Goldstein M, Apter S, Kerman B, Jaff S, Davidson M. Increments in plasma homovanillic acid concentrations after neuroleptic discontinuation are associated with worsening of schizophrenic symptoms. Prog Neuropsychopharmacol Biol Psychiatry 1990; 14:879-84. [PMID: 1980541 DOI: 10.1016/0278-5846(90)90074-q] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
1. Thirty-two male schizophrenic patients participated in this study. 2. Plasma concentrations of the dopamine metabolite, homovanillic acid (pHVA) were assessed once on neuroleptic medication and twice a week for a maximum of six weeks after its discontinuation. 3. Psychiatric symptomatology was assessed once on neuroleptic medication and once a week for a maximum of six weeks after its discontinuation, using the brief psychiatric rating scale (BPRS). 4. pHVA and total BPRS score increased significantly after discontinuation of neuroleptic as compared to baseline. 5. The magnitude of pHVA and BPRS increments after discontinuation of neuroleptic correlated significantly. 6. Results of this study suggest that worsening of schizophrenic symptoms after discontinuation of neuroleptic treatment is associated with increased pHVA concentrations.
Collapse
Affiliation(s)
- R S Khan
- Dept. of Psychiatry, Mount Sinai Medical Center/Bronx Veterans Administration Hospital, New York, NY
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Brannan T, Knott P, Kaufmann H, Leung L, Yahr M. Intracerebral dialysis monitoring of striatal dopamine release and metabolism in response to L-dopa. J Neural Transm (Vienna) 1989; 75:149-57. [PMID: 2918307 DOI: 10.1007/bf01677428] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We have used intracerebral dialysis to monitor the striatal extracellular fluid (ECF) in rats with unilateral lesions of the nigrostriatal dopamine (DA) pathway. Dialysis samples were collected before and after L-dihydroxy-phenylalanine (L-DOPA) administration both in the presence and absence of carbidopa, an extracerebral DOPA decarboxylase (DDC) inhibitor. The baseline ECF levels of DA, 3,4-dihydroxyphenylacetic acid (DOPAC), and homovanillic acid (HVA) were always higher in the intact than in the lesioned striata. In the normal striata, dopamine (DA) concentrations increased following L-DOPA administration. Pretreatment with carbidopa prolonged the duration of the DA increase. In the lesioned striata, DA levels increased following L-DOPA administration only in animals pretreated with carbidopa. Following L-DOPA administration, striatal HVA and DOPAC levels increased considerably more in animals not pretreated with carbidopa than they did in pretreated animals. This increase was particularly marked in the lesioned striata and leads us to conclude that extracerebrally produced HVA and DOPAC can enter the brain extracellular space.
Collapse
Affiliation(s)
- T Brannan
- Department of Neurology, Mount Sinai School of Medicine, New York, New York
| | | | | | | | | |
Collapse
|
40
|
Brannan T, Weinberger J, Knott P, Taff I, Kaufmann H, Togasaki D, Nieves-Rosa J, Maker H. Direct evidence of acute, massive striatal dopamine release in gerbils with unilateral strokes. Stroke 1987; 18:108-10. [PMID: 3810742 DOI: 10.1161/01.str.18.1.108] [Citation(s) in RCA: 70] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Dopamine release into the extracellular space was measured with in vivo electrochemical detection in the ipsilateral and contralateral striata in Mongolian gerbils that suffered a stroke after acute unilateral carotid artery ligations. A sevenfold increase in the dopamine signal occurred within 15 minutes of carotid ligation in the ischemic side, while the unlesioned side had no significant change. Increased extracellular levels of dopamine persisted throughout the 3-hour recording period. Pretreatment with alpha-methyl-p-tyrosine 6 hours prior to recording significantly attenuated the signal increase. This study is the first direct demonstration of the marked, continuous dopamine release that occurs during acute cerebral ischemia.
Collapse
|
41
|
Needle RH, Knott P. Contraception and the college freshman. Health Educ 1977; 8:23-4. [PMID: 402339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|