[Diagnostic workup and therapy of acute venous diseases]

Acute venous diseases, especially deep leg and pelvic vein thrombosis, present an angiological emergency and can lead to acute life-threatening events such as pulmonary embolism. Long-term consequences may be postthrombotic syndromes. In addition to stroke and myocardial infarction, deep leg and pelvic vein thrombosis are one of the most common cardiovascular diseases. Early diagnosis and rapid initiation of therapy are important.

Adverse performance effects of acute lorazepam administration in elderly long-term users: pharmacokinetic and clinical predictors

BACKGROUND

The benzodiazepine lorazepam is widely utilized in the treatment of elderly individuals with anxiety disorders and related conditions. Negative effects of acute lorazepam administration on cognitive performance, especially memory, have been reported in both previously untreated elderly and in individuals who have received short term (up to three weeks) treatment with therapeutic doses. However, it remains unclear if these adverse cognitive effects also persist after long-term use, which is frequently found in clinical practice.

METHODS

Cognitively intact elderly individuals (n=37) on long-term (at least three months) daily treatment with lorazepam were studied using a double-blind placebo-controlled cross-over study design. Subjects were administered their highest daily unit dose of lorazepam (0.25-3.00 mg) or placebo on different days, approximately 1 week apart in a random order, and were assessed on memory, psychomotor speed, and subjective mood states.

RESULTS

Subjects had significantly poorer recall and slowed psychomotor performance following acute lorazepam administration. There were no significant effects on self-ratings of mood, sedation, or anxiety in the whole group, but secondary analyses suggested a differential response in subjects with Generalized Anxiety Disorder.

CONCLUSIONS

The reduced recall and psychomotor slowing that we observed, along with an absence of significant therapeutic benefits, following acute lorazepam administration in elderly long-term users reinforces the importance of cognitive toxicity as a clinical factor in benzodiazepine use, especially in this population.

Assessing African American adolescents' risk for suicide attempts: attachment theory

The threat of separation from a parent theoretically increases the risk of adolescent suicide attempts. The present study evaluated this and other hypothesized risk factors in a sample of adolescent suicide attempters and nonsuicidal controls, using the Psychiatric Consultation Checklist (Lyon, 1987). Stepwise logistic regression was used to predict group membership. It was found that threat of separation from a parental figure, insomnia, neglect, substance abuse, suicidal ideation, and failing grades were the strongest predictors of suicide attempt. Ten predictor variables correctly identified 97% of suicide attempters and 86% of nonattempters. Unexpected findings included high levels of truancy, threatening others, and separation from a parent before the age of 12 among nonattempters.

Testing the hypothesis of the multidimensional model of anorexia nervosa in adolescents

This study statistically tested six hypothesized risk factors of the model for anorexia nervosa. Forty-three adolescents with anorexia nervosa and 85 controls were administered the EAT, EDI, and FES. In addition, 43 parents of anorexics and 85 parents of controls completed the Family History Data Sheet, the FES, and the Perfect Child Questionnaire. Three of six hypothesized risk factors were confirmed: family history of depression, feelings of ineffectiveness, and poor interceptive awareness. Log-linear analysis indicated that the hierarchical model that best fit the data had significant two-way interactions with anorexia nervosa, G2 (11, N = 128) = 65.87, p < .001. In addition, alcohol and drug abuse or dependence figured prominently in the family history of patients with anorexia nervosa. The multidimensional model for anorexia nervosa holds up as an exploratory model of this condition in the adolescent age group.

Long-term morbidity and mortality in morbidly obese adolescents after jejunoileal bypass

To evaluate the long-term results of jejunoileal bypass in the treatment of morbidly obese adolescents, we studied 11 patients who underwent surgery between 1972 and 1974. More than 10 years after surgery, 45% of the patients had extremely satisfactory results (correction of morbid obesity). Three patients died within the year after surgery, two of them under extenuating clinical circumstances. There have been no subsequent deaths. All eight survivors were found to have metabolic abnormalities to various degrees. Two patients had a total of five pregnancies; each had one healthy infant, and three pregnancies ended in abortion (one spontaneous). Two patients had significant medical problems related to the procedure but basically remained in good health, whereas three patients had severe symptoms requiring reanastomosis. Of the five patients who continue with the bypass, none has become significantly obese. They have all maintained a weight loss of between 45 and 90 kg, and as adults express strong feelings in favor of the procedure. This series demonstrates that, although significant weight loss was maintained, and improvement in the quality of life for half of our patients was dramatic, side effects and complications continue to develop, mandating careful follow-up for an indefinite time.

[Complications after surgery of ENT-tumors. A comparison between preoperatively irradiated and nonirradiated patients]

Complications after preoperative high-dosage radiation of head and neck cancer are reported: 1. Preoperative radiation leads to complications in 42% compared to surgery alone in 20%. The results are statistically significant (alpha = 2%). 2. The complications after preoperative radiation are more severe (three ruptures of the carotid artery, three defects, which could only be managed by flap rotation). These results indicate the preoperative high-dosage radiation implies the risk of major surgical complications.

Obstetric care in a family health-oriented university associated neighborhood health center

The structure, staffing, and planning methods of the obstetric component of a family-oriented University Hospital associated family health care facility are briefly described. The interviews and screening procedures are outlined necessary to develop a broad data base for total health care planning. The roles of the members of the multiprofessional team employed are described with particular emphasis on the use of a nurse midwife as the primary obstetric care professional. Management procedures are referred to as well as the educational component present within such a program. The program is evaluated in terms of clinical outcome, patient and professional acceptance, and cost.