Chickenpox in 'immune' hospital employees.
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Chickenpox↗
Biomedical subjects
E Frank
Publications and source records attributed to E Frank.
An adjustable ventriculoscope guide for use with stereotactic frames.
A ventriculoscope guide intended for use with stereotactic frames is described. This guide allows the ventriculoscope to be moved freely and then fixed rigidly into position without readjustment of the stereotactic frame. This design address requirements for extremely strong fixation of the ventriculoscope, adaptability to most stereotactic systems, and minimal damage to the brain tissue traversed by the ventriculoscope.
Cerebral Ventricles↗
Lineage of neurons and glia in chick dorsal root ganglia: analysis in vivo with a recombinant retrovirus.
We used retrovirus-mediated gene transfer to study the lineage of neural crest cells in chick embryos. Individual crest cells were infected before they migrated from the neural tube, and their clonal progeny were subsequently revealed in sensory ganglia and associated structures by a histochemical stain for the viral gene product (lacZ). We found that crest cells were multipotential in several respects. (1) Many clones contained both ventrolateral (VL) and dorsomedial (DM) neurons, which had been suggested to be lineally distinct. (2) Many clones contained both large and small neurons, which are known to innervate distinct targets. (3) Many clones contained multiple glial subtypes, e.g. both Schwann cells, which ensheath axons, and satellite cells, which ensheath neuronal somata. (4) Many clones contained both neurons and glial cells. On the other hand, a sizeable minority of clones was homogenous, e.g. they contained only neurons or only glial cells--suggesting that some progenitors may be, or become, restricted in potential. Finally, this study provides the first opportunity to compare directly the two methods currently available for tracing cell lineage in vertebrate embryos, retroviral infection and tracer injection: our results and those of Bronner-Fraser and Fraser (1989), who used the latter method, provide complementary but consistent views of crest lineage.
Animals↗
Clinical significance of reversed vegetative subtypes of recurrent major depression.
The significance of reversed vegetative forms of atypical depression (AD) was investigated in a sample of 211 outpatients with recurrent major depression. Consistent with several earlier reports, AD patients were younger, had fewer typical symptoms of melancholia, and responded slower to imipramine and psychotherapy treatment given according to protocol. There were few differences between reversed vegetative AD patients with reactive and nonreactive moods; both subforms of AD responded well to monoamine oxidase inhibitor when crossed over after initial protocol treatment failed.
Adult↗
Stereotaxic placement of a ventricular catheter and reservoir for the administration of morphine sulfate.
Patients with intractable pain due to cancer present a unique challenge to both medical and nursing personnel. This case study illustrates a unique home hospice managed pain control regime that has been implemented for a terminal cancer patient with intractable pain. A ventricular catheter attached to a reservoir was stereotaxically implanted for the administration of preservative-free morphine sulfate. The presentation will include the history of intraspinal morphine, the surgical placement of the ventricular access devise, and the procedure for intraventricular morphine administration. Also, the preoperative nursing assessment and patient family education will be discussed. Education of hospice nurses in the technique of injection, postoperative pain assessment, monitoring of side effects and discharge planning will conclude the presentation.
Adult↗
Sleep in late-life recurrent depression. Changes during early continuation therapy with nortriptyline.
The sleep of thirty elderly patients with recurrent unipolar depression was examined at baseline (before acute treatment of the index episode) and again in a state of symptomatic remission with nortriptyline (mean steady-state level: 82.1 ng/ml). Continuation therapy with nortriptyline was associated with improvement of polysomnographic sleep maintenance (mainly in the third and fourth sleep cycles, to a level similar to that of controls), prolongation of rapid-eye-movement (REM) sleep latency (exceeding that of controls), and potentiation of slow-wave activity during the first non-REM (NREM) sleep period. Clinical improvement, as measured by the Hamilton Depression Rating Scale, was significantly associated with shift of delta activity toward sleep onset (p less than 0.002), prolongation of REM sleep latency (p less than 0.0001), and improvement in sleep maintenance (p less than 0.0002). Multiple regression analysis showed that the single best correlate of clinical change was prolongation of REM sleep latency (i.e., prolongation of first NREM period). Perceived sleep quality improved significantly during early continuation therapy with nortriptyline, but not to the level reported by a group of 30 age- and sex-matched healthy controls. The findings are consistent with the concept that anti-depressant drug efficacy may depend upon strengthening of the homeostatic regulation of sleep and upon changes in the REM-sleep regulation.
Aged↗
Specific monosynaptic sensory-motor connections form in the absence of patterned neural activity and motoneuronal cell death.
The importance of neural activity and motoneuronal cell death in the formation of specific synaptic connections between muscle afferents and motoneurons was studied in chick embryos. Patterned neural activity was blocked by applying d-tubocurarine (dtc) chronically to embryos during the period when sensory-motor connections are formed [stages (St) 28-42]. Dtc blocks neurogenic muscle contractions, thereby abolishing any temporal correlation between neural activity in motoneurons and stretch-sensitive afferents. The normal pattern of motoneuronal bursting is also blocked (Landmesser and Szente, 1986), as is motoneuronal cell death (Pittman and Oppenheim, 1979). Dtc applications were started more than 1 d before muscle sensory afferent collaterals make anatomical contact with motoneuronal dendrites and continued until St 38-42, when the pattern of synaptic connectivity was examined by recording synaptic potentials intracellularly from identified lumbosacral motoneurons upon stimulation of identified populations of muscle afferents. In both normal and dtc-treated animals, large monosynaptic excitatory potentials were evoked in homonymous motoneurons (those that supply the same muscle as the sensory afferents) and were often observed in motoneurons that supplied synergistic muscles. Monosynaptic potentials were uncommon in motoneurons supplying antagonistic muscles. The overt patterns of sensory-motor connections in normal and dtc-treated embryos were essentially identical. However, the amplitudes of the composite EPSPs recorded in dtc-treated animals were consistently about twice as large as normal. These observations suggest that neither normal patterns of neuronal activity nor motoneuronal cell death play a large role in determining the specificity of connections between the sensory and motor neurons involved in the stretch reflex.
Afferent Pathways↗
Times of origin of brachial sensory neurons are not correlated with neuronal phenotype.
The times of origin (birthdays) of sensory and motor neurons that innervate the triceps brachii muscles of the bullfrog (Rana catesbeiana) were determined to learn whether neurons innervating a specific target are generated at a particular developmental time. 3H-thymidine (3H-TdR) was made available continuously throughout a specific developmental period. All neurons that innervated the triceps muscle in juvenile frogs (identified by filling cells retrogradely with HRP) were generated prior to metamorphosis. Triceps motoneurons were all postmitotic by early limb bud stage V. Triceps sensory neurons were generated over a protracted period of larval development, from stage V through early pre-metamorphic stage XV. Most large triceps sensory neurons were generated before the majority of the small cells. However, there was considerable overlap in the times of origin of the two populations; both large and small cells were generated at all stages of sensory neurogenesis. There was thus no strict relationship between sensory soma size and birthdate. Late-generated sensory neurons tended to be located in clusters within ganglia, whereas HRP-filled triceps neurons were not. These 3H-labeled clusters may represent clones of neurons which would indicate that late stage neuroblasts give rise to neurons that supply different peripheral targets. The time course of triceps neuronal generation paralleled that of all other brachial sensory neurons implying that the time of last cell division does not in itself determine either the target a neuron will innervate or the sensory modality to which it will respond.
Animals↗
Sleep, gender, and depression: an analysis of gender effects on the electroencephalographic sleep of 302 depressed outpatients.
Gender-related differences in electroencephalographic (EEG) sleep were examined in 151 pairs of men and women with major depression, all outpatients, matched for age and severity of depression. Across five decades (age 21-69), depressed men had less slow-wave sleep than did depressed women. Gender differences were small with respect to visually scored measures of slow-wave sleep time and percent, but moderate for gender differences in automated measures of slow-wave density. The time constant of the polygraph preamplifier significantly affected both visually scored and automatically scored slow-wave sleep. Other measures such as REM sleep latency, first REM period duration, sleep efficiency, and early morning awakening, showed robust age effects, but no main effects for gender or gender-by-age interactions. Gender effects on slow-wave sleep and delta-wave counts in depression parallel gender effects seen in healthy aging. The possibility of occult alcohol use by depressed male outpatients cannot be definitely excluded as a partial explanation of the current findings. However, covarying for past alcohol abuse did not negate the statistical significance of the observed gender effects on slow-wave sleep and delta-wave density. The possibility of gender differences in slow-wave regulatory mechanisms is suggested, but similarity in temporal distribution of delta-wave density between the first and second non-rapid-eye-movement (NREM) periods does not support gender differences in slow-wave sleep regulation.
Adult↗
Evidence against close linkage of unipolar affective illness to human chromosome 11p markers HRAS1 and INS and chromosome Xq marker DXS52.
The genetic basis of various subtypes of the affective disorders has been investigated by family, twin, and adoption studies, as well as by segregation and linkage analysis. Linkage analyses of bipolar disorder with the chromosome 11p15 DNA markers HRAS1 and INS, and the chromosome Xq28 markers for color blindness and G6PD have been reported. We have used restriction fragment length polymorphisms as markers to examine linkage in three extended families with unipolar affective illness, ascertained through probands with either recurrent unipolar or bipolar II illness. Using an inclusive definition of the affected phenotype, linkage could be excluded up to 28cM around the HRAS1-INS linkage group on chromosome 11p15, and up to 5 cM around the DNA marker DXS52 on Xq28. Negative linkage results were also obtained for two more restrictive definitions of affective illness. Thus, we find no evidence for the involvement of the chromosomal regions 11p15 and Xq28 with unipolar affective disorder in these three families.
Bipolar Disorder↗
[Hyposensitization in pollinosis. Results of a 3-year controlled study with 2 depot-allergoid grass pollen extracts: aluminum hydroxide-adsorbed allergoid and tyrosine-adsorbed allergoid].
For controlled hyposensitization treatment over a period of three years 36 patients with confirmed grass pollen sensitization had been selected in 1986 and randomly distributed to receive preseasonal injection therapy: 23 patients were treated with an average of seven AGD (aluminium-adsorbed allergoid) injections, and 13 patients had received six TA (tyrosine-adsorbed allergoid) injections. Evaluation of the trial data collected during three years of preseasonal treatment showed the following results of tolerance and efficacy: Systemic side-reactions registered during therapy were only mild and transient and occurred in the average after 3% of the AGD injections and after 10% of the TA injections. Local reactions over 5 cm diameter were registered after 7% in the AGD group and after 9% in the TA group. Before therapy there was no significant difference (p greater than 0.05) between the groups; after three years of therapy the AGD injections had resulted in a mean net rise of specific IgG of 220% (significant, p = 0.001); during the same time, TA injections had resulted in a final net increase of 10% (not significant, p greater than 0.05). Both treatment forms did not lead to any statistically relevant changes of specific IgE values. After three years of hyposensitization treatment, patients of both groups had improved; but an advantage was documented for patients treated with AGD on the basis of scores for objective assessment as well as for registered symptom and medication scores.
Adult↗
Direction of weight change in recurrent depression. Consistency across episodes.
The direction and extent of weight change during two separate episodes of severe, unipolar depression were assessed in 53 (unmedicated) outpatients in the Pittsburgh (Pa) study of maintenance therapy of depression. There was a high concordance (45 of 53 patients) of direction of self-reported weight change during the two episodes. Twenty-three patients lost weight during both episodes, 17 gained weight, and 5 showed no change. The extent of weight change between the two episodes was highly correlated. Self-reported weight change corresponded closely to measured weight changes in a large sample of the study population. Changes in appetite paralleled those in body weight. Duration of the episode and body mass index were related to the weight change, but two features of depression with which weight loss in depression has been associated (the endogenous character of the depression and it severity) were not. Direction and extent of weight change in unipolar depression appear to be stable patient characteristics across episodes and are thus potential markers for subtypes of depression. This stability of weight change is in sharp contrast to the lack of stability of the endogenous subtype in consecutive episodes of major depression.
Adult↗
Three-year outcomes for maintenance therapies in recurrent depression.
We conducted a randomized 3-year maintenance trial in 128 patients with recurrent depression who had responded to combined short-term and continuation treatment with imipramine hydrochloride and interpersonal psychotherapy. A five-cell design was used to determine whether a maintenance form of interpersonal psychotherapy alone or in combination with medication could play a significant role in the prevention of recurrence. A second question was whether maintaining antidepressant medication at the dosage used to treat the acute episode rather than decreasing to a "maintenance" dosage would provide prophylaxis superior to that observed in earlier trials in which a maintenance dosage strategy was employed. Survival analysis demonstrated a highly significant prophylactic effect for active imipramine hydrochloride maintained at an average dose of 200 mg and a modest prophylactic effect for monthly interpersonal psychotherapy. We conclude that active imipramine hydrochloride maintained at an average dose of 200 mg is an effective means of preventing recurrence and that monthly interpersonal psychotherapy serves to lengthen the time between episodes in patients not receiving active medication.
Adult↗
Delta sleep ratio. A biological correlate of early recurrence in unipolar affective disorder.
Slow wave sleep abnormalities have long been described in depression but were considered to be nonspecific indicators of psychopathology. Computerized techniques, including amplitude frequency measures and spectral analyses, are permitting new approaches to the examination of delta sleep. Early studies suggested that many depressed patients demonstrate lower delta wave intensity during the first non-rapid eye movement period than the second one. This finding, prominent in middle-aged depressed patients, has led to an examination of the ratio between the first and second non-rapid eye movement periods. This delta sleep measure seems to be a more robust predictor of recurrence than rapid eye movement latency. Analysis of data on 74 patients in a long-term maintenance treatment study for a minimum of 24 months demonstrates that the delta sleep ratio can predict survival time following discontinuation of drug treatment. Individuals with a high delta sleep ratio remain clinically remitted five times longer than those with a low delta sleep ratio.
Adult↗
Specification of synaptic connections between sensory and motor neurons in the developing spinal cord.
Experimental studies of mechanisms underlying the specification of synaptic connections in the monosynaptic stretch reflex of frogs and chicks are described. Sensory neurons innervating the triceps brachii muscles of bullfrogs are born throughout the period of sensory neurogenesis and do not appear to be related clonally. Instead, the peripheral targets of these sensory neurons play a major role in determining their central connections with motoneurons. Developing thoracic sensory neurons made to project to novel targets in the forelimb project into the brachial spinal cord, which they normally never do. Moreover, these foreign sensory neurons make monosynaptic excitatory connections with the now functionally appropriate brachial motoneurons. Normal patterns of neuronal activity are not necessary for the formation of specific central connections. Neuromuscular blockade of developing chick embryos with curare during the period of synaptogenesis still results in the formation of correct sensory-motor connections. Competitive interactions among the afferent fibers also do not seem to be important in this process. When the number of sensory neurons projecting to the forelimb is drastically reduced during development, each afferent still makes central connections of the same strength and specificity as normal. These results are discussed with reference to the development of retinal ganglion cells and their projections to the brain. Although many aspects of the two systems are similar, patterned neural activity appears to play a much more important role in the development of the visual pathway than in the spinal reflex pathway described here.
Animals↗
Features associated with suicide attempts in recurrent major depression.
Sixty-seven individuals with recurrent major depression and a history of suicide attempts are compared with 163 individuals with recurrent major depression and no history of suicide attempts. The groups are contrasted on demographic features, clinical course, severity of depression, co-morbidity, and acute symptom profiles. Patients with a history of attempts are distinguished from non-attempters by suicidal ideation, marital isolation, neurovegetative signs, feelings of failure, and co-morbid alcoholism or bipolar II disorder. Logistic regression analysis using a model which included a portion of the significant variables correctly classified 77% of the cases. These findings are discussed with reference to prediction of suicide attempts in individuals with major affective disorder.
Adult↗
Prevalence of axis I and axis II disorders in women with late luteal phase dysphoric disorder.
The authors interviewed 78 female patients with late luteal phase dysphoric disorder and found a 78% lifetime prevalence of axis I disorders but only a 10% prevalence of axis II disorders. A prior depression was the predominant axis I disorder found, and 29% of parous patients had a prior postpartum depression. A comparison of Global Assessment Scale scores obtained at both the follicular and luteal phases of the menstrual cycle confirmed luteal increases in symptoms and role impairment.
Adult↗
Imipramine and weight gain during the treatment of recurrent depression.
Weight change was examined in 128 depressed outpatients treated successfully with an average dose of 215 mg imipramine and then continued on that treatment regimen for 5 additional months, an average duration of over 33 weeks. More than half the patients experienced a change in weight of 5% or less and only 13.3% experienced a gain of greater than 10%. While males and females did not differ in their pattern of change during acute treatment, females experienced a greater percent change (P less than 0.06) and change in body mass index (P = 0.05) during continuation treatment. The clinical implications of these findings are discussed, especially with respect to the extreme group.
Adult↗