Biomedical subjects
Publications and source records attributed to E Frank.
Psychological functioning within the first four weeks after rape was compared for married and single victims. Marital status did not significantly affect psychological symptoms following the assault. For married women, lack of support by the partner--particularly when it was unexpected--was significantly related to poor psychological functioning after the rape.
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The Social Rhythm Metric (SRM) is an instrument designed to quantify an individual's daily social rhythms. Social rhythms are important both as a way of structuring the day cognitively and as time cues (or zeitgebers) that drive the biological clock (circadian system). The development of the SRM and its pilot testing in 50 healthy control subjects is described, along with measurements of reliability and validity. The potential of the SRM for integrating psychosocial and biological research and its clinical applicability are discussed.
An inexpensive technique is described for measuring eyelid closure during classical (Pavlovian) conditioning experiments. This technique employs a Coulbourn Instruments Co. densitometric device that focuses a beam of infrared light on the cornea. Reflection of the light is interrupted by the eyelids when they are closed, which is sensed by an infrared detector. The latter causes a voltage change to occur, which can then be measured in a variety of ways. Details of both the hardware required and software developed for this purpose are described.
The authors determined the prevalence of late luteal phase dysphoric disorder in 217 university women aged 17-29 years. Unaware of the focus on premenstrual syndrome (PMS), the participants rated DSM-III-R symptoms of late luteal phase dysphoric disorder over 90 days. Using a 30% or greater premenstrual change as an index of luteal variation, the authors found that 10 women (4.6%) met the symptom criteria during two menstrual cycles. Compared to 25 young women seeking treatment for PMS who met the same diagnostic criteria, the 10 women from the university sample reported significantly less fatigue and impaired concentration and somewhat less severe depression and overall symptoms.
A variety of mechanisms underlie the specification of synaptic connections during development. In the monosynaptic stretch reflex in vertebrates, sensory neurones innervating muscle spindles are not determined until they make contact with a particular muscle. Instead, the muscle they supply appears to specify the pattern of central connections they establish with motoneurones. Developing thoracic sensory neurones made to project to novel peripheral targets in the forelimb of tadpoles project into the brachial spinal cord, something they never do in normal frogs. Moreover, these foreign sensory neurones make monosynaptic connections with the now functionally appropriate brachial motoneurones. 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 does not prevent the formation of correct sensory-motor connections. Competitive interactions among the afferent fibres also do not appear to be important in this process. When the number of sensory neurones projecting to the forelimb is drastically reduced during development, each afferent fibre still makes central connections of the same strength and specificity as normal. Together, these results suggest that peripheral targets induce some molecular change in developing sensory neurones such that they can recognize their appropriate synaptic partners in the spinal cord.
Cerebrospinal fluid (CSF) shunt malfunction in patients with hydrocephalus is common and can result in prolonged hospitalisation, operative exploration or progressive neurologic damage. The evaluation of shunt function usually requires invasive techniques that can be inaccurate or cause complications. Magnetic Resonance Imaging (MRI), which has been used to study both intraluminal blood flow and intraventricular CSF flow, may offer an alternative noninvasive test of shunt function. The MR characteristics of flow related enhancement were studied in a model shunt system. A special section of tubing for MRI was inserted into the system proximal to the valve. Flow through the system could be varied from 0 to 20 ml/h. Multiple spin echo images were made (TR2000, TE20) transverse to the specialised tubing. The intensity of the intraluminal MR signal at specific locations along this tubing and from a 'no flow' standard were measured. The signal intensity varied as a linear function of flow rate from 2.5 ml/h to 20 ml/h. These results suggest that MRI has potential for evaluating the slow flow in CSF shunts.
The influence of patterned neuronal activity on the formation of specific monosynaptic connections between muscle sensory and motor neurons was studied in the developing spinal cord of the bullfrog. Motor innervation of the forelimb was disrupted in tadpoles by resection of the brachial ventral root before these synaptic connections began to form in the spinal cord. In those frogs accepted for analysis, motor reinnervation of the forelimb was nonspecific and there was no coordinated movement of the limb. Synaptic connections therefore developed in the absence of temporal correlations of activity in muscle spindle afferents and motoneurons. Despite this disruption, afferent fibers supplying the triceps brachii muscles selectively innervated a restricted subpopulation of brachial motoneurons. Those motoneurons that received large synaptic inputs from afferents in one branch of the triceps nerve also received large inputs from afferents in the other triceps branches. Inputs from afferents supplying other muscles were not correlated with those from triceps afferents, suggesting the existence of a property common to all triceps afferents causing them to innervate a common subpopulation of motoneurons. These results show that in the absence of normal patterned sensory activity, sufficient cues still exist to permit the formation of specific sets of synaptic connections, and they argue indirectly for the existence of chemical labels that can determine the pattern of these connections.
The diagnosis of Pasteurella multocida meningitis was confused by a false-positive latex particle agglutination test implicating group B streptococcus. This illness and false-positive reactions in antigen detection are discussed.
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The development of central projections of sensory neurons in lumbosacral dorsal root ganglia (DRGs) was examined by using horseradish peroxidase labeling techniques in chick embryos from stage 23 (E4) to stage 39 (E13). Our results show that primary afferents reach the spinal cord by stage 23. Afferent axons extend in the primordium of the dorsal funiculus for several segments rostral and caudal to their segment of entry for over 24 hours before invading the gray matter at stage 28 (E6). Sensory fibers grow into the vicinity of motoneuron dendrites by stage 32 (E7.5), about the time that reflexes and apparent monosynaptic EPSPs can first be elicited. Dense projections into the dorsal laminae of the spinal cord, presumably representing cutaneous afferents, appear somewhat later, at about stage 39 (E13), when the segmental projection pattern begins to resemble the mature pattern.
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While some advances have occurred in the maintenance treatment of unipolar depression, empirical data on recurrences of illness following the discontinuation of medication are sparse. We examined survival time during the first 18 months after discontinuation of medication in 74 patients with recurrent unipolar depression. Although demographic characteristics, clinical characteristics, and pharmacologic treatment variables failed to predict time to recurrence, continued interpersonal psychotherapy was significantly related to longer survival time.
Two key questions regarding the treatment of depression remain unanswered: whether early treatment intervention will shorten the length of the episode and whether a previously successful treatment will be associated with a more rapid response when administered during the subsequent episode. A group of 45 patients with recurrent major depression treated with combined pharmacotherapy and psychotherapy in a similar fashion for two consecutive episodes showed comparable mean times to stabilization of between 11 and 12 weeks. However, the early intervention in the second treatment episode significantly shortened the overall length of the depressive episode by approximately 4 to 5 months.
The sleep electroencephalogram (EEG) of young, drug-free, recurrently depressed outpatients was analyzed for 2 nights and was compared to age-matched controls using a variety of standard and computerized measures of sleep activity. On the first night, young depressives showed significantly greater difficulty in falling asleep and decreased sleep efficiency. Sleep architecture differences between the young depressives and controls were highlighted by increased percentages of Stage 2 sleep and major decreases in Stages 3 and 4 (delta wave) sleep among the depressives, as indicated by either period analyses or spectral analysis. The greatest differences in delta wave activity during night 1 were found in the first two (non-rapid eye movement (NREM) periods as measured by period analysis (NREM period 1, p less than 0.04; NREM period 2, p less than 0.001--average delta wave count) or by spectral analysis for the first 100 min of sleep (0.5-2.0 Hz). In contrast to the NREM sleep findings, various REM variables, including REM latency did not significantly distinguish the two subject groups for either night 1 or 2. Stepwise discriminant analysis demonstrated that night 1 sleep latency and delta wave counts during the second NREM period correctly classified 100% of all 16 individuals studied. The only differences between the young depressed patients and controls that remained on night 2 were significant reductions in slow-wave sleep as quantified by the computerized methods. Taken together, these findings suggest that the EEG response of young outpatients to the first night's stay in a sleep laboratory may be a useful tool for the diagnosis of depression in this age group. In addition, the use of computerized methods in this study point to an underlying deficit in delta sleep waveforms as being a prominent feature of the sleep of young depressed subjects.
Fusiform aneurysmal dilatation of the petrous portion of the right carotid artery was found in a young patient with von Recklinghausen's neurofibromatosis. The patient presented with sudden left-sided hearing loss, and, during the evaluation of the hearing deficit, an asymptomatic right-sided vascular abnormality was identified. This vascular abnormality is unusual because those abnormalities commonly associated with von Recklinghausen's neurofibromatosis include occlusion of the cerebral arteries, arteriovenous malformations, and intracranial aneurysms. The pathophysiology and natural history of vascular abnormalities accompanying von Recklinghausen's neurofibromatosis are discussed.
We report preliminary findings from an ongoing, open trial of maintenance nortriptyline pharmacotherapy in 27 elderly depressed patients (median trial length: 18 months). While patients were on maintenance nortriptyline (mean dose: 50 mg/day) with steady-state plasma levels in the range of 50-150 ng/ml, 58% of Q-6 monthly ratings on the Hamilton Rating Scale for Depression have been 10 or lower, Folstein Mini-Mental State ratings have remained above 27, and a minimal level of side effects with no increase over time has been observed. Four of 27 patients (14.8%) have suffered recurrences and have required rehospitalization at 6, 9, 10, and 13 months. Survival analysis showed an 85% survival rate (without recurrence) at 12 months and 81.5% at 18 months. Mean survival time without recurrence is 21.3 months to date. Although our pilot experience with maintenance nortriptyline in late-life depression appears more favorable than outcomes reported in earlier naturalistic studies (where no attempt was made to keep patients in systematic maintenance therapy), the need for controlled studies of maintenance therapies in late-life depression is nonetheless underscored by the current data and other naturalistic data from the United Kingdom.
In this comparative study, both cefmetazole and cefoxitin were found to be safe and effective in the treatment of skin and soft tissue infections. Greater activity of cefmetazole against some strains of Staphylococcus aureus, Streptococcus pneumoniae, beta-haemolytic streptococci and aerobic Gram-negative bacilli was confirmed. A 90% or better cure rate was achieved with both drugs. At late follow up, three patients treated initially with cefmetazole had recurrent signs and symptoms. However, these three patients had vascular insufficiency which predisposed them to infection. Since cefmetazole has a longer half-life than cefoxitin, it may prove to be more convenient, or more cost effective, or both, in these and other infections.