Maintenance treatment of recurrent unipolar depression: pharmacology and psychotherapy.
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Adult↗
Biomedical subjects
E Frank
Publications and source records attributed to E Frank.
Implications of noncompliance on research in affective disorders.
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Adult↗
Associated focal and segmental glomerulosclerosis in the acquired immunodeficiency syndrome.
Of the 92 patients with the acquired immunodeficiency syndrome (AIDS) who were seen at our institution over a two-year period, 9 acquired the nephrotic syndrome (urinary protein greater than 3.5 g per 24 hours) and 2 had azotemia with lesser amounts of urinary protein. Five of these 11 patients had a history of intravenous-heroin addiction, but in the remaining six, there were no known predisposing factors for nephropathy. In nine patients (including the six non-addicts) the course of renal disease was marked by rapid progression to severe uremia. Renal tissue examined by biopsy in seven patients and at autopsy in three revealed focal and segmental glomerulosclerosis with intraglomerular deposition of IgM and C3. In the 11th patient, renal biopsy revealed an increase in mesangial matrix and cells, with deposition of IgG and C3 consistent with a mild immune-complex glomerulonephritis, and severe interstitial nephritis. We conclude that focal and segmental glomerulosclerosis may be associated with AIDS and suggest that rapid deterioration to uremia may characterize this renal disease.
Acquired Immunodeficiency Syndrome↗
The effects of dexamethasone administration on EEG sleep in depressed patients.
Since DST non-suppression and sleep abnormalities have been shown to co-exist in depressive states, it seems important to examine what effects dexamethasone administration might have on the sleep of depressed patients. Therefore, the effects of 1 mg dexamethasone p.o. administered at 11 p.m. to a group of 12 depressed outpatients was examined. In this series of patients, the hypothesis of no significant changes in sleep continuity, sleep architecture or REM sleep features was confirmed aside from an increase in Stage 2 sleep percent and decrease in Stage 1 REM percent in these patients (both variables stayed in the normal range). It can be concluded that acute administration of dexamethasone does not influence the sleep of depressed patients in a major way.
Adult↗
The relationship of EEG sleep to vital depression.
EEG sleep and clinical characteristics of 111 depressed inpatients with primary unipolar depression were examined in relation to several proposed definitions of endogenous depression (RDC criteria; DSM-III melancholia; and Nelson-Charney criteria). While each of these clinical schema demonstrated specific relationships to the EEG sleep findings in the overall group, the group with DSM-III melancholia showed definite REM sleep abnormalities, especially with REM activity and distribution. Further studies with sleep, neuroendocrine, and neurochemical measures are indicated in order to confirm the biologic 'substrate' of melancholia or vital depression.
Adult↗
Depressive symptoms in rape victims. A revisit.
Ninety recent victims of sexual assault were assessed within 4 weeks of the assault for evidence of depressive symptomatology and major depressive disorder. The results suggested 43% of the subjects met Research Diagnostic Criteria for major depressive disorder, with sleep disturbance and dysphoria being the most frequently endorsed symptoms. Older subjects and subjects who had been sexually victimized prior to the current assault were at significantly higher risk for developing major depressive disorder post-assault. Follow-up assessments revealed a diminution of depressive symptoms by 3 months after initial assessment and a continuing stabilization of mood at 6 and 12 months.
Adolescent↗
Biological and clinical predictors of response in recurrent depression: a preliminary report.
Electroencephalographic (EEG) sleep and selected hormone measurements were investigated in a group of 34 recurrent depressives receiving both pharmacotherapy and psychotherapy. These biological variables were examined to determine whether such measures could predict the rapidity of treatment response. While the EEG measures of sleep onset difficulty and degree of rapid eye movement (REM) density provided some level of discrimination, the serum cortisol measure, particularly the cortisol nadir, significantly discriminated between normal responders and slow or nonresponders. These data support the notion that biological factors measured before treatment might relate to the rapidity and extent of clinical response achieved by the patient.
Adult↗
Alkaline phosphatase activity in fresh intestinal mucosa and cultured mucosal explants.
Alkaline phosphatase (AP) activity is an accepted marker of epithelial cell differentiation and integrity in intestinal mucosal explant systems. In experiments involving AP it is usually expressed as activity per unit protein in tissue culture. It has been previously demonstrated that during organ culture a considerable amount of protein and nucleic acid (NA) may leave the cell and enter the surrounding medium. It may therefore not be appropriate to measure enzyme synthesis in relation to total tissue protein. In this study we attempted to gather additional information on enzyme dynamics and tissue integrity during organ culture of intestinal mucosal explants from children with celiac disease (CD) on a normal diet (ND) (n = 21), children with CD on a gluten-free diet (GFD) (n = 12), and patients with gastrointestinal disorders other than CD (controls) (n = 17). We confirmed the leakage of protein, NA, and AP from the tissue explant into the medium, and normalized the AP data by expressing AP as total AP in tissue plus medium per total NA in tissue plus medium. In patients with CD on a ND, the AP level at time 0 was 9.58 (+/- 12.2) mIU/micrograms NA and after 24 h culture rose to 21.9 (+/- 15.7) mIU/micrograms NA. In patients with CD on a GFD the baseline AP level was 24.9 (+/- 34.8) mIU/micrograms NA, and this value rose after culture to 28.6 (+/- 17.9) mIU/micrograms NA. In the controls the initial AP activity was 17.2 (+/- 15.7) mIU/micrograms NA, and the increase was to 38 (+/- 27.6) mIU/micrograms NA.(ABSTRACT TRUNCATED AT 250 WORDS)
Alkaline Phosphatase↗
Human umbilical artery for microvascular grafting. Experimental study in the rat.
As microvascular surgery has developed, the necessity for smaller arterial prostheses of less than 2 mm in internal diameter (ID) has increased markedly. Glutaraldehyde-stabilized human umbilical arteries with 1.5 to 2.0 mm ID are smaller than any other graft material currently available. This study was designed to determine whether this graft material has potential clinical application for microanastomosis. Twenty male albino rats, each weighing 400 to 500 gm, were used in this study. The abdominal aorta was exposed and a 3- to 4-mm segment was resected. A 10-mm interposition graft of glutaraldehyde-stabilized human umbilical artery was implanted by end-to-end anastomosis. The patency of the grafts was determined by repeated operative exploration at intervals of 1 week, and 1, 3, 9, and 12 months. Two grafts were found to be occluded each time at the 1-, 3-, and 9-month explorations. At each exploration time, five rats were sacrificed and histopathological studies conducted. All five remaining grafts were patent at 12 months. There was no evidence of endothelial proliferation on the luminal surface of the patent grafts as determined by scanning electron microscopy. The luminal surface and underlying region consisted of an amorphous proteinaceous-like material. Significant degeneration of the vessel wall was noted in all grafts surviving over 9 months. Central necrosis surrounded by a chronic inflammatory process that extended to and included the adventitia was observed in the occluded grafts. While the patency demonstrated was good, the tissue changes noted in the walls of the grafts indicate that further study is necessary before this material can be used as a graft in humans.
Animals↗
Regeneration of sensory-motor synapses in the spinal cord of the bullfrog.
Sensory fibers innervating muscles in the arm of the bullfrog form specific patterns of monosynaptic connections with motoneurons in the spinal cord. We show here that these normal patterns are re-established after interruption of the second dorsal root (DR2) in tadpoles and postmetamorphic frogs. DR2 was either cut or crushed, and 2 to 8 months later the extent and specificity of regeneration were assessed anatomically and physiologically. Horseradish peroxidase labeling of DR2 showed that sensory afferents had regenerated back into the spinal cord to form local arborizations, as in the normal adult. However, few long-tract fibers in the dorsal columns regenerated. Intracellular recording from different classes of motoneurons at the level of DR2 revealed that triceps muscle sensory afferents had regenerated to form functionally appropriate synapses. As in the normal adult, stimulation of the triceps nerves elicited larger monosynaptic EPSPs in triceps motoneurons than in non-triceps motoneurons. Thus, in the central nervous system of the bullfrog, specific monosynaptic connections are re-formed within the region of local regeneration.
Animals↗
Relationship among selected neuroendocrine and sleep measures in patients with recurrent depression.
Relationships among cortisol, TSH, and EEG sleep variables were examined in a group of 23 outpatients with recurrent unipolar depression at initial assessment prior to treatment for an acute major depressive episode. Blunted TSH responses were found in 39% of the sample (criteria of less than or equal to 7 microU/ml); cortisol nadir of greater than 2.5 micrograms% was rated in 41% of the group; and a reduced REM latency (less than or equal to 60 min) was measured in 57% of the group. Although almost all patients demonstrated abnormalities in at least one major neuroendocrine or sleep category, this preliminary analysis failed to find significant associations among these multiple biologic variables. Further studies on this so-called lack of association in a larger group of recurrent depressives is indicated. At this point caution is urged in assuming that biologic measures will identify a homogeneous group of severely depressed patients.
Adult↗
Physiological evidence for specificity of synaptic connections between individual sensory and motor neurons in the brachial spinal cord of the bullfrog.
We have studied synaptic connections between individual stretch-sensitive muscle afferents and motoneurons in the brachial spinal cord of bullfrogs. Sensory afferents from a given head of the triceps brachii muscle preferentially innervate motoneurons that project to the same muscle head. This preference is characterized in two ways: each class of sensory axon innervates a greater proportion of corresponding motoneurons than of motoneurons projecting to synergistic or unrelated muscles, and the synaptic potentials in these corresponding motoneurons are motoneurons that project to the same muscle head. This preference is characterized in two ways: each class of sensory axon innervates a greater proportion of corresponding motoneurons than of motoneurons projecting to synergistic or unrelated muscles, and the synaptic potentials in these corresponding motoneurons are of larger amplitude. A novel feature of these experiments is that even the smallest averaged synaptic potential is several times larger than the noise level. These smallest synaptic potentials thus represent the smallest synaptic interaction between a sensory and motor cell, and they could be the physiological correlate of a single sensory bouton on a motoneuronal dendrite.
Animals↗
Anatomical basis of specific connections between sensory axons and motor neurons in the brachial spinal cord of the bullfrog.
The anatomical basis for the specificity of the monosynaptic stretch reflex has been studied in the brachial spinal cord of bullfrogs. Sensory axons from the triceps brachii muscle innervate the corresponding triceps motoneurons but do not innervate two types of unrelated motoneurons (subscapularis and pectoralis) (Lichtman, J.W., and E. Frank (1984) J. Neurosci. 4: 1745-1753). Retrograde labeling of these three types of motoneurons with horseradish peroxidase (HRP) demonstrated that their cell bodies had overlapping distributions in the lateral motor column, and their dendrites all occupied the same region of the dorsal horn. In addition, triceps sensory axons aborized extensively in the dorsal horn throughout the brachial spinal cord, with no obvious predilection for the region of the triceps motoneurons. Thus, the physiological specificity of these sensory-motor connections was not apparent from the anatomical location of the sensory or motor neurons. However, by injecting single pairs of related or unrelated sensory and motor cells with HRP, we found that related pairs formed anatomical contacts with each other more frequently than unrelated sensory-motor pairs did. These observations suggest that the specificity of these connections is most likely the result of local interactions between sensory and motor processes.
Animals↗
Central projections of the brachial nerve in bullfrogs: muscle and cutaneous afferents project to different regions of the spinal cord.
The central projections of muscle and cutaneous sensory neurons in the bullfrog were labeled by filling their peripheral axons in the forelimb with horseradish peroxidase (HRP). Muscle afferent fibers were found to project exclusively to the ventral neuropil of the brachial spinal cord in the intermediate gray zone. Cutaneous afferent axons had their arbors limited to the dorsal neuropil. There is therefore a topography in the central representation of two classes of sensory modalities.
Animals↗
Identification of motoneurons innervating the tensor tympani and tensor veli palatini muscles in the cat.
The somatotopic arrangement of the motoneurons associated with the two non-masticatory muscles innervated by the trigeminal motor nerve, tensor tympani (TT) and tensor veli palatini (TVP), was determined in the cat using retrograde transport of horseradish peroxidase. The motoneurons of the TT are distinct and separate, ventral and ventral-lateral to the rostral two-thirds of the trigeminal motor nucleus. The cells are smaller than those of the motor nucleus and constitute a parvocellular division. Based on functional and morphological criteria, TT motoneurons may be considered as an accessory trigeminal nucleus. The somatotopic arrangement of TVP motoneurons has been described for the first time. These motoneurons are located in the rostral two-thirds of the ventromedial division of the cat trigeminal motor nucleus. The location of motoneurons associated with TT and TVP does not fit the parcellation of the cat trigeminal motor nucleus as described by previous investigators. The motoneurons of these muscles can now be assigned to areas either within (TVP) or adjacent to (TT) the rostral two-thirds of the motor nucleus.
Animals↗
Acquired immune deficiency in Haitians: opportunistic infections in previously healthy Haitian immigrants.
We describe acquired immune deficiency manifested by opportunistic infections in 10 previously healthy heterosexual Haitian men. The opportunistic pathogens included Toxoplasma gondii (in four patients), Cryptococcus neoformans (in one), Pneumocystis carinii (in four patients), and Candida albicans (in three). Six of the patients also had Mycobacterium tuberculosis. Immunologic studies of three patients showed a decrease in the numbers and activity of helper T cells, with normal or increased populations of suppressor T cells. Serologic markers for previous infections from hepatitis A, cytomegalovirus, and herpes simplex virus were detected in several patients. Six of the patients died despite specific antimicrobial therapy. The clinical and immunologic findings in these 10 Haitians are similar to those reported in drug addicts and homosexuals with the acquired immune-deficiency syndrome.
Acquired Immunodeficiency Syndrome↗
Development of sensory-motor synapses in the spinal cord of the frog.
The development and specificity of monosynaptic sensory-motor synapses were studied in the brachial spinal cord of bullfrog tadpoles. Intracellular and extracellular recordings were made from motoneurones innervating several different muscles of the forelimb. Excitatory synaptic potentials (e.p.s.p.s) were elicited by stimulation of various peripheral muscle nerves. Sensory and motor axons in the triceps brachii muscle nerves were electrically excitable at stage XIII, the earliest stage studied. Their conduction velocities were 0.2-0.4 m/s. These velocities increased during subsequent development so that by stage XXII they were approximately 5 m/s. Before stage XVII, synaptic potentials evoked in motoneurones by stimulation of the triceps sensory fibres had a long central latency and fatigued easily. These potentials were probably mediated polysynaptically. At stage XVII, the first short-latency triceps synaptic potentials appeared. They had central latencies of less than 3 ms and represented the direct, monosynaptic input from muscle sensory cells on to motoneurones. During subsequent development the percentage of triceps motoneurones innervated by triceps sensory fibres increased, while the number of long-latency polysynaptic inputs decreased. Both the electrical and chemical components, characteristic of these monosynaptic e.p.s.p.s in adult frogs, were prominent from the time the e.p.s.p.s first appeared. The pattern of innervation of brachial motoneurones by triceps sensory afferents was specific from the beginning. Triceps sensory fibres innervated most triceps motoneurones but very few subscapular or pectoralis motoneurones, just as in adult frogs. At no time were there appreciable numbers of 'aberrant' connexions. The developmental time course of several different classes of sensory-motor connexions was similar. Thus the synaptic specificity of this system cannot be explained by a differential timing of synaptogenesis.
Animals↗
Bilateral epidural hematomas.
Sixty-four cases of bilateral epidural hematomas were reviewed. The factors of patient age, direction of injuring forces, location of hematomas, presence of associated skull fracture, and time interval between injury and onset of signs and symptoms were analyzed. The results of this analysis show that bilateral epidural hematomas may develop slowly indicate that they occur with traumatic forces predominantly oriented in the anteroposterior direction, have fewer overlying fractures associated with them than unilateral epidural hematomas, and commonly contain venous blood. the differences between unilateral and bilateral epidural hematomas in direction of injuring forces, frequency of overlying skull fracture, and type of hemorrhage suggests that varying mechanisms may be responsible for production of these hematomas. Serial angiograms and CT scans have shown delayed accumulation of blood in bilateral epidural hematomas. This finding challenges the theory that epidural hematomas develop within minutes following injury.
Brain Injuries↗