Population and familial association between the D4 dopamine receptor gene and measures of Novelty Seeking.
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Biomedical subjects
Publications and source records attributed to J Benjamin.
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The authors of this study examined the health behaviors of Texas college students, using a telephone survey to assess 1,408 randomly selected students enrolled in 23 institutions of higher education. Eighty-nine percent of those surveyed had consumed alcohol at least once, and nearly one third considered themselves regular smokers. More than 81% reported they had had sexual intercourse at least once, and one fourth of the sexually active men had had more than 10 partners. However, of the 1,148 students who were sexually active, only 40.1% reported using a condom at last intercourse. Almost 59% of the students surveyed had never been taught about HIV or AIDS in any of their college classes. Given the large sample size and the random methods employed, the authors suggest that the results of this study can be used to establish a baseline of information regarding health behaviors of college students that can be extrapolated to college populations across the country.
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1. Major family studies of bipolar disorder report the frequency of affective disorder among probands' relatives, but do not usually report the frequency of a positive family history among probands. A single previous study was not population based. 2. The Division of Psychiatry of Ben Gurion University provides virtually all psychiatric services for a catchment area of 300,000 people. The authors reviewed the charts of all 236 treated bipolar I patients in 1991, and interviewed 177 of them with a modified FH-RDC. 3. 48% of probands had a family history of mental illness. 4. However, the present methods of ascertainment may have been insufficiently sensitive.
OBJECTIVE: Because they found in an earlier study that inositol, an important intracellular second-messenger precursor, was effective against depression in open and double-blind trials, the authors studied its effectiveness against panic disorder. METHOD: Twenty-one patients with panic disorder with or without agoraphobia completed a double-blind, placebo-controlled, 4-week, random-assignment crossover treatment trial of 12 g/day of inositol. RESULTS: The frequency and severity of panic attacks and the severity of agoraphobia declined significantly more after inositol than after placebo administration. Side effects were minimal. CONCLUSIONS: The authors conclude that inositol's efficacy, the absence of significant side effects, and the fact that inositol is a natural component of the human diet make it a potentially attractive therapeutic for panic disorder.
Respiratory abnormalities have been proposed as a central feature of panic disorder, but the literature is not unanimous. Symptoms of anxiety were quantitatively recorded with the Hamilton Rating Scale for Anxiety (HAM-A) in 72 psychiatric out-patients in two anxiety disorders clinics in Israel; 44 patients had panic disorder with or without agoraphobia and 28 patients had other anxiety disorders. Panic patients had more cardiovascular symptoms, but not more respiratory symptoms, than other patients. The relative importance of respiratory symptoms in panic disorder is not yet settled.
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Inositol, a naturally occurring isomer of glucose, is a key intermediate of the phosphatidyl-inositol (PI) cycle, a second-messenger system used by several noradrenergic, serotonergic and cholinergic receptors. The suggestion that lithium might treat mania via its reduction of inositol levels led to experiments showing that pharmacological doses of peripheral inositol reverse behavioral effects of lithium in animals and side effects of lithium in man. Cerebrospinal fluid (CSF) levels of inositol are low in depression. An open-label, add-on trial of inositol in depression suggested a beneficial effect. In a subsequent 1-month, parallel-groups, double-blind, placebo-controlled study of 28 patients, inositol was effective as sole therapy for depression (p = .043). Inositol was also effective for panic disorder in a double-blind, random-assignment, placebo-controlled crossover study of 21 patients, with 4 weeks in each phase (p = .02); the effect was comparable to that of imipramine in recent studies.
BACKGROUND: Control of methicillin-resistant Staphylococcus aureus (MRSA) is particularly difficult in burn units, which are often cited as sources of hospital-wide MRSA outbreaks. We developed a successful MRSA control program and document here its apparent effectiveness in controlling MRSA transmission in a pediatric burn unit. METHODS: An MRSA control program that included surveillance culturing, clinician feedback, flexible, site-specific isolation, and a list of known carriers was consistently applied in a pediatric burn unit through a 7-year period. Microbiology reports of MRSA isolates from patients and environmental surfaces and records of all patients from whom MRSA was isolated were reviewed. RESULTS: During calendar years 1985 through 1991, a total of 991 acutely burned children were admitted to the Boston unit of the Shriners Burns Institute. Forty MRSA cases (4%) were identified. One patient both had MRSA at admission and met our criteria for nosocomial MRSA. Of the remaining 39 patients, 11 had MRSA at admission and 28 had nosocomial MRSA. There were 17 wound infections, two cases of pneumonia, and two bloodstream infections. No deaths were attributed to MRSA sepsis. CONCLUSION: An MRSA control program including surveillance culturing, clinician feedback, flexible, site-specific isolation, and a list of known carriers is associated with a low rate of nosocomial MRSA in a pediatric burn unit.
A review of 37 ankle arthrodesis procedures done over a 12-year period by multiple surgeons at a single institution was performed. Six different techniques were used during the study period. The initial success rate, defined as cases achieving a solid union after the index procedure, was 65%. Seven additional patients went on to a solid arthrodesis after subsequent surgical procedures, for an ultimate success rate of 84%. The initial success rate varied considerably depending on the surgical technique used, and ranged from 29% with the RAF fibular strut technique to 100% with T-plate fixation. Although there are many variables that influence the success or failure of ankle arthrodesis, in our hands rigid internal fixation gave the most predictable rate of primary union.
We studied the relationship of the administration and dosage of steroids to the development of avascular necrosis of bone in 168 patients who had had a heart transplantation (156 patients) or a heart and lung transplantation (twelve patients). One hundred and forty-one of the patients were male and twenty-seven were female. The average age was forty-five years (range, seven to sixty-six years). The average duration of follow-up was forty months (range, twelve to eighty months). Avascular necrosis developed in five patients (3 per cent). The femoral head was involved in three patients (bilaterally in two and unilaterally in one), the medial femoral condyle was involved bilaterally in one, and several sites were involved in the fifth patient. The avascular necrosis was diagnosed an average of five months (range, two to eleven months) after the transplantation. In order to evaluate the influence of the dosage of the steroids on the development of avascular necrosis of bone, the doses of prednisone and Solu-Medrol (methylprednisolone) at one week, one month, six months, and one year after the transplantation were calculated for each patient. There was no association between the cumulative dose of prednisone and the development of avascular necrosis. There was, however, a strong statistical association (p = 0.005), as determined with pooled two-tailed variance analysis, between the cumulative dose of Solu-Medrol administered in the first month after the transplantation and the development of avascular necrosis.
Synovial fluid from 13 knees undergoing revision total knee arthroplasty was subjected to chemical digestion and ultrafiltration. Scanning electron microscopy was used to visualize high-density polyethylene particles filtered from the fluid, and the images were analyzed using digital imaging software. This data were correlated with polyethylene wear patterns seen at the time of revision surgery. Patients' prostheses with gross polyethylene wear were differentiated from those with surface deformation and burnishing. The knees had been in situ for periods ranging from 3 to 112 months, and included 6 different prosthetic designs. The average area of the polyethylene particles measured ranged from 41 to 701 mu 2, and the total number of particles identified for each sample ranged from 38 to 279 mu 2. The largest particle identified had a surface area of 17,500 mu 2. Using the fluid volume analyzed, the particle area per milliliter of synovial fluid examined was calculated, and values ranged from 6.22 x 10(4) to 2.06 x 10(6) mu 2/ml. Visualization of high-density polyethylene using scanning electron microscopy allows greater resolution of morphologic detail than is possible with routine histologic examination using light microscopy. There were trends toward increasing particle size and total particle area in patients with gross polyethylene wear. The area of high-density polyethylene per milliliter of fluid in patients with gross wear was found to be statistically greater than that of patients without gross wear (p = 0.047). This technique offers a potentially valuable method of evaluating the status of high-density-polyethylene bearing surfaces in situ using a noninvasive technique.
BACKGROUND: Paraphilias are psychosexual disorders that are usually conceptualized as deviant in nature. Yet in some cases, paraphilia can be conceptualized as an obsessive compulsive disorder. METHOD: We describe an exhibitionist treated under partial single-blind conditions (patient was blind to placebo but was aware he was receiving desipramine and fluvoxamine) with the serotonin selective reuptake inhibitor fluvoxamine, followed by desipramine and a placebo that looked like fluvoxamine, in an ABACA design. He was serially assessed with the Yale-Brown Obsessive Compulsive Scale. RESULTS: Fluvoxamine eliminated the undesired impulse and behavior without affecting sexual desire. Desipramine and single-blind fluvoxamine-placebo treatment were both associated with relapses. CONCLUSION: A subset of paraphiliacs may be suffering from obsessive-compulsive-related disorders and may benefit from serotonergic agents.
The pathogenesis of both Legg-Calvé-Perthes disease (LCPD) and avascular necrosis (AVN) remains controversial. Evidence suggests, however, that both conditions are produced by vascular compromise in the femoral head. A patient with a previous history of LCPD at age eight subsequently developed AVN at age 46 after having a cardiac transplant for ischemic cardiomyopathy. A review of the past ten years' literature disclosed no reports of similar cases.
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Panic disorder is a specific psychiatric entity with specific and successful treatments. A parturient patient with sudden hypertension, hyperreflexia and headache was diagnosed with pre-eclampsia and treated with magnesium sulphate. Further attacks after discharge were recognized as panic attacks, and resolved with the anti-depressant imipramine.
Routine surveillance of infection in England and Wales detected 394 cases of campylobacter bacteraemia in 11 years. This represented an average incidence of 1.5 per 1000 intestinal campylobacter infections, with a range of 0.3/1000 in children aged 1-4 years to 5.9/1000 in patients aged 65 years or more. Definitive identification of 257 isolates showed that 89% were Campylobacter jejuni or C. coli; other species were C. fetus (8.6%), C. lari (0.8%), C. upsaliensis (0.8%), Helicobacter (Campylobacter) fennelliae (0.8%), and Helicobacter (Campylobacter) cinaedi (0.4%). Most (71%) of the C. jejuni/C. coli bacteraemias were in patients with acute enteritis. Of the patients with C. fetus bacteraemia only 27% had diarrhoea; they were older than patients with C. jejuni or C. coli bacteraemia (54.1 v. 45.9 years) and proportionally more of them were male (M:F ratio 2.7:1 v. 1.9:1); 41% had endovascular pathology or cellulitis. There was a higher proportion of C. jejuni serogroup O 4 (Penner) and O 18 strains among blood than faecal isolates, which suggests that they were unusually serum resistant and/or invasive.