Biomedical subjects
Publications and source records attributed to J Sweeney.
The authors compared the effects of 6 weeks of imipramine treatment with 6 weeks of placebo treatment on social and vocational impairment in chronic depression. Imipramine was associated with significantly greater pre- to posttreatment improvement of social-vocational impairments in chronic depression, suggesting that these impairments may have represented affective symptoms rather than characterologic deficits.
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External pneumatic calf compression is effective but imperfect for antithrombotic prophylaxis in surgical patients. In preliminary studies, sequential filling of multisegmented leggings with graded pressure decreasing from ankle to knee increased venous flow velocity and wall shear stress, decreased residual venous volume, and enhanced postoperative fibrinolysis more than uniform compression. To determine if improved hemodynamics also increased antithrombotic activity, we performed a prospective randomized trial in neurosurgical patients comparing sequential application of graded pressure with uniform pressure applied to either a segmented bladder or to a single bladder. Deep vein thrombosis was diagnosed by leg scanning and impedance plethysmography and confirmed by phlebography. Venous thrombosis developed in 3 of 45 patients with graded-sequential filling, 6 of 50 with uniform compression-multiple compartments, and 3 of 41 with uniform pressure single bladder (differences not significant). These results suggest either that uniform compression offers all that can be expected of external pneumatic calf compression in prevention of venous thrombosis, or that even if a study with greater statistical power showed graded-sequential filling to be superior, the benefit/cost ratio of the more complex latter system is not likely to be large.
This paper reports on a retrospective study of 70 patients who were admitted to the Royal Adelaide Hospital with rectal bleeding. The study demonstrates several points; first, that there are two distinct groups of patients. The majority of patients had minor bleeds that ceased spontaneously. The remaining group of patients (12%) had what could be described as massive rectal bleeds. There was also noted to be a significant number of patients (21%) who were discharged with no final diagnosis. The utilization of investigations such as angiography and nuclear medicine scans was minimal. The paper concludes that there is a need to establish a protocol for the management of rectal bleeding and, if diagnostic yield is to be satisfactory, energetic attempts must be made to commence investigations at presentation, as soon as resuscitative measures are in progress.
To investigate the effect of treatment modality on length of hospital stay, the authors retrospectively studied 86 admissions of 74 patients with major depression. All 19 patients who received ECT recovered, in contrast to only 27 (49%) of 55 patients given tricyclic antidepressants or other medication. The 28 patients who had not responded to antidepressants recovered after treatment with ECT. Treatment modality had a highly significant effect on length of hospital stay: patients given ECT stayed a mean of 13 fewer days, saving more than $6,400 per patient at current rates. These findings of significant economic and therapeutic benefits in the use of ECT raise issues about treatment selection for depressed inpatients.
Research in hemodialysis adaptation has been facilitated by the use of reliable outcome measures such as BUN, K, and interdialysis weight gain. Their use, however, has at times been impressionistic, without reference to the actual range and distribution of those markers in a large population of dialysis patients over a long period of time. This study is a retrospective review to determine that range and distribution at one center. We found the interdialysis weight gains for most patients to be much higher than the levels used in the literature as cut-off points in determining 'non-compliance'. High levels on non-compliance in previous reports may be inflated. Significant correlations among the three biological markers and between each marker and staff assessment of compliance validate the use of inter-dialysis weight gain. Suggestions are made for interpreting such data in the future.
The present study investigated the effects of a potent inhibitor of choline acetyltransferase (ChAT), BW813U, on the choice accuracy of rats in the radial arm maze. BW813U (100 mg/kg, IP) produced a rapid (within 1 hour) and substantial decrease in ChAT activity throughout the brain, ranging from 66% (hippocampus) to 80% (caudate nucleus) that lasted up to 5 days. A single injection (50 mg/kg, IP) into rats with lesions (using ibotenic acid) in the nucleus basalis magnocellularis and medial septal area, decreased ChAT activity by 75% and 60% in the cortex and hippocampus, respectively. Lesioned and unlesioned rats were trained on the radial arm maze until they reached a criterion level of performance. Each rat then received an injection of BW813U (50 or 100 mg/kg, IP). Choice accuracy was not impaired at any time following the injection. The lack of effect on performance may be due to 2 possible factors: The radial maze retention paradigm chosen may not be sufficiently difficult, or the decrease in acetylcholine production was not sufficient to affect behavior. Compensation by non-cholinergic neural systems might account for the insensitivity of the rats to significant cholinergic depletion.
A 1.2-kilobase-pair BamHI fragment from a cell envelope-cell division gene cluster of Escherichia coli containing ddl and part of ftsQ was cloned and sequenced, and the sequence was interpreted with the aid of genetic complementation and promoter fusion data for the region. Both ddl and ftsQ were transcribed in the same direction (clockwise on the genetic map). ddl was shown to be capable of independent expression from a promoter of its own, and a promoter was identified within the ddl structural gene. The structural gene of ddl consisted of 918 nucleotides, encoding a 306-residue polypeptide of molecular weight 32,840; the synthesis of a protein of this molecular weight was shown to be directed from the 1.2-kilobase-pair BamHI fragment in minicells. Analysis of the DNA sequence further showed that the termination codon of ddl is separated from the initiation codon of ftsQ by one base, which suggests that these two genes may be translationally coupled when transcription is initiated upstream of ddl. This represents a second instance of potential translational coupling within this gene cluster and also indicates that the ddl and ftsQ transcriptional units must overlap (as has been reported earlier for ftsQ and ftsA and for ftsA and ftsZ).
The nocturnal rise of melatonin in serum of humans is the result of endogenously released norepinephrine (NE) acting upon beta-adrenergic receptors of the pineal gland. As there is much interest in the possibility of there being changes in the function of beta-receptors in depressed patients, the nocturnal rise of melatonin was measured in depressives and healthy control subjects. In one study, multiple serum samples were taken between 4.30 p.m. to 7.30 a.m. in seven male depressed patients with melancholia and five healthy male control subjects. The melancholic patients had a significantly reduced nocturnal elevation of melatonin. In a separate study, serum samples were taken at 8 a.m. and 11 p.m. in melancholic depressives, non-melancholic depressives and healthy control subjects. The melancholic patients had a significantly lower concentration of melatonin at 11 p.m., but not at 9 a.m., than that measured in either the control subjects or the non-melancholic depressed patients. These results are similar to those found recently by several other groups of investigators. Further research is indicated to elucidate mechanism(s) responsible for this phenomenon.
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Assessment of potentially thromboresistant polymers and other materials has been impeded by the lack of a simple and safe test procedure in man. This report describes the use of a portable gamma radiation detector to assess accumulation of 125I-fibrinogen in thrombi related to intravenous cannulae. The method was first employed in 19 dogs and one sheep with FEP-Teflon forelimb intravenous cannulae which were scanned for up to 6 h after insertion. Results were compared with findings at post mortem examination. Eleven thrombi developed, nine of which emitted more than 3500 counts per minute; eight of these (89%) were detected by external scanning. The smallest thrombus detected weighed 0.7 mg. The method did not distinguish between thrombus and hematoma. Fifty FEP-Teflon cannulae were then studied in 39 patients after injection of 100 microCi 125I-fibrinogen. Cannulae and control sites were scanned twice daily and an independent blind clinical appraisal was performed by an experienced nurse. A rise in percentage uptake (count at a limb site/heart count X 100) of 20 or a difference of 40 between adjacent sites was regarded as a positive test. Scans became positive up to 30 h before clinical evidence of phlebitis was observed. The interval between insertion and thrombosis of both large and small cannulae detected by scanning was significantly shorter than that determined by clinical assessment (p less than 0.001). Physical signs of phlebitis were noted with 58% of large cannulae (16 or 18 gauge)and 33% of small cannulae (22 gauge) at the time of removal. Positive 125I-fibrinogen tests were obtained with 70% of large cannulae and 75% of small cannulae. 125I-fibrinogen scanning is a safe simple sensitive technique to detect thrombosis related to intravenous cannulae. The test should enable comparisons of different cannula materials in man.
In a placebo-controlled single-crossover study, seven patients with treatment-resistant chronic paranoid schizophrenia who received methadone plus neuroleptic showed significant improvement. Methadone may be a useful adjunctive treatment in a subpopulation of patients with chronic paranoid schizophrenia.
The authors provide a critical review of the evidence from psychotherapy outcome research for and against the assumption that specific techniques produce specific effects. They describe the refinement in research and methodology that will be necessary to document specific effects.
The relationship of preinjury left-hand dominance for motor performance to postinjury distal motor skills following penetrating brain wounds in patients without overt hemiplegia was examined. We studied 13 controls, 13 right-hemisphere brain-damaged patients, and 11 left-hemisphere brain-damaged patients on motor tasks measuring reaction time, strength, and coordination. Our results indicated that no persistent deficits were seen on distal motor tasks in left-handed adults who suffered a penetrating brain wound. These findings are compatible with the relative sparing of persistent neuropsychological deficits in left-handers following brain damage.
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In this study, 31 patients with involutional-onset major depression had significantly more somatization and hypochondriasis and less loss of libido, guilt, suicidal intent, and family history of depression than 60 patients with an earlier onset. Regardless of age at onset, patients over age 50 had more agitation, initial insomnia, and hypochondriasis than those under 50. These findings suggest that clinical characteristics of patients with unipolar endogenous depression may be influenced by age at both onset and time of current episode. Although there is insufficient evidence to view involutional melancholia as a separate clinical entity, further research into the genetic and biochemical basis of late-onset depression is warranted.
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