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PubMed2000

What parts of PTSD are normal: intrusion, avoidance, or arousal? Data from the Northridge, California, earthquake.

The incidence and comorbidity of posttraumatic stress disorder (PTSD) are addressed in a study of 130 Northridge, California, earthquake survivors interviewed 3 months post-disaster. Only 13% of the sample met full PTSD criteria, but 48% met both the re-experiencing and the arousal symptom criteria, without meeting the avoidance and numbing symptom criterion. Psychiatric comorbidity was associated mostly with avoidance and numbing symptoms. For moderately severe traumatic events, re-experiencing and arousal symptoms may be the most "normal," and survivors with a history of psychiatric problems may be those most likely to develop full PTSD. A system that considers people who meet all three symptom criteria to have a psychiatric disorder yet recognizes the distress of other symptomatic survivors may best serve traumatized populations.

Adult↗
PubMed1997

Depression subtyping in PTSD patients.

A Structured Clinical Interview for the DSM-IV (SCID) and psychological testing were administered to 260 combat veterans in order to investigate the relationship between symptoms of post-traumatic stress disorder (PTSD) and melancholic features of depression. Sixty-seven percent of PTSD patients experiencing comorbid major depression acknowledged symptoms indicative of a melancholic-depression subtype. Correlational and regression analyses show that the presence of melancholic features is related to severity of emotional-numbing experienced by the PTSD patients. These results suggest PTSD patients are likely to experience depressive episodes phenomenologically similar to melancholic-depression. It is likely that acknowledgment of melancholic symptoms is due to (a) the inclusion of guilt as a melancholic feature, and (b) the similarities between emotional numbing symptoms and other melancholic features.

Adult↗
PubMed1999

Validation of the PTSD Checklist-Civilian Version in survivors of bone marrow transplantation.

Life-threatening illness now qualifies as a precipitating stessor for posttraumatic stress disorder (PTSD). We examined the validity of the PTSD Checklist-Civilian Version (PCL-C; Weathers, Litz, Herman, Juska, & Keane, 1993), a brief 17-item inventory of PTSD-like symptoms, in a sample of 111 adults who had undergone bone marrow transplantation an average of 4.04 years previously. Exploratory factor analysis of the PCL-C identified four distinct patterns of symptom responses: Numbing-Hyperarousal, Dreams-Memories of the Cancer Treatment, General Hyperarousal, Responses to Cancer-Related Reminders and Avoidance-Numbing. Respondents meeting PTSD symptom criteria on the PCL-C had significantly lower physical, role, and social functioning, greater distress and anxiety, and significantly more intrusive and avoidant responses than individuals who did not meet PTSD symptom criteria.

Activities of Daily Living↗
PubMed2004

An experimental study of emotional responding in women with posttraumatic stress disorder related to interpersonal violence.

Although posttraumatic stress disorder (PTSD) is defined by the experience of intense negative emotions and emotional numbing (American Psychiatric Association, 1994), empirical study of emotional responding in PTSD has been limited. This study examined emotional responding among women with and without PTSD to positive and negative film stimuli across self-reported experience, facial expression, and written expression. Consistent with previous findings, no evidence for generalized numbing was found. In general, women with PTSD exhibited higher levels of negative activation and expressed more negative emotion words to both positive and negative film stimuli, whereas no group differences emerged in facial expressivity. Results are interpreted within the context of the current literature on emotional deficits associated with PTSD.

Adult↗
PubMed2004

Posttraumatic stress disorder symptoms and parenting satisfaction among a national sample of male vietnam veterans.

This study examined relationships between posttraumatic stress disorder (PTSD) symptoms and parenting satisfaction. Total PTSD severity scores and avoidance and emotional numbing symptoms were significantly associated with parenting satisfaction. These associations remained significant even after controlling for partner violence, major depression, and alcohol abuse/dependence. Results suggest that higher levels of PTSD symptoms and avoidance and emotional numbing symptoms in particular may have a deleterious effect on parent-child relationship satisfaction.

Adult↗
PubMed1998

The structure of posttraumatic stress symptoms.

Posttraumatic stress disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. and 4th ed.; American Psychiatric Association, 1987, 1994, respectively), is characterized by 17 symptoms, descriptively clustered into 3 groups: (a) intrusions, (b) hyperarousal, and (c) avoidance and numbing. The present study sought to identify the basic dimensions (factors) that underlie these symptoms. Two samples were assessed: 103 victims of motor vehicle accidents and 419 United Nations peacekeepers deployed in Bosnia. A principal axis factor analysis was conducted for each sample. In each sample, 2 correlated factors were obtained, which were very similar across samples. Factor 1 was labeled Intrusions and Avoidance, and Factor 2 represented Hyperarousal and Numbing. These factors loaded on a single higher order factor. The higher order factor accounted for 13% to 38% of variance in symptom severity, and the lower order factors accounted for an additional 8% to 9% of variance. If the authors assume that each factor corresponds to a distinct mechanism (R. B. Cattell, 1978), then the results suggest that posttraumatic stress reactions arise from a general mechanism, with contributions from 2 specific mechanisms.

Adult↗
PubMed2001

Posttraumatic stress disorder and depression symptomatology in a sample of Gulf War veterans: a prospective analysis.

The authors examined the relationship over time of posttraumatic stress disorder (PTSD) and depression symptoms in a sample of Gulf War veterans. A large sample (N = 2,949) of Gulf War veterans was assessed immediately following their return from the Gulf region and 18-24 months later. Participants completed a number of self-report questionnaires including the Mississippi Scale for Combat-Related PTSD (T. M. Keane, J. M. Caddell, & K. L. Taylor, 1988) and the Brief Symptom Inventory (L. R. Derogatis & N. Melisaratos, 1983) at both time points and an extended and updated version of the Laufer Combat Scale (M. Gallops, R. S. Laufer, & T. Yager, 1981) at the initial assessment. A latent-variable, cross-lag panel model found evidence for a reciprocal relation between PTSD and Depression. Follow-up models examining reexperiencing, avoidance-numbing, and hyperarousal symptoms separately showed that for reexperiencing and avoidance-numbing symptoms, the overall reciprocal relation held. For hyperarousal symptoms, however, the association was from early hyperarousal to later depression symptoms only.

Adult↗
PubMed2001

Frizzled regulates localization of cell-fate determinants and mitotic spindle rotation during asymmetric cell division.

Cell-fate diversity is generated in part by the unequal segregation of cell-fate determinants during asymmetric cell divisions. In the Drosophila pupa, the pI sense organ precursor cell is polarized along the anterior-posterior axis of the fly and divides asymmetrically to generate a posterior pIIa cell and an anterior pIIb cell. The anterior pIIb cell specifically inherits the determinant Numb and the adaptor protein Partner of Numb (Pon). By labelling both the Pon crescent and the microtubules in living pupae, we show that determinants localize at the anterior cortex before mitotic-spindle formation, and that the spindle forms with random orientation and rotates to line up with the Pon crescent. By imaging living frizzled (fz) mutant pupae we show that Fz regulates the orientation of the polarity axis of pI, the initiation of spindle rotation and the unequal partitioning of determinants. We conclude that Fz participates in establishing the polarity of pI.

Animals↗
PubMed1996

Role of inscuteable in orienting asymmetric cell divisions in Drosophila.

Drosophila neuroblasts and epithelial cells in the procephalic neurogenic region divide perpendicular to the surface, and segregate the proteins Numb and Prospero into the basal daughter cell. We demonstrate here that orientation of the mitotic spindle and correct localization of Numb and Prospero in these cells require the inscuteable gene. Moreover, ectopic expression of inscuteable in other epithelial cells leads to spindle reorientation. The Inscuteable protein localizes to the apical cell cortex before mitosis, suggesting that Inscuteable functions in establishing polarity for asymmetric cell division.

Actins↗
PubMed1992

Assessment of morbidity from complete axillary dissection.

The importance of axillary dissection as part of the primary surgical procedure in the treatment of operable cases of carcinoma of the breast is established. The morbidity of this procedure, however, is less well documented. A study of 126 women who had had full axillary dissection as part of their initial surgical treatment was undertaken to assess their degree of morbidity in terms of numbness, pain, weakness, swelling, and stiffness. Seventy per cent of cases complained of numbness, 33% of pain, 25% of weakness, 24% of limb swelling, and 15% of stiffness. Objective measurements confirmed decreased sensation in 81%, weakness in 27%, swelling in 10%, and stiffness in 10%. In no case were these symptoms described as severe, though they did have an effect upon the daily lives of 39%. The side effects of full axillary dissection are common and all women should be warned of them prior to surgery; however they are usually mild and therefore should not preclude this procedure as a part of definitive surgical treatment.

Breast Neoplasms↗
PubMed2006

Drosophila homologs of mammalian TNF/TNFR-related molecules regulate segregation of Miranda/Prospero in neuroblasts.

During neuroblast (NB) divisions, cell fate determinants Prospero (Pros) and Numb, together with their adaptor proteins Miranda (Mira) and Partner of Numb, localize to the basal cell cortex at metaphase and segregate exclusively to the future ganglion mother cells (GMCs) at telophase. In inscuteable mutant NBs, these basal proteins are mislocalized during metaphase. However, during anaphase/telophase, these mutant NBs can partially correct these earlier localization defects and redistribute cell fate determinants as crescents to the region where the future GMC "buds" off. This compensatory mechanism has been referred to as "telophase rescue". We demonstrate that the Drosophila homolog of the mammalian tumor-necrosis factor (TNF) receptor-associated factor (DTRAF1) and Eiger (Egr), the homolog of the mammalian TNF, are required for telophase rescue of Mira/Pros. DTRAF1 localizes as an apical crescent in metaphase NBs and this apical localization requires Bazooka (Baz) and Egr. The Mira/Pros telophase rescue seen in inscuteable mutant NBs requires DTRAF1. Our data suggest that DTRAF1 binds to Baz and acts downstream of Egr in the Mira/Pros telophase rescue pathway.

Animals↗
PubMed2000

Pilot randomized controlled study of preservation or division of ilioinguinal nerve in open mesh repair of inguinal hernia.

BACKGROUND: There is uncertainty as to whether preservation or elective division of the ilioinguinal nerve influences pain and sensory loss following inguinal hernia repair. METHODS: In 20 men with primary bilateral inguinal hernias undergoing open tension-free mesh repair, the sides (right or left) were randomized for preservation or division of the ilioinguinal nerve. Patients were reviewed on day 1, 4 weeks and 6 months after operation. Any pain or numbness, as well as any loss of sensation in the area supplied by the nerve, was recorded. RESULTS: No significant difference was seen in pain or numbness between the divided and preserved sides. Sensory loss detected by clinical examination was more common following the division of the nerve compared with preservation. CONCLUSION: Within the limitations of a small sample size, elective division of the ilioinguinal nerve during inguinal hernia repair does not appear to be associated with a significant increase in postoperative symptoms.

Aged↗
PubMed1998

Persistent infection of the chin with an unusual skin pathogen (Streptococcus milleri): a sign of intraoral carcinoma.

Streptococcus milleri is a commensal of the oropharynx and gastrointestinal tract which is not generally associated with skin disease. We now report a patient who presented with a pustular mass of the chin with lower lip anaesthesia. He was initially thought to have sycosis barbae, but response to treatment was poor and lesional swabs repeatedly cultured S. milleri. After some delay, squamous cell carcinoma of the mouth, involving the mandible and overlying skin, was detected. We consider that the S. milleri either invaded through the tumour from the mouth or root canal or colonized the skin from saliva dribbled over the numb lower lip. Isolation of an unusual organism and numbness of the chin are features that should suggest the need for early radiography.

Aged↗
PubMed1996

Blood donation-related neurologic needle injury: evaluation of 2 years' worth of data from a large blood center.

BACKGROUND: There is little information in the medical literature on t he clinical spectrum of blood donation-related neurologic needle injury and on its frequency in a blood donor population. STUDY DESIGN AND METHODS: Sixty-six cases of blood donation-related neurologic needle injury were identified from nursing reports made during a 2-year collection period involving 419,000 whole blood donations. Telephone follow-up was completed on 56 of the 66 cases to better define clinical symptoms, the donor's desire for physician consultation, recovery times, and residual effects. RESULTS: Symptoms in 66 donors included numbness or tingling (n = 54), excessive or radiating pain (n = 43), and loss of arm or hand strength (n = 8). Of the 56 donors with complete follow-up, 17 (30%) consulted a physician one or more times. Recovery times in these 56 donors were <3 days (n = 22), 4 to 29 days (n = 17), 1 to 3 months (n = 13) 3 to 6 months (n = 2), and >6 months (n = 2). Fifty-two of 56 donors achieved a full recovery, and 4 other donors had only a mild, localized, residual numbness. The incidence of blood donation-related neurologic needle injury was 1 of every 6300 donations. CONCLUSION: While donor recovery may in some cases require a great deal of time and/or physician consultation(s), total recovery appears to be the rule. The incidence of blood donation-related neurologic needle injury is relatively low.

Adult↗
PubMed2000

Application of endoscope in zygomatic fracture repair.

The endoscope has been used to visualise the upper face and brow in aesthetic facial surgery which is performed without a coronal incision. We applied these principles to repair zygomatic fractures with the aid of a 4 mm, 30 degree telescope inserted through a small temporal incision. Fracture sites at the zygomatic arch and the zygomaticofrontal suture were exposed and fixed with miniplates under endoscopic control. This technique was used in 15 consecutive patients including 2 with isolated zygomatic arch comminuted fractures and 13 having displaced zygomatic fractures with segmental, displaced zygomatic arch fractures. Nine patients were men and six patients were women with a mean age of 35 years. Three patients had associated mandibular fractures. The periods of follow-up ranged from 3 to 22 months. Two patients developed transient frontal nerve palsy which recovered within 2 months. One patient had mild temporal hollowing on the side of the facial fracture. All patients achieved the adequate anatomic reduction and satisfactory malar symmetry. There has been no case of chewing problems, cheek numbness or progressive enophthalmos developing postoperatively. Application of the endoscope in zygomatic fracture repair minimises the scalp scar, avoids forehead numbness, provides a comfortable postoperative recovery and shortens hospital stay. Careful preoperative evaluation and proper surgical technique are mandatory for achieving optimal results in selected patients.

Accidents, Traffic↗
PubMed2006

Endoscopic carpal tunnel release in the elderly.

The present study is aimed to clarify the postoperative outcome of endoscopic carpal tunnel release in elderly patients with carpal tunnel syndrome. Endoscopic carpal tunnel release was performed on 37 hands of 27 patients (2 men, 25 women) who were aged 70 years or older and clinically and electrophysiologically diagnosed with carpal tunnel syndrome. Mean age at the time of surgery was 74.5 years (range: 70-85 years). Mean postoperative follow-up was 35.5 months (range: 12-114 months). Pain was present preoperatively in 20 hands, but quickly resolved postoperatively in all cases. Numbness completely disappeared in 13 of 37 hands (35.1%), but some degree of numbness remained in the remaining cases. Preoperative severity of thenar muscle atrophy was none in 4 hands, mild in 7 hands, moderate in 12 hands and severe in 14 hands. Postoperative severity of thenar muscle atrophy at final follow-up was none in 13 hands, mild in 16 hands, moderate in 2 hands and severe in 6 hands, confirming that thenar muscle atrophy improves even in elderly patients. However, moderate or severe thenar muscle atrophy remained in 8 hands (21.6%). Endoscopic carpal tunnel release should be considered in the elderly, even though clinical symptoms may not improve substantially in advanced cases.

Age Factors↗
PubMed1995

[Palatal sensory impairment after setoplasty].

A certain percentage of patients complain of numbness or pain in the palatine mucosa, posterior to the incisors, following septal surgery. The symptoms arise from lesions of the nasopalatine nerve near the floor of the nose. In order to demonstrate the sequelae of these lesions, we performed a prospective study on 31 individuals undergoing septoplasty. A maxillary-premaxillary approach to the nasal floor was used on one side in a group of 13 patients and on both sides in a group of 18 patients according to the respective unilateral or bilateral septal pathology. Unilateral or bilateral division of the nasopalatine nerves was anticipated. The threshold of sensitivity to a direct current of up to 500 mA with pulses of 100 msec duration was determined preoperatively. The test was repeated 8 days postoperatively at 5 defined points of the palatine mucosa: posterior to both incisors and both canine teeth and at the incisive papilla. In addition, the patients were questioned about distinct palatine sensations 8 days and 3 to 5 months after septoplasty. Neither group showed any significant elevation of the threshold of sensitivity to a direct current 8 days postoperatively, regardless of whether unilateral or bilateral subperiostal tunnels of the nasal floor had been. However, thirteen patients (32%) described disturbances of sensitivity, most frequently numbness or soreness. The symptoms occurred in both groups with equal distribution. After an interval of 3 to 5 months postoperatively, 16% of all operated patients still had some kind of palatine discomfort.(ABSTRACT TRUNCATED AT 250 WORDS)

Cranial Nerves↗
PubMed2002

Relationship between fibromyalgia features and smoking.

OBJECTIVE: The objective of this study was to examine a possible relationship between smoking and fibromyalgia features among 233 female patients with fibromyalgia syndrome. METHODS: Data on clinical and psychological features were collected by a protocol. Smoking status was evaluated by a question inquiring about the packs of cigarettes smoked per day. Differences between the smokers and non-smokers were tested by Mann Whitney U test. To adjust data for age and education, a partial correlation test was used. A p value of < or = 0.01 was accepted as the level of significance. RESULTS: Fifty-one patients (21.9%) smoked. After adjustment for age and education, significantly positive relationship was found between smoking and pain, patient global severity, functional disability, and numbness. There was no difference between smokers and non-smokers for fatigue, morning fatigue, sleep difficulties, tender points (TP), depression, anxiety and stress. CONCLUSIONS: Smokers reported significantly more pain, numbness, patient global severity, and functional difficulties than non-smokers. There was no significant difference between smokers and non-smokers for fatigue and TP.

Adult↗