bluuebunny/crossref_metadata_2025 huggingface dataset:
Subarachnoid Cyst Simulating an Intracanalicular Acoustic Neuroma
Authors: Parnes Steven M. , Nelson Louis R.
Published: January 2017

Acoustic neuromas are the most common lesions found in the cerebellopontine angle. A subarachnoid cyst rarely involves this area. A review of the literature indicates that this is only the third case report in which the subarachnoid cyst manifested itself clinically and radiographically as an intracanalicular acoustic neuroma.
Association of Epstein‐Barr Virus with Acute Exudative Tonsillitis
Authors: Grady Dwight , McClung James E. , Veltri Robert W. , Sprinkle Philip M. , Veach John S.
Published: January 2017

This report is concerned with acute exudative tonsillitis as a pathologic response to the Epstein‐Barr virus (EBV). The concept of a bacterial‐viral etiology for tonsillitis has been suggested, and previous studies implicate EBV as a major pathogen in exudative tonsillitis. A prospective study of 16 patients with this diagnosis was conducted. EBV serologic data plus viral and bacterial throat cultures were compiled and evaluated. EBV as a causal agent alone or concurrent with other organisms was seen in 56% (9) of the patients under study. EBV activation was associated with infection by other organisms in 19% (3) of the cases. The overall total incidence of EBV in association with severe acute exudative tonsillitis was 75% (12). The data further documents EBV as a significant causal or associative agent in acute exudative tonsillitis.
Severe Upper Airway Obstruction Caused by Bullous Pemphigoid: Diagnostic Usefulness of the Flow‐Volume Curve
Authors: Hallenborg Carl , Rowe Lee D. , Gamsu Cordon , Boushey Homer A. , Golden Jeffrey A.
Published: January 2017

The site and severity of upper airway obstruction were accurately determined by analysis of the flow‐volume curve obtained from a dyspneic patient with bullous pemphigoid. The limitation of maximum inspiratory flow to 0.5 L/s and of maximum expiratory flow to 0.7 L/s over most of the vital capacity suggested that the lumen of the extrathoracic trachea was narrowed to a diameter of 3 mm. The marked improvement in flow with the patient breathing a helium‐oxygen mixture further confirmed that flow was limited in a large central airway. The predictions made from analysis of the flow‐volume curve were confirmed by fiberoptic bronchoscopic examination and by computerized axial tomography, which revealed severe supraglottic obstruction. After a tracheostomy was performed, maximal inspiratory and expiratory flows were normal.
Monitoring of Intraoperative Auditory Brain Stem Responses
Authors: Daspit C. Phillip , Raudzens Peter A. , Shetter Andrew G.
Published: January 2017

The use of intraoperative monitoring of auditory brain stem responses is described in a small series of neurotologic procedures. This testing modality appears to give the surgeon adequate warning regarding impending damage to the auditory system. It is useful in those procedures done in and around the temporal bone in which hearing is serviceable.
A Versatile Argon Microsurgical Laser
Authors: Dibartolomeo Joseph R.
Published: January 2017

A laser instrument designed for use in otologic, dermatologic, and cosmetic surgery is evaluated. The argon ion laser produces a visible wavelength in the emerald green range (0.488 to 0.515μm). Its attachments include a handpiece and a micromanipulator. The handpiece is manufactured with a 1‐ or 2‐mm spot size and may be used for treatment of cutaneous lesions such as telangiectasia, hemangiomas, and tattoo marks. The micromanipulator is made for attachment to the Zeiss Omni I microscope. The working distance coordinates with that of the operating microscope when used for otologic procedures such as ossicular reconstruction, stapedectomy, tympanoplasty, or soft tissue tumor removal. The technical specifications and medical applications are outlined.
Argon Laser and Soft Tissue Interaction
Authors: Gillis T. M. , Strong M. Stuart , Shapshay Stanley M. , Incze J. , Simpson George
Published: January 2017

The interaction of the argon laser with the mucous membrane of the upper aerodigestive tract was studied. The advantages of the argon laser are a small spot that can be varied in size and intensity, selective vascular absorption, the capability of being incorporated into a flexible delivery system, and a coincident aiming beam. The acute soft tissue effects are characterized by subepithelial extension, with a variable delayed reaction between the application of the laser and a detectable break in the epithelium. Postoperative edema persisted, with an increase in the lateral spread of the lesion over 3 days and an acute inflammatory reaction extending over 7 days. By 21 days the lesions were reepithelialized and healed, but their width was 30% greater than the original defect. The unpredictable interaction with soft tissue, the postoperative edema, and the quality of wound healing are disadvantages. The argon laser appears to have limited clinical potential as a surgical tool for the air and food passages.
Cochleosacculotomy
Authors: Silverstein Herbert , Hyman Susan , Silverstein David
Published: January 2017

Schuknecht introduced the cochleosacculotomy procedure in 1982. This procedure has an advantage in that it can be done with a local anesthesic. The idea is to create a permanent fistula between the endolymph and perilymph. The fistula is created by introducing a 3 mm right‐angle pick through the round‐window membrane, thus rupturing the cochlear duct and osseous spiral lamina. The procedure is safe and rapid, with minimal postoperative morbidity. Its success rate in curing vertigo was 70% during a 6‐month follow‐up period. The main drawback is that the surgeon cannot visualize the area of the fistula. One week after the procedure, 8 of 14 patients had a sensorineural hearing loss of greater than 15 dB (pure‐tone average [PTA]), and 11 of 14 had a loss of speech discrimination greater than 15%. In the next 1 to 3 months postoperatively, hearing generally improved, so that 3 of 10 had a 15 dB (PTA) loss and 8 of 10 had a loss of speech discrimination greater than 15%. At this time follow‐up has been too short to determine long‐term effects and results. Early results, however, indicate that this procedure may have value in selected patients with Meniere's disease when hearing preservation is not of great concern.
Simultaneous Use of CO2 Laser with Continuous Monitoring of Eighth Cranial Nerve Action Potential during Acoustic Neuroma Surgery
Authors: Silverstein Herbert , Norrell Horace , Hyman Susan M.
Published: January 2017

In a 38‐year‐old patient with bilateral acoustic neuromas a CO2 laser mounted on an operating microscope was used to remove the tumor on the right side. The technique of tumor evaporation reduced surgical manipulation. The eighth cranial nerve action potential was continuously monitored with the recording electrode fixed to the proximal trunk of the eighth nerve. Clicks were delivered through an ear mold insert at a sound pressure level of 115 dB at 10 clicks/sec. The preoperative auditory brain stem response (ABR) showed no wave I and a delayed wave V and no response to electrocochleography with a promontory electrode. Tumor removal resulted In an improvement In the abnormal action potential latency from 5.1 msec to 4.32 msec. Overuse of the laser above the cochlear nerve caused a transient reduction in wave amplitude. At the end of the procedure the latency was 4.6 msec, and the amplitude was reduced to 2.3 μV. Audiometry at 1 week showed the pure‐tone speech reception threshold reduced from 50 dB preoperatively to 60 dB postoperatively and discrimination reduced from 72% to 52%. There are two advantages to direct monitoring of the eighth nerve action potential: surgical trauma to the auditory nerve can be identified rapidly without averaging as many responses as are necessary when using ABR to monitor surgery; and when there is no preoperative response to electrocochleography or ABR, surgical manipulation can still be guided by direct recording from the eighth nerve. To our knowledge this is the first case in which an acoustic neuroma was removed with a CO2 laser while the eighth nerve action potential was continuously monitored. The combination of these two new techniques may allow the surgeon to preserve auditory function in a greater percentage of cases.
Ramsay hunt facial paralysis: Clinical analyses of 185 patients
Authors: Robillard Robert B. , Hilsinger Raymond L. , Adour Kedar K.
Published: January 2017

In a prospective study of 1507 patients, evaluated consecutively for facial palsy in the Cranial Nerve Research Clinic at the Kalser Permanente Medical Center, Oakland, California, between 1966 and 1976, 185 cases (12%) were diagnosed as Ramsay Hunt syndrome. In 46 cases (25%), the diagnosis of herpes zoster was confirmed by acute and convalescent serum titers for varicella‐zoster virus. In 139 cases (75%), viral titers were not performed and the diagnosis was based on the characteristic clinical presentation of the Ramsay Hunt syndrome. The data were subjected to multivariate analysis evaluating age, sex, race, signs and symptoms at onset, severity of paralysis, associated medical problems with concomitant neurologic deficits, and response to therapy. These were compared with data of 1202 patients with Bell's (herpes simplex) palsy. The facial palsy of Ramsay Hunt syndrome was found to be more severe, to cause late neural denervation, and to have a less favorable recovery profile than Bell's (herpes simplex) facial palsy. Prognostic factors and treatment recommendations are discussed.
Effects of nasal and laryngeal stimulation upon peripheral lung function
Authors: Jacobs John R. , Dickson Clark B.
Published: January 2017

Arterial hypoxemia and sudden death have been associated with the placement of posterior packs for control of severe epistaxis. There exists some controversy as to the mechanism underlying the clinically observed hypoxemia; some authors postulate a nasal pulmonary reflex as the basis for the hypoxemia. In an attempt to further investigate this theory, collateral ventilation was measured in the dog model during nasal and laryngeal stimulation. Collateral ventilation is thought to be one of the most sensitive techniques available to assess the resistive and elastic properties of the lung periphery. In the dog, with respiratory rate controlled (i.e., anesthetized and paralyzed), nasal stimulation with mechanical, thermal, and chemical stimuli failed to affect collateral ventilation. This finding suggests that the reflex may be acting either in larger lung segments or on the pulmonary vascular bed itself.
IgG levels after treatment with antigen vials based on the scratch testing, intradermal testing, modified rast testing
Authors: Trevino Richard J.
Published: January 2017

In this study, there were three groups of patients—each group consisting of four patients. The first group had been skin tested by the scratch method, the second group was skin tested by the end point titration intradermal method, and the third group had been tested for inhalant allergy by the modified RAST technique. All of them had multiple treatment vials made, dependent on the type of testing they had, and the vials all included the ten inhalants that were tested for. All patients had been treated for a year with weekly immunotherapy injections. Specific IgG levels, blocking antibody levels to the ten inhalant allergens, were determined. The results were that the patients who had been scratch tested had the lowest levels of specific IgG blocking antibody—while both intradermal end point titration and modified RAST testing had much higher elevations of blocking IgG antibody, with the RAST having the highest. It is concluded that, since the treatment vials prepared after scratch testing of all the antigens are at the same concentration, there are many antigens that are not given in adequate amounts to cause a good IgG response whereas, by calibrating the concentrations of antigens in the intradermal titration and the modified RAST testing, all the antigens are being injected in sufficient quantities to get a good blocking antibody response.
Phonatory volume velocity recording by use of hot film anemometry and signal analysis
Authors: Woo Peak
Published: January 2017

Phonatory airflow volume velocity signal was recorded from nine normal adult males and eight hoarse patients with laryngeal carcinoma; hot film anemometry and computer‐aided signal analysis were used. Marked differences in phonatory flow signal were seen in the two groups. The normal phonatory flow signal is quasiperiodic, with excellent cycle‐to‐cycle repetition at the frequency of vocal fold vibration. The signal's spectral energy is dominated by the fundamental and its harmonics. The phonatory flow signal in cancer is characterized by random and aperiodic fluctuations. There is decreased AC‐to‐DC signal ratio. The phonatory signal spectra reveal little harmonic power. The loss of periodic flow signal is consistent with clinical observation of aperiodic vocal fold vibration in cancer. The analysis of airflow signal is a potentially valuable method for monitoring airflow during phonation in conditions affecting the larynx.
Low‐frequency harmonic acceleration in the evaluation of patients with intracanalicular and cerebellopontine angle tumors
Authors: Moretz William H. , Orchik Daniel J. , Shea John J. , Emmett John R.
Published: January 2017

The application of low‐frequency harmonic acceleration (HA) with the rotary chair is becoming more widespread in the clinical evaluation of the vestibular system. In the last 2 years, 18 patients with surgically or radiologically confirmed intracanalicular or cerebellopontine angle tumors have been evaluated with this clinical modality. In all cases (100%)—which included seven small tumors—vestibular evaluation with HA was abnormal. Slow harmonic acceleration, as is the case with other methods of vestibular evaluation, is not specific for acoustic tumors. Its great sensitivity in detecting peripheral vestibular abnormalities, however, may make it a useful addition to the test battery in the evaluation of patients with suspected intracanalicular or cerebellopontine angle tumors.
Results of surgical repair of inapparent perilymph fistulas
Authors: Parell G. Joseph , Becker Gary D.
Published: January 2017

In patients who are thought to have a perilymph (PL) fistula, careful inspection of the round and oval windows during exploratory tympanotomy may be normal. The decision must then be made either to terminate the procedure—knowing that the patient's symptoms will probably continue or deteriorate—or to repair both windows as if PL fistulas were present, risking further damage to the inner ear. From a series of 14 patients explored for possible PL fistulas, we report on 6 patients with preoperative diagnoses of PL fistula, based on history, physical examination, and audiometry. Symptoms resulting from trauma were present from 10 days to 23 years before surgery. During exploratory tympanotomy, no fistulas were evident; however, both the oval and round windows were repaired with tissue grafts. Follow up—for 1 to 5 years—revealed that vertigo was relieved in all patients. Postoperatively, one patient had a mild conductive hearing loss; yet no patient sustained a sensory neural hearing loss. We conclude that patch grafting of both the oval and round windows is a safe and effective method of treating suspected, but inapparent fistulas. Patient selection, surgical technique, and results shall be detailed.
Vestibular evoked potentials in man: An overview
Authors: Hamid Mohamed A. , Hughes Gordon B.
Published: January 2017

Evoked potentials (EPs) have been used to detect auditory, visual, and somatosensory dysfunction. Evoked potentials are recorded by averaging an optimal number of responses (that are time‐locked) to the same number of appropriate stimuli. Adequate stimulus levels and “minimal” response latency are necessary for recording evoked potentials. Vestibular evoked potentials have received considerably less attention because of (1) the difficulty in providing appropriate stimuli, (2) the relatively long latency of vestibular responses, and (3) the adaptation of the vestibular system to repeated stimulation. Technological advances have made it possible to provide accurate stimuli by use of computer‐controlled rotating chairs and computer‐averaging procedures.
Unilateral Sensorineural Deafness in Children
Authors: Kielmovitch Izak H. , Friedman William H.
Published: January 2017

Heredity, viral infection, and head or acoustic trauma are considered the common etiologies for a unilateral sensorineural deafness in children. The incidence of perilymphatic fistula in a unilateral hearing loss is still unknown. Inner ear‐related symptoms in children are scarce, and little diagnostic laboratory testing is available. A definite diagnosis of a perilymphatic fistula can therefore be made only by an exploratory tympanotomy. Four children, ages 5 to 15 years, with a history of a recent and rapidly progressive unilateral sensorineural hearing loss, were explored. Preoperative laboratory data, which included a fistula test, ENG, CT scan of the temporal bones, and an ABR, were all within normal limits. An overt fistula was found in only one of the patients. Only an exploratory tympanotomy can arrest and possibly reverse a unilateral hearing loss or discontinue a middle ear‐cranial cavity communication. It is therefore our feeling that, in patients with an appropriate history, the potential benefit outweighs the risk and morbidity of an exploratory tympanotomy.
Effect of Epidermal Growth Factor (EGF) on a Newly Established Head and Neck Squamous Carcinoma Cell Line
Authors: Weber Randal S. , Pathak Sen , Frankenthaler Robert , Gallick Gary E. , Sacks Peter G.
Published: January 2017

A new cell line designated 584A2 has been recently established from a patient with squamous cell carcinoma of the larynx. Cytogenetic analysis of the cell line revealed multiple copies of chromosome 7, as well as a homogeneous staining region (HSR) on one chromosome 7. Since overexpression of epidermal growth factor (EGF) cell surface receptors (EGFr) often occurs in other squamous carcinoma cell lines, it was predicted that 584A2 might overexpress EFGr. This was confirmed by: (1) metabolic labeling, with subsequent immunoprecipitation of EGFr and comparing autoradiographs to a cell line without an HSR and fewer copies of chromosome 7, and (2) performing EGF binding assays with Scatchard analysis. Since overexpression of EGFr correlates with an inhibitory effect of EGF on cell culture, the biological effects of EGF on 584A2 were examined in this study. At 5 ng/ml (serum‐free medium), EFG stimulated incorporation of [3H] thymidine into trichloroacetic acid‐precipitable material compared with controls. Incorporation increased between days 0 to 1 and 1 to 2 days with a 6‐ to 7‐fold maximum. Dose‐response studies (0 to 100 ng/ml) indicated maximum incorporation (6‐ to 7‐fold) occurred between 0.1 ng/ml and 1.0 ng/ml. Cell growth was monitored over 7 days and, during this time, 5 ng/ml EGF produced a 10‐ to 12‐fold increase in absolute cell numbers when compared with controls. We concluded that, unlike other squamous carcinoma lines with elevated EGFr, EGF stimulates rather than inhibits 584A2 cell proliferation.
Selection of surgical approaches for meningiomas affecting the temporal bone
Authors: Arriaga Moises , Shelton Clough , Nassif Paul , Brackmann Derald E.
Published: January 2017

The varied locations of meningiomas within the temporal bone require a wide array of neurotologic approaches to accomplish complete resection with minimal morbidity. We reviewed 56 consecutive patients with temporal bone meningiomas. The six surgical approaches are described with regard to site of lesion, morbidity of procedure, and long‐term patient outcome. Recommendations are made for selection of surgical approach. Hearing preservation was attempted in 25%. Middle fossa tumor removal was performed in nine patients (16%), retrosigmoid (suboccipital) in five patients (9%), translabyrinthine In 24 patients (43%), transcochlear in 15 patients (27%), infratemporal fossa In two patients (4%), and retrolabyrinthine In one patient (2%). Overall, meningioma surgery has higher morbidity, poorer facial nerve outcome, and higher recurrence rates than acoustic neuroma surgery. Thirteen percent of patients were unable to resume full preoperative activities after their surgery. Facial nerve transection occurred In 9% of the cases, and 83% of cases with more than 1 year followup had satisfactory or Intermediate facial function (grades I to IV). Meningiomas of the temporal bone are insidious and aggressive lesions. Particular care is required to select the surgical approach appropriate for location, level of hearing, and the anatomic structures Involved. Patients must be realistically counseled about the surgical morbidity and long‐term outcome associated with each approach.
Prevention of early otorrhea in ventilation tubes
Authors: Epstein Jeffrey S. , Beane Joanne , Hubbell Richard
Published: January 2017

The incidence of early postoperative otorrhea after placement of ventilation tubes ranges from 12% to 40%. This prospective randomized study of 430 children, ages 6 months to 15 years, examined the efficacy of sulfacetamide/prednisolone otic drops used for 3 days postoperatively in reducing the Incidence of otorrhea at 1 week after the placement of Donaldson tubes. Subjects were randomized into two groups‐drops and no drops. Preoperative diagnosis and intraoperative findings were correlated with findings. The incidence of otorrhea among ail patients was 11.9%. The use of sulfacetamide/prednisolone drops for 3 days after insertion of ventilation tubes failed to reduce the incidence of otorrhea In the overall study population. The drops did demonstrate a trend toward reducing the Incidence of otorrhea in certain subpopulations, including children under 3 years of age, blood at the myringotomy site, and thick middle ear effusions. Subpopulations associated with a higher incidence of otorrhea were also Identified.
Antihistamines and decongestants
Authors: Krause Helen F.
Published: January 2017

Drug therapy for allergic rhinitis is used either to prevent symptoms from occurring by short‐circuiting the reaction and thus inhibiting the production of chemical mediators or to control symptoms after the target organs have been stimulated by these mediators. Antihistamines, the mainstay treatment of allergic rhinitis, are H1‐receptor antagonists that bind competitively to histamine receptors. The older, classic antihistamines are effective in treating the symptoms of allergic rhinitis, but most are sedating because they cross the blood‐brain barrier. They also have anticholinergic activity, which further restricts their use. The new, nonsedating antihistamines have overcome most of these limitations, and because they are long‐acting, they require fewer daily dosages. Many still under development are quite potent and may be used for indications other than allergic rhinitis. Decongestants, sympathomimetic amines, are available both orally and topically as either short‐ or long‐acting preparations. Topical decongestants should be used only for a short time to prevent rebound and ensuring overusage. These drugs interact with numerous antihypertensive medications and tricyclic antidepressants. Often combined with antihistamines, decongestants help offset their sedative effect.
Use of heparin-bonded surfaces in cardiopulmonary bypass
Authors: von Segesser Ludwig K
Published: January 2017

Heparin surface coating is a convenient means of improving the thrombo resistance of blood-exposed surfaces. At this time, heparin can be bonded to oxygenator/heat-exchanger structures, soft venous reservoirs, cardiotomy reservoirs, centrifugal pump heads, tubings, and cannulae. Following experimental evaluation, these devices have become available for clinical application. Cardiopulmonary bypass with low or no systemic heparinization can be realized in selected cases. Improved haemostasis in combination with modification of standard surgical techniques results in limited blood loss and reduced transfusion requirements and appears to be the main benefit of cardiopulmonary bypass with heparin-bonded surfaces. Experience using heparin- bonded equipment in various clinical situations is reviewed.
Haemostatic dysfunction and cardiopulmonary bypass: mechanisms and therapeutic choices
Authors: Prentice Colin , Orchard Margaret , Goodchild Colin
Published: January 2017

Cardiopulmonary bypass is characterized by multiple haemostatic defects. These are due to haemodilution, platelet damage, the effects of hypothermia, heparin administration, and, in many patients, preoperative use of aspirin. The result is often excessive blood loss. Pharmacological agents such as desmopressin, prostacyclin, and aprotinin have been introduced to improve haemostasis during cardiopulmonary bypass. The protease inhibitor aprotinin appears to be particularly promising in reduction of bleeding associated with bypass. Study of aprotinin may provide new insights into the mechanisms of haemostatic dysfunction, particularly platelet dysfunction.
Research and the associations: an era for partnership
Authors: Cardy Peter
Published: January 2017

A growing volume of research is being conducted into amyotrophic lateral sclerosis/motor neurone disease, driven in part by a perceived rise in incidence of the disease. This increase in research coincides with the emergence of the voluntary associations. Originally critical of the lack of research, the associations have started to raise funds for a variety of studies. Many of these require the active involvement of patients, and, given the relatively small numbers, there are dangers of the associations, research and good clinical care becoming too closely interdependent. There are also dangers of pharmaceutical companies and the voluntary associations being put under pressure to produce results extremely quickly. As well as having a valuable part to play in research, the voluntary associations are also involved in patient education, and in trying to spread the word on which available options are the subject of 'informed choice'.
Dying at home: a way of maintaining control for the person with ALS/M N D
Authors: Moore Myrna K
Published: January 2017

Control is a key issue for patients with amyotrophic lateral sclerosis, and caring for them in their own homes is often an essential part of remaining in control. This goal can usually be achieved if all resources are correctly used.
Victims of Efficiency: Tracking Victim Impact Information through the System in Victoria, Australia
Authors: Douglas Roger , Laster Kathy , Inglis Nicole
Published: January 2017

The courts of summary jurisdiction in Victoria have recently streamlined procedures for the hearing of guilty pleas: sentencing decisions are now determined largely on the basis of a brief summary of ‘facts’ presented by the prosecution. To assess the extent to which these summaries detail the harm suffered by victims we analysed 276 assault case summaries. The data indicate that summaries rarely report details of victim injury even where this information had been gathered by police. However, the data also suggest that disclosing details of victim injury makes little difference to sentencing and other decisions. This article outlines how existing procedures have allowed information about victims to ‘get lost’ in the system. It argues that demands for reform of the criminal justice system to give greater attention to the interests of victims must take into account the system's commitment to administrative rationalism and technocratic justice. Systematising police summaries in the mention court may prove to be a practical way of reconciling the concerns of victims with the organisational priorities of criminal justice agencies.
Taking Account of the Victim in Sentencing in South Australia
Authors: Sumner C.J.
Published: January 2017

South Australia's practical measures to give effect to the spirit and letter of the 1985 UN Declaration of Basic Principles of Justice for Victims of Crime and Abuse of Power have meant changes to legislation and to legal procedures. This extract from a previously given Paper on these changes concentrates on the principles of Anglo-Australian law adopted by Courts in Australia in sentencing offenders, and in particular deals with the relevance of the victim in sentencing.
18F-positron-emitting/fluorescent labeled erythrocytes allow imaging of internal hemorrhage in a murine intracranial hemorrhage model
Authors: Wang Ye , An Fei-Fei , Chan Mark , Friedman Beth , Rodriguez Erik A , Tsien Roger Y , Aras Omer , Ting Richard
Published: January 2017

An agent for visualizing cells by positron emission tomography is described and used to label red blood cells. The labeled red blood cells are injected systemically so that intracranial hemorrhage can be visualized by positron emission tomography (PET). Red blood cells are labeled with 0.3 µg of a positron-emitting, fluorescent multimodal imaging probe, and used to non-invasively image cryolesion induced intracranial hemorrhage in a murine model (BALB/c, 2.36 × 108 cells, 100 µCi, <4 mm hemorrhage). Intracranial hemorrhage is confirmed by histology, fluorescence, bright-field, and PET ex vivo imaging. The low required activity, minimal mass, and high resolution of this technique make this strategy an attractive alternative for imaging intracranial hemorrhage. PET is one solution to a spectrum of issues that complicate single photon emission computed tomography (SPECT). For this reason, this application serves as a PET alternative to [99mTc]-agents, and SPECT technology that is used in 2 million annual medical procedures. PET contrast is also superior to gadolinium and iodide contrast angiography for its lack of clinical contraindications.
The Bonds of Kinship, the Ties of Freedom in Colonial Peru
Authors: O’Toole Rachel Sarah
Published: January 2017

By contrasting how families who mobilized African-descent networks gained more autonomy than those who relied on slaveholder patronage, this article explores the interplay between kinship and manumission on the northern Peruvian coast from the mid-seventeenth century into the early eighteenth century. For enslaved and freed people, kinship did not constitute a status, but a series of exchanges that required legal or public recognition and mutual acknowledgment. Manumission was embedded in articulated kinships, or announced relations, as well as in silenced kinships that often occurred because owners refused to recognize their relationships with enslaved women.
Validation of a Revised Visual Analog Scale for Premenstrual Mood Symptoms: Results from Prospective and Retrospective Trials
Authors: Steiner Meir , Streiner David L , Pham Ba‘
Published: January 2017

Objective:

Previous studies have demonstrated that visual analog scales (VASs) are valid and reliable instruments for measuring the severity of premenstrual symptoms. Most of these studies, though, predate the introduction of DSM-IV diagnostic criteria for premenstrual dysphoric disorder (PMDD). Our objective was to assess the reliability and validity of VASs that were revised to better reflect the DSM-IV definition of PMDD.

Methods:

Concurrent information from the well-validated Premenstrual Tension Syndrome-Observer (PMTS-O) rating scale was used to evaluate the revised VASs. Data from 4 randomized controlled trials ( n = 1208) evaluating the efficacy of paroxetine for the treatment of PMDD were used. Cronbach's alpha coefficient was used to evaluate the internal consistency of the core VAS mood items. Pearson's correlation between scores from the 2 scales was used to assess reliability.

Results:

The internal consistency among the core VAS mood items (Cronbach's α > 0.90 across trials) was high. Luteal VAS scores and corresponding PMTS-O scores were moderately correlated at baseline ( P < 0.01). Luteal VAS change scores and corresponding PMTS-O change scores were strongly correlated ( P < 0.01). These results did not differ regardless of whether the PMTS-O data were collected prospectively or retrospectively.

Conclusion:

The revised VASs, which approximate the current DSM-IV definition of PMDD, provide a valid and reliable measure of the severity of premenstrual symptoms when evaluated against the validated PMTS-O scale. Our results also suggest that, whether observers assessed severity of PMDD symptoms retrospectively or prospectively using the PMTS-O scale, the correlations with the patient-reported VAS scores were comparable.
Prevalence of Depression and Prescriptions for Antidepressants, Bella Coola Valley, 2001
Authors: Thommasen Harvey V , Baggaley Earle , Thommasen Carol , Zhang William
Published: January 2017

Objective:

To determine the prevalence of depression–anxiety disorders and the degree to which physicians prescribed antidepressants for Aboriginal and non-Aboriginal populations living in a remote rural community in British Columbia in 2001.

Methods:

To obtain data for our main outcome measures, we retrospectively reviewed the charts of 2375 patients living in the Bella Coola Valley as of September 2001 and attending the Bella Coola Medical Clinic.

Results:

The 2001 prevalence rate of depression–anxiety disorders in the Bella Coola Valley was 7.5% (177/2375). Depression was the most common problem (86%) in these patients. Women had a higher rate of depression–anxiety disorders (10.3%) than did men (4.7%) ( P < 0.001). Non-Aboriginal people had a slightly higher rate (8.5%) than did Aboriginal people (6.3%); however, the difference was not statistically significant. Antidepressant medications were commonly prescribed for chronic pain and insomnia. The general pattern of antidepressant medication use in 2001 among both Aboriginal and non-Aboriginal people living in the Bella Coola Valley was as follows: peak use of antidepressants was in the middle to late years; the rate for women was roughly double the rate for men; and proportionately more Aboriginal people, especially the women, were taking antidepressants.

Conclusions:

Depression–anxiety disorder prevalence rates for Aboriginal and non-Aboriginal populations are similar. When using antidepressant medication prescriptions as a community health indicator, health care administrators should be aware that antidepressant medications are commonly prescribed for conditions other than depression–anxiety disorder.
Flashback: Psychiatric Experimentation with LSD in Historical Perspective
Authors: Dyck Erika
Published: January 2017

In the popular mind, d-lysergic acid diethylamide (LSD) research in psychiatry has long been associated with the CIA-funded experiments conducted by Ewen Cameron at the Allen Memorial Institute in Montreal, Quebec. Despite this reputation, a host of medical researchers in the post–World War II era explored LSD for its potential therapeutic value. Some of the most widespread trials in the Western world occurred in Saskatchewan, under the direction of psychiatrists Humphry Osmond (in Weyburn) and Abram Hoffer (in Saskatoon). These medical researchers were first drawn to LSD because of its ability to produce a “model psychosis.” Their experiments with the drug that Osmond was to famously describe as a “psychedelic” led them to hypothesize and promote the biochemical nature of schizophrenia. This brief paper examines the early trials in Saskatchewan, drawing on hospital records, interviews with former research subjects, and the private papers of Hoffer and Osmond. It demonstrates that, far from being fringe medical research, these LSD trials represented a fruitful, and indeed encouraging, branch of psychiatric research occurring alongside more famous and successful trials of the first generation of psychopharmacological agents, such as chlropromazine and imipramine. Ultimately, these LSD experiments failed for 2 reasons, one scientific and the other cultural. First, in the 1950s and early 1960s, the scientific parameters of clinical trials shifted to necessitate randomized controlled trials, which the Saskatchewan researchers had failed to construct. Second, as LSD became increasingly associated with student riots, antiwar demonstrations, and the counterculture, governments intervened to criminalize the drug, restricting and then terminating formal medical research into its potential therapeutic effects.
The Prevalence and Incidence of Treated Major Depressive Disorder among National Health Insurance Enrollees in Taiwan, 1996 to 2003
Authors: Chien I-Chia , Kuo Chien-Cheng , Bih Shin-Huey , Chou Yiing-Jenq , Lin Ching-Heng , Lee Cheng-Hua , Chou Pesus
Published: January 2017

Objective:

We used the National Health Insurance (NHI) database to examine the prevalence and incidence of treated major depressive disorder (MDD) and their associated factors.

Method:

The National Health Research Institute provided a database of 200 432 randomly selected subjects for study. We obtained a population-based random sample aged 15 years or older ( n = 136 045) as a fixed cohort dated 1996 to 2003. We identified study subjects with a principal diagnosis of MDD who had at least one service claim during these years for either ambulatory or inpatient care.

Results:

From 1996 to 2003, the cumulative treated prevalence increased from 1.67 per 1000 to 17.24 per 1000. From 1997 to 2003, the annual treated incidence increased from 1.89 per 1000 to 2.58 per 1000. A higher incidence of treated MDD was detected in the groups aged 25 to 44 years (hazard ratio [HR] 1.28; 95% confidence interval [CI], 1.13 to 1.45), 45 to 64 years (HR 1.90; 95%CI, 1.66 to 2.16), and 65 years or older (HR 1.87; 95%CI, 1.59 to 2.20); in female subjects (HR 1.97; 95%CI, 1.80 to 2.15); in those with with an insurance amount of US$1281 or more (HR 1.15; 95%CI, 1.01 to 1.31); in those with a fixed premium (HR 1.44; 95%CI, 1.27 to 1.62); and among those who lived in urban areas (HR 1.22; 95%CI, 1.10 to 1.35).

Conclusions:

For treated MDD, the prevalence and incidence in Taiwan were lower than in community studies in Western countries. Individuals with MDD are underdiagnosed and undertreated in Taiwan.
An Outcome Measure in Schizophrenia: Mortality
Authors: Seeman Mary V
Published: January 2017

Objective:

To determine the current outcome of schizophrenia, with mortality rate as the outcome measure.

Method:

Recent health, suicide, victim of violence, and mortality statistics were reviewed.

Results:

The general health of individuals with schizophrenia suffers from neglect, poor life style choices, and current treatments that increase death rates.

Conclusion:

Mortality in schizophrenia is rising, and it is the responsibility of physicians and health care planners to intervene.
Depressed Mood in the Suicidal Population
Authors: Bethell Jennifer , Rhodes Anne E
Published: January 2017

Objective:

To determine whether, and to what extent, those who reported suicidal ideation and (or) attempts in the previous year, without meeting the criteria for major depressive episode (MDE), might still have experienced subthreshold depression.

Method:

Data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2) were examined to estimate and compare the prevalence of depressed mood, a core symptom of MDE and subthreshold depression, within the previous month for the following 4 population groups: MDE within the previous month [D(1 month)], MDE within the previous year but not the previous month [D(1 year)], suicidality without MDE within the previous year (D-S+), and no MDE or suicidality within the previous year (D-S-).

Results:

As expected, the D(1 month) group showed the highest prevalence of depressed mood in the previous month. However, the D-S+ group had a significantly higher prevalence of depressed mood than the D-S-group and only a slightly lower level than that of the D(1 year) group.

Conclusions:

A fraction of those who reported suicidality in the previous year met the criteria for MDE during that time; however, subthreshold depression might be common in the suicidal population. Future epidemiologic research in the areas of suicidality and depression will benefit from a comprehensive assessment of subthreshold depression.
Clinical and Demographic Variables Related to “Fitness to Stand Trial” Assessments in Manitoba
Authors: Robertson R Gail , Gupton Ted , McCabe Scott B , Bankier Robert G
Published: January 2017

Objective:

To assess the extent to which clinical and nonclinical variables have been used by mental health professionals in Manitoba to determine fitness to stand trial. Researchers at a forensic setting in another province have suggested that demographic variables account for as much of the variance in predicting the outcome of these assessments as clinical variables.

Method:

These variables were assessed by the examination of 100 fitness assessments conducted at Winnipeg's Forensic Services unit during a 2-year period.

Results:

Contrary to findings reported in Ontario, the variance in fitness evaluations in Manitoba was primarily accounted for by clinical rather than demographic variables.

Conclusion:

Since Manitoba's forensic clinicians were using standardized criteria that were very similar to 1992 Criminal Code revisions of fitness, the findings attest to the usefulness of these criteria.
Assessment and Treatment of Social Phobia
Authors: Antony Martin M
Published: January 2017

Social phobia is an anxiety disorder characterized by heightened fear and avoidance of one or more social or performance situations, including public speaking, meeting new people, eating or writing in front of others, and attending social gatherings. People with social phobia are typically anxious about the possibility that others will evaluate them negatively and/or notice symptoms of their anxiety. Social phobia affects up to 13% of individuals at some time in their lives and is usually associated with at least moderate functional impairment. Research on the nature and treatment of social phobia has increased dramatically over the past decade. As with many of the anxiety disorders, sensitive assessment instruments and effective treatments now exist for people suffering from heightened social anxiety. Typical assessment strategies include clinical interviews, behavioural assessments, monitoring diaries, and self-report questionnaires. Treatments with demonstrated efficacy for social phobia include pharmacotherapy (for example, phenelzine, moclobemide, selective serotonin reuptake inhibitor [SSRI] medications) and cognitive behaviour therapy (CBT) (for example, cognitive restructuring, in vivo exposure, social skills training). Although preliminary comparative studies suggest that both approaches are about equally effective in the short term, each approach has advantages and disadvantages over the other. Trials examining combined psychological and pharmacological treatments are now under way, although no published data on the relative efficacy of combined treatments are currently available.
A Biopsychosocial Understanding of the Irritable Bowel Syndrome: A Review
Authors: Goldberg Jeremy , Davidson Paul
Published: January 2017

Objectives:

To review and examine the clinical and research literature on irritable bowel syndrome (IBS) with a view to establishing the role that psychiatric factors play in the pathogenesis and treatment of this syndrome.

Results:

Comorbid psychiatric illness is common with IBS, yet only a small proportion of these patients seek medical attention. Many patients are either satisfied by reassurance or experience symptom relief from medical treatment directed at target symptoms. A small group of patients do not experience much relief, and it is largely this group who come to the psychiatrist's attention. Psychotropic medication is helpful when clinically indicated, and tricyclic antidepressants in small doses (for example, 50 mg) may be helpful for those patients with a pain-predominant pattern of IBS. Psychotherapy (including cognitive, behavioural, relaxation, thermal-biofeedback, insight-oriented therapy, and hypnosis) has been shown to provide relief, although it has often been difficult to differentiate this improvement from a placebo response.

Conclusions:

The group of patients with “refractory IBS” used a large amount of health care resources in an attempt to find relief to their distress. Further study is needed to gain a better understanding of which component of psychotherapy is most cost-effective and which patients are most likely to benefit. The large group of those who admit to symptoms compatible with IBS but who do not seek medical attention has to a large extent been excluded from most studies. Exploring this group may provide further insight into this perplexing syndrome.
Psychiatric Admissions of Asian Canadians to an Adolescent Inpatient Unit
Authors: Roberts Nasreen , Crockford David
Published: January 2017

Objective:

To compare the psychiatric diagnoses for Asian Canadians admitted to an adolescent inpatient unit with those of their white Canadian peers.

Method:

A literature review was first completed and then followed by a hospital file review of the Asian Canadians admitted over a 5-year period to the adolescent inpatient psychiatric unit. The data extracted (relating to psychiatric diagnosis, age, length of stay, referral source, family type, and gender) were then compared with a random sample of white Canadians admitted to the same unit during the same 5-year time frame.

Results:

There were far fewer Asian Canadians admitted than would be expected based on Calgary's demographics. There was equal gender representation among those who were admitted, and they tended to be older and to have a greater preponderance of severe psychiatric symptomatology than their white Canadian peers.

Conclusions:

This paper adds to previous research in emphasizing that ethnocultural factors play a significant role in the utilization of psychiatric services by immigrant populations.
Disorientation in Chronic Psychiatric Patients
Authors: Gabriel Adel
Published: January 2017

Objective:

To explore the effect of chronic institutionalization on cognitive performance in chronic psychiatric patients with emphasis on age disorientation, a phenomenon that was found in previous research to occur in up to 25% of chronic schizophrenic patients.

Method:

One hundred and ten chronic psychiatric patients, forming 4 main groups—schizophrenic patients, nonschizophrenic patients, institutionalized, and noninstitutionalized—were examined for age disorientation (inability to give one's chronological age correctly on request), and their Minimental State scores (MMSE) were compared across the 4 groups.

Results:

Twelve out of 43 patients (26%) who were institutionalized according to our definition were age-disoriented and had significantly lower MMSE scores than the other 3 groups. The chronic, noninstitutionalized schizophrenic group and the other chronic psychiatric patients, whether they were institutionalized or not, were negative for this phenomenon. One of the 12 age-disoriented patients was age delusional, and 5 of the 12 had a total MMSE score consistent with dementia (21 or lower).

Conclusion:

Age disorientation is a specific phenomenon that characterizes a subgroup of chronically ill and institutionalized schizophrenic patients. It is unlikely that chronicity per se or prolonged hospitalization alone will lead to cognitive impairment.