A study of deliberate self-poisoning in patients with adjustment disorders

A sample of 140 patients (34 men and 106 women), hospitalized for deliberate self-poisoning in a toxicological clinic, was evaluated clinically and by P?ldinger's risk list for assessment of suicidality. All subjects met the criteria of DSM-IV adjustment disorder with no additional Axis I and Axis II comorbidity. 18% of the patients had a chronic adjustment disorder. The most common problems on Axis IV were those with the primary support group (especially in women). Occupational and economic problems were more frequent in men than in women. Most of the studied subjects undertook the suicidal attempt impulsively. Suicidal thoughts after deliberate self-poisoning persist in only 11% of the patients. The suicidal risk measured by P?ldinger's risk list for assessment of suicidality was negligible in 4/5 of the cases. The suicidal risk was higher in patients with chronic adjustment disorder and in patients with previous suicide attempts. The most represented age group - from 15 to 19 years old showed the highest suicidal risk. In women the suicidal risk increased with age. Women with impulsive suicide attempt showed a lower suicidal risk than women with a non-impulsive suicide attempt. A cathartic and abreactive effect of the suicide attempt was detected, but this effect only partially accounts for the relatively low percentage of suicidal thoughts after the suicidal act and the insignificant suicidal risk in 4/5 of the studied subjects.     

Mortality after deliberate self-poisoning. A prospective follow-up study of 587 persons observed for 5279 person years: risk factors and causes of death

A follow-up study of mortality and factors associated with death from various causes were done on two unselected groups of patients surviving deliberate self-poisoning in 1978 and 1987. The persons were studied up to the end of 1993. In 1978 the group included 152 female and 101 male subjects and in 1987 the group included 190 female and 144 male subjects. By the end of 1993 a total of 37 (24%) of the female and 33 (33%) of the male patients admitted in 1978 had died (n.s.) and 18 (10%) of the female and 29 (20%) of the male patients admitted in 1987 had died (P < 0.01). The main causes of death were suicide and death from cardiovascular disease. The 5-year follow-up mortality more than doubled in males from 1978 to 1987 but decreased in females. In female subjects, the total follow-up mortality was 3.6 times the expected ratio, with a 95% confidence interval (95% CI of 2.7-4.6); in male subjects it was 5.0 times the expected ratio (95% CI = 3.8-6.4). The cause-specific mortality ratio was highest for deaths from suicide--in the female group it was 65.5 (39.4-102.3) times the expected and in the male group 41.5 (26.0-62.8)--and from accidental poisoning--for females 50.0 (6.1-180.6) times the expected and for males 66.7 (24.5-145.1). In the female group none of the variables examined reached significance as predictors for subsequent suicide or death from unnatural causes. In the male group being aged 30 years or more came out as a predictor for subsequent suicide [relative risk (RR) = 5.66 (1.05-30.37)], while imprisonment came out as a protective factor [RR = 0.08 (0.01-0.64)]. Significant predictors for death from unnatural causes were: having been convicted (but not been in jail) [RR = 34.01 (1.07-1078.15)] and a serious suicidal intent [RR = 138.62 (1.38-13,946.79)]. It is concluded that patients who survive deliberate self-poisoning are at increased risk of death. The predictors for death are not very specific and are considered difficult to apply in the clinical work with these patients.     

The Stanmore total hip arthroplasty. A 15- to 20-year follow-up study

An ongoing study was made of 804 primary Stanmore total hip prostheses implanted in 839 patients between 1973 and 1991. The earliest surviving implants were brought back for radiologic and clinical review in 1995 at an average of 17 years after surgery. The remainder of the patients still living were sent a questionnaire to assess their current status. Survivorship was 95% at 10 years, 85% at 15 years, and 73% at 20 years. The average Merle d'Aubigné-Postel score was excellent up until 14 years. Patient satisfaction remained high until 22 years. Overall, 10% of the prostheses had failed. The results of this study suggest that the Stanmore prosthesis is capable of producing satisfactory long-term results that compare favorably with those of other cemented prostheses.     

A 5-year follow-up study of suicide attempts

We reviewed 59 hips in 44 children with slipped capital femoral epiphysis (SCFE), all treated by in situ pinning. The average clinical and radiographic follow-up was 11.4 years. Fifty-three hips (90%) were rated as either excellent or good. Osteonecrosis or chondrolysis developed in five patients. Postoperative remodeling was noted, not only by a process of local resorption and apposition of bone, but also by correction of the disturbed anatomic axes, in proportion to the severity of the slip, together with global thickening of the femoral neck. We believe that the good long-term results after in situ pinning are the consequence of this important remodeling process.     

Motor recovery after stroke depends on intact sustained attention: A 2-year follow-up study.

The functional recovery of 47 right-brain-damaged stroke patients was studied over a 2-year period. The researchers hypothesized that sustained attention capacity should predict the degree of motor and functional recovery over this period because of a proposed privileged role of sustained attention in learning-based recovery of function. As predicted, significant correlations were found between sustained attention capacity at 2 months and functional status (including the Barthel Index) at 2 years. This relationship was shown to exist independently of 2-month functional status. Furthermore, compared with a left-brain-damaged group of cerebrovascular accident (CVA) patients, the right-brain CVA group did not recover functional ability as well over the 2-year period. This increasing difference in functional status over a 2-year period was mirrored by an emerging difference in sustained attention capacity, in favor of the left-brain CVA group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

15-year follow-up of renin and blood pressure in reflux nephropathy

BACKGROUND: Beginning in 1978 a cohort of patients with reflux nephropathy first seen at a London Childrens hospital have had 5-yearly follow-ups. This is the fourth (15-year) report from that series. METHODS: Of the original 100 normotensive children with reflux nephropathy 78 were traced for the 15-year study in 1994. Five patients were excluded because of nephrectomy, ten for other reasons, and eight refused to take part, leaving 55. 26 were on oral contraceptives. Supine blood pressure and plasma renin activity (PRA) were measured, and daily sodium excretion was assessed on a sample of overnight urine. FINDINGS: Of the 55 patients (15 male, 40 female, median age 27 years, range 20-31), five had systolic and two had diastolic hypertension. Compared with the 10-year (1988) follow-up there was no change in blood pressure standard deviation scores (SDS) in this cohort. PRA showed an increasing dissociation from controls after 15 years of age and was significantly above that of controls by age 25. Exclusion of the patients on oral contraceptives did not significantly alter the results. The PRA values in 1988 were not individually predictive of the development of hypertension over the ensuing 5 years. INTERPRETATION: Previously, in the long-term study of reflux nephropathy, blood pressure SDS had progressively increased with age. By 15 years blood pressure had levelled out and the PRA, though raised, did not predict the development of hypertension. Oral contraceptive use did not significantly modify the results.     

The relationship between coping and adjustment after spinal cord injury: A 5-year follow-up study.

Investigated the relationship between coping and adjustment (including psychological distress, acceptance of disability, vocational hours, and medical status) 5 to 6 yrs after spinal cord injury. 28 people who had provided coping data during acute rehabilitation (AR) completed various measures including the SCL-90 (Revised). Results indicate that coping strategies during AR were not associated with long-term adjustment. However, at 5-yr follow-up, cognitive restructuring was positively associated and wish-fulfilling fantasy was negatively associated with acceptance of disability. Self-blame was related to psychological distress during AR but not at 5-yr follow-up. These results suggest that the importance of specific coping strategies to adjustment changes over time and support the belief that coping is a dynamic process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pollicisation of the index finger. A 27-year follow-up study

We have reviewed 11 patients with congenital absence of the thumb, treated by pollicisation of the index finger, after follow-up for 20 to 38 years. Seven of the hands also had an associated radial club-hand deformity. Function as assessed by the Percival score was excellent in six, good in three, fair in two and poor in four; three of the poor results were in patients with radial club hand. Ten of the 15 transfers were used as normal thumbs, but in five hands function required trick movements. Of the seven unilateral cases, two transplants were used as the dominant hand, and in another two thumb strength was more than 50% of that on the opposite side. For patients with isolated congenital absence of the thumb, pollicisation of the index finger gives good functional and cosmetic results which are maintained. The results are less reliable for those with radial club hand.     

A 35-year follow-up study on burnout among Finnish employees.

This three-wave 35-year prospective study used the Job Demands-Resources model and life course epidemiology to examine how life conditions in adolescence (1961–1963) through achieved educational level and working conditions in early adulthood (1985) may be indirectly related to job burnout 35 years later (1998). We used data (N = 511) from the Finnish Healthy Child study (1961–1963) to investigate the hypothesized relationships by employing structural equation modeling analyses. The results supported the hypothesized model in which both socioeconomic status and cognitive ability in adolescence (1961–1963) were positively associated with educational level (measured in 1985), which in turn was related to working conditions in early adulthood (1985). Furthermore, working conditions (1985) were associated with job burnout (1998) 13 years later. Moreover, adult education (1985) and skill variety (1985) mediated the associations between original socioeconomic status and cognitive ability, and burnout over a 35-year time period. The results suggest that socioeconomic, individual, and work-related resources may accumulate over the life course and may protect employees from job burnout. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

5-year follow-up of patients after subtotal laryngectomy

1. The gross composition, triglycerides and phospholipids of brown adipose tissue were studied in young and adult rats chronically treated with cold or thyroxine. 2. Cold induced an increase of the total water, protein and phospholipid of tissue while the main effect of thyroxine treatment was an accumulation of triglycerides. Thyroxine treatment prevented the cold-induced increase of phospholipid percentage in the tissue. 3. Cold exposure altered the fatty acid pattern of phospholipids, whereas thyroxine had smaller and different effects. 4. The differential effects of cold and hyperthyroidism upon triglycerides and phospholipids of brown adipose tissue are briefly discussed.     

The Japanese career progress study: A 7-year follow-up.

A longitudinal study of managerial progress, begun by the present 1st author and colleagues (1978, 1980) in 1972 in a Japanese department store chain, monitored the professional and dyadic development of a cohort group of 80 newly recruited male college graduates (mean age 23.6 yrs) over their 1st 3 yrs with the company. Seven waves of data were collected from Ss, their immediate superiors, and company records. After 7 yrs with the company, Ss were promoted to their 1st management positions. The present study examined the preemployment selection test results and measured quality of vertical dyadic exchanges between S and his immediate superior over the 1st 3 yrs and the interaction of these 2 factors in predicting the speed of promotion, annual salary, and size of bonus after 7 yrs. Results show that the 1st 3 yrs were critically important to Ss; the combined effect of exchange and ability produced significant contributions to all 3 career outcomes assessed. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Laparoscopic splenectomy for idiopathic thrombocytopenic purpura. A 1-year follow-up study

BACKGROUND: Laparoscopic splenectomy is a novel approach for the treatment of idiopathic thrombocytopenic purpura (ITP) in patients requiring surgical intervention. This technique was used for treatment in 16 consecutive patients. Follow-up was initiated at a median of 13.5 months after surgery to determine whether or not laparoscopic splenectomy is a safe and successful procedure that should be used in all patients requiring splenectomy for ITP. METHODS: Sixteen patients underwent laparoscopic splenectomy for ITP between May 1994 and September 1996. They were evaluated prospectively prior to surgery, immediately following surgery, at discharge, and at 13.5 months following surgery (n = 14) to determine the short- and long-term results of the procedure. RESULTS: Mean operation time was 123.4 +/- 12.1 min, and there were no significant intra- or postoperative complications. Mean intraoperative blood loss was 437.5 +/- 73.5 ml. Autologous blood transfusion was necessary in one patient (6.3%). Mean organ weight was 202.2 +/- 47.3 g. Mean postoperative hospital stay was 4.6 +/- 0. 4 days. Before discharge, mean platelet count rose by 100.7%. At follow-up (13.5 months postoperatively), it was 77.7% above preoperative values. No additional surgery was necessary in any of the patients undergoing laparoscopic splenectomy, and hematologic success was achieved in 12 patients (85.7%). CONCLUSIONS: Our results clearly indicate that laparoscopic splenectomy is a safe and successful procedure in patients suffering from ITP. It offers the well-known advantages of minimal invasive surgery as well as the surgical effectiveness of the open approach. This surgical technique should therefore be considered in all patients requiring splenectomy for the treatment of ITP.     

A 15-year series of gastrointestinal non-Hodgkin''s lymphomas: a population-based study

Although macrophages scavenge oxidatively modified low density lipoprotein (ox-LDL) via specific receptors, the uptake of ox-LDL by endothelial cells is thought to be mediated by a different receptor (LOX-1). We examined the presence of LOX-1 on cultured human coronary artery endothelial cells (HCAECs) by RT-PCR, radioligand blot, and binding assays. LOX-1 mRNA and protein were consistently identified in HCAECs. [125I]-ox-LDL binding assay also identified high affinity binding sites for LOX-1 on HCAECs (KD: 1.71 x 10(-8) M: Bmax: 29.7 ng/mg protein). There was no change in LOX-1 expression in HCAECs treated with native-LDL. In contrast, incubation of HCAECs with ox-LDL (10-40 micrograms/ml) increased LOX-1 expression (mRNA and protein). The upregulation of LOX-1 expression appeared to be dependent on ox-LDL concentration. Higher concentration (100 micrograms/ml) however, decreased LOX-1 expression, perhaps related to its cytotoxic effect. These observations indicate that ox-LDL upregulates its own receptor on HCAECs. This phenomenon may explain enhanced uptake of ox-LDL by HCAECs in hyperlipidemia resulting in cellular dysfunction.     

A surgically treated unicameral (solitary) bone cyst of the talus with a 15-year follow-up

Unicameral bone cysts are uncommon in the foot. When they do occur, they must be differentiated from a variety of other benign lesions. The author describes a unicameral bone cyst of the talus, and its surgical management. The patient returned 15 years later with complaint of mild ankle joint arthrosis, although recurrence of the cyst was not demonstrated.     

Sexual function in patients with disseminated sclerosis. A 5-year follow-up study

Sexual dysfunction is known to occur in multiple sclerosis (MS). The purpose of the study is to describe the change in sexual function and symptoms in a five year follow-up study. Forty-nine patients (27 females, 22 males) with definite MS were interviewed and examined. The number of patients with sexual dysfunction increased significantly (p = 0.004) and involved females and males equally. Males usually had one or two symptoms, while females frequently had two or more symptoms. It is concluded that the risk of sexual dysfunction increases over time. Further studies concerning treatment possibilities are needed.     

Anti-HBs antibody kinetics--a 4-year follow-up after hepatitis B vaccination

The characteristics of binding sites in rat cerebral cortical synaptic membranes labeled by 125I-ifenprodil, a noncompetitive NMDA receptor antagonist, are described. 125I-ifenprodil was synthesized using Na125I in the presence of chloramine-T and purified by paper chromatography. Binding of the 125I-ligand was optimal at pH 7.7 in 5 mM Tris.HCl buffer. Equilibrium binding of 125I-ifenprodil was displaced by spermine (1 mM) but not by ifenprodil or its analogue, SL 82.0715 (both 16.7 microM). Zn2+, Ca2+, and Mg2+ inhibited specific binding of 125I-ifenprodil in a concentration-dependent manner, with IC50 values of 0.11, 1.1, and 1.7 mM, respectively. The dissociation constant (KD) for unlabeled ifenprodil determined by saturation binding was 205 nM. Scatchard plots of saturation data appeared curvilinear but were best described by a single-binding-site model (Hill coefficient = 0.95), with a density of binding sites (Bmax) of 141 pmol/mg of protein. Binding of 125I-ifenprodil was inhibited by polyamines, with a rank potency order of spermine > spermidine > putrescine = 1,3-diaminopropane. The pattern of inhibition produced by spermidine was apparently competitive. Ifenprodil congeners also fully inhibited polyamine-sensitive binding of 125I-ifenprodil, with a rank potency order of ifenprodil > SL 82.0715 = tibalosine > nylidrin = isoxsuprine. It was found that sigma/antitussive agents partially inhibited specific binding, but inclusion of the sigma drug GBR 12909 had little effect on the binding of 125I-ifenprodil, suggesting this site was not involved. The binding site labeled by 125I-ifenprodil is polyamine sensitive, has a discrete pharmacological profile, and apparently is unrelated to the sigma site.     

Pulsatile tinnitus. A 15-year experience

BACKGROUND: We have previously demonstrated by 31P nuclear magnetic resonance (NMR) that succinylcholine (SCh) induces metabolic changes in denervated muscle. To specify those changes, we attempted to inhibit them using two different kinds of drugs, dantrolene and vecuronium. METHODS: Three weeks after unilateral sciatic nerve section, 75 male Wistar rats were randomly assigned to one of the following 5 groups: (1) non-pretreated normal muscle group; (2) non-pretreated denervated muscle group; (3) denervated muscle group pretreated with a low dose of vecuronium (0.02 mg.kg(-1)); (4) denervated muscle group pretreated with a high dose of vecuronium (0.2 mg.kg(-1)); (5) denervated muscle group pretreated with dantrolene (2 mg.kg(-1)). The change of the inorganic phosphate/phosphocreatine (Pi/PCr) ratio of each muscle was measured by 31P-NMR before and after SCh (1 mg.kg(-1)) administration and the corresponding peak amplitude of the electromyograms (EMG) was determined. RESULTS: The high dose of vecuronium totally inhibited SCh-induced fasciculation on EMG (100%-->2%). In this group, though the Pi/PCr ratio significantly increased 10 min after SCh, the peak after 5 min disappeared. The inhibition with dantrolene was about the same order of magnitude as with the low dose of vecuronium (35%:21%). However, the increase in the Pi/PCr only lasted about 10 min, in contrast to the other drugs. CONCLUSION: Our findings indicate that the Pi/PCr increases 5 and 10 min after SCh, respectively, as a result of two different processes. The first peak is caused by an excessive energy consumption in response to excessive muscle contraction. This in turn triggers the second peak, caused by breakdown of glycogen, initiated by an increased Ca2+ concentration.     

A 24-year follow-up of California narcotics addicts

OBJECTIVE: This study examined longitudinal patterns of narcotics use, other substance use, criminal involvement, morbidity, and mortality among narcotics addicts. DESIGN: A 24-year follow-up study. Data were obtained from admission records and two face-to-face interviews conducted in 1974-1975 and 1985-1986. PARTICIPANTS: Five hundred eighty-one narcotics addicts admitted to the California Civil Addict Program during the years 1962 through 1964. RESULTS: Most of this sample initiated narcotics use before age 20 years and had a mean age at program admission of 25.4 years. In 1974-1975, 13.8% of the sample died and 28.6% tested negative for opiates. Corresponding rates in 1985-1986 were 27.7% and 25.0%, respectively. Substance use and criminal involvement remained high among this sample into their late 40s. In any given year during the 10 years prior to the 1985-1986 interview, less than 10% of the sample participated in community-based treatment programs such as methadone maintenance. Disability, long periods of heavy alcohol use, heavy criminal involvement, and tobacco use were among the strongest correlates of mortality. CONCLUSIONS: The results suggest that the eventual cessation of narcotics use is a very slow process, unlikely to occur for some addicts, especially if they have not ceased use by their late 30s.