Citalopram in the treatment of obsessive-compulsive disorder: an open pilot study

PURPOSE: To evaluate QT dispersion in hypertensive patients, with and without left ventricular hypertrophy, and compare with normal persons. METHODS: Thirty eight patients (21 male and 17 female, age 55 +/- 15 years) underwent echocardiography and simultaneous 12 lead, vertically aligned, electrocardiogram at 50 mm/s speed. No patient was on antiarrhythmic therapy. There were 19 non-hypertensive patients that constituted the control group (G-I). Group II was constituted by the other 19 patients, who were hypertensives. This group was further divided in group II-A (9 patients without left ventricular hypertrophy) and group II-B (10 patients with left ventricular hypertrophy). QT dispersion was obtained by the difference between the longest and the shortest QT registered. RESULTS: QT dispersion was significantly increased on hypertensive patients, both with and without left ventricular hypertrophy, when compared to controls (G-I 31 +/- 9 ms, G-II 52 +/- 15 ms. P < 0.0001; G-IIa 46 +/- 10 ms and G-IIb 56 +/- 18 ms X G-I, p < 0.0005). In hypertensive patients, there was no statistically significant difference between group II-A and group II-B. CONCLUSION: We conclude that QT dispersion is significantly increased on hypertensive patients when compared to non-hypertensive individuals and that such increase, occurs before left ventricular hypertrophy develops. These findings suggest that, in hypertensive patients, electrical changes in left ventricular myocardium can precede structural and morphological abnormalities. Such findings offer new insights into the mechanisms related to enhanced mortality among hypertensive patients.     

Long-term treatment with desmopressin in children with primary monosymptomatic nocturnal enuresis: an open multicentre study. Swedish Enuresis Trial (SWEET) Group

Cache Valley virus (CVV) and Potosi virus (POTV) are two closely related mosquito-borne viruses (Bunyaviridae: Bunyamwera group) that appear to circulate in several regions of the United States, especially the Midwest. We determined the prevalence of specific neutralizing antibodies to both viruses in Indiana white-tailed deer and conducted infection experiments to assess whether deer could serve as an vertebrate-amplifying host. Cross-infection experiments also were carried out to investigate the level of antibody cross-reactivity and cross-protection between the two viruses. The seroprevalence rate was high for both CVV (> 66%) and POTV (> 43%) in adult deer statewide. Antibodies neutralizing CVV were more common among deer harvested in the northern part of Indiana whereas the prevalence of POTV antibodies suggested a more southern distribution for this virus. Experimental infections of captive deer showed that they may serve as amplifying hosts for either virus. Deer infected with CVV or POTV developed a 1-3-day viremia with 3.0 and 4.1 log10 plaque-forming units/ml mean peak titers, respectively. However, significant levels of antibody cross-reactivity between the two viruses were observed. Viremia was lower and shorter when animals immune to either CVV or POTV were cross-infected with the alternate virus and antibody responses following cross-infections resembled original antigenic sin with higher titers of antibodies against the primary agent.     

Group treatment for postpartum depression: a pilot study

OBJECTIVE: There are few reports on the efficacy of treatment programs for women with postpartum depression, despite the long-term nature of this disorder. This study describes a pilot evaluation of a treatment program with educational, social support and cognitive-behavioural components. METHOD: Ten women with persistent depression originating in the postpartum period were offered a 10-week group treatment program and compared to a wait-list control group. RESULTS: Following treatment, a significant improvement in depression was demonstrated on the Edinburgh Post-Natal Depression Scale, Beck Depression Inventory, and Profile of Mood States. Several common factors in women suffering from postpartum depression were also identified, as were drop-out characteristics. CONCLUSION: These results are encouraging and suggest that a cognitive-behavioural group program might be effective as a treatment for depression in the postpartum period. However, further detailed studies are required to conform this pilot study.     

Efficacy of zuclopenthixol acetate on psychotic anxiety evaluated in an open study

We undertook the present study to determine whether there might be variables other than CD4 counts which might help predict survival of HIV-infected patients who are placed on chronic hemodialysis, survival which often is extremely poor. We studied prospectively (n = 18) and retrospectively (n = 6) 24 consecutive HIV-positive patients on chronic hemodialysis at our institution over a 7-year period and recorded clinical and laboratory variables at the time of initiation of dialysis. The mean survival for the group as a whole was 11 +/- 8 (range 2-32) months. A highly significant positive correlation was found between survival and CD4 counts (p < 0.001) and blood pressure (systolic, p < 0.02; diastolic, p < 0.05; mean arterial, p < 0.05). Infection rate and urine protein excretion both had significant negative correlations with survival (p < 0.01 and p < 0.02, respectively). The presence of edema appeared to have a positive effect on survival (p < 0.01). The use of antiretroviral therapy resulted in significantly greater survival of HIV-infected patients (15.2 +/- 2.2 vs. 6.2 +/- 1.2 months, p < 0.01). Using a general linear model, it was found that CD4 count and systolic, diastolic, and mean arterial blood pressures and infection rate all were independent estimators of survival. We conclude that variables other than CD4 counts might also be useful in predicting survival in HIV-infected patients on chronic hemodialysis.     

Increasing treatment adherence among outpatients with depression and cocaine dependence: results of a pilot study

OBJECTIVE: This pilot study examined the effect of a modified motivational therapy intervention on outpatient treatment adherence and completion for patients with comorbid depressive disorder and cocaine dependence. METHOD: Depressed cocaine patients, stabilized with antidepressant medications on an inpatient psychiatric unit, were consecutively assigned on discharge to motivational therapy (N = 11) or treatment-as-usual (N = 12) during the first month of outpatient care. Patients were compared on treatment adherence and completion and on 1-year rehospitalization rates. RESULTS: Motivational therapy patients attended significantly more treatment sessions during month 1, completed 30 and 90 days of outpatient care at higher rates, and experienced fewer psychiatric rehospitalizations and days in the hospital during the first year from entry into outpatient treatment. CONCLUSIONS: An outpatient program combining individual and group motivational therapy sessions holds promise for improving treatment adherence and completion among depressed patients with cocaine dependence.     

A comparison of fluvoxamine and fluoxetine in the treatment of major depression

Two monoclonal antibodies (MAbs) to human placenta laminin (pl-LAM), 1D8 (IgG1) and 6G5 (IgG2b) were generated and shown by ELISA and immunoblot analysis to recognize only native pl-LAM, but not denatured, reduced pl-LAM or mouse EHS laminin. Intact pl-LAM was easily isolated and purified in large scale from human placenta by 1D8-conjugated affinity chromatography. Electrophoretic analysis of the purified pl-LAM revealed the presence of a major 750-kDa component composed of 320-, 220-, and 200-kDa polypeptides and a minor 800-kDa component composed of 320-, 240-, and 220-kDa polypeptides. Neither molecule had a 400-kDa component corresponding to the A chain. It has already been shown that the 320-kDa polypeptide is identical to the M chain of human merosin (Hori et al. J. Biochem. 1994;116:1212-1219). Electron microscopy revealed that isolated merosin was composed of three short arms and one long arm. By immunohistochemistry, MAbs showed positive staining in human adult kidney and liver. These results indicate that these MAbs recognize only native merosin and can be used to study merosin structure and function by rapid purification of native merosin and by immunohistochemical analysis.     

Long-term follow-up of 453 rheumatoid arthritis patients treated with methotrexate: an open, retrospective, observational study

A total of 453 rheumatoid arthritis (RA) patients were followed up for 35.2 +/- 27.9 months (range 3-106). The clinical parameters decreased significantly after 6 months. Twenty-eight patients were in remission (6.4%). Rheumatoid factor (RF) positivity was less common in the group of patients in remission, with a higher frequency of visits and methotrexate (MTX) onset after 65 yr. There was a significant degradation of radiographic lesions (n = 60). A total of 101 patients (23.1%) stopped MTX, for toxicity (n = 61) and failure (n = 20). The onset of MTX after 65 yr, a low number of visits and the occurrence of side-effects were predictive of MTX withdrawal. A total of 259 patients (59.3%) had side-effects. A Ritchie's index < or = 10, a lower polymorphonuclear cell count and the absence of RF were predictive of side-effects. The probability of being on MTX at 5 yr was 73%. This study confirms the high efficacy of MTX in RA.     

Attendance versus compliance with tuberculosis treatment in an occupational setting--a pilot study

AIM: To determine the prevalence of non-compliance with tuberculosis treatment at Freegold Mines. OBJECTIVES: 1. To establish the rates of attendance and collection of anti-tuberculosis drugs. 2. To determine prevalence of non-compliance by means of urine tests. DESIGN: A cross-sectional study conducted over 2 weeks at mine medical stations. METHOD: Urine samples were collected from tuberculosis patients 3 hours after drug ingestion. Non-compliance was established by testing these samples for rifampicin and/or isoniazid (INH) metabolites. Non-compliance was defined as a negative urine test result for these drugs in participants whose treatment regimens included one or both. Daily attendance and collection of drugs statistics are recorded in the medical station tuberculosis register. The patient rate of adherence was calculated as the observed number of days on which medication had been collected over the expected treatment days in a given period. RESULTS: Urine test results showed an overall prevalence of non-compliance of 14.6 +/- 3.3%. The study showed that non-compliance with tuberculosis treatment was underestimated by the surveillance data. The rate of non-adherence with treatment established from the formal surveillance procedure was 0.2%. The poor response rate of patients was found to be a major problem and fewer than 40% per day returned to bring urine specimens. The mean prevalences of non-compliance established by rifampicin and INH tests were 19.5 +/- 5.3% and 9.8 +/- 3.9%, respectively, and these were significantly different (Chi 2 = 7.44; P < 0.05). The proportion of false-positive results for INH and rifampicin urine tests were 21% (11/53) and 35% (17/48), respectively, showing that some patients were taking the wrong treatment. CONCLUSIONS: It is clear that attendance at the clinics does not accurately reflect compliance. Both programme compliance (dispensing of the correct treatment) and patient compliance need to be improved. This has important implications for the new national tuberculosis control policy adopted by the South African government that stresses the importance of directly observed therapy, short-course (DOTS) and a patient-centred approach.     

Dehydroepiandrosterone (DHEA) treatment of depression

Dehydroepiandrosterone (DHEA) and its sulfate, DHEA-S, are plentiful adrenal steroid hormones that decrease with aging and may have significant neuropsychiatric effects. In this study, six middle-aged and elderly patients with major depression and low basal plasma DHEA f1p4or DHEA-S levels were openly administered DHEA (30-90 mg/d x 4 weeks) in doses sufficient to achieve circulating plasma levels observed in younger healthy individuals. Depression ratings, as well as aspects of memory performance significantly improved. One treatment-resistant patient received extended treatment with DHEA for 6 months: her depression ratings improved 48-72% and her semantic memory performance improved 63%. These measures returned to baseline after treatment ended. In both studies, improvements in depression ratings and memory performance were directly related to increases in plasma levels of DHEA and DHEA-S and to increases in their ratios with plasma cortisol levels. These preliminary data suggest DHEA may have antidepressant and promemory effects and should encourage double-blind trials in depressed patients.     

Treatment of peripheral vascular disease with misoprostol (Cytotec): a pilot study

Autonomic dysfunction commonly occurs in Parkinson's disease, but the pathogenesis of autonomic dysregulation remains uncertain. Autonomic functions regulating the cardiovascular system have been investigated in Parkinson's disease, but those involving the extremities has not been well demonstrated. To compare autonomic dysfunctions of the cardiovascular system with those of the extremities, we performed sympathetic skin response (SSR) and cardiovascular autonomic function tests (CAFT)-30 : 15 ratio, E : I ratio, Valsalva ratio, isometric exercise test (IET)--in 37 patients with Parkinson's disease and 33 age- and sex-matched healthy controls. The patients were asked to stop antiparkinsonian medications for at least 12 hours prior to the tests. SSR was measured at the right hand and foot after electrical stimulation of the right median and posterior tibial nerves. Absent SSR at either one or both extremities and CAFT beyond normal ranges were regarded as abnormal. Abnormal SSR was observed in 59% of patients, while abnormal CAFT were found in the range of 32%-81%. Patients with abnormal SSR showed more frequent and severe CAFT abnormalities than did patients with normal SSR. Among the CAFT, IET was well correlated with the SSR. The results suggest that parkinsonian sympathetic dysfunction involving either the cardiovascular system or the extremities may have the same pathophysiology.     

Brief treatment for young substance abusers: A pilot study in an addiction treatment setting.

The present study evaluated a motivationally based, 4-session outpatient intervention for young substance abusers presenting for addiction treatment. Follow-up interviews were conducted 6 months after assessment on (a) clients who sought additional help (n = 22) and (b) clients who did not seek additional help (n = 28). Results indicated that (a) participating in an assessment and brief intervention was associated with reduced use and consequences and increased confidence in high-risk situations up to 6 months after entry into the program, and (b) clients who participated in additional treatment showed less of a decrease in substance-related consequences. These findings suggest that brief interventions can serve as either a stand-alone intervention for individuals who need short-term assistance or a first-step intervention for those with more specialized or long-term needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Compulsive exhibitionism successfully treated with fluvoxamine: a controlled case study

BACKGROUND: Paraphilias are psychosexual disorders that are usually conceptualized as deviant in nature. Yet in some cases, paraphilia can be conceptualized as an obsessive compulsive disorder. METHOD: We describe an exhibitionist treated under partial single-blind conditions (patient was blind to placebo but was aware he was receiving desipramine and fluvoxamine) with the serotonin selective reuptake inhibitor fluvoxamine, followed by desipramine and a placebo that looked like fluvoxamine, in an ABACA design. He was serially assessed with the Yale-Brown Obsessive Compulsive Scale. RESULTS: Fluvoxamine eliminated the undesired impulse and behavior without affecting sexual desire. Desipramine and single-blind fluvoxamine-placebo treatment were both associated with relapses. CONCLUSION: A subset of paraphiliacs may be suffering from obsessive-compulsive-related disorders and may benefit from serotonergic agents.     

Bipolar depression: an underestimated treatment challenge

We sought to determine whether depressive and mixed/cycling episodes were as responsive to standardized pharmacotherapeutic interventions as were manic episodes in bipolar 1 patients. As part of the Maintenance Therapies in Bipolar Disorder (MH29618, E. Frank, PI) study, forty-two acutely ill bipolar 1 patients who had been randomly assigned to one of two preliminary phase non-pharmacologic treatment strategies (interpersonal and social rhythm therapy [IPSRT] or a standard medication clinic approach) were treated according to a standardized pharmacotherapeutic protocol. Symptom severity was measured weekly with the Hamilton Depression Rating Scale and the Bech-Rafaelsen Mania Scale in order to assess symptomatic remission. Survival analysis with the proportional hazards model was performed on time to remission. Manic patients were significantly more likely to achieve clinical remission than the depressed patients (100 vs. 59%) and did so significantly more rapidly. The difference in proportion remitting and time to remission between the depressed and mixed/cycling groups was not statistically significant. No significant effect for non-pharmacologic treatment assignment was found. These results point to the need to develop more effective treatments for bipolar depression. They also suggest that psychotherapy has a limited impact in the acute phase treatment of bipolar episodes.     

Eradication of Helicobacter pylori with lansoprazole, roxithromycin and metronidazole--an open pilot study

BACKGROUND: The most extensively studied Helicobacter pylori eradication regimen comprises omeprazole, clarithromycin and metronidazole. Macrolide antibiotics other than clarithromycin should achieve similar efficacy, but they have not yet been thoroughly tested. AIM: To determine the efficacy and safety of a triple therapy regimen using lansoprazole, roxithromycin, and metronidazole on the basis of multicentre outpatient care in an open pilot study. METHODS: 163 patients with duodenal ulcer and proven H. pylori infection received lansoprazole 30 mg b.d., roxithromycin 300 mg b.d. and metronidazole 500 mg b.d. for 7 days followed by another 7 days of lansoprazole 30 mg once daily. H. pylori status was determined by urease quick test, histology, microbiology and 13C-urea breath test before starting and at least 4 weeks after completing treatment. RESULTS: 150 patients were available for evaluation; H. pylori was successfully eradicated in 84.7% (127/ 150) as determined by urease quick test, 78.0% (117/150) by histology, 81.3% (109/134) by 13C-urea breath test; and in 75.3% (113/150), at least two tests were negative. Side-effects were reported in 34 patients (most commonly diarrhoea and changes in liver function tests), in two cases the study medication was interrupted. Prior to treatment, 23% of the H. pylori isolates were resistant against metronidazole and 3.4% against roxithromycin. After unsuccessful treatment, 84% of the isolates were resistant against metronidazole and 21% against roxithromycin. Primary resistance to metronidazole increased the chance of treatment failure approximately sevenfold (7% vs. 53%). CONCLUSIONS: For H. pylori eradication, the combination of lansoprazole, roxithromycin and metronidazole proved to be as safe as other current triple therapy regimens, while a comparison of efficacy rates yet remains to be assessed in prospective controlled trials. The metronidazole-resistant H. pylori is not rare in Germany and, in the present study, has strongly influenced treatment success.     

Cognitive therapy of psychotic depression: A case report.

Treatment with cognitive therapy (milieu therapy and 12 individual sessions) was associated with significant clinical improvement and reduction of symptoms on measures of mood and cognition in a 21-yr-old female psychotic depressive. Cognitive restructuring as proposed by A. T. Beck et al (1979) was emphasized. Improvements were noted through the use of the Beck Depression Inventory and the Hamilton Rating Scale for Depression. Results were achieved without the use of medication. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term results of percutaneous endopyelotomy in the treatment of children with failed open pyeloplasty

PURPOSE: We reviewed our experience with the safety and long-term efficacy of percutaneous endopyelotomy in children with secondary ureteropelvic junction obstruction who previously underwent open pyeloplasty. MATERIALS AND METHODS: Nine patients a median of 7 years old underwent endopyelotomy between June 1985 and July 1995. Anderson-Hynes pyeloplasty had previously been performed in all children. Antegrade endopyelotomy was done with a cold knife in conjunction with balloon dilation in some cases. Postoperative stenting lasted 6 weeks. RESULTS: The median interval between pyeloplasty and endopyelotomy was 7.5 months. Mean operative time was 240 minutes. Percutaneous endopyelotomy was successful in 8 of the 9 patients. One patient who required repeat endopyelotomy after 4 years is presently well at 5 years of followup. Average followup was 5.6 years (range 2 to 10). There was a low morbidity rate, including 1 case of urinary tract infection, 1 of pneumonia and 1 that required blood transfusion. CONCLUSIONS: Percutaneous antegrade endopyelotomy is a safe, effective and durable alternative for children who previously underwent unsuccessful pyeloplasty.     

A pilot study of affect-focused psychotherapy for antepartum depression.

Logically, psychotherapy should be the first-line treatment for depression during pregnancy, yet there have been very few nondrug interventions tested in this patient population. The present study examines the impact of affect-focused psychotherapy as a treatment for antepartum depression. The treatment model was thought to be feasible to test with this population because depressed pregnant women are in need of an integrative model that can engage the client quickly and work rapidly to reduce symptom distress. Participants were 10 pregnant women with major depressive disorder who were treated with five sessions of affect-focused psychotherapy, as outlined in a published treatment manual. All therapy sessions were videotaped. Results indicate that participants experienced significant improvements in depressive symptoms, as well as increased therapeutic alliance and patient-therapist bond. These preliminary results provide promising data that demonstrate the effectiveness of a short-term (five-session) affect-focused psychotherapeutic treatment with a patient population suffering from antepartum depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative results of thrombolysis treatment with rt-PA and urokinase: a pilot study

AlphaT3-1 cells showed a slope resistance of 1.8 Gomega. The cell membrane surface was not smooth and a scanning electron micrograph showed a complex structure with blebs and microvilli like projections. The cells showed spontaneous fluctuations at zero current resting membrane potential and hyperpolarization increased the amplitude of membrane potential fluctuations. The amplitude of membrane potential fluctuations at hyperpolarized membrane potential was attenuated on application of TTX to the bath solution. The potential at which half steady state inactivation of isolated sodium current occurred, was at a very hyperpolarized potential (-95.4 mV). The study presented in this paper shows that the voltage gated sodium channels contribute to the increase in the amplitude of electrical noise with hyperpolarization in alphaT3-1 cells.