Neuroendocrine tests in depressive stroke patients.

1. In the present study 63 stroke patients and 23 control patients participated. The presence and degree of depression was defined by the Hamilton Rating Scale for Depression and the Research Diagnostic Criteria. 2. The TRH stimulation test was performed in all the patients. 3. No difference in Delta Max TSH was found between stroke patients and control patients. 4. No difference in Delta Max TSH was found between patients with the lesion in the right or left hemisphere. 5. No correlation was found between the frequency of blunted response to the TRH stimulation test and the presence of depression. 6. No difference in Delta Max TSH was found between suppressors and non-suppressors to the DST.

Dexamethasone suppression test in depressive stroke patients.

Depressive psychiatric patients often shown non-suppression to the dexamethasone suppression test (DST). Stroke patients shows a high frequency of depression. In the present study the DST was studied in 76 stroke patients and 26 controls. No difference was found in frequency of non-suppression to the DST between depressive and non-depressive stroke patients. It was found that postdexamethasone plasma cortisol level at 08 a.m. was significantly higher in patient with the lesion in the right hemisphere compared to patients with the lesion in the left hemisphere.

A long-term metabolic study to assess the nutritional value of and immunological tolerance to two soy-protein concentrates in adult humans.

Seventeen healthy young adult men participated in a long-term metabolic study (11 wk) to evaluate the tolerance to and protein nutritional value of two commercially produced soy-protein concentrates. Danpro-S (nine subjects) and Danprotex-H 40 (eight subjects) (Aarhus Oliefabrik A/S, Aarhus, Denmark). Each test protein (0.8 g.kg-1.d-1) served as the sole source of dietary nitrogen. Subjects remained healthy, no problems of clinical or metabolic significance appeared, body weight remained constant, and body composition indices (lean body mass by H2(18)O dilution and creatinine excretion) and basal metabolic rate did not change. N balances fluctuated around body N equilibrium. Immunological studies confirmed the absence of any allergic responses in these subjects. It is concluded that these protein concentrates can be consumed as the sole source of dietary protein for protein nutritional maintenance and with excellent tolerance.

Depression among patients with stroke.

Ninety-two stroke patients and 30 control patients participated in this study. Stroke patients showed a higher frequency of depression than controls. Stroke patients with the lesion in the right hemisphere were more depressed than patients with the lesion in the left hemisphere. No correlation was found between the degree of depression and the degree of impaired physical function, degree of aphasia or volume of lesion.

Sternal Hodgkin's disease. Report of two cases.

Hodgkin's disease of the mediastinum presented as a sternal mass in two young adults. The original biopsy materials were incorrectly interpreted as eosinophilic granuloma of bone (histiocytosis X). A delayed diagnosis (15 months) resulted in the death of one patient, whereas the other patient, whose diagnosis was made in one week, had an excellent response to therapy.

A comparison of the antigenicity of soya-bean-based infant formulas.

1. The antigenicity of four soya-bean-based infant formulas (Prosobee powder, Prosobee liquid concentrate (Mead Johnson, Uxbridge, Middx), Wysoy (Wyeth, Maidenhead, Berks) and Formula S (Cow and Gate, Trowbridge, Wilts] was measured by enzyme-linked immunosorbent assays (ELISAs) specific for glycinin and beta-conglycinin. Results were compared with in vivo assessments of antigenicity using guinea-pigs, rabbits and calves. 2. The levels of antigenic glycinin and beta-conglycinin in Wysoy and Formula S were below the limits of detection of the ELISA. Both these proteins were detected in Prosobee powder and Prosobee liquid concentrate with the highest levels, especially for glycinin, being present in Prosobee powder. 3. Wysoy was sufficiently antigenic to evoke a soya-bean-specific serum antibody response in rabbits injected with this formula emulsified in complete Freunds adjuvant. A significantly greater response was obtained when rabbits were similarly injected with Prosobee powder. 4. The formulas varied in their ability to sensitize guinea-pigs for both anaphylaxis and antibody production when given orally, although the differences were not statistically significant. Prosobee powder appeared to be the most antigenic and Formula S the least, with Prosobee liquid concentrate and Wysoy being intermediate. 5. Similar variations in antigenicity were observed when Prosobee powder, Wysoy and Formula S were fed to soya-bean-sensitive calves. These formulas were all capable of provoking intestinal disturbances (seen as increased ileal flow-rate, decreased small intestinal transit time and decreased nitrogen absorption) but the most severe reactions were seen when Prosobee powder was fed and the least with Formula S. 6. Thus the four soya-bean-based infant formulas showed considerable differences in antigenicity. In vivo studies using guinea-pigs, rabbits and calves were in good agreement and broadly correlated with the immunochemical assessment of antigenicity. However, the in vitro and in vivo results did not correspond exactly and levels of glycinin and beta-conglycinin below the limit of detection by ELISA could evoke an immune response in the different animal species. We believe that these variations in antigenicity of different commercial products prepared from isolated soya-bean protein may be important when interpreting the results from studies of the development of allergy in infants given soya-bean-based formulas.

Screw fixation of closed oblique and spiral fractures of the tibial shaft.

The difficulty of reducing and holding fractures of the tibial shaft, especially those of oblique configuration, is well known. A high incidence of malalignment after closed treatment of fractures of the distal third of the tibial shaft, as compared with fractures in more proximal sites, has also been reported. In 29 of 37 fractures in the present study treatment by closed methods had failed. In highly selected cases of closed tibial shaft fractures, notably those in the distal third and at the middle third-distal third junction with an oblique or a spiral configuration and an unacceptable position after closed reduction, simple screw fixation followed by plaster immobilization provides an effective treatment alternative.

Ectopic calcification as a late sequela of compartment syndrome. Report of two cases.

Ectopic calcification occurred in two patients as a late sequela of compartment syndrome. The clinical and roentgenographic appearance are sufficiently typical that the diagnosis should be made without difficulty. Leaving the wound open after incision and drainage of these lesions may lead to secondary infection. Closing the wound after decompression over suction drainage or needle decompression are treatment alternatives that may lead to more satisfactory results.

Long-term prognosis after transient ischemic attacks.

A retrospective follow-up study of 243 patients with transient ischemic attacks (TIA) is reported. The long-term mortality of the patients was higher than that of the corresponding general population. It is demonstrated that the excess mortality over the whole period of observation, irrespective of the age and sex of the patients, can be characterized by a single figure expressing the slope of the curve obtained by semilogarithmic plotting of the ratios of observed to expected survival against time. The use of this numerical expression--in the present series -0.04--will thus facilitate comparisons of the survival of TIA patients drawn from different populations. Unfavourable prognostic factors were: carotid TIA, associated extracerebral disease, and a history of hypertension. Fatal strokes, being four times as frequent as expected according to published incidence figures, accounted for 20% of the deaths, heart disease 38%. Stroke deaths tended to occur earlier than cardiac deaths. The results support the concept that most TIAs, like strokes, are incidents in the progressive course of a generalized vascular disease. The finding of a constant excess mortality over the years following a TIA makes it difficult to recommend a discontinuation of prophylactic therapy at any particular time.

Fractures of the femur secondary to low-velocity gunshot wounds.

Forty-three fractures of the shaft of the femur secondary to low-velocity gunshot wounds were evaluated to determine healing time, fracture alignment after healing, complications, and fracture characteristics. This study confirmed the previous reports of low infection rates and the need for minimal debridement for such fractures. The healing time was faster than that of closed fractures treated by similar means: the average healing time was 144.3 days. Alignment was easy to obtain and maintain, the average angular deformity being 5 degree or less with no rotational deformities. Three characteristic fracture types were noted: the double butterfly configuration of the shaft of the femur, the drill-hole fracture of the distal third of the femur as previously described experimentally, and a third type of fracture with an incomplete fracture secondary to the gunshot wound which acted as a stress riser with a resultant spiral fracture either proximal or distal to the impact site.

Anti-depressive treatment in Parkinson's disease. A controlled trial of the effect of nortriptyline in patients with Parkinson's disease treated with L-DOPA.

Nineteen patients with L-DOPA treated parkinsonism involving depressive symptoms, the therapeutic effect of nortriptyline was compared to placebo in a controlled trial. The depressive and neurological symptoms were evaluated by rating scales. Nortriptyline had a clinical significant effect with regard to the depressive symptoms, whereas the neurological parameters were unchanged. The authors suggest the depression in Parkinson's disease to be of both reactive and endogenous origins.

Fat embolism prophylaxis: a study of four treatment modalities.

Significant coagulation and blood gas changes may occur with uncomplicated extremity fractures. To more accurately define the effect of therapy on these changes, a prospective study of 58 patients with uncomplicated fractures was undertaken. An initial group of 10 selected patients was studied to determine the changes with "standard therapy." The remaining 48 patients were then randomized into five groups: control, increased fluid intake, increased glucose intake, aspirin, and massive steroids. The patients were studied on 5 consecutive days. Treatment of patients in the latter four groups with aspirin or steroids resulted in significant normalization of blood gases, coagulation proteins, and platelet numbers when compared to controls. These measurements in patients treated with fluid loading or increased glucose intake were not significantly different from controls.