Association between suicidal behaviour and impaired glucose metabolism in depressive disorders.

BACKGROUND: Disturbances in lipid metabolism have been linked to suicidal behaviour, but little is known about the association between suicide risk and abnormal glucose metabolism in depression. Hyperglycaemia and hyperinsulinaemia may increase the risk of depression and also the risk for suicide, we therefore studied associations between suicidal behaviour and disturbances in glucose metabolism in depressive patients who had been referred to depression nurse case managers. METHODS: Patients aged 35 years and older (N = 448, mean age 51 years) who were experiencing a new depressive episode, who were referred to depression nurse case managers in 2008-2009 and who scored ≥10 on the Beck Depression Inventory were enrolled in this study. The study was conducted in municipalities within the Central Finland Hospital District (catchment area of 274 000 inhabitants) as part of the Finnish Depression and Metabolic Syndrome in Adults study. The patients' psychiatric diagnoses and suicidal behaviour were confirmed by the Mini-International Neuropsychiatric Interview. Blood samples, for glucose and lipid determinations, were drawn from participants after 12 h of fasting, which was followed by a 2-hour oral glucose tolerance test (OGTT) when blood was drawn at 0 and 2 h. Insulin resistance was measured by the Quantitative Insulin Sensitivity Check Index (QUICKI) method. RESULTS: Suicidal ideation (49 %) and previous suicide attempts (16 %) were common in patients with major depressive disorder or dysthymia. Patients with depression and suicidal behaviour had higher blood glucose concentrations at baseline and at 2 hours in the OGTT. Glucose levels associated positively with the prevalence of suicidal behaviour, and the linearity was significant at baseline (p for linearity: 0.012, adjusted for age and sex) and for 2-hour OGTT glucose (p for linearity: 0.004, adjusted for age and sex). QUICKI levels associated with suicidal behavior (p for linearity across tertiles of QUICKI: 0.026). Total and LDL cholesterol and triglyceride levels were also higher in those patients with suicidal behaviour. Multivariate analysis revealed that blood glucose levels, BDI scores and antidepressive medications associated with suicidal behaviour. CONCLUSION: Insulin resistance and disturbances in glucose and lipid metabolism may be more common in middle-aged depressive patients with suicidal behaviour.

Cardiometabolic risk factors in patients referred to depression nurse case managers.

BACKGROUND: Disturbances in lipid and glucose metabolism are associated with depressive symptoms, and may increase suicidal behavior. AIMS: To investigate the prevalence of cardiometabolic risk factors, severity of depressive symptoms, and suicidal thoughts and previous attempts in patients referred to depression nurse case managers. METHODS: Blood cholesterol, triglyceride and glucose levels, depressive symptoms and suicidality were studied in 706 depressed participants and 426 controls. In addition, we compared the Beck Depression Inventory (BDI) with a diagnostic interview. RESULTS: 448 (63%) of the patients scoring ≥ 10 on BDI had major depression or dysthymic disorder, 258 had an anxiety or alcohol use disorder, 137 (19%) had two or more diagnoses in the Mini-International Neuropsychiatric Interview. Suicidal thoughts (49%) and previous suicide attempts (16%) were more common in patients with depressive disorders. Patients diagnosed with depression had highest BDI scores and higher blood glucose levels measured at baseline and at 2 h in the oral glucose tolerance test (OGTT). Both patient groups also had higher triglyceride levels compared with the controls. In addition, metabolic syndrome and type 2 diabetes were most common among the depressed participants. In the whole study population, levels of low-density lipoprotein-cholesterol as well as baseline and 2-h blood glucose in OGTT were higher among patients with suicidal behavior. CONCLUSIONS: Cardiometabolic risk factors and metabolic syndrome are common in patients with depression, and in patients with anxiety and alcohol use disorders. The results imply that disturbance in glucose metabolism may be associated with suicidal thoughts and previous attempts.

Personality profiles and health: longitudinal evidence among Finnish adults.

This study investigates the associations of longitudinal Big Five personality profiles with long-term health in 304 adults (53% males). Personality traits (Neuroticism, Extraversion, Openness, Conscientiousness, Agreeableness) were assessed at ages 33, 42, and 50. Subjective (self-rated health, symptoms, psychological distress) and objective (body mass index, waist-to-hip ratio, blood pressure, cholesterol, triglycerides) indicators of health were measured at ages 42 and 50. Five longitudinally stable personality profiles were extracted over 17 years by latent profile analysis. The levels of traits were the same in each profile at each age. Resilient individuals (N = 65; Neuroticism low, other traits high) had the best subjective health and Overcontrolled individuals (N = 40; Neuroticism high, other traits low) the poorest health over eight years. Reserved individuals (N = 25; high Conscientiousness, other traits low), Undercontrolled (N = 41; high Openness and Extraversion, low Conscientiousness), and Ordinary (N = 133; all traits scored medium) individuals were in the middle of these extremes in subjective health. No differences between the profiles were found in the objective indicators of health. Thus, overcontrol and resilience were most discriminative in terms of good health. Moreover, personality profiles revealed associations with health to be more nuanced than simply being composed of single traits. High Extraversion needed to be combined with high Conscientiousness (Resilients) in order to be associated with the best health; high Extraversion with low Conscientiousness (Undercontrolled) was associated with average health; and low Extraversion with high Neuroticism (Overcontrolled) was associated with the poorest health.

Sentinel lymph node biopsy or elective neck dissection for patients with oral squamous cell carcinoma?

Sentinel lymph node biopsy (SNB) seems to be a promising method for staging clinically N0 neck in patients with oral squamous cell carcinoma (OSCC). In the present study, SNB was performed on 46 patients having elective neck dissection (END; six bilateral dissections) for T1-T3N0 OSCC. Sentinel lymph nodes (SLN) were first examined according to only slightly modified standard histopathologic protocol including sections at 1-2 mm intervals and H&E staining. SLN that appeared false negative (i.e. metastatic non-SLN without metastasis in a SLN) after the initial histopathologic examination were further assessed by step sectioning at 150 microm intervals and immunohistochemistry. Of the 47 neck sides with at least one SLN identified, nine contained metastasis in nine patients. After the initial histopathologic examination, SLNs were negative for malignant cells in four out of the nine metastatic neck sides. In one neck side, two metastatic SLNs were detected after the additional meticulous histopathologic work-up of the initially false negative SLNs. Therefore, in three neck sides the SLN did not contain metastasis although there was a metastasis in a non-SLN. In all these three cases with a false negative SLN, only one SLN had been identified. The sensitivity of the method (employing extensive histopathologic work-up) for detection of occult cervical metastasis was 67% (6/9 neck sides). The sensitivity of SNB for detection of occult metastasis seems to be poor in cases where only one SLN can be identified. The results of this study do not entitle us to entirely replace END by SNB in patients with OSCC.

1,2-benzisothiazolin-3-one in disposable polyvinyl chloride gloves for medical use.

BACKGROUND: Benzisothiazolinone is used as a slimicide in the manufacture of disposable powder-free polyvinyl chloride (PVC) gloves. We recently reported 6 patients from dentistry and health care probably sensitized to benzisothiazolinone in PVC gloves. OBJECTIVE: The study aimed to investigate how widely disposable PVC gloves for medical use on the Finnish market in 2006 contain benzisothiazolinone and to report new cases from 2 clinics in Helsinki. METHODS: 31 brands of disposable PVC gloves were analysed for their benzisothiazolinone content. We looked through the patient material of Helsinki University Central Hospital to find benzisothiazolinone allergic patients. We also described 3 previously unpublished benzisothiazolinone allergic patients from Finnish Institute of Occupational Health. RESULTS: 9 (30%) of the 31 glove brands contained 3-26 p.p.m. benzisothiazolinone. From the 2 clinics, we found 5 new benzisothiazolinone allergic patients who had used PVC gloves containing benzisothiazolinone. In addition, 3 patients had used disposable PVC gloves whose benzisothiazolinone content remained unknown. CONCLUSIONS: In Finland, benzisothiazolinone in powder-free PVC gloves has caused a small epidemic of allergic contact dermatitis in dental personnel and other health care workers. 1/3 of the disposable PVC gloves contained some benzisothiazolinone. A concentration of 20 p.p.m. benzisothiazolinone in a glove seems to be enough for sensitization.

Determination of tamsulosin in human aqueous humor and serum by liquid chromatography-electrospray ionization tandem mass spectrometry.

A simple, sensitive and selective LC-MS/MS method was developed for the determination of tamsulosin in human aqueous humor and serum to study the recently reported eye-related adverse effects of this alpha(1)-blocker drug. Aqueous humor samples were analyzed by direct injection, after addition of the internal standard, labetalol. Liquid-liquid extraction with ethyl acetate was used for serum sample preparation. The chromatographic separation was performed on a reversed phase column by gradient elution with acetonitrile -0.1% formic acid at a flow-rate of 0.2 ml/min. Detection and quantification of the analytes were carried out with a linear ion trap mass spectrometer, using positive electrospray ionization (ESI) and multiple reaction monitoring (MRM). The limit of quantification was 0.1 ng/ml for both aqueous humor and serum samples and linearity was obtained over the concentration ranges of 0.1-4.7 ng/ml and 0.1-19.3 ng/ml for aqueous humor and serum samples, respectively. Acceptable accuracy and precision were obtained for concentrations within the standard curve ranges. The method has been used for the determination of tamsulosin in aqueous humor and serum samples from patients that were on tamsulosin medication and underwent cataract surgery.

Fatal case of myonecrosis and septicaemia caused by Aeromonas hydrophila in Finland.

A 48-y-old female developed cellulitis, myonecrosis and sepsis after a prick wound in her hand while boning freshwater fish. Cultures revealed Aeromonas hydrophila, a Gram-negative bacillus. Despite prompt care the patient died 4 d after the incident. Our case shows that the occurrence of severe Aeromonas infections is not limited to tropical and subtropical areas of the world.

Influence of tamsulosin on the iris and its implications for cataract surgery.

PURPOSE: To study iris-related complications during cataract surgery in patients on tamsulosin medication. METHODS: Twenty-one consecutive cataract patients administered tamsulosin and 21 control patients were studied. Characteristics of the iris during surgery were recorded. Pupillary diameters of 16 patients were measured before and after iris dilatation. Tamsulosin concentrations in the aqueous humor and serum were analyzed. In five patients, surgery on the second eye was carried out after a 7- to 28-day pause in tamsulosin medication. RESULTS: Each patient administered tamsulosin had a sluggish hypotonic iris, along with a tendency toward miosis and a tendency for prolapse of the iris into the phaco tunnel or into the side port during cataract surgery. Sluggish irises also often adhered to the phaco tip or to the irrigation-aspiration tip. Despite a pause of 7 to 28 days in the use of tamsulosin, the adverse effects persisted. Tamsulosin concentrations varied between 0.1 and 1.0 ng/mL in the anterior chamber fluid. In three of five cases, tamsulosin remained in detectable amounts the aqueous humor after the 7- to 28-day pause. Preoperative pupillary diameter was smaller in the patients using tamsulosin than in the controls. CONCLUSIONS: Tamsulosin has selective alpha1A-adrenoreceptor antagonistic properties and obviously binds for a long period to the postsynaptic nerve endings of the iris dilator muscle, thus affecting iris dilatation and leading to complications in cataract surgery. The iris remained floppy after 7- to 28-day interruption of the tamsulosin regimen.

The clinical value of parasternal sentinel node biopsy in breast cancer.

BACKGROUND: Lymphoscintigraphy (LS) with sentinel node (SN) biopsy is proposed to provide a feasible method to complete lymphatic staging in breast cancer. The aim of this study was to evaluate the clinical value of parasternal SN biopsy. METHODS: A total of 984 consecutive patients with clinical stage T1/2N0 invasive breast cancer who underwent LS and SN biopsy were included in the study. A prospectively collected database was used. An intratumoral injection of 50 to 145 MBq of (99m)Tc-labeled human albumin colloid (Nanocoll) was used for preoperative LS. RESULTS: LS showed the axillary SN in 844 (86%) cases and the parasternal SN in 138 (14%) cases. The median number of visualized parasternal SN was 2 (range, 1-6). Visualization of the parasternal SN was more common in patients with mediocentral tumors (81 of 399; 20%) and in patients with lateral tumors (56 of 585; 10%; P < .0001). Parasternal SNs were visualized more often, in 100 (17%) of 584 patients without axillary metastases compared with 38 (10%) of 400 patients with metastatic axillary nodes (P = .0006). Parasternal SNs were harvested successfully in 121 (88%) patients with visualization of those nodes. Parasternal SN metastases were detected in 18 patients, with a median of 1 metastasis (range, 1-4 metastases). Eight of these 18 patients were axillary node negative. CONCLUSIONS: Parasternal SN biopsy results in upstaging in 2% of all breast cancer patients who undergo SN biopsy. The clinical value of the procedure seems insignificant, although it may influence the adjuvant treatment regimen in some patients.

The impact of radiopharmaceutical particle size on the visualization and identification of sentinel nodes in breast cancer.

OBJECTIVES: The aim of this study was to compare the success rate in lymphatic mapping and sentinel node biopsy in breast cancer using two radiopharmaceuticals. METHODS: The study included 119 breast cancer patients who underwent lymphoscintigraphy after a single intratumoral injection of 99mTc-labelled human albumin colloid with a particle size of 0.2-3 microm (Albu-Res) (large particle group) and 119 pair-matched control patients who underwent lymphoscintigraphy using 99mTc-labelled albumin colloid with a particle size of < 80 nm (Nanocoll) (small particle group). The dose of the tracer was used as the matching factor. RESULTS: Lymphoscintigraphy showed sentinel nodes in the axilla in 101 patients (85%) in the large particle group and in 104 patients (87%) in the small particle group. The mean number of visualized nodes in the axilla was 1.7 in the small particle group and 1.3 in the large particle group (P < 0.05). No radioactive nodes were found in the axilla during the operation in 22 patients (18%) in the small particle group and 11 patients (9%) in the large particle group (P < 0.06). Patients who avoided axillary clearance had a similar number of harvested radioactive nodes irrespective of the particle size of the tracer. CONCLUSIONS: It can be concluded that the success rate in the identification of axillary sentinel nodes may be higher when using the smaller particles, despite the similar visualization rate in lymphoscintigraphy. The number of harvested radioactive nodes was not affected by the particle size of the tracer in patients who avoided axillary clearance.

Radio-guided occult lesion localization in patients undergoing breast-conserving surgery and sentinel node biopsy.

BACKGROUND: The objective of the study was to evaluate the feasibility of radio-guided occult lesion localization (ROLL) in breast-conserving surgery for nonpalpable breast cancer. METHODS: Altogether 215 breast cancer patients were included in a prospective study. Ultrasonographically guided intratumoral injection of radioactive tracer was used for tumor localization in 64 patients with nonpalpable tumors, visible in breast ultrasonography (the ROLL group). Nonpalpable tumors, visible only in mammography, were localized with a help of a guidewire in 14 patients (the WGR group). The remaining 137 patients had palpable tumors. RESULTS: The proportion of specimens with close or involved margins (0 to 3 mm) was the same in the ROLL group (6%) and among cases with palpable tumors (5%). In addition the median length of the closest margin did not differ significantly between the groups. CONCLUSIONS: The results of ROLL for nonpalpable breast cancer are comparable with those for resection of palpable tumors.

Motion restriction and axillary web syndrome after sentinel node biopsy and axillary clearance in breast cancer.

BACKGROUND: We evaluated the prevalence of motion restriction and axillary web syndrome (AWS) after sentinel node biopsy (SNB) and axillary clearance (AC) in a prospective study. AWS is a self-limiting cause of early postoperative morbidity after axillary surgery. Limited range of motion associated with palpable cords of tissue in the axilla are typical for AWS. METHODS: Altogether 85 breast cancer patients who underwent SNB only (49 patients) or SNB and AC (36 patients) were examined before and after surgery. The range of shoulder flexion and abduction and the presence of AWS were registered. RESULTS: The range of shoulder movements was restricted in 24 (45%) patients after SNB only and in 31 (86%) patients who also underwent AC (P = 0.002). AWS was encountered in 10 (20%) patients with SNB and in 26 (72%) with AC (P <0.00005). CONCLUSIONS: In the SNB group, significantly less early postoperative morbidity was observed.

Case report: complete lymphatic staging in breast cancer by lymphoscintigraphy and sentinel node biopsy.

The status of the lymph nodes in the axilla and in the internal mammary chain are the most significant prognostic factors for survival in breast cancer. Lymphoscintigraphy shows lymphatic drainage outside the axilla, most often to the internal mammary nodes, usually in 20% to 30% of breast cancer patients, when intraparenchymal techniques of the radioactive tracer injection are used. Lymphoscintigraphy and sentinel node biopsy are potential tools for more accurate staging in breast cancer, because they provide additional information compared to axillary staging alone. We report a breast cancer case with 10 hot spots in five different lymphatic basins (axilla, internal mammary chain, intramammary, infraclavicular, and high interpectoral) in the lymphoscintigraphy.