The influence of affective temperaments and psychopathological traits on the definition of bipolar disorder subtypes: a study on bipolar I Italian national sample.

UNLABELLED: Affective temperament and psychopathological traits such as separation anxiety (SA) and interpersonal sensitivity (IPS) are supposed to impact on the clinical manifestation and on the course of Bipolar Disorder (BD); in the present study we investigated their influence on the definition of BD subtypes. METHOD: : Among 106 BD-I patients with DSM-IV depressive, manic or mixed episode included in a multi-centric Italian study and treated according to the routine clinical practice, 89 (84.0%) were in remission after a follow-up period ranging from 3 to 6 months (Clinical Global Impression-BP [CGI-BP] <2). Remitting patients underwent a comprehensive evaluation including self-report questionnaires such as the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A) scale, Separation Anxiety Symptom Inventory (SASI), Interpersonal Sensitivity Measure (IPSM) and the Semi-structured interview for Mood Disorder (SIMD-R) administered by experienced clinicians. Correlation and factorial analyses were conducted on temperamental and psychopathological measures. Comparative analyses were conducted on different temperamental subtypes based on the TEMPS-A, SASI and IPSM profile. RESULTS: : Depressive, cyclothymic and irritable TEMPS-A score and SASI and IPSM total scores were positively and statistically correlated with each other. On the contrary, hyperthymic temperament score was negatively correlated with depressive temperament and not significantly correlated with the other temperamental and psychopathological dimensions. The factorial analysis of the TEMPS-A subscales and SASI and IPSM total scores allowed the extraction of 2 factors: the cyclothymic-sensitive (explaining 46% of the variance) that included, as positive components, depressive, cyclothymic, irritable temperaments and SASI and IPSM scores; the hyperthymic (explaining the 19% of the variance) included hyperthymic temperament as the only positive component and depressive temperament and IPSM, as negative components. Dominant cyclothymic-sensitive patients (n=49) were more frequently females and reported higher number of depressive, hypomanic and suicide attempts when compared to the dominant hyperthymic patients (n=40). On the contrary, these latter showed a higher number of manic episodes and hospitalizations than cyclothymic-sensitive patients. The rates of first-degree family history for both mood and anxiety disorders were higher in cyclothymic-sensitive than in hyperthymic patients. Cyclothymic sensitive patients also reported more axis I lifetime co-morbidities with Panic Disorder/Agoraphobia and Social Anxiety Disorder in comparison with hyperthymics. As concerns axis II co-morbidity the cyclothymic-sensitive patients met more frequently DSM-IV criteria 1, 5 and 7 for borderline personality disorder than the hyperthymics. On the contrary, antisocial personality disorder was more represented among hyperthymic than cyclothymic patients, in particular for DSM-IV criteria 1 and 6. LIMITATION: : No blind evaluation and uncertain validity of personality inventory. CONCLUSION: : Our results support the view that affective temperaments influence the clinical features of BD in terms of both clinical and course characteristics, family history and axis I and II co-morbidities. Hypothetical temperamental subtypes as measured by TEMPS-A presented important interrelationships that permit to reliably isolate two fundamental temperamental disposition: the first characterized by rapid fluctuations of mood and emotional instability, and the second by hyperactivity, high level of energy and emotional intensity. Dominant cyclothymic and hyperthymic bipolar I patients reported important differences in terms of gender distribution, number and polarity of previous episodes, hospitalizations, suicidality, rates of co-morbid anxiety and personality traits and disorders. Our data are consistent with the hypothesis that affective temperaments, and in particular cyclothymia, could be utilized as quantitative, intermediate phenotypes in order to identify BD susceptibility genes.

Primary cauda equina tumors.

During the last seven years (1985-91) 28 primary tumours in the cauda among 104 intraspinal tumors were observed. The largest group (71%) comprised ependymomas and neurinomas. The rest included 5 lipomas, 2 astrocytomas and 1 epidermoid. Low-back pain without or with sciatic or crural irradiation was the most common initial symptom. The length of symptomatology is generally measured in months, because pain is erroneously referred to discal pathology for long time. The X-ray standard test and the CT scan have been of modest utility in the diagnosis of these lesions, but however they have been necessary for diagnostic screening. The MNR, a bloodness test, showed an important diagnostic value for the identification of these tumors; it is also useful in follow-up to exclude recurrence. The lipoma's and ependymoma's surgery, although performed by microsurgical techniques, showed great problems. Total removal of the ependymomas assured no recurrence at the follow-up. Sphincter disturbances were frequent after the operation, but they disappeared after some months. In most patients with lipomas the resection was partial, but at follow-up they were symptomless. Neurinomas' surgery presented less technical difficulties and the postoperative course was more favorable. Astrocytomas underwent to radiotherapy but their prognosis is not favorable.

Sulphation of hydroxybiphenyls in human tissues.

1. Sulphotransferase is an important detoxication pathway of hydroxybiphenyls and the kinetics of sulphotransferase activity were studied in human liver, ileum and colon mucosae, lung, kidney, urinary bladder mucosa and brain using 0-, m- and p-hydroxybiphenyl as substrates. 2. Sulphotransferase activity was detectable in all tissues studied, although it showed marked tissue-dependence. The rate of sulphation ranged greater than 100-fold in different tissues and the highest and lowest activities of sulphotransferase were found in liver and brain, respectively. 3. The Km of sulphotransferase was not tissue-dependent but was dependent on the isomer of hydroxybiphenyl. The Km varied over a 500-fold range and the highest and lowest values of Km were found with p-hydroxybiphenyl and m-hydroxybiphenyl, respectively.

Human brain sulphotransferase and glucuronyltransferase.

The activities of cytosolic sulphotransferase (ST) and microsomal glucuronyltransferase (GT) were measured with 1-naphthol as the substrate in three frontal cortex, three temporal cortex, one parietal cortex, one occipital cortex and two cerebellar cortex specimens from human brain. The average activity was 11.7 +/- 4.2 pmol/min/mg protein/(ST) and 26.8 +/- 13.6 pmol/min/mg protein (GT). The kinetics of ST were studied varying the concentration of 1-naphthol in five brain specimens (temporal cortex, temporal subcortex, occipital cortex, cerebellum cortex and frontal cortex) whereas those of GT were studied in a sample obtained by pooling the microsomal fractions from the following eight brain tissues: one frontal cortex, four temporal cortex, one parietal cortex and two cerebellar cortex specimens. The Km of the first and second enzyme was 1.55 +/- 0.47 microM (mean +/- s.d.) and 121 microM, respectively. The Vmax values were 13.70 +/- 8.16 (mean +/- s.d.) pmol/min/mg protein (ST) and 103 pmol/min/mg protein (GT). Vmax/Km was ten times higher for ST than GT. These data suggest that ST is the predominant pathway at low concentrations of 1-naphthol whereas at higher concentrations, GT becomes the predominant pathway.

Orbital decompression for severe Graves' ophthalmopathy. Results of a three-wall operative technique.

Nine patients out of more than 300 with severe Graves' ophthalmopathy followed in this institution were submitted to orbital decompression carried out on 16 eyes by a three-wall procedure consisting of a transfrontal approach with the removal of the roof, the lateral wall and part of the floor of the orbit. All patients had been previously unsuccessfully treated by orbital radiotherapy and/or systemic corticosteroid administration. The main indications for surgery were marked proptosis or sight-threatening optic neuropathy. Results of treatment were evaluated on clinical grounds and by the variation of the ophthalmopathy index (OI). A significative reduction of proptosis was observed in all eyes, with a mean decrease in the Hertel reading of 3.2 mm, from 22.6 +/- 1.8 mm to 19.4 +/- 1.4 mm (p less than 0.001). A complete regression or improvement of inflammatory signs, corneal lesion and, with one exception, extraocular muscle dysfunction was obtained in all cases. Loss of visual acuity and other manifestations of optic neuropathy were present in 11 out of 16 eyes before surgery. A complete restoration or a marked improvement of optic neuropathy was obtained in 7 cases: failure occurred in the two patients (4 eyes) with longstanding sight loss. The OI decreased in all patients after surgery, from a mean pretreatment value of 8.6 to a mean posttreatment value of 3.8 (p less than 0.001). The clinical response to surgery was excellent in 4 cases, good in 3 and slight in 1; no changes were observed in the remaining patient. Bacterial meningitis which resolved with no sequelae occurred in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical treatment of Graves' ophthalmopathy by decompressive orbitotomy.

Malignant exophthalmos is often not resolvable using only medical or radiation therapy. The pressure on the optic nerve which is generally associated with it evolves rapidly in many cases towards optic atrophy and subsequently loss of vision. Only surgical treatment offers any guarantee of success and of the various techniques proposed, subfrontal orbital decompression seems clearly the more effective, in that it makes for an optimal alleviation of pressure in the optic pathways. The Authors describe their technique, a variation on the original approach, and report the results achieved with it.

Pulmonary embolism in neurosurgical patients: diagnosis and treatment.

Pulmonary embolism was suspected in 45 neurosurgical patients who were treated between January, 1980, and December, 1981. Hypoxemia with respiratory alkalosis and sudden tachycardia gave rise to this suspicion more often than any other sign or symptom. Perfusion lung scanning confirmed the presence of pulmonary embolism in 23 of these cases. A retrospective analysis of the clinical course of these 23 patients suggested that one or more previous episodes of pulmonary embolism had occurred in 16 cases (69.6%), and had been either overlooked or misdiagnosed. Treatment was started immediately after diagnosis. Twenty-one patients were given heparin; however, two could not be treated because of contraindication to using anticoagulant drugs. Two patients died during treatment. The 21 surviving patients were assessed and 11 of them submitted again to perfusion lung scanning 1 week after diagnosis: 14 had improved, but seven did not show significant changes either clinically or on perfusion lung scanning. Nine treated patients developed hemorrhage, but it was readily controlled. In two of the nine patients, hemorrhage involved the surgical area. It is stressed that pulmonary embolism may be suspected and diagnosed in neurosurgical patients at an early stage. Heparin may be given and the survival rate appears to be better than previously reported figures.

Intrasellar metastasis mimicking a pituitary adenoma.

An unusual case of pituitary metastasis from renal cell carcinoma mimicking an adenoma is reported. Panhypopituitarism and chiasmal compression were the first manifestations of the tumor. The clinical, endocrinologic, and pathologic features of pituitary carcinomatous metastasis are discussed.

Effect of cytidine diphosphate choline on growth hormone secretion in patients with brain or pituitary lesions.

Plasma GH levels basally and after CDP-Choline (300 mg) i.v. administration were evaluated by radioimmunoassay in patients with brain lesions variously located (frontal lobe, temporal lobe or hypothalamus) as well as in subjects with pituitary lesions. The results were statistically analyzed and compared with those obtained in normal subjects. A lack of response to CDP-Choline was observed in patients with pituitary adenomas or hypothalamic lesions. The GH response was delayed in patients with frontal lobe diseases. On the basis of the results obtained, we discuss the role of the different central nervous structures on the control of the GH activating system.

Blink reflexes in posterior fossa lesions.

Blink reflexes obtained by electrical stimulation of the supraorbital nerve and electromyographic recording of the orbicularis oculi muscle proved useful as a preliminary method in diagnosis of lesions of the brainstem and the fifth and seventh cranial nerves, and in differentiating intrinsic lesions of the brainstem from extrinsic ones. It was noted that R1 and R2 reflexes were different in the two types of lesions.