Antidepressants and mortality risk in a dementia cohort: data from SveDem, the Swedish Dementia Registry.

BACKGROUND: The association between mortality risk and use of antidepressants in people with dementia is unknown. OBJECTIVE: To describe the use of antidepressants in people with different dementia diagnoses and to explore mortality risk associated with use of antidepressants 3 years before a dementia diagnosis. METHODS: Study population included 20 050 memory clinic patients from the Swedish Dementia Registry (SveDem) diagnosed with incident dementia. Data on antidepressants dispensed at the time of dementia diagnosis and during 3-year period before dementia diagnosis were obtained from the Swedish Prescribed Drug Register. Cox regression models were used. RESULTS: During a median follow-up of 2 years from dementia diagnosis, 25.8% of dementia patients died. A quarter (25.0%) of patients were on antidepressants at the time of dementia diagnosis, while 21.6% used antidepressants at some point during a 3-year period before a dementia diagnosis. Use of antidepressant treatment for 3 consecutive years before a dementia diagnosis was associated with a lower mortality risk for all dementia disorders and in Alzheimer's disease. CONCLUSION: Antidepressant treatment is common among patients with dementia. Use of antidepressants during prodromal stages may reduce mortality in dementia and specifically in Alzheimer's disease.

Carcinoid tumour of the appendix: problems of diagnosis and treatment.

Carcinoids (neuroendocrine tumours) are considered the most common primary appendiceal neoplasm. Primary appendiceal tumours are uncommon. Routine histopathological examination of appendicectomy specimens is justified given the not infrequent incidental finding of appendiceal tumours. In cases of appendicitis in the elderly, the index of suspicion for epithelial tumours of the appendix should be raised. Moreover, once the diagnosis of an adenomatous lesion is made, colonoscopic examination of the entire large bowel is mandatory given the frequency of synchronous colorectal neoplasia in our population. In our study, we review 3 cases of carcinoid tumor of the appendix and describe their presentation, treatment and outcome. They are often diagnosed incidentally after histopathological examination of the vermiform appendix submitted in the course of the management of another clinical diagnosis. Appendectomy is appropriate for lesions < 1 cm but for lesions over 2 cm in diameter there is a significant increase in metastatic spread and thus right hemicolectomy is required in such cases. Appendiceal carcinoid tumours are found in 0,3 - 0,9 per cent of patients undergoing appendicectomy. Controversy exists over the management following appendicectomy, especially with regard to the role of right hemicolectomy in patients with tumours smaller than 2 cm in diameter.

PET imaging shows no changes in TSPO brain density after IFN-α immune challenge in healthy human volunteers.

Depression is associated with peripheral inflammation, but its link with brain microglial activity remains unclear. In seven healthy males, we used repeated translocator protein-Positron Emission Tomography (TSPO-PET) dynamic scans with [11C]PBR28 to image brain microglial activation before and 24 h after the immune challenge interferon (IFN)-α. We also investigated the association between changes in peripheral inflammation, changes in microglial activity, and changes in mood. IFN-α administration decreased [11C]PBR28 PET tissue volume of distribution (Vt) across the brain (-20 ± 4%; t6 = 4.1, p = 0.01), but after correction for radioligand free-plasma fraction there were no longer any changes (+23 ± 31%; t = 0.1, p = 0.91). IFN-α increased serum IL-6 (1826 ± 513%, t6 = -7.5, p < 0.001), IL-7 (39 ± 12%, t6 = -3.6, p = 0.01), IL-10 (328 ± 48%, t6 = -12.8, p < 0.001), and IFN-γ (272 ± 64%, t6 = -7.0, p < 0.001) at 4-6 h, and increased serum TNF-α (49 ± 7.6%, t6 = -7.5, p < 0.001), IL-8 (39 ± 12%, t6 = -3.5, p = 0.013), and C-reactive protein (1320 ± 459%, t6 = -7.2, p < 0.001) at 24 h. IFN-α induced temporary mood changes and sickness symptoms after 4-6 h, measured as an increase in POMS-2 total mood score, confusion and fatigue, and a decrease in vigor and friendliness (all p ≤ 0.04). No association was found between changes in peripheral inflammation and changes in PET or mood measures. Our work suggests that brain TSPO-PET signal is highly dependent of inflammation-induced changes in ligand binding to plasma proteins. This limits its usefulness as a sensitive marker of neuroinflammation and consequently, data interpretation. Thus, our results can be interpreted as showing either that [11C]PBR28 is not sensitive enough under these conditions, or that there is simply no microglial activation in this model.

[Intestinal tuberculosis in children. Differential diagnosis and treatment]. / Tuberculoza intestinala la copil. Diagnostic diferential, conduita terapeutica.

Lately, tuberculosis has became a top priority problem in health all over the world. The actual level of epidemiological indicates of tuberculosis Shaw that Romania is the country that has the most unfavorable situation in Europe except for Bosnia-Herzegovina. Tuberculosis incidence from 1996 to 1997 ranks Dolj county second in Romania from the point of view of the increasing rate (154.3% + 25.4% versus 107% + 4.3%). The National Programme of Controlling Tuberculosis for 1997-2000 has as main object the neutralization of a least 85% of the discovered contamination sources. At the same time with the pulmonary tuberculosis were discovered 17.2% extrapulmonary localizations. The purpose of these works is that of presenting in the frame of extrapulmonary TBC the localization of intestinal TBC with children (peritonitic form with infants and pseudotumoral with child). In class cooperation with the veterinary Medicine Service we have also studied the possibility of same sources of TBC infection of animal origin, knowing the fact that besides the human Koch bacillus were discovered bovine, ovine, poultry sources. Presenting a number of 16 cases of intestinal tuberculosis with children, rare cases of extra pulmonary tuberculosis, the authors also present 2 cases with children whose differential diagnosis had to be made ou a histopathological base between tuberculosis with an abdominal lymphoma or peritonitic carcinomatosis. The results of the surgical treatment that made the diagnosis with the help of the histopathological examination and the tuberculostatic treatment were very good, the evolution and the control in true of all the patients, proving that intestinal tuberculosis extrapulmonary form with children can be cured.

[Beta-blockers in glaucoma]. / Betablocantele în glaucom.

The paper presents the main beta-blockers used in glaucoma therapy, the common international nomination and the commercial nominations of these therapeutical agents which have opened up new prospects in the medication of glaucoma. Some pharmacological properties of the beta-blockers are reviewed: the beta-adrenolytic strength, the pharmacodynamic properties, the pharmacokinetic effects, the action principle, the therapeutical effects and also the local and general side effects of the beta-blockers used in glaucoma therapy.

[Melanosis oculi and malignant choroid melanoma]. / Melanosis oculi et le mélanome choroïdien malin.

The patient aged 75 years presents since her youth, in the left eye, ocular melanosis with abnormal pigmentation of the sclerotic, hyperpigmentation of the iris and abnormal pigmentation of the fundus oculi. Six months ago, she noticed that she is not able to see with this eye, and the fundus oculi examination emphasizes a malignant choroidal melanoma, with a fixed detachment of the retina. The authors show that the denomination Bourquin's benign ocular melanosis, under which the affection is known, is improper, as 10% of the cases of ocular melanosis degenerate into melanosarcomas. The term melanosis oculi is the most adequate one.

[The extraction of the crystalline lens with trabeculectomy in open-angle glaucoma]. / Extraction du cristallin avec trabéculectomie dans la glaucome a angle ouvert.

Trabeculectomy with the extraction of the crystalline in a single operating tempo, represents a progress in the solving of two affections through a single intervention. Of the total of 101 cases of open-angle glaucoma operated and analysed on 21 patients, trabeculectomy was practised in the extraction of the crystalline (21%). The ocular tension before the operation was between 21-30 mm Hg, on 15 patients, 31-40 mm Hg, on 4 patients and over 41 mm Hg on 2 patients. As to the visual acuity, it was below 1/50, due to the opacity of the crystalline and the advanced stage of the glaucoma. The technicality varied, according to the operator--either classical Cairns trabeculectomy, or Franimopoulos-protected trepano-trabeculectomy followed by the extraction of the intracapsulated crystalline. Small postoperation hemorrhages appeared in 6 of the cases observed in the anterior chamber and 4 small hemorrhages in the vitreous body were resorbed in 7-10 days. In all cases under observation, the postoperative ocular tension kept within 11 to 17 mm Hg. The extraction of the crystalline with trabeculectomy in open-angle glaucoma is easily performed and complications are not more frequent than in the simple extraction of the crystalline.

Remarks on some cases of stromal hyperplasia and endometrial sarcoma.

Our study works out different aspects which can appear both in stomal hyperplasias and endometrial sarcoma. It is possible to recognise histopathologic varieties of the stromal hyperplasias by a close co-operation with the gynaecologist. The necessity of a right diagnosis for all the forms of stromal hyperplasia spreads from the significance of precancerous lesion of some of them. We also mention the difficulties of diagnosis risen by stromal hyperplasias and endometrial sarcoma and also the necessity of a certain diagnosis having into consideration the prognostic and the different therapy imposed by the two diseases.

Cerebrovascular diseases and depression: epidemiology, mechanisms and treatment.

Both cerebrovascular disease (CVD) and depression are common conditions in the elderly, and there is emerging evidence of a bi-directional relationship: 1) depression can cause CVD and stroke, transient ischemic attack; and 2) subcortical CVD are associated with increased risk for depression. The frequency of poststroke depression is highest during the first month after the stroke, but remains high even after several years. Depression is associated with poorer functional prognosis and higher mortality after stroke. There is good evidence that severity of functional impairment, high neuroticism, low social support as well as genetic factors are associated with an increased risk for post-stroke depression. Deep white matter lesions are the most consistent imaging correlate of depression. Potential mechanisms mediating the association between depression and CVD are neuroinflammation and HPA-axis activation, fronto-subcortical circuit lesions, and serotonergic dysfunction. Antidepressants have demonstrated effect on poststroke depression in meta-analyses, and such drugs as well as vitamin B can reduce the incidence of depression in stroke survivors. In addition, serotonergic drugs may strengthen poststroke motor and cognitive recovery, potentially through restorative mechanisms. Psychotherapeutic strategies such as problem-solving therapy seem to be effective. There is emerging evidence that treatment of cardiovascular disease and risk-factors can reduce the risk for late-life depression, but more studies are needed to test this hypothesis.

[Ocular lesions produced by the sting of Hymenoptera]. / Leziuni oculare produse prin întepaturi de himenoptere.

The author reports on two clinical cases and discusses the possible pathogenic mechanisms of the ocular manifestations induced by Hymenoptera bites in the eye and around the eye. The ocular manifestations are polymorphous both clinically and pathogenically. The appearance of cornea manifestations following bites in the periocular region suggest a possible elective localization of the symptomatology. Various mechanisms may be involved: direct traumatic, toxic, allergic and certain local predisposing tissular factors.

Changes in the use of antibacterial drugs in the countries of central and eastern Europe.

Use of systemic antibacterial drugs in the countries of central and eastern Europe (CCEE) has been studied using the defined daily doses (DDD) methodology. For the comparison, national wholesale data from Bulgaria, the Czech Republic, Estonia, Hungary, Lithuania, Slovakia, Slovenia and Romania for the years 1989 and 1992 were used, i.e. for the years before and after the rapid sociopolitical changes in these countries. Substantial differences in the patterns of antibacterial drug use between countries as geographically and economically similar as the CCEE were observed. The general sales of antibiotics varied almost twofold among the CCEE and had decreased in most of the CCEE during the study period. The proportion of tetracyclines in the sales of 1992 ranged from 10% in Slovenia to 49% in Estonia, and that of broad-spectrum penicillins from 6% in Estonia to 40% in Slovenia. The use of narrow-spectrum penicillins varied within the range of 4% in Bulgaria to 38% in Slovakia, and had decreased during the study years in all countries. Aminoglycosides accounted for 5-12% of all antibacterials in Bulgaria, Estonia, Lithuania, Romania and Slovakia in the study period, and these countries, with the exception of Slovakia, also had a high consumption of chloramphenicol. In 1992, by far the most popular antiinfectives in the CCEE were doxycycline, ampicillin and co-trimoxazole, which ranked among the top ten drugs in all countries studied.(ABSTRACT TRUNCATED AT 250 WORDS)