End-to-side nerve repair. A review.

In recent years, there has been a resurgence of end-to-side peripheral nerve repair. This technique offers a management of a peripheral nerve defect in the absence of a suitable proximal stump. Although numerous animal laboratory investigations demonstrate motor and sensory functional recovery without deleterious effects to the donor nerve, clinical outcomes are yet to be determined.

Delayed rupture of the flexor pollicis longus tendon after inappropriate placement of the pi plate on the volar surface of the distal radius.

The pi plate (Synthes Ltd, Paoli, PA) was designed to fit the unique contour of the dorsal aspect of the distal radius. Complications of pi plate fixation of the dorsal distal radius have been previously reported to include both extensor tenosynovitis and delayed extensor tendon rupture. We report a case of rupture of the flexor pollicis longus tendon associated with inappropriate placement of the pi plate on the volar surface of the distal radius.

Responses to phenelzine and amitriptyline absence of differential predictors by multiple regression analysis.

Multiple regression analyses using initial symptoms to predict outcome were carried out on data from an outpatient controlled comparison of amitriptyline, phenelzine and placebo. Separate analyses were carried out in the three treatment groups and regression equations were compared. Significant prediction was obtained only for phenelzine. On only one of three outcome measures analysed, however were there significant differences between treatment groups in regressions. Individual predictors were not easily interpretable. There was little evidence for different clinical predictors or response to phenelzine and amitriptyline in this sample.

Serum levels and response to amitriptyline in depressed out-patients.

Serum levels of amitriptyline plus nortriptyline were measured by radioimmunoassay at 1 and 6 weeks in depressed out-patients treated with amitriptyline for 6 weeks. Serum concentrations at 6 weeks were higher in older patients. Serum levels showed no relationship to clinical response at 6 weeks, and a week inverse relationship with response at 2 weeks. Routine monitoring of serum levels appears to be of little value in depressed out-patients treated with amitriptyline.

Nosology of atypical depression.

A review of the literature on atypical depression indicated three relatively separate usages for the term: anxiety or phobic symptoms additional to depression, reversed functional shift, and non-endogenous depression. A sample of 160 out-patient depressives was rated on a variety of diagnostic systems measuring these concepts. Inter-relationships between groups selected by the three definitions were found to be low. In addition, although there was moderate consistency within different definitions of endogenous depression and of additional anxiety, reversed functional shift symptoms did not correlate well with each other. These findings suggest that atypical depression may be of limited value as a specific diagnosis within non-psychotic depression.

Influence of acetylator phenotype on antidepressant effects of phenelzine.

Acetylator phenotype, determined by blood levels after sulphadimidine, was related to outcome in a controlled trial of phenelzine in patients with depression and mixed anxiety depression. Slow acetylators showed more improvement and greater phenelzine-placebo differences than did fast acetylators, at two, four and six weeks. A tendency towards faster acetylation was observed in subjects with previous increased alcohol intake. Acetylator phenotype was not related to other symptom, diagnostic or history data.

Response to phenelzine and amitriptyline in subtypes of outpatient depression.

Outpatients with depression and mixed anxiety-depression were treated for six weeks with phenelzine sulfate, amitriptyline hydrochloride, or placebo in a controlled trial. Both active drugs were superior to placebo and were closely comparable in efficacy. Interactions were examined between drug response and classifications based on three different usages of the term atypical depression: additional anxiety or phobic symptoms, atypical functional shift, and nonendogenous depression. Some additional related classifications were also included. There was a tendency for phenelzine to have stronger effects in patients with additional anxiety and without evidence of chronic characterological depression. However, interactions were relatively few. These findings suggest that the two classes of antidepressant affect similar clinical subgroups within the outpatient depressive spectrum, with only relatively weak differences.

Phenelzine and amitriptyline: effects on symptoms of neurotic depression.

A double-blind controlled trial of phenelzine, amitriptyline and placebo was carried out in out-patients suffering from depression or mixed anxiety and depression. After six weeks treatment both active drugs were clearly superior to placebo and of similar efficacy; therapeutic effects started to appear at two weeks. Comparisons on symptom ratings showed that both drugs acted as true antidepressants, producing their greatest effects on ratings of depressive mood and thought content. There were additional weak differences, phenelzine producing more improvement on anxiety ratings, while amitriptyline gave greater effects on depressive impairment of work and interests and anergia. Analyses showed little evidence of clinical subgroups responding preferentially to either drug. The findings indicate that MAO inhibitors and tricyclic antidepressants have more closely similar clinical effects than has been thought and that either may be a useful treatment for these patients who are often considered to respond poorly to antidepressant drug treatment.