Relationships between coping, anxiety, depression and health-related quality of life in outpatients with substance use disorders: results of the SUBUSQOL study.

Previous research showed that coping strategies are associated with depressive symptoms and health-related quality of life (HRQoL) in patients with chronic somatic conditions. The aim of this study was to examine the coping strategies used in patients with substance use disorders and to assess the relationships between coping strategies, HRQoL, anxiety and depression. Coping was assessed in a prospective outpatient cohort by the Brief COPE. Additionally, sociodemographic and clinical data were collected, and questionnaires assessing HRQoL (SF-12) and states of anxiety and depression were completed. Cross-sectional analysis using Pearson correlations and multiple linear regression was performed. A total of 244 patients were included. Acceptance, planning and self-blame were the most used coping strategies. Strong correlations were found between anxiety, depression, coping strategies and HRQoL. On the MCS-12, better scores were associated with male gender, lack of anxiety or depression and coping styles based on less self-blame, on positive reframing, acceptance, and behavioral disengagement. Patients without depression or anxiety, and no comorbidity had better scores on the SF-12 PCS. Coping strategies of substance-dependent outpatients should be assessed, as they might be useful for identifying patients in need of support. Furthermore, interventions that improve coping capabilities might be helpful for improving HRQoL.

More actors, different play: sphenoethmoid cell intimately related to the maxillary nerve canal and cavernous sinus apex.

The sphenoid sinus is one of the most morphologically variable and surgically important structures of the skull base. Located below the sella turcica, neighbored by parasellar regions, such as the orbital apex, pterygopalatine fossa and lateral sellar region (cavernous sinus), it is clinically related to these and surgically relevant as corridor for various approaches. Moreover, at the sphenoethmoidal junction, important variations occur, most of these related to the presence of the Onodi cells and the intrasinusal protrusions of the optic nerve. That is why any identified and previously undescribed morphological variation at that level must be added to the well-established protocols, clinical and surgical. During a retrospective CT study of the sphenoid sinus anatomical features a previously unreported morphology was encountered and is reported here. It refers to a unilateral sphenoethmoid cell (SEC), Onodi-positive, not only overriding the superior aspect of the sphenoid but also its lateral side to get intimately related to the maxillary nerve. As that SEC expanded medially to the cavernous sinus apex, it altered the usual endosinusal morphological correlations and also added itself within the limits of the Mullan's triangle. It appears so that such postero-infero-lateral extended pneumatization of an Onodi cell alters the surgical landmarks and also can blur clinical pictures, by adding maxillary and pterygopalatine signs and symptoms.

The maxillary recess of the sphenoid sinus.

The most studied recess of the sphenoid sinus seems to be the lateral one, which is highly variable. Less attention seems to be paid to the maxillary recess, extending anterior, inferior and lateral towards the maxillary sinus. Twenty patients were referred for CT of the paranasal sinuses (axial CT), during a 3-month period. After examining the morphology of the sphenoid sinuses, the authors found bilateral maxillary recesses in one patient. On either side, the maxillary recess of the sphenoid sinus was directed anterior and lateral, being separated from the maxillary sinus by a distinctive bony wall; the longitudinal size of these recesses was 1.36 cm, on the left, and 1.22 cm, on the right. As it becomes part of the antero-medial wall of the pterygopalatine fossa, the maxillary recess of the sphenoid sinus should be evaluated prior to the endoscopic endonasal approach of the fossa; the detail becomes more relevant when one takes into account the fact that in our case, on the right side, the CT-scan suggested that the sphenopalatine artery could traverse directly through the maxillary recess. Therefore, such a maxillary recess of the sphenoid sinus seems to be anatomically located in the situs of the orbital process of the palatine bone and thus, it assumes the respective topography. The differential diagnosis with a Haller cell is relevant--the surgical procedures that approach a Haller cell could lead to a misdiagnosed maxillary recess of the sphenoid sinus into the middle nasal meatus. This aspect determined us to consider the maxillary recess of the sphenoid sinus as a false Haller cell and to claim the imperative of a CT-evaluation performed prior to interventions.

Study of the diameter and number of the pulmonary veins orifices.

The present study was made in the anatomy laboratory on 100 heart specimens. It was studied the morphological parameters about diameter and number of the atrial orifices of the pulmonary veins. The number of the orifices and their diameter depends on the lungs weight. Generally (70% of the cases) the orifices number is four and rarely three or five. An increased number of orifices are more frequently in the right side and a decreased number especially in the left side. The orifices diameter is much larger at the male's veins than the female's ones, and much larger in the right than the left side and also much larger at the superiors than the inferior veins.

Former and present aspects in upper level of viscero-skull architecture.

The classical reference material describes two resistance arcs, the maxillary arc and the mandibulary arc, from which the masticatory forces direct themselves towards the functional resistance structures of the viscero-skull. From the maxillary arc, three pairs of vertical pillars ascend (that is fronto-nasal, zygomatic and pterygoid). Certain authors add to these a median arc--the bony part of the nasal septum. From the mandibulary arc, the lines of force make for the cordyle and the coronoid process of the mandible. In terms of the new outlook, at the upper level of the viscero-skull, there are five vertical blades described: one median, two medial and two lateral, those last including the pillars from the classical descriptions. These vertical blades are joined by three horizontal laminae: the upper one, the middle one--interrupted by the median line and the lower one--included in the concavity of the maxillary arc. These structures of laminae induce the formation of some resistance cylinders and cones. Within the lower level of the viscero-skull there are three mandibulary arcs described: the upper one (the classic mandibulary arc), the middle one (with an oblique direction) and the lower one.

Aspects referring to the morphological variability of the abdominal branches of pneumogastric nerve (nervus vagus).

Terminal part and the abdominal branches of pneumogastric nerve were and still is an up-to-date problem not only through the anatomic importance but also through its implications in surgical practice. The study was done on 50 corpses using the dissection method. We are looking after torsion variants of pneumogastric nerves around the esophagus, morphological variability of the periesophageal pnemogastric plexus among witch the pnemogastric nerves loose theirs individuality through the mixture and the anastomoses of the fibers and the morphological variability of abdominal branches of the nerve, grouped by us in anterior and posterior branches.

Correlations between the colic branches of the mesenteric arteries and the vascular territories of the colon.

The study, done on 100 corpses from the dissection rooms of anatomy laboratory, hinted the morphological variability of the colic arteries and their territories. Morphological variability of the colic branches derived from the mesenteric arteries (superior right colic artery -- 98%; middle right colic artery -- 88%; inferior right colic artery -- 100%; middle colic artery - 36%; superior left colic artery -- 100%; middle left colic artery -- 50%; inferior left colic artery -- 100%) allows us to give out a morphogenetic supposition related their ramification and number. Analyze of the results guide us to a tentative of setting down the vascular territories of the colon. In the beginning were established the territories of the mesenteric arteries (superior and inferior) and after that, were marked the subterritories for each colic artery. Establishing the vascular territories of the colic arteries have not only anatomical importance but also a surgical one, been known the difficult postoperatory colon's revitalization.