Muromonab-CD3-induced neurotoxicity: report of two siblings, one of whom had subsequent cyclosporin-induced neurotoxicity.

Muromonab-CD3 is widely used for immunosuppression in patients undergoing solid organ transplant. We report two siblings with oligomeganephronia and end-stage renal disease who developed encephalopathy and seizures from muromonab-CD3 following renal transplant. The first case is a 13-year-old girl who developed encephalopathy, seizure, and triparesis following renal transplant while muromonab-CD3 was used for immunosuppression. The second case was the 6-year-old sister of the first case, who also developed recurrent focal seizures while she was on muromonab-CD3 for renal transplant immunosuppression. In both cases, a sequential brain magnetic resonance image (MRI) showed progression of abnormalities from the cerebral cortex to the white matter. In the first case, the MRI normalized after muromonab-CD3 was discontinued. In the second case, the patient developed a leukoencephalopathy following cyclosporin administration. The pathophysiology of muromonab-CD3 encephalopathy is believed to be a disturbance to the blood-brain barrier mediated by cytokine release from lymphocyte stimulation by muromonab-CD3. Because the major histocompatibility complex genes are known to regulate cytokine responses, it is possible that the excessive production of cytokines that causes encephalopathy may occur in patients who share close major histocompatibility complex genes. Muromonab-CD3 in a patient whose sibling has developed cerebral complications from its use should be administered with caution. The second case suggests that muromonab-CD3 encephalopathy predisposes patients to develop cyclosporin neurotoxicity. Because the pathogenesis of muromonab-CD3 encephalopathy and cyclosporin-related cerebral complications are both potentially mediated through a disturbance of the blood-brain barrier, it is possible that one agent may predispose a patient to the complication of the other.

Schizophrenic patients show facial reactions to emotional facial expressions.

Facial reactions in schizophrenic patients were assessed via electromyography (EMG) in response to pictures of facial expressions. Male patients and nonpatient controls viewed photographs of positive and negative facial expressions while EMG activity from the corrugator and zygomatic muscle regions was recorded. Both schizophrenic patients and controls exhibited greater zygomatic reactivity in response to positive pictures than in response to negative pictures and greater corrugator reactivity in response to negative pictures than in response to positive pictures. Schizophrenic patients exhibited greater corrugator reactivity than did nonpatient controls. Implications for understanding emotion expression and perception in schizophrenic patients are discussed.

More evidence for generalized poor performance in facial emotion perception in schizophrenia.

Previous studies showing that schizophrenic patients have a deficit in the ability to perceive facial expressions of emotion in others often have not used a differential deficit design and standardized measures of emotion perception. Using standardized and cross-validated measures in a differential deficit design, S. L. Kerr and J. M. Neale (1993) found no evidence for a deficit specific to emotion perception among unmedicated schizophrenic patients. The present study replicated and extended the findings of Kerr and Neale in a sample of medicated schizophrenic patients. Results showed that medicated patients performed more poorly than controls overall; however, they performed no worse on facial emotion perception tasks than on a matched control task. These findings support Kerr and Neale's conclusion that schizophrenic patients do not have a differential deficit in facial emotion perception ability. Future research should examine the nature of schizophrenic patients generalized poor performance on tests of facial emotion perception.

Focus groups describe rural nursing in New York state.

Focus groups were conducted at three sites in rural regions of New York state to describe the nature of rural nursing in terms of scope of practice, barriers, needs, and resources. Five nurses from a variety of rural practice settings participated in each group (n = 15), which was led by a nurse facilitator who was a member of the New York State Nurses Association Committee on Rural Nursing. The focus group methodology included a semi-structured format in which three defined questions were circulated before the meeting and addressed in sequence at the meeting according to the established and prearranged agenda. Key characteristics defining the scope of rural nursing included autonomy, flexibility, and creativity. The main needs identified were for accessible education and professional collegial relationships. Resources included the ease of communication without complex structures, interdisciplinary interaction and respect, and the sense of being part of the community in which the practice agency existed. Despite the barriers, these rural nurses received a great deal of satisfaction from their nursing activities and felt that they made a significant contribution to health care in their community. They also had feasible suggestions to address their needs.

Flat affect in schizophrenia does not reflect diminished subjective experience of emotion.

Although accorded historical significance, affective features of schizophrenia have only begun to receive systematic empirical attention. Interestingly, both early psychopathology writers and more recent investigators have reported frequent discrepancies between schizophrenics' feelings and outward expressions of emotion. Using a more comprehensive assessment of emotion, the present study examines the relationship between emotional experience and expression in a sample of medication-free schizophrenics. Compared with their normal counterparts, schizophrenics were indeed much less facially expressive of both positive and negative emotions during emotion-eliciting films, yet they reported experiencing as much positive and negative emotion. Therefore, the blunted affect typical of some schizophrenics misrepresents their underlying emotional experience. Future research into an inhibition hypothesis is recommended.

Emotion perception in schizophrenia: specific deficit or further evidence of generalized poor performance?

Several studies have investigated the ability of schizophrenics to perceive facial and vocal emotion in others. Although most suggest that schizophrenics have an emotion perception deficit, there is little agreement as to its specific nature. Much of the confusion may be attributed to the failure of investigators to use the differential deficit design and standardized measures of emotion perception. The present study reexamined the question of an emotion recognition deficit in a sample of 29 unmedicated schizophrenics and 23 normal controls, using facial and vocal emotion identification and discrimination tests that have been standardized and cross-validated plus two neuropsychological control tests. Results suggested that differences between schizophrenics and normals on such tasks reflect a generalized performance deficit, rather than a specific emotion recognition deficit.

The medical imaging technologist shortage in New Jersey: its extent and magnitude.

The medical imaging and radiation therapy communities in New Jersey were surveyed to: (1) quantify the personnel shortage, (2) determine the percentage of licensed technologists not employed in the field of medical imaging and radiation therapy, and (3) identify the medical facility type(s) most affected by the personnel shortage. The data supports the claim that a shortage of technologists in all areas of medical imaging and radiation therapy exists. Activities being conducted to address the shortage are presented.

Sequential use of standard and ambulatory EEG in neonatal seizures.

Adequate predictors do not exist to indicate whether seizures are likely to continue beyond the neonatal period. Thirteen neonates with seizures occurring after 7 days of age were evaluated with standard short-term electroencephalography (SEEG) during the initial seizures and with ambulatory EEG (AEEG) when each infant was within 37-44 weeks corrected age (i.e., gestational age plus chronologic age). Eight of 13 SEEGs, 10 of 13 AEEGs, and 12 of 13 with the combined use of both SEEGs and AEEGs accurately predicted the occurrence of seizures at 3-4 months corrected age. Results with SEEG and AEEG did not produce significantly different outcomes. Combined analysis of SEEG and AEEG produced significantly different results from those calculated when the two EEG types were analyzed independently (Z = 3.98, p less than 0.001). The findings indicate that the use of both of these tests may improve the ability to predict continued seizure activity in infants with neonatal seizures when compared to the use of each measure separately.