Search

Social cognition (SC) appears to contribute to long-term outcomes in schizophrenia; however, little is known about whether different forms of SC are supported by the same cognitive processes. Accordingly, we examined the relationship of two domains of SC: emotion recognition (ER), using the Bell-Lysaker Emotion Recognition Test, and social inference (SI), using the Social Attribution Task-Multiple Choice, to measures of neurocognition, metacognition, theory of mind (ToM), and symptoms. Participants were 72 adults with schizophrenia in a nonacute phase. Multivariate analysis of variance and univariate analysis of variance revealed participants with intact ER had better neurocognition (MATRICS Consensus Cognitive Battery [MCCB]), metacognition (Metacognition Assessment Scale-Abbreviated), ToM (The Hinting Task), and higher emotional discomfort symptoms than participants with impaired scores. Participants with intact SI had higher MCCB visual and verbal learning and SC scores. Stepwise regressions revealed neurocognition and metacognition uniquely contribute to ER performance. Results suggest ER and SI are differentially related to cognitive processes.

Background: Fracture-dislocation of the midfoot with collapse of the longitudinal arch is common in patients with neuropathic arthropathy of the foot. In this study, we describe a technique of midfoot arthrodesis with use of intramedullary axial screw fixation and review the results and complications following use of this technique. Methods: A retrospective study of twenty-two patients who had undergone surgical reconstruction and arthrodesis to treat Charcot midfoot deformity was performed. Bone resection and/or osteotomy were required to reduce deformity. Axially placed intramedullary screws, inserted either antegrade or retrograde across the arthrodesis sites, were used to restore the longitudinal arch. Radiographic measurements were recorded preoperatively, immediately postoperatively, and at the time of the last follow-up and were analyzed in order to assess the amount and maintenance of correction. Results: Patients were evaluated clinically and radiographically at an average of fifty-two months. Complete osseous union was achieved in sixteen of the twenty-two patients, at an average of 5.8 months. There were five partial unions in which a single joint did not unite in an otherwise stable foot. There was one nonunion, with recurrence of deformity. All patients returned to an independent functional ambulatory status within 9.5 months. Weight-bearing radiographs showed the talar-first metatarsal angle, the talar declination angle, and the calcaneal-fifth metatarsal angle to have improved significantly and to have been corrected to nearly normal values by the surgery. All measurements remained significantly improved, as compared with the preoperative values, at the time of final follow-up. There were no recurrent dislocations. Three patients had a recurrent plantar ulcer at the metatarsophalangeal joint that required additional surgery. There were eight cases of hardware failure. Conclusions: Open reduction and arthrodesis with use of multiple axially placed intramedullary screws for the surgical correction of neuropathic midfoot collapse provides a reliable stable construct to achieve and maintain correction of the deformity. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

The American College of Preventive Medicine (ACPM) this position statement is intended to guide physicians in counseling children and adolescents to prevent overweight. Rigorous reviews of the published literature have found insufficient evidence to permit the development of formal recommendations by the US Preventive Services Task Force and others. However, numerous public health and physician organizations have developed recommendations on the basis of expert opinion, professional judgment, and the available scientific evidence. This article presents the position of the ACPM in light of these ambiguities. The ACPM will review and modify its recommendations as new scientific evidence emerges.

Study Design. Three experimental groups and one control group of chickens underwent different surgical procedures to determine the effects of pineal gland transplantation on the development of scoliosis. Objective. To determine whether transplantation of the pineal gland to the body wall musculature maintains serum melatonin levels at normal values and prevents the development of scoliosis. Summary of Background Data. Scoliosis occurs consistently after pinealectomy in young chickens. Many characteristics of this scoliosis are similar to those seen in patients with adolescent idiopathic scoliosis. It is not clear whether the underlying mechanism is dependent on reduced levels of serum melatonin or some other aspect of the extensive surgery. Methods. Four groups of chickens were selected: normal chickens, pinealectomized chickens, chickens that underwent simple cutting of the pineal stalk, and chickens that underwent transplantation of the pineal gland into the body wall. Development of scoliosis was determined from measurement of the Cobb angle from weekly radiographs. Results. All of the experimental groups showed the same levels of incidence and the same patterns of scoliosis development. Serum melatonin levels were reduced to nearly zero in all the experimental groups for the duration of the experiment. Scoliosis developed in none of the normal chickens. Conclusions. Neither transplantation of the pineal gland into the body wall musculature nor simple cutting of the pineal stalk was able to maintain normal levels of serum melatonin because both procedures reduced levels to nearly zero. The incidence and pattern of scoliosis development in these groups were the same as those for the pinealectomized group. Reduction of serum melatonin levels remains a prerequisite for scoliosis development in young chickens.

Current population studies characterize idiopathic scoliosis as a single-gene disorder that follows the patterns of mendelian genetics, including variable penetrance and heterogeneity. The role of melatonin and calmodulin in the development of idiopathic scoliosis is likely secondary, with indirect effects on growth mechanisms. Reported abnormalities of connective tissue, skeletal muscle, platelets, the spinal column, and the rib cage are all thought to be secondary to the deformity itself. Although no consistent neurological abnormalities have been identified in patients with idiopathic scoliosis, it is possible that a defect in processing by the central nervous system affects the growing spine. The true etiology of idiopathic scoliosis remains unknown; however, it appears to be multifactorial.

Langerhans cell histiocytosis is an interesting disorder with a variety of presentations and variable outcomes. This study evaluates response to treatment, recurrence, and survival in disseminated Langerhans cell histiocytosis treated at Regional Cancer Centre, Trivandrum, India from 1983 through 1994. Thirty-five patients with disseminated Langerhans cell histiocytosis were seen. Six had group A disease, 21 had group B disease, and eight had group C disease. In group A, five of six patients are disease free at a median follow-up of 48 months. Two had recurrence after initial treatment, which was salvaged. In group B, 13 of 15 patients had complete response after chemotherapy, nine of whom experienced recurrence later. Three of five patients who received irradiation alone experienced recurrence. One died of progressive disease. Two patients were lost to follow-up. Seventeen of 20 are alive with median follow-up of 67 months. In group C, one of eight patients are alive after multiple recurrences. Of the surviving patients, 29% had significant sequelae. In summary, group A and B patients do well with treatment, and most of the recurrences can be salvaged. A significant proportion of patients have sequelae. Newer aggressive protocols must be developed for treating group C patients. Measures to prevent sequelae must also be developed.

Clozapine therapy does not produce the rapid response that may be required in severely disturbed patients. The latter, not uncommonly, obstruct treatment by refusing to give blood for haematological monitoring or refusing to swallow tablets. Whereas electroconvulsive therapy (ECT) may be used for rapid behavioural control, the effects wane once the treatment course comes to an end. This paper reports an alternative strategy in such patients--combined jointly initiated therapy with clozapine and ECT. Six disturbed patients with treatment resistant schizophrenia were given a course of 12 ECT over 6 weeks. Blood was drawn for clozapine monitoring during the first anaesthetic, allowing the introduction of clozapine on day 6. There was a mean 32% improvement in Brief Psychiatric Rating Scale scores at week 6. This improvement persisted after the cessation of ECT, by which time all patients were compliant with blood testing and tablet taking. There were no adverse reactions apparent in the combination of the two therapies. Elective combined ECT and clozapine therapy may be useful in treatment-resistant schizophrenics where the clinical state necessitates a rapid therapeutic response and where blood tests are refused. A possible synergistic reaction between clozapine and ECT is worthy of further investigation.

The mechanism underlying the development of scoliosis after pinealectomy in young chickens is unknown. However, since the main product of the pineal gland is melatonin, melatonin remains an obvious focus in studies designed to discover this mechanism. One confounding factor is that serum melatonin levels are close to zero after pinealectomy but scoliosis does not develop in all chickens that have had this procedure. Therefore, the role of melatonin in the development of scoliosis in chickens after pinealectomy remains controversial. In the current investigation, two pilot studies demonstrated that a physiological therapeutic dose of melatonin (2.5 milligrams per kilogram of body weight) restored the circadian rhythm of melatonin, as measured by serum assay. In the main study, this dose was administered daily starting either immediately after the pinealectomy or two weeks after it, when scoliosis had developed. Scoliosis was assessed on weekly radiographs, and the Cobb angle was determined for all chickens in which scoliosis developed. Overall, scoliosis developed in only 56 percent (fifty) of the eighty-nine chickens that had had a pinealectomy; this rate was consistent throughout all experimental groups. Scoliosis did not develop in any of the control chickens, which did not have a pinealectomy. On the basis of the average Cobb angles in the chickens in which scoliosis had developed, it was determined that neither the prevalence nor the pattern of the scoliosis was affected by the therapy in any of the experimental groups. It was thus concluded that melatonin therapy after pinealectomy in young chickens has no effect on the development or progression of scoliosis. These results raise doubts regarding the role of melatonin in the development of scoliosis after pinealectomy in the young chicken. CLINICAL RELEVANCE: Although scoliosis has been produced in some animal studies, none of these models has proved to be entirely satisfactory. Consequently, research regarding adolescent idiopathic scoliosis has been hampered. Recently, it was shown that scoliosis with many characteristics similar to those seen in patients who have adolescent idiopathic scoliosis can be produced consistently in chickens after pinealectomy. This finding encourages the development of this model. An understanding of the mechanism involved in the development of scoliosis after pinealectomy in chickens might provide new insights into adolescent idiopathic scoliosis and aid in the development of novel treatment methods.

The aim of this paper is to investigate the problem of monitoring effective dose to hospital staff who are involved in the treatment of tumors using sealed sources placed inside the body (brachytherapy). In addition, the use of an unsealed source to treat the thyroid was also considered. Radiation distributions produced by both sealed sources commonly used in brachytherapy (192I, 137Cs, 226Ra) and an unsealed source used in the treatment of the thyroid (131I) were used to irradiate a Rando phantom. The brachytherapy treatments of esophageal and gynecological carcinoma were simulated. The Rando phantom was loaded with lithium fluoride thermoluminescent dosimeters at positions corresponding to a number of radiosensitive organs. Film badges and electronic personal dosimeters were attached to the Rando phantom at various anatomical sites. The Rando phantom was positioned adjacent to the patient at an angle of 90 degrees to the longitudinal axis of the patient. Irradiations were performed with and without a portable lead screen used on the radiotherapy wards. Effective dose was estimated for each simulated radiotherapy treatment and compared with the personal monitor readings. The data were used as a basis for the provision of advice on the wearing of the film badge dosimeters and the design of portable lead screens. The data also permitted a comparison between the two types of dosimeter when used for personal monitoring in brachytherapy.

Hallux valgus correction by distal soft-tissue release and proximal metatarsal osteotomy is the procedure of choice for most patients with moderate and severe hallux valgus deformity. Complications can be avoided by selecting a procedure that provides adequate correction of the intermetatarsal angle and ensuring proper balancing of the metatarsophalangeal joint though lateral soft-tissue releases and medial joint plication. Arthrodesis should be considered when revision of failed surgery is planned, degenerative joint disease is present, and where the likelihood of failure of a bunion procedure is high (such as in elderly individuals with osteoporosis, severe deformity with significant involvement of the lesser metatarsophalangeal joint, and when spasticity is present). A review of biomechanical data, clinical studies, and surgical techniques is important for successful treatment of moderate and severe hallux valgus deformity.