The use of strontium 89 for palliation of pain from bone metastases associated with hormone-refractory prostate cancer.
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Aged↗
Biomedical subjects
R G Robinson
Publications and source records attributed to R G Robinson.
Are there two depressive syndromes after stroke?
The objective of this study was to describe the clinical characteristics of minor depression after stroke and to compare this disorder with poststroke major depression and the nondepressed state. Ninety-four stroke inpatients were examined 8 weeks after stroke and reexamined 15 months later. Twenty-one (22%) of the 94 patients suffered from minor depression, 14 (15%) suffered from major depression, and 59 (63%) were not depressed. Minor depressed patients were twice as symptomatic as nondepressed patients but were only half as symptomatic as major depressed patients. Minor depressed patients were more likely than nondepressed patients to have a previous history of stroke and were more physically disabled. They were less likely than major depressed patients to have a family history of affective disorder. Depression symptom severity was associated with greater physical disability among minor but not major depressed patients. Fewer minor than major depressed patients were depressed at 15 months. These findings suggest that poststroke major and minor depression may be different depressive syndromes. Some cases of minor depression may be construed as an adjustment reaction to stroke disability.
Aged↗
Longitudinal assessment of depression and cognitive impairment following stroke.
Previous studies have demonstrated that patients with major depression following stroke have a greater degree of cognitive impairment than nondepressed patients with comparable lesions. The present study examined the longitudinal course of cognitive impairment related to depression. Patients were prospectively evaluated following an acute stroke (N = 309), using a structured psychiatric interview and the Mini-Mental State Examination. Longitudinal evaluations were obtained at 3, 6, 12, and 24 months follow-up in a subset of these patients. During the initial in-hospital evaluation, the frequency and severity of cognitive impairment was significantly greater in patients with major depression compared with nondepressed patients. This effect occurred predominantly in patients with major depression following left hemisphere stroke. The association of depression and cognitive function was strongest during the initial evaluation, but was present for up to 1 year. The year-long effect, however, was evident only in patients with left hemisphere stroke. Patients with both depression and cognitive impairment had a greater duration of depression than depressed patients without cognitive impairment. Depression with cognitive impairment appears to be a phenomenon produced by left hemisphere lesions. This suggests that left hemisphere stroke may produce depression through a different mechanism than lesions in other locations. In addition, the fact that the strongest influence of depression on cognitive function was seen during the initial evaluation suggests that this phenomenon may be mediated by acute or subacute physiological effects of the lesion.
Cerebrovascular Disorders↗
Specificity of changes in cerebral blood flow in patients with frontal lobe dementia.
Eight patients with a clinical diagnosis of probable Alzheimer's disease, eight patients with the clinical diagnosis of frontal lobe dementia, and eight controls were examined with single photon emission tomography (SPECT) using 99Tc-HMPAO. Patients with Alzheimer's disease and those with frontal lobe dementia met DSM-III-R criteria for mild dementia and were in the early stages of the illness. Compared with patients with Alzheimer's disease, the group with frontal lobe dementia had significantly lower blood flow in the frontal lobes (dorsolateral and orbital), the anterior temporal cortex, and the basal ganglia. Within the frontal lobe dementia group, blood flow was significantly lower in the orbital than in the dorsal frontal cortex, and in the anterior temporal than in the dorsal temporal cortex. The present study shows the specificity of changes in regional cerebral blood flow in the diagnosis of different types of dementia, and supports the importance of orbitofrontal, anterior temporal, and basal ganglia dysfunction in the production of the psychiatric syndrome of frontal lobe dementia.
Aged↗
Gastroesophageal reflux with nasogastric tubes. Effect of nasogastric tube size.
Pulmonary aspiration of gastric contents results initially from reflux of stomach contents into the esophagus. Small-bore enteral feeding tubes are thought to result in less pulmonary aspiration and less reflux. We prospectively investigated the effect of nasogastric tube size upon gastroesophageal (GE) reflux in normal volunteers in a randomized crossover trial. Reflux was assessed by gastroesophageal scintiscanning, a radioisotopic technique that detects and quantitates GE reflux. A total of 11 subjects were studied three times: control, no nasogastric tube, small-bore (8F) nasogastric tube, and large-bore (14F) nasogastric tube. Reflux was assessed in each subject under each experimental condition by provocative testing in which abdominal pressure was increased from 0 to 100 mm Hg by 20-mm Hg increments with an abdominal pressure device. GE reflux indices were calculated for each measurement and the groups compared. A positive indicator of reflux was defined as a > or = 4% reflux index. Gastroesophageal reflux was not detected at any level of abdominal pressure regardless of the presence or size of a nasogastric tube. With maximum 100 mm Hg abdominal pressure, the reflux index was control, 1.75 +/- 0.45%; small-bore tube, 1.67 +/- 0.28%; and large-bore tube, 1.88 +/- 0.35% (NS). The reflux index was not different between small-bore and large-bore nasogastric tubes. Our data suggest the size of a nasogastric tube is not an important determinant of GE reflux in normal subjects during short-term intubation. Large-bore tubes did not cause more reflux than small-bore tubes. The presence of a nasogastric tube did not cause reflux in normal subjects. These data suggest that factors other than the size of nasogastric tube are more important in GE reflux in normal subjects.
Abdomen↗
Prospective longitudinal study of depression following spinal cord injury.
A group of 60 patients with spinal cord injury was examined to assess mood disorders during the rehabilitation hospital admission and 6 months of follow-up. During the initial evaluations, 13 patients (22%) had major depression and 5 patients (8%) had minor depression. The development of mood disorders during the hospital admission appeared to be related to heterogeneous etiological factors, including previous psychiatric history and severity of impairment in activities of daily living. During the first 3 months after SCI, about half of the depressions resolved. Nonrecovery from depression may be related to lack of adequate social support.
Adult↗
Neuropsychological and neuroradiologic correlates of emotional prosody comprehension.
We examined a series of 59 patients with acute stroke lesions for the presence of comprehension emotional aprosody. Based on a standardized assessment of comprehension of emotional intonation, 29 patients (49%) showed emotional aprosody (17% "mild" aprosody [n = 10] and 32% "severe" aprosody [n = 19]). Patients with comprehension emotional aprosody showed a higher frequency of extinction on double-simultaneous stimulation, anosognosia, and deficits in facial emotion comprehension. Patients with comprehension emotional aprosody also showed a higher frequency of right-hemisphere lesions involving the basal ganglia and the temporoparietal cortex and more severe frontal and diencephalic atrophy. Comprehension emotional aprosody was not necessarily associated with poststroke depression (PSD) since patients with and without PSD showed similar impairments in emotional prosody comprehension.
Adult↗
Depression following myocardial infarction: a one year longitudinal study.
OBJECTIVE: The purpose of this study was to examine the course and clinical correlates of depression during the first year after myocardial infarction. METHOD: A group of seventy patients hospitalized for the treatment of myocardial infarction (MI) were assessed for the presence of mood disorders during their hospital admission and at three, six, nine, and twelve months follow-up. Patients were evaluated and diagnosed using the Present State Examination and DSM-III criteria. Impairment in activities of daily living was measured by the Johns Hopkins Functioning Inventory and impairment in social functioning was measured by the Social Functioning Examination. RESULTS: A total of twenty-four patients met DSM-III criteria for major depression at some time during the study (18 in the acute stage, 6 during follow-up). There were two patients with minor depression (dysthymia) at intake and six developed minor depression during the follow-up period. The median duration of major depression was 4.5 months. Patients with depression at intake had greater impairment in activities of daily living than non-depressed patients. Depressions lasting more than six months were more likely to be anxious depressions than those lasting less than six months. After the acute MI period, there was a consistent relationship between the existence of depression and impaired social functioning. CONCLUSIONS: This is a pilot study and needs further replication due to the low rate of follow-up participation. However, these data suggest that there may be two types of depression following MI: an acute depression associated with greater functional impairment, and a prolonged depression that may be associated with inadequate social support.
Acute Disease↗
Influence of major depression on 1-year outcome in patients with traumatic brain injury.
The authors examine those factors that contributed to deterioration in social functioning, activities of daily living, or intellectual functioning during a 1-year period after traumatic brain injury (TBI). Fifty-two patients suffering an acute TBI were evaluated for existence and severity of mood disorders and impairment during their hospital stays and at 3-, 6-, and 12-month follow-up examinations. Patients whose scores on intellectual function, social function, or daily activities deteriorated during the 1-year period after trauma were considered to have a poor outcome. Eleven of 52 patients had a poor outcome in social function, which was associated with race, right-hemisphere lesions, intellectual impairment, and prolonged major depression. Seven of 52 patients had a poor outcome in daily activities, which was associated with a major depression of more than 6 months' duration and severity of Hamilton Depression Rating Scale scores. Eleven of these patients had a poor outcome in cognitive function, which was associated with cognitive impairment immediately after TBI. A major depression lasting more than 6 months was associated with deterioration of social functioning and activities of daily living during the 1-year period after TBI.
Activities of Daily Living↗
The CDC and the NMA--partnerships to control tobacco in the African-American community.
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Adolescent↗
Strontium-89--precursor targeted therapy for pain relief of blastic metastatic disease.
Strontium-89 is a radioactive calcium analog that provides an energetic beta particle for radiation therapy of osteoblastic disease. Strontium-89 is used as palliative therapy with the primary goal being pain relief. More than 500 patients with painful blastic metastatic disease were treated at University of Kansas Medical Center since the initiation of the first clinical trial there 15 years ago. Most patients have had metastatic prostate cancer to bone or breast cancer, as these tumors are commonly associated with bone pain as their primary clinical management problem. Improvement (decrease in pain, increase in physical activity level) was noted in 80% of patients with prostate carcinoma and 81% of patients with metastatic breast cancer to bone. Marrow toxicity levels were acceptable. The therapy can be repeated at 3-month intervals. Strontium-89 is a safe and effective systemic therapy for painful blastic metastatic disease. There is no longer any reason why the vast majority of persons with painful blastic metastatic disease should continue to hurt.
Bone Neoplasms↗
The effect of a stiff spinal implant and its loosening on bone mineral content in canines.
A canine spine surgery model was used to study bone mineral loss induced in vertebrae bypassed by stiff implants. Loosening of implants was measured, and a determination was made as to the effect of loosening on the degree of bone mineral loss. Sixteen dogs were implanted with a rigid screw-rod construct and randomized to one of four groups depending on the motion segments immobilized. No fusions were performed. Bone mineral was studied by DEXA at baseline, and postoperatively at 3, 6, and 9 months. Loosening measurements were made at the implant-implant interface and the implant-bone interface at 9 months postoperatively. Results show that bone mineral loss occurred uniformly at 3 months postoperatively in vertebrae spanned by the implants, with the average bone mineral density at 3 months representing 81% of baseline. When the implant remained secure, bone mineral loss persisted at 6 and 9 months but did not worsen. When the implants loosened, there was recovery of bone mineral to the baseline level by 9 months postoperative.
Absorptiometry, Photon↗
Depression following traumatic brain injury: a 1 year longitudinal study.
A group of 66 patients hospitalized for the treatment of closed head injury, were assessed for the presence of mood disorders during their hospital admission and at 3, 6 and 12 months follow-up. A total 28 patients met DSM-III-R diagnostic criteria for major depression at some time during the study (17 in the acute stage, 11 during follow-up). The mean duration of major depression was 4.7 months. However, there appeared to be a group of transiently depressed patients (41%) who where depressed inhospital but were no longer depressed at 3 months follow-up. Throughout the follow-up period, major depression showed a strong relationship with poor social functioning. There was not, however, a consistent relationship between depression and quantitative measures of either physical or cognitive impairment. Location of the brain lesion was associated with the development of major depression only in the acute stage. Transient depressive syndromes were associated with left dorsolateral frontal and/or left basal ganglia lesions.
Adult↗
Isolation and characterization of monoclonal antibodies to a recombinant human topoisomerase II polypeptide.
We have produced two murine monoclonal antibodies (SWT3D1 and SWR1C2) to a recombinant polypeptide corresponding to the carboxyl-terminal one-third (amino acid 854-amino acid 1447) of human topoisomerase II alpha. Each antibody is able to recognize intact human topoisomerase II using immunoblotting and enzyme-linked immunosorbent assay (ELISA) techniques. Data is presented demonstrating that the antibodies bind specifically to topoisomerase II alpha but do not interact with topoisomerase II beta. The monoclonal antibodies do not recognize murine or calf thymus topoisomerase II indicating that each may bind exclusively to the human enzyme. The topoisomerase II binding sites for each monoclonal antibody have been compared in a competition ELISA. The SWT3D1 antibody had no significant effect on the binding efficiency of biotinylated SWR1C2 antibody. Although SWR1C2 was capable of inhibiting the binding of biotinylated SWT3D1, this only occurred at concentrations approximately 1000-fold higher than those required of SWT3D1 to block binding of itself. These results suggest that SWT3D1 and SWR1C2 do not recognize identical epitopes on topoisomerase II.
Animals↗
Are there symptoms that are specific for depressed mood in patients with traumatic brain injury?
This study examined the specificity of vegetative and psychological symptoms of depression among 66 patients with acute traumatic brain injury followed over 1 year. The median frequencies of vegetative and psychological symptoms among patients with depressed mood were 3 and 3. These frequencies were three times the respective rates among nondepressed patients. Although change in self-attitude and subjective anergia distinguished depressed from nondepressed patients throughout the 1-year follow-up, some symptoms, such as early awakening and difficulty concentrating, distinguished groups only after 6 months. If diagnostic criteria for major depression were modified to include only specific symptoms of depression, the standard (i.e., unmodified) DSM-III-R still had a 100% sensitivity and 94% specificity at the initial evaluation and 80% and 100%, respectively, at 1 year. There were almost no patients with depressive symptoms without a depressed mood (i.e., "masked" depressions). These findings suggest that DSM-III-R criteria for major depression are useful, even in an acute head-injured population, but also suggest that the nature of posttraumatic brain injury depressive disorder may change over time.
Acute Disease↗
Generalized anxiety disorder after stroke.
A series of 309 admissions to a stroke unit was examined for anxiety symptoms. Patients were diagnosed with DSM-III-R generalized anxiety disorder (GAD) symptom criteria. They were divided into groups of no anxiety (59.2%), worried but not fulfilling GAD criteria (13.9%), and GAD (26.9%). Patients were then divided into depressed and nondepressed groups based on the existence of DSM-III major or minor (dysthymic) depression. These groups were not significantly different in their background characteristics, family or personal psychiatric history, social support or the severity of physical impairment. Anxiety plus depression was associated with left cortical lesions, whereas anxiety alone was associated with right hemisphere lesions. Patients with worry had anterior and patients with GAD had posterior right hemisphere lesions. These findings suggest that anxiety disorder (independent of depression) is not related to background characteristics or to severity of impairment but is, in part, influenced by the brain structures that are injured.
Activities of Daily Living↗
Apathy following cerebrovascular lesions.
BACKGROUND AND PURPOSE: Although apathy has been reported to constitute a frequent sequela of stroke lesions, there have been no prospective studies on the frequency and correlates of apathy after stroke lesions. In the present study, we examined the frequency and correlates of apathy in a consecutive series of 80 patients with cerebrovascular lesions. METHODS: We included patients within the first 10 days after a stroke lesion. Patients were examined with a comprehensive neuropsychiatric battery that included the Apathy Scale. RESULTS: Eighteen patients (22.5%) showed apathy, nine of whom were also depressed. On the other hand, 18 patients (22.5%) showed depression in the absence of apathy. Although depression and apathy may exist independent of one another, major depression (but not minor depression) was associated with an increased frequency of apathy. Apathy was also significantly associated with older age, cognitive impairments, and deficits in activities of daily living. Finally, apathy was significantly associated with lesions in the posterior limb of the internal capsule. CONCLUSIONS: These findings demonstrate that apathy is a frequent finding among patients with acute stroke lesions and may coexist with important emotional and cognitive poststroke disturbances.
Cerebral Hemorrhage↗
Association of depression with 10-year poststroke mortality.
OBJECTIVE: Depression has been linked to higher than expected mortality from natural causes, particularly among elderly patients with physical illness. The authors examined the effect of depression on mortality among a group of stroke patients followed up for 10 years. METHOD: A consecutive series of 103 patients was assessed for major or dysthymic (minor) depression approximately 2 weeks after stroke with the use of a structured mental status examination and DSM-III diagnostic criteria. Vital status was determined for 91 of these patients 10 years later. RESULTS: Forty-eight (53%) of the 91 patients had died. Patients with diagnoses of either major or minor depression were 3.4 times more likely to have died during the follow-up period than were nondepressed patients, and this relationship was independent of other measured risk factors such as age, sex, social class, type of stroke, lesion location, and level of social functioning. The mortality rate among depressed patients with few social contacts was especially high: over 90% had died. CONCLUSIONS: These results indicate that depressed mood following stroke is associated with an increased risk of subsequent mortality. Patients who are depressed and socially isolated seem to be particularly vulnerable.
Brain↗