Manic Episode Associated with Mega Cisterna Magna

Mega cisterna magna is a part of "Dandy-Walker Complex" and it is characterized by the enlargement of the cisterna magna, morphologically intact vermis and cerebellar hemispheres. We report a case of manic attack in a 23-year-old man with mega cisterna magna. The patient was treated with quetiapine 1,000 mg/day and sodium valproate 1,500 mg/day and the symptoms were ameliorated within 2.5 months. In this case, mega cisterna magna and manic symptoms may be found together coincidentally or any cerebellar dysfunction due to mega cisterna magna may cause or contribute to the appearance of affective symptoms. To our knowledge, this is the first case reporting manic attack with psychotic symptoms associated with mega cisterna magna. This report suggests that any lesion in the cerebellum might contribute to the occurrences of some affective and psychotic symptoms seen in bipolar disorder

The Effects of Galantamine Hydrobromide Treatment on Dehydroepiandrosterone Sulfate and Cortisol Levels in Patients with Chronic Fatigue Syndrome

Objective Mental fatigue, cognitive disorders, and sleep disturbances seen in chronic fatigue syndrome (CPS) may be attributed to cholinergic deficit. A functional deficiency of cholinergic neurotransmission may cause the hypothalamic-pituitary-adrenal axis hypoactivity seen in CPS. Therefore, we investigated the alterations in stress hormones such as cortisol and dehydroepiandrosterone sulfate (DHEAS) in CPS patients before and after 4-week administration of galantamine hydrobromide, a selective acetylcholinesterase inhibitor, and aimed to investigate whether there are any relationships between the probable hormonal changes and cholinergic treatment

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Ultrasound-Guided Combined Interscalene-Cervical Plexus Block for Surgical Anesthesia in Clavicular Fractures: A Retrospective Observational Study

Objective. We aim to report our experiences regarding the implementation of the ultrasound-guided combined interscalene-cervical plexus block (CISCB) technique as a sole anesthesia method in clavicular fracture repair surgery. Materials and Methods. Charts of patients, who underwent clavicular fracture surgery through this technique, were reviewed retrospectively. We used an in-plane ultrasound-guided single-insertion, double-injection combined interscalene-cervical plexus block technique. During the performance of each block, the block areas were visualized by using a linear transducer, and the needles were advanced by using the in-plane technique. Block success and complication rates were evaluated. Results and Discussion. 12 patients underwent clavicular fracture surgery. Surgical regional anesthesia was achieved in 100% of blocks. None of the patients necessitated conversion to general anesthesia during surgery. There were no occurrences of acute complications. Conclusions. The ultrasound-guided combined interscalene-cervical plexus block was a successful and effective regional anesthesia method in clavicular fracture repair. Prospective comparative studies would report the superiority of the regional technique over general anesthesia

Growth hormone response to the GABA-B agonist baclofen in 3-week abstinent alcoholics

Gamma-aminobutyric acid (GABA) dysfunction is a known feature of alcoholism. We investigated GABA-B receptor activity in 3-week abstinent alcoholics using the growth hormone (GH) response to baclofen, a GABA-B receptor agonist. The study aimed to investigate the relationship between GABA-13 receptor activity and alcohol withdrawal. GH response to baclofen was measured in alcohol-dependent males without depression (n = 22) who were on day 21 of alcohol abstinence and in healthy control male subjects (n = 23). After 20 mg baclofen was given orally to the subjects, blood samples for GH assay were obtained every 30 min for the subsequent 150 min. The patients were divided into two subgroups (continuing withdrawal and recovered withdrawal subgroups) according to their withdrawal symptom severity scores on day 21 of alcohol cessation. Baclofen administration significantly altered GH secretion in the controls, but not in the patients. When GH response to baclofen was assessed as Delta GH, it was lower in the patients with continuing withdrawal symptoms than in the controls and in the recovered withdrawal group. Impaired GH response to baclofen in all patients mainly pertained to the patients whose withdrawal symptoms partly continued. Our results suggest that reduced GABA-B receptor activity might be associated with longerterm alcohol withdrawal symptoms in alcoholic patients. (c) 2007 Elsevier Inc. All rights reserved

A potential biomarker for bipolar I disorder: serum arginine vasopressin levels

Amaç: Bir nöropeptid olan arjinin vasopressin (AVP), davranış ve stres düzenlenmesi üzerinde etkiler gösterir. Bu düzenlenme bipolar bozuklukta hasar görmüştür. Depresif bozuklukların aksine bipolar bozuklukta çok az sayıda çalışma AVP düzeylerini araştırmıştır. Bu çalışmada manik, depresif ve remisyon dönemleri sırasında ve tedaviye yanıttan sonra bipolar I bozukluğu (BB-I) olan hastalarda ve sağlıklı kontrollerde serum AVP düzeylerinin araştırılması amaçlanmıştır. Yöntem: Çalışmaya BB-I olan 67 hasta ve 24 sağlıklı kontrol alınmıştır. Hastalar BBI'in manik, depresif ve remisyon dönemlerindeydi. BB-I olan hastaların üç grubunda ve kontrollerde çalışma başlangıcında serum AVP düzeyleri ölçülmüştür. Daha sonra manik ve depresif atakta olan hastalarda tedaviye yanıttan sonra ikinci kez serum AVP düzeyleri ölçülmüştür. Tedaviye yanıt, manik ve depresif hastalar için sırasıyla Young Mani Derecelendirme Ölçeği ve Hamilton Depresyon Derecelendirme Ölçeği puanlarında %50 azalma olarak tanımlanmıştır. Bulgular: Sağlıklı kontrollerle karşılaştırıldığında BB-I'in manik, depresif ve remisyon dönemlerinin tamamında anlamlı şekilde daha düşük serum AVP düzeyleri çalışmanın temel bulgusudur. Tedaviye yanıt sonrasında depresif BB-I olan hastalarda serum AVP düzeyleri sağlıklı kontrollerin düzeyine yükseldi ve BBI'in remisyon dönemindekinden daha yüksek duruma gelmiştir. Sonuçlar: Serum AVP düzeylerindeki global azalma bipolar bozuklukta görülen bozulmuş nöronal işlevin ve ilerleyici nöronal yıkımın bir göstergesi olabilir. Özellikle majör depresif bozukluktaki artmış AVP düzeyleri dikkate alındığında, serum AVP düzeyleri depresif BB-I'in majörObjective: The neuropeptide arginine vasopressin (AVP) has effects on behavior and stress regulations which are impaired in bipolar disorder (BD). Only a very limited number of studies have investigated AVP levels in bipolar disorder in contrast to depressive disorders. The study aimed to investigate serum AVP levels during the manic, depressive, or remission periods and after treatment response in patients with bipolar I disorder (BD-I) and healthy controls. Methods: The study consisted of 67 patients with BD-I and 24 healthy controls. The patients were in the manic, depressive, or remission periods of BD-I. Serum AVP levels were assayed in the three groups of patients with BD-I and the controls at the study onset. Then, a second measurement of the AVP levels were carried out in the manic or depressive periods after treatment response. The treatment response was defined as a 50% decrease in the young mania rating scale and the Hamilton Depression Rating Scale scores for manic and depressive episodes, respectively. Results: The main finding was the significantly lower serum AVP levels in BD-I during manic, depressive, or remission periods compared to healthy controls. After-treatment-response serum AVP levels in depressive BD-I patients increased to the levels of healthy controls and became higher than in the remission period of BD-I. Conclusions: The global reduction in serum AVP levels may be an indicator of impaired neuronal function and neuroprogressive deterioration seen in BD. Notably, given the increased AVP levels in major depressive disorder, serum AVP levels may contribute to distinguishing depressive BD-I from major depressive disorder

A potential biomarker for bipolar I disorder: serum arginine vasopressin levels

WOS: 000404603100001Objective: The neuropeptide arginine vasopressin (AVP) has effects on behavior and stress regulations which are impaired in bipolar disorder (BD). Only a very limited number of studies have investigated AVP levels in bipolar disorder in contrast to depressive disorders. The study aimed to investigate serum AVP levels during the manic, depressive, or remission periods and after treatment response in patients with bipolar I disorder (BD-I) and healthy controls. Methods: The study consisted of 67 patients with BD-I and 24 healthy controls. The patients were in the manic, depressive, or remission periods of BD-I. Serum AVP levels were assayed in the three groups of patients with BD-I and the controls at the study onset. Then, a second measurement of the AVP levels were carried out in the manic or depressive periods after treatment response. The treatment response was defined as a 50% decrease in the young mania rating scale and the Hamilton Depression Rating Scale scores for manic and depressive episodes, respectively. Results: The main finding was the significantly lower serum AVP levels in BD-I during manic, depressive, or remission periods compared to healthy controls. After-treatment-response serum AVP levels in depressive BD-I patients increased to the levels of healthy controls and became higher than in the remission period of BD-I. Conclusions: The global reduction in serum AVP levels may be an indicator of impaired neuronal function and neuroprogressive deterioration seen in BD. Notably, given the increased AVP levels in major depressive disorder, serum AVP levels may contribute to distinguishing depressive BD-I from major depressive disorder