Case Series Investigations Research Articles

Expanding the spectrum of phenotypes for MPDZ: Report of four unrelated families and review of the literature.

MPDZ, a gene with diverse functions mediating cell-cell junction interactions, receptor signaling, and binding multivalent scaffold proteins, is associated with a spectrum of clinically heterogeneous phenotypes with biallelic perturbation. Despite its clinical relevance, the mechanistic underpinnings of these variants remain elusive, underscoring the need for extensive case series and functional investigations. In this study, we conducted a systematic review of cases in the literature through two electronic databases following the PRISMA guidelines. We selected nine studies, including 18 patients, with homozygous or compound heterozygous variants in MPDZ and added five patients from four unrelated families with novel MPDZ variants. To evaluate the role of Mpdz on hearing, we analyzed available auditory electrophysiology data from a knockout murine model (Mpdzem1(IMPC)J/em1(IMPC)J) generated by the International Mouse Phenotyping Consortium. Using exome and genome sequencing, we identified three families with compound heterozygous variants, and one family with a homozygous frameshift variant. MPDZ-related disease is clinically heterogenous with hydrocephaly, vision impairment, hearing impairment and cardiovascular disease occurring most frequently. Additionally, we describe two unrelated patients with spasticity, expanding the phenotypic spectrum. Our murine analysis of the Mpdzem1(IMPC)J/em1(IMPC)J allele showed severe hearing impairment. Overall, we expand understanding of MPDZ-related phenotypes and highlight hearing impairment and spasticity among the heterogeneous phenotypes.

Diagnostic Utility of EWSR1 in Clear Cell Odontogenic Carcinoma: A Systematic Review.

In the 2022, World Health Organisation classification of odontogenic tumours, the clear cell odontogenic carcinoma is designated as a malignant odontogenic tumour with high recurrence and aggressive behaviour. Deceptive behaviour in the context of a wide range of differentials presents a significant diagnostic problem. It is the fifth most commom type of malignant odontogenic tumor. A systematic assessment of published cases, case series, and retrospective investigations of diagnostic significance of EWSR1 gene in clear cell odontogenic carcinoma is presented to determine trends in presentation, diagnostic characteristics, treatment, and patient outcome. To locate papers reporting clear cell odontogenic carcinoma and EWSR1, extensive database searches were carried out. Demographics, tumour location, immunohistochemical and molecular tests, treatment, follow-up, and recurrence were the variables. 34 cases were detected; 52.9% (n = 18) of the cases were females. The average age was 62.5years, with a range of 43-82years. The average size ranged from 3.4 to 8cm. The mandibular body was the most common location, followed by the maxilla. Maximum immunohistochemistry positivity revealed by CK 19, CKAE1/3, EMA and p63. Most common gene fusion detected was EWSR1-ATF1 in 62.4% of cases contributing to its diagnostic attributes. Surgical treatment was used in 97% of cases. The average follow-up period was 30.3months, and recurrence was reported in 52.4% of the cases. CCOC can metastasize, and the prognosis is fair. This is first systematic review, where we have attempted to consolidate the mutational expression of EWSR1 in Clear cell odontogenic carcinoma. It is difficult to identify from other clear cell tumours of the head and neck region. It is crucial to distinguish it from other clear cell lesions because of its aggressiveness.

Acute epistaxis management by hemostatic agents a systematic review

Background: When compared to nasal packing, the data shows that hemostatic medications are more successful in controlling acute epistaxis. A comprehensive analysis was conducted to assess the effectiveness of topical hemostats in the treatment of epistaxis. Method: Four databases were searched thoroughly for literature. Only admissible observational studies were included. Information retrieved from eight studies included the following: country, rate of short-term and 30-day hemostatic control, patient-reported outcome measures, adverse events, sample size, intervention, treating method, and length of stay in hospital. Results: Eight papers were included in the review when it reached the second stage and satisfied the qualifying requirements. A total of 268 individuals were involved in three cohort and five case series investigations; 232 of them received absorbable intranasal medications. Two investigations on oxidized cellulose compounds and 5 studies on agents that promote the common coagulation pathway were presented. While oxidized regenerated cellulose was inserted endoscopically on the bleeding site in one trial and sutured to the nasal septum in another study, the earlier medicines were applied intranasally. Successful short-term hemostasis was attained in 80% to 100% of patients in 7 out of 8 trials. Patients treated with oxidized regenerated cellulose had considerably lower pain scores than those treated with nasal packing. There were no negative effects linked to the use of intranasal agents in any of the investigations. Conclusion: When compared to nasal packing, the data shows that hemostatic medications are more successful in controlling acute epistaxis.

The effects of botulinum toxin A injection on the lateral pterygoid muscle in patients with a painful temporomandibular joint click: a randomized clinical trial study

BackgroundTemporomandibular disorder (TMD) is the main cause of non-dental pain in orofacial area. The most common symptoms of TMD are joint pain, joint sound and limitation of jaw function. Botulinum toxin (BTX) injection is considered a potential treatment for TMD due to its pain-relieving properties and its ability to reduce muscle activity. Most of the studies are case series and further investigations are required to prove the efficacy of this treatment modality. Thus, in this study, we aimed to investigate the effect of BTX-A injection on the lateral pterygoid (LP) muscle and to evaluate its efficacy regarding TMD.Materials and methodsThirty-eight patients (19 women and 19 men; mean age of 26.53 years) with painful unilateral temporomandibular joint click and LP muscle tenderness were enrolled in this study. They were divided into two groups; one received an extraoral BTX-A injection in the LP muscle, and the other received a placebo injection. Pain severity, jaw movements, click severity, and Helkimo index were recorded at the first visit, as well as one week, one month, and three months after the intervention. Data were analyzed using repeated-measures analysis of variance and t-tests.ResultsThe results showed that click severity was not significantly different between the BTX-A and placebo groups (P = 0.07). Pain and Helkimo index decreased significantly in the BTX group (P = 0.00 and P = 0.006, respectively); however, there was no significant difference between the two groups (P = 0.22 and P = 1, respectively). There was a significant difference in lateral movements between the groups (P = 0.00) but not in protrusive movement (P = 0.095).ConclusionsIt can be concluded that although some studies have stated that BTX injection can make the click sound disappear, in this study, we did not find a significant difference between the two groups. Furthermore, our results showed that click and pain severity decreased, but the difference was not statistically significant. Therefore, further studies with a higher dosage of BTX and more participants are recommended.Trial registration The local Ethics Committee of Shiraz University of Medical Sciences approved this research (IR.SUMS.REC. 01/10/2018 and IRCT20130521013406N3).

The Disease Ecology, Epidemiology, Clinical Manifestations, Management, Prevention, and Control of Increasing Human Infections with Animal Orthopoxviruses.

Zoonotic orthopoxvirus outbreaks have occurred repeatedly worldwide, including monkeypox in Africa and the United States, cowpox in Europe, camelpox in the Middle East and India, buffalopox in India, vaccinia in South America, and novel emerging orthopoxvirus infections in the United States, Europe, Asia, and South America. Waning smallpox immunity may increase the potential for animal-to-human transmission followed by further community transmission person-to-person (as demonstrated by monkeypox and buffalopox outbreaks) and by contact with fomites (as demonstrated by camelpox, cowpox, and, possibly, Alaskapox). The objectives of this review are to describe the disease ecology, epidemiology, clinical manifestations, prevention, and control of human infections with animal orthopoxviruses and to discuss the association with diminished population herd immunity formerly induced by vaccinia vaccination against smallpox. Internet search engines were queried with key words, and case reports, case series, seroprevalence studies, and epidemiologic investigations were found for review.

Prognosis and Management of Communicating and Non-communicating Hydrocele

Hydrocele can be found as a collection of fluid within the testicular tunica vaginalis. According to the etiology and pathophysiology of the disease, it can be classified into primary and secondary. Furthermore, primary hydrocele might include the closed or non-communicating, the communicating type, the congenital and or neonatal type. Many management approaches have been proposed for both the communicating and non-communicating hydrocele with different post-operative and prognostic outcomes. In this literature review, we have discussed the current management approaches and prognosis of communicating and non-community hydrocele. Adequate diagnosis of the condition is the first step to achieve favorable management outcomes. Although the reported management outcomes are reported to be effective in the literature, the surgical approaches seem to be superior. However, many side effects might be associated with these operations. Estimates show that following varicocelectomy procedures, ipselateral (left) hemi-scrotal varicocele is the most common condition to occur, which might even develop following the procedure by several months and years (in some cases). Further investigations are still needed because the current evidence is largely based on case reports and small case series investigations. Therefore, larger studies are needed to help draw effective management protocols and enhance the outcomes and prognosis.

Clinical spectrum of glutamic acid decarboxylase antibodies in a Taiwanese population.

High levels of autoantibodies against glutamic acid decarboxylase (GAD-abs) are associated with stiff-person syndrome (SPS). However, the full clinical spectrum associated with GAD-abs in Asians is unclear. The clinical and immunological features of patients positive for GAD-abs were reviewed in a large Taiwanese series. Retrospective case series and immunological investigations were conducted between July 2007 and July 2017 at a tertiary referral centre in Taiwan. Amongst 361 patients with GAD-ab reactivity, 185 with detailed clinical records were included. Twenty-seven patients (14.59%), with a mean age at assessment of 54.8±13.9years, presented with neurological symptoms. The major neurological presentations (mean GAD-ab concentrations) were SPS (n=9, 33.3%; 135.45±27.84U/ml), cerebellar ataxia (n=3, 11.1%; 95.61±49.63U/ml), encephalopathy (n=2, 7.4%; 51.8±49.64U/ml) and epilepsy (n=1, 3.7%; 83.3U/ml). Notably, eight patients fulfilling the clinical diagnosis of multiple system atrophy had relatively lower GAD-ab concentrations (2.57±0.82U/ml), which has not been reported previously. There was no correlation between disease severity and GAD-ab concentration. Patients presenting with comorbid endocrinopathies (n=15, 55.5%) had higher GAD-ab concentrations than those without endocrinopathies (n=12, 44.4%; 104.45±22.51U/ml vs. 34.08±21.83U/ml, P=0.04). Of 158 patients (85.4%) without a neurological presentation, 133 had type 1 diabetes mellitus and 20 had diabetes of other aetiologies (type 2 or gestational diabetes mellitus, or diabetes secondary to pancreatitis); the remaining four patients had pure thyroid disorders. A clinical and immunological evaluation of East Asian patients positive for GAD-abs is presented and a different clinical spectrum of anti-GAD syndrome is identified compared to Caucasians.

Postoperative Complications in Patients Undergoing Minimally Invasive Sacroiliac Fusion

Introduction Minimally invasive sacroiliac (SI) fusion has become increasingly popular as a treatment for non-traumatic sacroiliac joint pain in recent years. This has created significant need for reliable data addressing risks associated with the procedure. Initial investigations have focused primarily on efficacy and patient satisfaction with small sample size. Furthermore, the majority of past studies have been primarily single center or case series investigations and as such their findings were limited to their sample populations. The aim of this study was to analyze complications associated with minimally invasive SI fusion using a large medical record database that more closely and accurately models the American population as a whole. Material and Methods Patients undergoing minimally invasive SI fusion from 2007–2014 were selected from records of the nationwide private insurance provider Humana. Using the Pearl Diver patient records database (Pearl Diver Technologies, West Conshohocken, PA, USA), patient data on age, procedure date, and medical diagnoses before and after the procedure was acquired. ICD-9 diagnosis codes (International Classification of Diseases 9th edition) were used to reveal incidence of post-operative complications including infection, pain, osteomyelitis, joint derangement, uterine tract infection (UTI), and nerve pathology. Cases of pre-existing conditions were excluded from the analysis. The data was also examined for incidence of patients with diagnoses of new lumbar pathology following the procedure. Patients undergoing SI fusion for surgical revision, neoplasia, or pelvic ring trauma were excluded from the study. Results Data from 469 patients (305 female; 164 male) showed a substantial increase in the number of minimally invasive sacroiliac fusion procedures performed from 2007–2014 [ p < .05]. Among these patients, an overall complication rate of 13.2% was seen at 90 days and 16.4% at 6 months post-op. Rates of individual complications were as follow. Infection: 30 days = 3.0%, 90 days = 3.6%, 6 months = 4.1%. Pain: 90 days = 2.6%, 6 months = 4.1%. UTI: 90 days = 3.8%, 6 months = 4.9%. Nerve pathology: 90 days = 4.3%, 6 months = 6.2%. Incidence of novel lumbar pathology was 3.6% at 90 days post-op and 5.3% at 6 months. Males experienced diagnoses of novel lumbar pathology at higher rates than females at both 90 days (M=6.7%; F≤3.3%) and 6 months (M=9.1%; F≤3.3%) [ p < .01]. Conclusion The results of this study show that minimally invasive SI joint fusion may carry higher risks of complications than previously stated, including a possible association with the development of lumbar pathology. These finding are critical for physicians and patients considering minimally invasive SI fusion as a treatment for chronic SI joint pain, and should be taken under careful consideration when deciding if surgical treatment is warranted.

Patterns of Orthographic Working Memory Impairments in Acquired Dysgraphia in Adults: A Case Series analysis

Patterns of Orthographic Working Memory Impairments in Acquired Dysgraphia in Adults: A Case Series analysis

Foodborne listeriosis acquired in hospitals.

Listeriosis is characterized by bacteremia or meningitis. We searched for listeriosis case series and outbreak investigations published in English by 2013, and assessed the strength of evidence for foodborne acquisition among patients who ate hospital food. We identified 30 reports from 13 countries. Among the case series, the median proportion of cases considered to be hospital-acquired was 25% (range, 9%-67%). The median number of outbreak-related illnesses considered to be hospital-acquired was 4.0 (range, 2-16). All patients were immunosuppressed in 18 of 24 (75%) reports with available data. Eight outbreak reports with strong evidence for foodborne acquisition in a hospital implicated sandwiches (3 reports), butter, precut celery, Camembert cheese, sausage, and tuna salad (1 report each). Foodborne acquisition of listeriosis among hospitalized patients is well documented internationally. The number of listeriosis cases could be reduced substantially by establishing hospital policies for safe food preparation for immunocompromised patients and by not serving them higher-risk foods.

Making sense of deviance: Identifying dissociating cases within the case series approach

The case series approach in cognitive neuropsychology provides a means to test theories that make quantitative predictions about associations between different components of the cognitive system [Schwartz, M. F., & Dell, G. S. (2010). Case series investigations in cognitive neuropsychology. Cognitive Neuropsychology, 27, 477–494]. However, even when the predicted association is borne out the study may include outliers—observations that deviate significantly from the rest of the data. These outliers may reveal individual cases whose cognitive impairments dissociate from other cases included in the study. These dissociating cases can pose a significant challenge to the theory being tested. Using a recent case series that investigated the underlying causes of letter perseveration in spelling [Fischer-Baum, S., & Rapp, B. (2012). Underlying cause(s) of letter perseveration errors. Neuropsychologia, 50, 305–318], I discuss statistical and theoretical issues that arise when using outlier detection techniques to identify dissociating cases in a case series study.

Risk Factors Associated With Suicide in Current and Former US Military Personnel

Beginning in 2005, the incidence of suicide deaths in the US military began to sharply increase. Unique stressors, such as combat deployments, have been assumed to underlie the increasing incidence. Previous military suicide studies, however, have relied on case series and cross-sectional investigations and have not linked data during service with postservice periods. To prospectively identify and quantify risk factors associated with suicide in current and former US military personnel including demographic, military, mental health, behavioral, and deployment characteristics. Prospective longitudinal study with accrual and assessment of participants in 2001, 2004, and 2007. Questionnaire data were linked with the National Death Index and the Department of Defense Medical Mortality Registry through December 31, 2008. Participants were current and former US military personnel from all service branches, including active and Reserve/National Guard, who were included in the Millennium Cohort Study (N = 151,560). Death by suicide captured by the National Death Index and the Department of Defense Medical Mortality Registry. Through the end of 2008, findings were 83 suicides in 707,493 person-years of follow-up (11.73/100,000 person-years [95% CI, 9.21-14.26]). In Cox models adjusted for age and sex, factors significantly associated with increased risk of suicide included male sex, depression, manic-depressive disorder, heavy or binge drinking, and alcohol-related problems. None of the deployment-related factors (combat experience, cumulative days deployed, or number of deployments) were associated with increased suicide risk in any of the models. In multivariable Cox models, individuals with increased risk for suicide were men (hazard ratio [HR], 2.14; 95% CI, 1.17-3.92; P = .01; attributable risk [AR], 3.5 cases/10,000 persons), and those with depression (HR, 1.96; 95% CI, 1.05-3.64; P = .03; AR, 6.9/10,000 persons), manic-depressive disorder (HR, 4.35; 95% CI, 1.56-12.09; P = .005; AR, 35.6/10,000 persons), or alcohol-related problems (HR, 2.56; 95% CI, 1.56-4.18; P <.001; AR, 7.7/10,000 persons). A nested, matched case-control analysis using 20:1 control participants per case confirmed these findings. In this sample of current and former military personnel observed July 1, 2001-December 31, 2008, suicide risk was independently associated with male sex and mental disorders but not with military-specific variables. These findings may inform approaches to mitigating suicide risk in this population.

Types of case series—the anatomically based approach: Commentary on M. F. Schwartz & G. S. Dell: Case series investigations in cognitive neuropsychology

The paper addresses a weakness in the Schwartz and Dell paper (2010)—namely, its discussion of the inclusion criteria for case series. The paper distinguishes the different types that exist and how they constrain the theoretical conclusions that one can draw about the organization of the normal cognitive system. Four different types of inclusion criteria are considered. Two are those treated by Schwartz and Dell—namely, theoretically derived clinical criteria, such as the example of semantic dementia, and broad clinical criteria such as the presence of aphasia. In addition, in the present paper two different types of anatomically based criteria are assessed—those using anatomical regions selected a priori and also regions selected as a result of an anatomical group study analysis. Putative functional syndromes are argued to be the empirical building blocks for cognitive neuropsychology. Anatomically based case series can aid in their construction or in their fractionation.

Finite case series or infinite single-case studies? Comments on “Case series investigations in cognitive neuropsychology” by Schwartz and Dell (2010)

In this commentary, though acknowledging that a case-series approach in neuropsychology is not always possible, we set out a series of considerations that in our view make this approach generally superior to single-case study. We argue that case-series designs are crucial for theory-testing, assessment of computational models, evaluation of inter-patient variation (including selection criteria, patient homogeneity/heterogeneity, premorbid individual differences, etc.) and to establish solid foundations for the interpretation of behavioural dissociations and associations. We conclude by suggesting that, alongside other neuroscience techniques, case-series cognitive neuropsychology provides a crucial contribution to the future of clinical and cognitive neuroscience.

Case series in cognitive neuropsychology: Promise, perils, and proper perspective

Schwartz and Dell (2010) advocated for a major role for case series investigations in cognitive neuropsychology. They defined the key features of this approach and presented a number of arguments and examples illustrating the benefits of case series studies and their contribution to computational cognitive neuropsychology. In the Special Issue on “Case Series in Cognitive Neuropsychology” there are six commentaries on Schwartz and Dell as well as a response to the six commentaries by Dell and Schwartz (2011 this issue). In this paper, I provide a brief summary of the key points made in Schwartz and Dell, and I review the promise and perils of case series design as revealed by the six commentaries. I conclude by placing the set of papers within a broader perspective, providing some clarification of the historical record on case series and single-case approaches, raising some cautionary notes for case series studies and situating both case series and single-case approaches within the larger context of theory development in the cognitive sciences.

Case series investigations in cognitive neuropsychology

Case series methodology involves the systematic assessment of a sample of related patients, with the goal of understanding how and why they differ from one another. This method has become increasingly important in cognitive neuropsychology, which has long been identified with single-subject research. We review case series studies dealing with impaired semantic memory, reading, and language production and draw attention to the affinity of this methodology for testing theories that are expressed as computational models and for addressing questions about neuroanatomy. It is concluded that case series methods usefully complement single-subject techniques.

Effectiveness of Low-Intensity Pulsed Ultrasound, Capacitively Coupled Electric Fields, or Extracorporeal Shock Wave Therapy in Accelerating Stress Fracture Healing: A Systematic Review

Stress fractures are a common injury in athletes and lead to significant time missed from activity. Low-intensity pulsed ultrasound (LIPUS), capacitively coupled electric fields (CCEF), or extracorporeal shock wave therapy (ESWT) effectively reduce the healing time of acute and nonunion fractures, but are they effective in treating stress fractures? Seven studies met the inclusion criteria for review (3 LIPUS, 3 CCEF, 1 ESWT). High quality research findings did not support LIPUS and CCEF; however, these interventions were supported by case series investigations, animal studies, and spinal fusion models. Extracorporeal shock wave therapy was supported by the sole article on the topic, although the quality of research was low. No modality appears to be superior, although direct comparison is difficult due to differences in modality. The research is inconclusive in supporting or refuting the effectiveness of these modalities in accelerating stress fracture healing. Stress fractures are a common injury seen in athletes and military recruits, resulting in significant loss of playing time and duty.1-6 Stress injuries to bone account for approximately 20% of all musculoskeletal stress injuries and approximately 5% of injuries in all sports, and as much as 6% to 20% in track and field athletes, with the majority occurring in the tibia and midfoot.2,7,8 Depending on the severity, stress fractures to the lower extremity can require anywhere from 2 to 17 weeks for full healing without bone loading.2,9 Several treatments have been investigated in accelerating stress fracture healing. More conservative treatment includes basic management of inflammation, including ice and compression, as well as rest from activity and bracing to allow proper healing.7,10 In addition, potential risk factors that contribute to the stress fractures must be addressed including diet, orthotics, or training.7,9,10 In an attempt to accelerate healing time from stress fractures, clinicians are using electrical modalities such as low-intensity pulsed ultrasound (LIPUS), capacitively coupled electric fields (CCEF), or extracorporeal shock wave therapy (ESWT). The aim of this article is to determine whether this practice works.7,9-12 Stress fractures occur most often in the lower extremity and are a result of the bone’s inability to withstand repetitive load. As the bone is loaded through walking, running, and jumping, all of which are common in sports and activities of daily life, microdamage occurs and accumulates faster than remodeling can occur.13-15 Although constant loading is required to maintain normal remodeling, overload may occur with unsuitable rest periods, in which bone remodeling is unable to take place. As this microdamage accumulates, crack initiation occurs in The authors are from the Department of Health, Nutrition & Exercise Sciences, University of Delaware, Newark, Del. Originally submitted December 20, 2008. Accepted for publication March 18, 2009. The authors have no financial or proprietary interest in the materials presented herein. Address correspondence to Alan R. Needle, ATC, CSCS, Human Performance Lab, Room 160, 541 S. College Avenue, Newark DE 19716; e-mail: arneedle@gmail. com. doi: 10.9999/19425864-20090427-08

Pilot Studies and Their Suitability for Publication in Physiotherapy Canada

Each year Physiotherapy Canada receives a number of submissions titled “Pilot Study.” Few are published. This editorial note reviews (1) the purpose of a pilot study, (2) a common shortcoming of many studies submitted under this heading, and (3) when the results from pilot studies are likely to be of interest to an audience beyond those who conducted the study. Pilot studies play a pivotal role in the planning of large-scale and often expensive investigations. As small-scale dress rehearsals, they provide important information concerning the feasibility of the proposed methods. Goals of pilot studies are (1) to evaluate eligibility criteria and recruitment methods, (2) to refine protocol procedures, such as equipment operation and measurement procedures, (3) to evaluate protocol adherence by both clinicians and patients, (4) to test data-collection procedures and data quality, and (5) to examine safety issues and adverse events.1 Pilot studies are also useful for providing estimates of effect and variation that can be used to calculate sample size for larger studies, particularly when this information is not available in the literature. A feature common to most “pilot studies” rejected by Physiotherapy Canada is their focus on hypothesis testing. Although the rationale for this practice is not clear, it would seem that the authors of these submissions have inadvertently equated small-sample studies with pilot studies or, perhaps, have attached the name “pilot study” to an under-powered study, believing that doing so enhances the study's credibility. This is not the case. True pilot studies consider the goals mentioned above. Thus, if the primary intent of the small-sample study is not to provide insights into the feasibility of a proposed larger-scale study, authors should avoid the term “pilot study.” We are not suggesting that Physiotherapy Canada is uninterested in well-conceived and well-executed small-sample studies. Examples of such studies include case reports, single-subject research designs, case series, and small-sample investigations supported by a priori power calculations, all of which are welcomed by Physiotherapy Canada. If you are considering submitting a pilot study to Physiotherapy Canada, ask yourself the following questions: Are your study's goals consistent with the true intent of a pilot study? Was the primary intent of your study to examine feasibility issues? Was the primary intent of your study to estimate the requisite sample size for a subsequent large-scale investigation? Are your results likely to be of interest to an audience beyond your team of investigators? What is novel about the findings from your pilot study? Why are your findings of potential interest to others? Pilot studies serve an important purpose for research teams and may at times be of interest to a wider audience. The challenge for investigators and editors is to determine at what point and in what form the results of such an inquiry are likely to interest a wider audience.

Cavum septum pellucidum and adhesio interthalamica in schizophrenia: an MRI study

Several studies have independently suggested that patients with schizophrenia are more likely to have an enlarged cavum septum pellucidum (CSP) and an absent adhesio interthalamica (AI), respectively. However, neither finding has been consistently replicated and it is unclear whether there is an association between these two midline brain abnormalities. Thus, we compared the prevalence of absent AI and the prevalence, size and volume of CSP in 38 patients with schizophrenia and 38 healthy controls using magnetic resonance imaging (MRI). There were no between group differences in the presence or volume of CSP; however, an enlarged CSP was commoner among patients than controls. There was also a positive correlation between CSP ratings and volumes. No differences in the presence or absence of the AI were found between patients and controls; however, an absent AI was commoner in male patients with schizophrenia than females. There was absolutely no overlap between the presence of a large CSP and an absence of AI. In conclusion, our findings are in line with several case series and other MRI investigations that have shown a higher incidence of putatively developmental brain abnormalities in patients with schizophrenia, particularly in males, and support the neurodevelopmental model of this disorder.

Benefits and risks to mother and infant of drug treatment for postnatal depression.

The postnatal period presents a special problem to healthcare providers treating psychiatric disorders in women. Many new mothers who need antidepressant treatment may wish to breastfeed their infants, but are hesitant to do so for fear of passing on possible harmful effects of the medication through their milk. The focus of this article will be on highlighting and interpreting the existing literature on the benefits and risks to mother and infant of drug treatment for postnatal depression, as well as outlining treatment guidelines for the use of antidepressants in breastfeeding mothers. The article will specifically focus on the use of fluoxetine, sertraline, paroxetine, fluvoxamine and citalopram, which are more commonly used and belong to the selective serotonin reuptake inhibitor group of antidepressants. The tricyclic and other newer antidepressant medications will also be discussed. As there are no published controlled studies on the use of antidepressants by breastfeeding women, publications of individual case reports, case series, and pharmacokinetic investigations serve as the basis for the development of treatment guidelines. Results from this growing body of literature are promising in that, with the exception of a few cases, no serious adverse events have been reported in infants exposed to antidepressant medications through breast milk. In addition nonpharmacological treatments consisting of different types of psychotherapies will be discussed. It is critical that healthcare providers evaluate each mother-infant dyad on an individual basis when faced with the decision to prescribe antidepressant medications during the postnatal period.