Faculty Bibliography

BACKGROUND: Previous research has provided evidence for brain abnormalities in schizophrenia, but their relationship to specific clinical symptoms and syndromes remains unclear. METHODS: With an all-male demographically similar sample of 53 schizophrenic patients and 29 normal control subjects, cerebral gray and white matter volumes (adjusted for intracranial volume and age were determined for regions in the prefrontal lobe and in the superficial and mesial temporal lobe using T1-weighted magnetic resonance imaging with 2.8-mm coronal slices. RESULTS: As a group, schizophrenic patients had wide-spread bilateral decrements in gray matter in the pre-frontal (7.4%) and temporal lobe regions (8.9%), but not in white matter in these regions. In the temporal lobe, gray matter reductions were found bilaterally in the superior temporal gyrus (6.0%), but not in the hippocampus and parahippocampus. While there were no overall group differences in white matter volumes, widespread decrements in prefrontal white matter in schizophrenic patients (n = 53) were related to higher levels of negative symptoms (partial r[49] = -0.42, P = .002), as measured by the Scale for the Assessment of Negative Symptoms. A post hoc analysis revealed that schizophrenic patients with high negative symptoms had generalized prefrontal white matter reductions (11.4%) that were most severe in the orbitofrontal subregion (15.1%). CONCLUSIONS: These results suggest that gray matter deficits may be a fairly common structural abnormality of schizophrenia, whereas reductions in prefrontal white matter may be associated with schizophrenic negative symptoms

BACKGROUND: The authors have reviewed their initial experience with laparoscopic splenectomy (LS) to identify the indications, success rate, and complications associated with this procedure compared with a series of children undergoing open splenectomy (OS) during the same time period. METHODS: The records of 51 children who underwent splenectomy from 1993 through 1998 were reviewed retrospectively. RESULTS: Thirty-five patients aged 1 to 17 years (mean, 9.4 years) underwent LS for the following indications: ITP (n = 20), sickle cell disease or thalassemia (n = 6), hereditary spherocytosis (n = 5), other hematologic disorders (n = 4). Seventeen patients aged 2 to 17 years (mean, 11.8 years) underwent OS during the same time period for ITP (n = 4), sickle cell disease or thalassemia (n = 4), hereditary spherocytosis (n = 5), and other indications (n = 4). Concomitant cholecystectomy was performed in 4 of 35 LS and 4 of 17 OS. Accessory spleens were identified in 10 of 35 LS and 2 of 17 OS cases. Eleven spleens were enlarged in the LS group, and 8 were enlarged in the OS group. One LS required conversion to an open procedure because the spleen did not fit in the bag. No other cases were converted. Median estimated blood loss was 50 mL for both the LS and OS groups. The only intraoperative complication in the LS group was a splenic capsular tear, which had no effect on the successful laparoscopic removal of the spleen. No patient in either group required a blood transfusion. The LS patients had a shorter length of hospital stay (1.8 +/- 1 versus 4.0 +/- 1 day, P = .0001). Total hospital charges were not significantly different. Follow-up ranged from 6 to 40 months. One LS patient died 47 days postoperatively from unrelated causes. Two LS patients had recurrent ITP; accessory spleens were found in one and resected laparoscopically. CONCLUSION: LS in children can be performed safely with a low conversion rate (2.9%) and is associated with a shorter hospital stay and comparable total hospital cost when compared with OS.

OBJECTIVES: To measure the frequency of people reporting torture among patients in a medical outpatient clinic and to determine primary care physicians' awareness of their patients' exposure to torture. DESIGN: Cross-sectional survey followed by selected in-depth interviews of participants reporting a history of torture. Medical record review and interview of torture survivors' primary care physicians. SETTING: The internal medicine clinic of a large, urban medical center. PARTICIPANTS: A convenience sample of 121 adult patients who were not born in the United States and who were attending the adult ambulatory care clinic. INTERVENTIONS: All participants were interviewed using the Detection of Torture Survivors Survey, a validated instrument that asks about exposure to torture according to the World Medical Association definition of torture. Participants who reported a history of torture were interviewed in depth to confirm that they had been tortured. We reviewed the medical records of participants who reported a history of torture and interviewed their primary care physicians. MAIN OUTCOME MEASURES: Self-reported history of torture. The awareness of primary care physicians of this history. RESULTS: Eight of 121 participants (6.6% [95% confidence interval: 3.1%-13.1%]) reported a history of torture. None of the survivors of torture had been identified as such by their primary care physician. CONCLUSIONS: Physicians of patients who have not been born in the United States and who attend urban general medical clinics frequently are unaware that their patients are survivors of torture. Primary care physicians can be the locus of intervention in the care of torture survivors. The first step is for physicians to recognize the possibility of torture survivors among their patients

Lamm discusses his mission as a doctor: to continue to serve as a repairman and fix people who are ill and to become a "coach" for his healthy patients. Lamm keeps abreast of the latest medical studies and breakthroughs and recommends any appropriate screening tests

Whatever therapy Mayor Rudolph W. Giuliani chooses for his early prostate cancer, it will probably interrupt his campaigning temporarily but should not prevent him from running for the Senate, cancer experts said yesterday. The two basic choices are surgery to remove the prostate and radiation. Some patients choose to wait for a much longer period while the cancer is monitored. But Mr. Giuliani indicated at a news conference yesterday that he was unlikely to wait long before initiating treatment. Dr. David G. McLeod, the chief urologist at Walter Reed Army Medical Center, who operated on former Senator Bob Dole for prostate cancer in 1991 and is not involved in Mr. Giuliani's case, said that if Mr. Giuliani were treated ''this early in the campaign schedule, by midsummer he should be able to hit his stride.''

A sound public health plan is in place nationally to combat further spread of the mosquito-borne West Nile virus, which caused an outbreak of encephalitis in New York City last year, federal health officials said here today. ''We may see some cases here and there this year,'' but no one knows when and where the West Nile virus will strike, said Dr. Stephen Ostroff, who is coordinating the West Nile effort for the Department of Health and Human Services. When the West Nile virus was first detected in the New York City outbreak last fall, ''there were a variety of federal agencies that were very concerned about bioterrorism, and some conducted investigations at that time,'' said Dr. Ostroff, an epidemiologist at the Centers for Disease Control and Prevention in Atlanta

The drug is Plavix, which helps prevent blood clots. Three million people have taken Plavix, which is also known as clopidogrel, since Bristol-Myers Squibb first marketed it two years ago. Doctors have been prescribing Plavix in the belief that it is safer than a pharmacologically related drug, ticlopidine or Ticlid. Ticlid can reduce the number of infection-fighting white blood cells to dangerously low levels in about 1 percent of users and apparently produces TTP in about 1 of every 1,600 to 5,000 patients. Now a team led by Dr. Charles L. Bennett of the Veterans Administration Healthcare System in Chicago has linked Plavix to 13 cases of TTP. Eleven of the cases are scheduled to be reported in the June 15 issue of the New England Journal of Medicine. Two probable cases were identified after the report was submitted, said a co-author, Dr. Charles J. Davidson of Northwestern University