No abstract

LD-AGE DEPRESSION IS WIDEspread, affecting at least 1 in 6 patients in general medical practice and an even higher percentage in hospitals and nursing homes. 1-3 Depression, especially in later life, has serious health consequences, including increased health care costs, 4 increased mortality related to suicide 5 and medical illness, 6,7 and amplification of disability associated with medical and cognitive disorders. 8 A recent study by the World Health Organization concluded that unipolar major depression and suicide accounted for 5.1% of the total global burden of disease in 1990, making depression the fourth most important cause of global burden of disability. 9 The study also showed that the significance of illness burden attributable to depression increases with age weighting and is projected to grow further by the year 2020, based on demographic shifts toward a greater proportion of aging adults in the population, especially of the very old.

This study confirmed the validity of the CIRS as an indicator of health status and demonstrated its ability to predict 18-month mortality and rehospitalization in hospitalized elderly patients. The availability of detailed guidelines for scoring the CIRS can improve its usefulness and facilitate more-widespread use for research and clinical aims.

Patients 70 years of age or older with major depression who had a response to initial treatment with paroxetine and psychotherapy were less likely to have recurrent depression if they received two years of maintenance therapy with paroxetine. Monthly maintenance psychotherapy did not prevent recurrent depression. (ClinicalTrials.gov number, NCT00178100.).

The relationship of the serotonin transporter gene promoter region polymorphism Variability in response to antidepressant treatment may be dependent on interindividual differences in drug concentration or drug targets. The serotonin transporter gene (SLC6A4) promoter region (5-HTTLPR) insertion/ deletion polymorphism is known to affect transporter expression and function . A long ( l , 528 bp) and a short ( s , 484 bp) form affect the expression and function of the serotonin transporter. Those with the s variant, approximately 42% of Caucasians, have reduced transcription of the 5-HTT gene promoter, resulting in decreased 5-HTT expression and an approximate 50% reduction in serotonin uptake Collier et al. 1996). We hypothesized that the initial pharmacologic impact of a selective serotonin reuptake inhibitor (SSRI) was likely to be proportionately greater for those patients with enhanced serotonin reuptake (i.e., those possessing the ll genotype). These patients would thus be expected to respond earlier to an SSRI than those with one or two copies of the dominant s allele. Because inhibition of serotonin reuptake by a SSRI is believed to be only the initial step in a complex 23 , NO . 5 adaptive process, we further hypothesized that final outcome, for those receiving paroxetine, would not differ between the transporter promoter genotypes and that the acute response of patients treated with nortriptyline, an antidepressant affecting predominately reuptake of norepinephrine, would not be affected by this polymorphism. METHODSThis study was conducted in the geriatric inpatient units and the outpatient Late Life Depression Clinic of Western Psychiatric Institute and Clinic as previously described (Mulsant et al. 1999). Study participants were evaluated with the Structured Clinical Interview for DSM-IV Axis-I Disorders (SCID-IV; First et al. 1997) and several rating scales, including the 17-item Hamilton Rating Scale for Depression (HRSD; Hamilton 1967) and the MiniMental State Examination (MMSE; Folstein et al. 1975). Written informed consent was obtained from each subject after the procedures had been fully explained.For inclusion in the study, patients had to meet the following criteria: age 60 years or older; DSM-IV major depressive episode with neither psychotic features nor history of bipolar or schizoaffective disorder; baseline HRSD score of 15 or above; MMSE score of 18 or above; no history of alcohol or other substance abuse or dependency during at least the past year; and no specific medical condition contraindicating treatment with either nortriptyline or paroxetine (e.g., QRS longer than 120 ms or bradychardia with heart rate below 50). Ninety-six subjects (mean age: 72.0 Ϯ 7.9 years) were randomized under double-blind conditions to treatment with either nortriptyline ( n ϭ 45) or paroxetine ( n ϭ 51) after a washout of all psychotropic medications except for lorazepam. Patients received initial doses of 25 mg of nortriptyline, or 20 mg of paroxetine. Nortriptyline doses were adjusted weekly until...

This review of the available literature suggests that delayed reconstructions of severe multiple-ligament knee injuries could potentially yield equivalent outcomes in terms of stability when compared with acute surgery. However, in the acutely managed patient, early mobility is associated with better outcomes in comparison with immobilization. Acute surgery is highly associated with range-of-motion deficits. Staged procedures may produce better subjective outcomes and a lower number of range-of-motion deficits but are still likely to require additional treatment for joint stiffness. More aggressive rehabilitation may prevent this from occurring in multiple-ligament knee injuries that are treated acutely.

Newer techniques for the anatomic reconstruction of the CC ligaments may have steep learning curves associated with complications such as coracoid and clavicle fractures. Loss of reduction continues to be associated with the operative treatment of high-grade AC separations. Further refinement of surgical technique and experience with the operative treatment of AC separation is warranted.

Background Increased contact stresses after meniscectomy have led to an increased focus on meniscal preservation strategies to prevent articular cartilage degeneration. Platelet-rich plasma (PRP) has received attention as a promising strategy to help induce healing and has been shown to do so both in vitro and in vivo. Although PRP has been used in clinical practice for some time, to date, few clinical studies support its use in meniscal repair. Questions/purposes We sought to (1) evaluate whether PRP augmentation at the time of index meniscal repair decreases the likelihood that subsequent meniscectomy will be performed; (2) determine if PRP augmentation in arthroscopic meniscus repair influenced functional outcome measures; and (3) examine whether PRP augmentation altered clinical and patient-reported outcomes. Methods Between 2008 and 2011, three surgeons performed 35 isolated arthroscopic meniscus repairs. Of those, 15 (43%) were augmented with PRP, and 20 (57%) were performed without PRP augmentation. During the study period, PRP was used for patients with meniscus tears in the setting of no ACL reconstruction. Complete followup at a minimum of 2 years (mean, 4 years; range, 2-6 years) was available on 11 (73%) of the PRP-augmented knees and 15 (75%) of the nonaugmented knees. Clinical outcome measures including the International Knee Documentation Committee (IKDC) score, Tegner Lysholm Knee Scoring Scale, and return to work and sports/activities survey tools were completed in person, over the phone, or through the mail. Range of motion data were collected from electronic patient charts in chart review. With the numbers available, a post hoc power calculation demonstrated that we would have expected to be able to discern a difference using IKDC if we treated 153 patients with PRP and 219 without PRP assuming an alpha rate of 5% and power exceeding 80%. Using the Lysholm score as an outcome measure, post hoc power estimate was 0.523 and effect size was À1.1 (À2.1 to À0.05) requiring 12 patients treated with PRP and 17 without to find statistically significant differences at p = 0.05 and power = 80%. Results There was no difference in the proportion of patients who underwent reoperation in the PRP group (27% [four of 15]) compared with the non-PRP group (25% [five of 20]; p = 0.89). Functional outcome measures were not different between the two groups based on the measures used (mean IKDC score, 69; SD, 26 with PRP and 76; SD, 17 without PRP; p = 0.288; mean, Tegner Lysholm Knee Scoring Scale, 66, SD, 32 with PRP and 89; SD, 10 without PRP; p = 0.065). With the numbers available there was no difference in the proportion of patients who returned to