Biomedical subjects

M J Andrew

Publications and source records attributed to M J Andrew.

10 recordsLinked to original sources

PubMed2001

Preoperative depression and mortality in coronary artery bypass surgery: preliminary findings.

BACKGROUND: There is convincing evidence to suggest that depression significantly increases the risk of mortality following myocardial infarction. There are few data concerning depression as a risk factor for mortality following cardiac surgery. The aim of the present observational study was to determine if preoperative depressive symptoms resulted in an increased risk of late mortality following cardiac surgery. METHODS: Preoperative assessments of depressive symptoms were performed on 158 patients undergoing coronary artery bypass surgery. Elevated preoperative depression symptoms were defined as a depression anxiety stress scale score of > or = 10. RESULTS: Twenty-four of the 158 patients ( 15.2%) were classified as having elevated preoperative depressive symptoms. Patients were followed for a median of 25 months (range: 4-38 months). Three of the 24 patients (12.5%) with preoperative depressive symptoms died within the follow-up period, compared with three of the 134 (2.2%) non-depressed patients (odds ratio: 6.24; 95% CI: 1.18-32.98; P = 0.046). There were no other group differences on variables including population demographics, medical risk factors, surgical parameters, and indices of postoperative morbidity. CONCLUSIONS: Elevated depressive symptoms before coronary bypass surgery may be a significant predictor of late death. Prospective studies evaluating the prevalence of depressive symptoms in cardiac surgical patients and their effect on long-term outcome must be undertaken.

Analysis of Variance↗

PubMed2001

A comparison of neuropsychologic deficits after extracardiac and intracaradiac surgery.

OBJECTIVE: To compare the incidence of neuropsychologic deficits 1 week and 6 months after coronary artery bypass graft (CABG) surgery (extracardiac) and valve surgery with or without CABG surgery (intracardiac) using reliable change indices to define the incidence of neuropsychologic deficits. DESIGN: Prospective study. SETTING: Cardiac surgical unit in a university teaching hospital. PARTICIPANTS: Patients scheduled for elective multiple-graft (> or =3 grafts) CABG surgery (n = 59), or elective valve surgery (with or without concomitant CABG surgery) (n = 50) and a matched sample of nonsurgical controls (n = 53). INTERVENTIONS: Neuropsychologic assessments were performed 1 day before surgery, 7 days and 6 months after surgery. MEASUREMENTS AND MAIN RESULTS: The 7-day assessment showed no significant differences between valve surgery patients and CABG surgery patients in the incidence of neuropsychologic deficits. When reassessed 6 months postoperatively, the valve group displayed a significantly higher incidence of deficits on the digit symbol test compared with the CABG group (valve 26.7% v CABG 6.8%). In the CABG group, there was a significant change in the incidence of deficits per patient from 7 days to 6 months (p = 0.03) that was not evident in the valve group. CONCLUSION: There are some differences in the neuropsychologic outcome of extracardiac and intracardiac surgery. Patients undergoing isolated CABG surgery showed a greater reduction in the incidence of persisting deficits at 6 months than patients undergoing valve surgery with or without CABG surgery. This finding warrants further investigation, with particular attention to patients undergoing combined valve and coronary artery procedures.

Aged↗

PubMed2001

Evaluation of neurologic assessment and outcomes in cardiac surgical patients.

It is well recognized that cardiac surgery with cardiopulmonary bypass can potentially induce a wide spectrum of central nervous system (CNS) sequelae. Our awareness of the prevalence of these CNS complications is dependent on the validity of the available diagnostic methods. Current assessment methods designed to detect both focal and diffuse cerebral ischemia include neurologic examination, imaging techniques, biochemical markers, neuropsychologic assessment, and patient perceived outcomes. These techniques vary in their sensitivity and specificity, as well as feasibility for use in everyday clinical practice. There are currently only limited standardized methodologic guidelines for the assessment of CNS complications after cardiac surgery, which has resulted in considerable interstudy variability in the identification and reporting of outcomes. The application of clearly definable endpoints for reporting of CNS outcomes would be beneficial. The wealth of available data suggests that the incidence of overt CNS injury such as stroke has declined since the 1980s and is now approximately 2%, whereas evidence suggests that up to one third of cardiac surgery patients experience postoperative cognitive deficits. One of the clear strengths of the current era is the recognition of CNS injury associated with cardiac surgery, and the quest to improve our understanding of these outcomes. The application of more uniform assessment and reporting practices is surely vital to the continued advancement of cardiac surgery.

Biomarkers↗

PubMed2001

The Octopus II stabilizing system: biochemical and neuropsychological outcomes in coronary artery bypass surgery.

INTRODUCTION: The aim of this study was to determine if coronary artery bypass graft (CABG) surgery performed utilizing the Octopus II stabilizing system provides myocardial and cerebral protection comparable to traditional CABG surgery utilizing cardiopulmonary bypass (CPB). METHODS: Elective patients requiring surgery for double or triple vessel disease were randomized to receive either conventional CABG with CPB (n = 14) or OPCAB using the Octopus II stabilizing system (n = 12), after receiving institutional approval and written consent. Exclusion criteria included previous cardiac surgery, recent myocardial infarction, and previous cerebrovascular disease. Troponin T (TnT) was measured preoperatively and at 2, 4, 6, 8, 10, 12, 24, and 72 hours after initiation of grafting. Neuropsychological assessments (10 measures) were performed in the week prior to surgery, one week, and six months after surgery. RESULTS: Troponin T release was reduced in the OPCAB patients at all time points (repeated measures ANOVA p = 0.043), reaching significance at 8, 10 and 12 hours (p = 0.033, 0.038, 0.019). Other factors (composite clinical end point (prolonged LOS or ICU stay or 30-day mortality), infarction, and intubation time) did not show any significant differences between the two groups. The incidence of neuropsychological deficits was not different between the two groups at both seven-day and six-month follow-up assessments. CONCLUSIONS: Decreased TnT release suggests a myocardial benefit for the OPCAB procedure. A neuropsychological benefit remains to be demonstrated.

Aged↗

PubMed2000

Mood state as a predictor of neuropsychological deficits following cardiac surgery.

OBJECTIVES: mood disorders and neuropsychological deficits are both commonly reported occurrences after cardiac surgery. We examined the relationship between mood state and postoperative cognitive deficits in this population. METHODS: assessments of neuropsychological functions and mood state (depression, anxiety, stress scales; DASS) were performed preoperatively and postoperatively on 147 patients undergoing cardiac surgery. RESULTS: the incidence of preoperative depression, anxiety, and stress symptomatology was 16%, 27%, and 16%, respectively. The incidence of postoperative anxiety symptomatology significantly increased to 45% (p<0.001), while the incidence of depression and stress symptomatology remained stable (19% and 15%, respectively; ns). Changes in mood state did not influence changes in neuropsychological performance. Preoperative mood was a strong predictor of postoperative mood, and was related to postoperative deficits on measures of attention and memory. CONCLUSIONS: an assessment of preoperative mood is critical in identifying patients at risk of postoperative mood disorders and neuropsychological deficits. Measures assessing somatic manifestations of anxiety may not be suitable for a surgical population.

Aged↗

PubMed1998

Neuropsychologic changes after coronary artery bypass grafting: use of reliable change indices.

BACKGROUND: A method of defining change in neuropsychologic test scores that accounts for test reliability and practice effects was applied to determine accurately the incidence of acquired neuropsychologic deficits after coronary artery bypass grafting. METHODS: Neuropsychologic assessment was performed on 50 patients before and at 7 days after either hypothermic or normothermic coronary artery bypass grafting. From a matched control group of 24 normal subjects who were examined twice over a similar interval, reliable change indices that controlled for measurement error and practice effects were calculated for each neuropsychologic measure. With the use of these indices, the incidence of postoperative decline among the study patients was determined. For comparison, the incidence of decline using the "one standard deviation" criterion also was calculated. RESULTS: Comparing the reliable change and standard deviation methods, statistically significant differences in the incidence of decline were observed in 5 of 11 neuropsychologic measures. The reliable change method identified more patients with neuropsychologic deficits on most measures. CONCLUSIONS: The control of measurement error and practice effects can alter significantly the calculated incidence of neuropsychologic impairment after coronary artery bypass grafting.

Aged↗

PubMed1998

Neuropsychological dysfunction after minimally invasive direct coronary artery bypass grafting.

BACKGROUND: We compared postoperative neuropsychological dysfunction after minimally invasive direct coronary artery bypass grafting (MIDCAB) operation with coronary artery bypass graft operations using cardiopulmonary bypass. METHODS: Neuropsychological assessment was performed preoperatively and before discharge on 7 patients undergoing MIDCAB procedures, 9 patients undergoing single-graft cardiopulmonary bypass operation, and 27 patients undergoing multiple-graft cardiopulmonary bypass operation. From a matched control group of 40 normal subjects reliable change indices were derived for each measure and used to determine the incidence of postoperative decline. RESULTS: There was little difference between the MIDCAB and single-graft cardiopulmonary bypass groups on the incidence of neuropsychologic decline. However, the multiple-graft cardiopulmonary bypass group had a significantly higher incidence of decline than the MIDCAB and single-graft cardiopulmonary bypass groups on specific neuropsychologic measures, coupled with a significantly greater number of postoperative deteriorations per patient. CONCLUSIONS: The elimination of cardiopulmonary bypass does not prevent neuropsychological dysfunction after cardiac operation as patients undergoing MIDCAB and single-graft cardiopulmonary bypass experience similar deteriorations in performance. However, the deterioration is markedly worsened when the number of surgical grafts is increased.

Aged↗

PubMed1980

Chromosomal aberrations in occupation-associated progressive systemic sclerosis.

An occupational association between progressive systemic sclerosis (PSS) and workers in the goldmining industry in South Africa was first documented in 1957. We investigated the chromosomes of 18 goldminers suspected to be suffering from PSS. Eight patients were classified as definite cases of PSS, and a highly significant increase in unstable (Cu) cells and random aneuploidy was found in this group compared with control subjects (P < 0,001). Ten patients had some of the features of the disease, and in this group there was a significant increase in the number of Cu cells ( P < 0,05) and a highly significant increase in the number of aneuploid cells (P < 0,001). There was a significant increase in the number of sister chromatid exchanges per cell in the 6 patients screened. These findings are similar to those reported in PSS sufferers who have not had occupational exposure.

Adult↗

PubMed1980

Familial hypercholesterolaemia--a common genetic disorder in the Afrikaans population.

Serum cholesterol levels have been studied in three groups of young White South Africans. The mean levels were highest among the Jewish (195,7 mg/dl or 5,10 mmol/l), lowest among the Afrikaans (174,9 mg/dl of 4,55 mmol/l), and intermediate in the English-speaking Gentile population (180,0 mg/dl or 4,67 mmol/l). Levels were significantly higher in females than in males in the Jewish and English-speaking Gentile populations, but not significantly higher in Afrikaans females compared with males. Studies carried out on the families of individuals found to have serum cholesterol levels above 300 mg/dl (7,8 mmol/l) emphasized that, in addition to the serum cholesterol studies, detailed family studies are essential if an accurate diagnosis of familial hypercholesterolaemia (FH) is to be made. From such studies in the Afrikaans population and also from the known number of homozygotes for FH in one area of South Africa, all of whom came from Afrikaans families, it has been estimated that the frequency of the FH gene is unusually high in this population. It is postulated that the latter finding could help to explain the high incidence of and mortality rate from ischaemic heart disease in young White South Africans.

Adolescent↗

PubMed1975

Serum immunoglobulins G, A and M in White and Black adults on the Witwatersrand.

Blood donors and hospital inpatients of the same sex and race group showed similar concentrations of serum immunoglobulins G and M. Serum IgA levels were significantly higher in three of four hospital patient groups as compared with blood donor groups matched for sex and race. Age was shown to be responsible for this difference, since on average the blood donors were younger and analysis of all subjects in age groups showed a progressive rise in IgA with increasing age. Lower IgA levels occurred in women than in men of comparable age and race group. A sex difference with higher IgM levels in women was confirmed. All values in Black adults were much higher than in Whites. It is therefore of importance to consider the ranges of values for any individual's age, sex and race when interpreting results of serum immunoglobulin assay.

Adolescent↗