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Does hostile neck anatomy preclude successful endovascular aortic aneurysm repair?

OBJECTIVES: Poor outcomes have been reported with endovascular aneurysm repair (EVAR) in patients with hostile neck anatomy. Unsupported endografts with active fixation may offer certain advantages in this situation. We compared EVAR results using the Ancure (Guidant) endograft in patients with and without hostile neck anatomy. METHODS: Records of EVAR patients from October 1999 to July 2002 at a tertiary care hospital were retrospectively reviewed from a division database. Patients with elective open abdominal aortic aneurysm (AAA) repair during the same period were reviewed to determine those unsuitable for EVAR. Hostile neck anatomy, assessed by computer tomography (CT) scans and angiograms, was defined as one or more of the following: (1) neck length </=10 mm, (2) focal bulge in the neck >3 mm, (3) >2-mm reverse taper within 1 cm below the renal arteries, (4) neck thrombus > or =50% of circumference, and (5) angulation > or =60 degrees within 3 cm below renals. RESULTS: Three hundred and twenty-two patients underwent EVAR with an average follow-up of 18 months. Patients in Phase II trials (n = 41), repaired with other graft types (n = 48), or without complete anatomic records (n = 27) were excluded. Demographics and co-morbidities were similar in the 115 good-neck (GN) and 91 bad-neck (BN) patients except for age (mean, 72.9 years GN vs 75.7 BN; P = 0.13), gender (11% female GN vs 22% BN; P =.04); neck length (mean, 21.8 mm GN vs 14.4 mm BN: P <.001), and angulation (mean, 22 degrees GN vs 40 degrees BN; (P <.001). Perioperative mortality (0 GN vs 1.1% BN), late mortality (5.2% GN vs 4.4% BN), all endoleaks (19.1% GN vs 17.6% BN), proximal endoleaks (0.8% GN vs 2.1% BN), and graft migration (0 for both groups) did not reach statistical significance. Neck anatomy precluded EVAR in 106 of 165 (64%) patients with open AAA. CONCLUSIONS: Unsupported endografts with active fixation can yield excellent results in treating many medically compromised patients with hostile neck anatomy. Nonetheless, an unsuitable neck remains the most frequent cause for open abdominal AAA.

Aged↗

Is it time to pull the plug on the hostile versus instrumental aggression dichotomy?

Psychologists have often categorized human aggression as hostile or instrumental. Hostile aggression is "hot," impulsive behavior that is motivated by a desire to hurt someone; instrumental aggression is "cold," premeditated behavior used as a means to some other end. This dichotomy was useful to the early development of aggression theories and continues to capture important features of nonhuman aggression, but it has outlived its usefulness as a descriptor of fundamentally different kinds of human aggression. It is confounded with the automatic-controlled information-processing dichotomy, and it fails to consider aggressive acts with multiple motives. Knowledge structure models of aggression easily handle these problems. Taking extreme measures to preserve the hostile-instrumental dichotomy will delay further advances in understanding and controlling human aggression. Therefore, this seems a proper time to "pull the plug" and allow the hostile-instrumental aggression dichotomy a dignified death.

Aggression↗

Memory bias for faces that are perceived as hostile by crime victims with acute post-traumatic stress disorder.

The present study tested, and found support for, the hypotheses that crime victims with acute post-traumatic stress disorder have: (i) a general memory impairment for faces; and (ii) a memory bias for faces that they perceive as hostile, even when these faces are not arranged to show any hostile face expressions. It is suggested that crime victims with acute post-traumatic stress disorder perform worse on recognition memory due to impaired concentration, and that they allocate their limited attentional resources to the detection of hostility in others in order to avoid being victimized again. This produces a memory bias for perceived hostility even in relatively innocuous everyday interactions with others, which contributes to maintaining the sense of serious current threat that characterizes post-traumatic stress disorder.

Journal Article↗

Bradycardia during baroreflex stimulation and active or passive stressor tasks: cardiorespiratory fitness and hostility.

We examined whether the resting bradycardia associated with cardiorespiratory fitness extends to lowered heart rate (HR) and mean arterial pressure during novel passive or active laboratory stressors and to a longer heart period during stimulation of the carotid-cardiac vagal baroreflex, independently of the Type A behavior pattern (TABP) and hostility. Forty-four normotensive Caucasian men (18-35 years of age) completed the Structured Interview for TABP, the Cook-Medley Hostility Scale, and a peak oxygen uptake (Vo2peak) test. Vo2peak was inversely related to HR prior to, during, and after each stressor and was positively related to heart period during baroreflex testing. Hostility was inversely related to heart period during baroreflex testing. TABP had no effects. Our findings indicate that cardiorespiratory fitness and low hostility are independently associated with a bradycardia during stimulation of the carotid-cardiac baroreflex, consistent with a possible enhancement of cardiac vagal tone.

Adult↗

Adjunctive divalproex and hostility among patients with schizophrenia receiving olanzapine or risperidone.

OBJECTIVE: This study compared the specific antihostility effects of atypical antipsychotic monotherapy (olanzapine or risperidone) with that of combination treatment with divalproex sodium among patients with schizophrenia experiencing an acute psychotic episode. METHODS: A total of 249 inpatients with schizophrenia were randomly assigned to receive olanzapine plus placebo, olanzapine plus divalproex, risperidone plus placebo, or risperidone plus divalproex in a double-blind, 28-day multicenter trial. The target daily dose was 15 milligrams for olanzapine, 6 milligrams for risperidone, and up to 30 milligrams per kilogram (minimum, 15 milligrams per kilogram) for divalproex. The hostility item of the Positive and Negative Syndrome Scale (PANSS) was the principal outcome measure. Covariates included the PANSS items reflecting positive symptoms of schizophrenia (delusions, suspiciousness/persecution, grandiosity, unusual thought content, conceptual disorganization, and hallucinatory behavior). RESULTS: Combination treatment with risperidone or olanzapine plus divalproex was associated with different scores on the hostility item of the PANSS compared with antipsychotic monotherapy. Combination therapy had a significantly greater antihostility effect at days 3 and 7 than monotherapy. This result was not seen beyond the first week of treatment, but there was a trend toward a difference in effect for the entire treatment period. The effect on hostility appears to be statistically independent of antipsychotic effect on other PANSS items reflecting delusional thinking, a formal thought disorder, or hallucinations. CONCLUSIONS: Divalproex sodium may be useful as an adjunctive agent in specifically reducing hostility in the first week of treatment with risperidone or olanzapine among patients with schizophrenia experiencing an acute psychotic episode.

Aggression↗

Impulsivity and schemas for a hostile world: postdictors of violent behaviour.

Forty male prisoners at a medium-security Canadian penitentiary completed the I Questionnaire, a measure of impulsivity, and two measures of schemas for a hostile world. Both hypervigilance for hostile words during a dichotic shadowing task and hostile attributions made about actors in social vignettes correlated greater than .30 with a criminal history of persistent violence. Impulsivity did not significantly correlate with the schema measures but correlated .30 with persistent violence. The results provide support for the Serin and Kuriychuk model of aggression that links impulsivity and hostile attributions with persistent male violence.

Aggression↗

Preliminary evidence for an association between aggressive and hostile behaviour and 3alpha,5alpha-tetrahydroprogesterone plasma levels in schizophrenia.

OBJECTIVE: Because it has been suggested that agents acting on the gamma-aminobutyric acid-A (GABA(A)) receptor complex, such as the neuroactive steroid 3!#!alpha;,5alpha-tetrahydroprogesterone (3alpha,5alpha-THP), may be biologic modulators of aggression, we aimed to measure 3alpha,5alpha-THP plasma concentrations in subjects with schizophrenia in order to investigate a possible relation with aggressive and hostile behaviour. METHODS: Eight outpatients with schizophrenia diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), were included. Aggression and hostility were assessed using the Modified Overt Aggression Scale and the paranoid/belligerence symptom cluster of the Positive and Negative Syndrome Scale. Plasma samples were obtained 1 hour before psychometric assessment and were quantified for 3alpha,5alpha-THP using a highly sensitive and specific combined analysis by gas chromatography-mass spectrometry. RESULTS: Increased aggressiveness and hostility were associated with increased 3alpha,5alpha-THP plasma levels (Pearson r = 0.72, p = 0.043 and Pearson r = 0.72, p = 0.041, respectively). CONCLUSIONS: These preliminary results suggest that the neuroactive steroid 3alpha,5alpha-THP may affect aggression and hostility in humans.

Adult↗

Hostility and physiological risk in the National Heart, Lung, and Blood Institute Family Heart Study.

BACKGROUND: The present analyses investigated possible pathways for earlier reported associations in the National Heart, Lung, and Blood Institute Family Heart Study between hostility and coronary and carotid end points. METHODS: The cross-sectional design recruited 535 women and 491 men with average familial risk for coronary heart disease and 1950 women and 1667 men with high familial coronary risk from 3 prospective ongoing studies at 4 sites. Recruitment of high-risk participants was based on family risk score. Average-risk participants came from a randomly selected group. Outcome measures were plasminogen activator inhibitor type 1 (PAI-1), homocysteine, fibrinogen, fasting glucose, blood pressure, high-density lipoprotein cholesterol, triglycerides, low-density lipoprotein cholesterol, and "lipid metabolic disorder" (LMD) (defined as systolic blood pressure >/=140 mm Hg or diastolic blood pressure >/=90 mm Hg); fasting glucose >/=126 mg/dL (>/=7.0 mmol/L) or the use of diabetes medications; body mass index (calculated as weight in kilograms divided by the square of height in meters) >/=30; triglycerides >/=250 mg/dL (>/=2.8 mmol/L), high-density lipoprotein cholesterol <40 mg/dL (<1.0 mmol/L) in men and <50 mg/dL (<1.3 mmol/L) in women; and low-density lipoprotein cholesterol level >/=130 mg/dL (>/=3.4 mmol/L). RESULTS: After adjustment for age and risk-related behaviors, hostility was significantly associated with glucose level and LMD in high-risk women, with LMD in average-risk women, with PAI-1 and LMD in high-risk men, and with fibrinogen level in average-risk men. CONCLUSIONS: Associations between hostility and physiological risk were only partially accounted for by health behaviors, suggesting that further investigation of mechanistic pathways is warranted.

Blood Glucose↗

Perceived availability of different types of social support among cynically hostile women.

One hundred and ninety six young women completed the Cook-Medley Hostility (Ho) scale and a measure of the perceived availability of social support. Results of partial correlations that adjusted for the confounding effects of neuroticism showed total hostility was most strongly associated with appraisal support (r = -.40, p < .001) and most weakly associated with esteem support (r = -.19, p < .01). These findings help contribute to a more precise understanding of the specific nature of the support deficits experienced by high hostile women. In addition, other findings suggest that different aspects of the Ho scale are differentially related to social support. Specifically, deficiencies in the perceived availability of support appear to be most strongly linked to cynicism.

Adult↗

COMT158 polymorphism and hostility.

The main study was designed primarily to compare the clinical effects of four antipsychotics in 157 patients with schizophrenia or schizoaffective disorder. The secondary genetic study, reported here, is based on a subset of 60 patients who consented to genotyping assays. Based on previous work with the catechol-O-methyltransferase (COMT) 158 polymorphism, we hypothesized that the Met-Met homozygotes would be more hostile than the heterozygotes and the Val-Val homozygotes. Hostility ratings at baseline were used to test this hypothesis. The Met-Met homozygotes (N = 7) were found to have significantly higher levels of hostility than the other patients (N = 53). The hypothesis was thus supported. The finding should be replicated in a larger sample.

Antipsychotic Agents↗

Blood-pressure responses during social interaction in high- and low-cynically hostile males.

The Cook and Medley Hostility (Ho) Scale has been found to predict the development of coronary heart disease, coronary death, and death from other causes. Enhanced physiological responsiveness among high-Ho subjects may represent a link between hostility and health. The present study examined the systolic and diastolic blood-pressure (SBP, DBP) and heart-rate (HR) responses of high- and low-Ho undergraduate males while they presented their position and listened to their partner's opposing position in a current events discussion task. Compared to low-Ho subjects, the high-Ho group displayed larger SBP and DBP responses. These results and others suggest that cynical hostility is associated with greater physiological responses to interpersonal stressors.

Arousal↗

Hostility, coronary heart disease (CHD) incidence, and total mortality: lack of association in a 25-year follow-up study of 478 physicians.

Higher levels of hostility, assessed by a Minnesota Multiphasic Personality Inventory (MMPI) scale (Ho), have been associated with the incidence of coronary disease and mortality from coronary disease and other causes in two prospective studies. In this study we examined the relationship between hostility and health status 25 years later in 478 physicians who completed the MMPI at the time of their medical-school admission interview. In contrast to earlier studies, higher Ho scores were not predictive of coronary disease incidence or total mortality. The implications of this finding for current research on the hostility component of the Type A behavior pattern are discussed.

Coronary Disease↗

Relationship of cynical hostility and PTSD among Vietnam veterans.

The personality construct of cynical hostility, as measured by the Cook-Medley scale (an MMPI subscale), has been implicated as a risk factor for cardiovascular disease. A literature review suggests that Vietnam veterans exhibit many cynical hostility-like characteristics. We examined the association between Cook-Medley scores and PTSD among Vietnam and other-era veterans. Study 1 involved analyses of data from 1293 MMPIs administered at Department of Veterans Affairs in Honolulu between 1986-1991. Cook-Medley scores were highly correlated with MMPI PTSD scores, and Vietnam Era veterans obtained higher scores than veterans from other eras. In Study 2, twenty nine Vietnam veterans with PTSD disability ratings obtained very high Cook-Medley scores which were higher than Vietnam Era veterans without rated PTSD. Findings indicate that the cynical hostility literature has considerable relevance for study of PTSD and suggest that PTSD veterans may have heightened risk for developing cardiovascular disease. Several directions for future research are suggested.

Adult↗

The influence of hostility and family history of cardiovascular disease on autonomic activation in response to controllable versus noncontrollable stress, anger imagery induction, and relaxation imagery.

Autonomic activation in response to controllable versus noncontrollable stress, anger imagery induction, and relaxation imagery was studied among 80 participants between the ages of 18 and 34 years. Participants differed in level of trait hostility and family history of cardiovascular disease. Results were obtained through power spectral analyses of electrocardiograph R-R intervals, which produced an index of autonomic nervous system activation. For both male and female populations, parasympathetic regulation was diminished during anger induction for individuals with high levels of trait hostility and having a family history of cardiovascular disease. Similar results were obtained for women during the uncontrolled stress condition. Based on family history of cardiovascular disease and trait hostility, men responded differentially to relaxation imagery induction, whereas no differences were found among females.

Adult↗

Suppressed hostility predicted hypertension incidence among middle-aged men: the normative aging study.

This study tested whether suppressed hostility predicted incident hypertension (HTN) in initially nonhypertensive men, using prospective data from the Normative Aging Study. Six hundred twenty-seven men who completed the MMPI and participated in a subsequent laboratory assessment were included in the study. The Cook-Medley Hostility scale (Ho), a suppression factor, and other risk factors were used to predict incident HTN over a 3-year period. Logistic regression showed a significant three-way interaction among Ho, suppression, and age in predicting incident HTN. Among middle-aged men (<or=60 years) with higher suppression, a 1-point decrease in the Ho score was associated with an 18% increase in HTN risk. This relationship remained significant after controlling for relevant risk factors. Among older participants, the HoxSuppression interaction was not predictive of HTN incidence. These results provide support for the Suppressed Hostility hypothesis in middle-aged men.

Adult↗

Refining the type A hypothesis: emergence of the hostility complex.

Recent negative research findings have raised questions regarding the robustness of the Type A hypothesis. A growing body of evidence suggests that not all aspects of the global Type A behavior pattern are pathogenic, but only those concerned with hostility and anger. Biologic mechanisms responsible for increased risk of coronary disease in persons with high levels of hostility and anger appear to involve increased cardiovascular and neuroendocrine responses to behavioral challenge, and, possibly, inadequate parasympathetic antagonism of sympathetic nervous system effects. Future research should concentrate on further refining our understanding of the hostility complex and its pathophysiologic mechanisms.

Coronary Disease↗

Hostility is related to narcissism controlling for social desirability: studies of college students and patients with myocardial infarction.

The authors examined the influence of narcissism and social desirability on hostility in two samples of 215 college students and 30 patients with myocardial infarction (MI). Results were as follows: (1) MI patients had stronger cynical hostility and lower social desirability than college students; (2) hostility was related to narcissism before and after controlling for social desirability in both MI patients and college students; and (3) these tendencies were stronger in MI patients than in college students, although there were no significant differences.

Adolescent↗

Acting out hostility in normal volunteers: negative correlation with levels of 5HIAA in cerebrospinal fluid.

We examined relationships in normal volunteers between cerebrospinal fluid (CSF) concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid (5HIAA) and scores on the Hostility and Direction of Hostility Questionnaire. There was a significant negative correlation between CSF 5HIAA levels and scores on the "urge to act out hostility" subscale, as well as a similar nonsignificant trend with CSF levels of homovanillic acid. These results suggest that among normal individuals reduced central serotonergic tone may be associated with impaired impulse control.

Adult↗