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PubMed2005

Impact of age on quality of life in patients with rectal cancer.

Some studies indicate that age at the time of surgery has a general effect on outcomes. The impact of age on the quality of life (QOL) of patients with rectal cancer, however, has not been investigated. The present study was conducted to address this issue. Over a 5-year period the European Organization for Research and Treatment of Cancer (EORTC)-QLQ-C-30 and a tumor-specific module were prospectively administered to patients before surgery, at discharge, and at 3, 6, 12, and 24 months postoperatively. Comparisons were made between age groups. A total of 519 patients participated in the study. QOL data were available for 253 patients. Significant differences were observed only between patients aged 69 years and younger (< or =69 years) (169/253) and those aged 70 years and older (> or =70 years) (85/253). Physical and role functioning was better for patients < or =69 years; patients > or =70 years suffered from increased pain and fatigue. Younger patients had more difficulty with sexual enjoyment, and over time sexual strain was worse for patients aged > or =70 years during the early postoperative period but improved, whereas patients aged < or =69 years had increasing levels of strain over time. The findings in this study confirmed that QOL is dynamic over time and that age has an impact on QOL and sexuality. Patients aged > or =70 years are affected by impaired physical functioning, global health, and fatigue, whereas increased treatment strain during the early postoperative period improves over time. Patients aged < or =69 years experience increased strain because of impaired sexual function.

Adult↗

PubMed1994

Mechanisms of myocardial depression after bolus injection of sodium bicarbonate.

PURPOSE: The classic model for the effects of NaHCO3 on myocardial function predicts transient myocardial depression after an intravenous bolus of sodium bicarbonate in association with myocardial acidosis. METHODS: Five anesthetized, paralyzed, and ventilated dogs underwent midline sternotomy. Myocardial global function was assessed by cardiac output, left ventricular (LV) dp/dt, LV end-systolic, and LV end-diastolic pressures. Regional myocardial function assessed by measuring the LV regional end-systolic, LV end-diastolic lengths, and LAD coronary blood flow. Coronary sinus, intramyocardial and arterial pH were measured as was free serum Ca++. Animals were made acidemia by infusion of 0.3 N HCl and then given a bolus of sodium bicarbonate. This produced transient depression followed by recovery of myocardial function. RESULTS: During the depression phase there was no significant decrease in interstitial pH or an increase in A-VCO2 difference as predicted by the current model. However, there was a significant decrease in the serum free Ca++ that coincided with myocardial depression. CONCLUSION: We could not confirm the predictions of the classic model and hypothesize that myocardial depression may be caused by decreased availability of free Ca++ of decreased Ca++ flux rather than intracellular acidosis.

Acidosis↗

PubMedDate not supplied

Frontal lobe and cognitive development.

In phylogeny as in ontogeny, the association cortex of the frontal lobe, also known as the prefrontal cortex, is a late-developing region of the neocortex. It is also one of the cortical regions to undergo the greatest expansion in the course of both evolution and individual maturation. In the human adult, the prefrontal cortex constitutes as much as nearly one-third of the totality of the neocortex. The protracted, relatively large, development of the prefrontal cortex is manifest in gross morphology as well as fine structure. In the developing individual, its late maturation is made most apparent by the late myelination of its axonal connections. This and other indices of morphological development of the prefrontal cortex correlate with the development of cognitive functions that neuropsychological studies in animals and humans have ascribed to this cortex. In broad outline, the ventromedial areas of the prefrontal cortex, which with respect to other prefrontal areas develop relatively early, are involved in the expression and control of emotional and instinctual behaviors. On the other hand, the late maturing areas of the lateral prefrontal convexity are principally involved in higher executive functions. The most general executive function of the lateral prefrontal cortex is the temporal organization of goal-directed actions in the domains of behavior, cognition, and language. In all three domains, that global function is supported by a fundamental role of the lateral prefrontal cortex in temporal integration, that is, the integration of temporally discontinuous percepts and neural inputs into coherent structures of action. Temporal integration is in turn served by at least three cognitive functions of somewhat different prefrontal topography: working memory, preparatory set, and inhibitory control. These functions engage the prefrontal cortex in interactive cooperation with other neocortical regions. The development of language epitomizes the development of temporal integrative cognitive functions and their underlying neural substrate, notably the lateral prefrontal cortex and other late-developing cortical regions.

Animals↗

PubMed2001

[Clinical application of gated SPECT imaging to regional function assessment: current status and limitations].

It is likely that clinical applications of ECG-gated single-photon emission computed tomography (SPECT) are established in nuclear cardiology practice because of the improved diagnostic accuracy of gated SPECT imaging for the detection of coronary artery disease and because this technique enables not only simultaneous assessment of myocardial perfusion and function but also improvement of risk stratification of coronary patients. Although a gated approach with SPECT imaging has been demonstrated to have high reproducibility and reliability for quantifying global function, there are several limitations in appropriate processing of 4-dimensional data for quantitative assessment of regional function. Even if limited spatial and temporal resolutions and a lack of attenuation and scatter corrections are disregarded, sufficient data collection, image-quality control, and precise application of algorithms to gated SPECT data are prerequisite. The results of several kinds of quantitative analysis of regional cardiac function, such as regional wall motion (distance deviation of the inner myocardial border), regional ejection fraction, percent wall thickening, and percent count increase with or without self-normalization have been reported. Further clinical application of quantitative regional function assessment by a gated SPECT technique, however, requires standardization of data acquisition, data analysis, and data presentation with appropriate quantitative parameters; production of a standard map using quantitative values; and validation study by comparison with results of visual analysis and other modalities in a large-scale patient population.

Algorithms↗

PubMed2002

[The comparison of the regional cerebral metabolism rate of glucose in Alzheimer's disease with mild cognitive impairment].

OBJECTIVE: To study the feature of regional cerebral metabolism rate of glucose (rCMRglc) of Alzheimer's disease (AD) and mild cognitive impairment (MCI) by positron emission tomography (PET) and the relationship between MCI and AD. METHODS: 13 AD patients, 10 MCI patients and 10 health volunteers as a control group (HC) were underwent 18F-fluoro deoxyglucose (18F-FDG)-PET scanning. RESULTS: (1) There was lightly decreasing of radioactivity of temporal lobe and parietal lobe in HC group, a little severer decrease in MCI group, markedly decrease of radioactivity of temporal lobe, parietal lobe and frontal lobe in AD group examined by naked-eye. (2) The rCMRglc of many parts of brain such as frontal lobe, including superior, middle and inferior frontal gyrus, orbital gyrus and rectus gyrus, temporal lobe, including superior, middle and inferior temporal gyrus, parietal lobe, including superior parietal lobe, supramarginal gyrus and angular gyrus, limbic system, including anterior cingulate gyrus, insular lobe, basal ganglions, including thalamus, caudate nucleus and amygdaloid nucleus decreased significantly in AD group, compared to MCI and HC groups (p < 0.05 to p < 0.001). (3) The rCMRglc of many parts of brain such as frontal lobe, temporal lobe, parietal lobe, limbic system, and basal ganglions in MCI group was lower than that in HC group, but not significantly (p > 0.05). Only that of the left caudate nucleus in MCI decreased significantly compared to that in HC group (p < 0.05). CONCLUSION: Decreasing of rCMRglc of parietal lobe is sensitive in evaluating cognitive function, next one is temporal lobe, and then frontal lobe. The rCMRglc of frontal lobe, temporal lobe, parietal lobe, limbic system, and basal ganglions decreasing markedly indicates that global function decayed in AD patients. While the rCMRglc of those parts in MCI patients' brain decreases mildly. This indicates that MCI is the middle state of AD and HC. Decreasing of rCMRglc of the left caudate nucleus has a certain role in diagnosis of MCI.

Aged↗

PubMedDate not supplied

Quantitation of the global right ventricular function in children with normal heart and congenital heart disease: a right ventricular myocardial performance index.

Although the assessment of right ventricular (RV) function is important in the clinical management of children with congenital heart disease, available imaging techniques have been limited because of the complex geometry of the right ventricle. A new Doppler index combining systolic and diastolic time intervals (the Tei index) has been reported to be useful for the assessment of global RV function in adults. However, normal values in children, age-related changes, and the clinical utility of the Tei index with regard to congenital heart disease have not been demonstrated. The purpose of this study was to prospectively assess RV function in children with normal heart and congenital heart disease using the Tei index. The subjects included 150 healthy children and 43 patients with congenital heart disease (35 patients with atrial septal defects and 8 patients who had had a Senning operation). The index was defined as the sum of isovolumetric contraction time and isovolumetric relaxation time divided by ejection time and was measured from conventional RV outflow and inflow Doppler velocity profiles. The Tei index was not affected by age in healthy children (0.24 +/- 0.04). There was a significant difference in index rating between patients who had had a Senning operation (0.58 +/- 0.09) and healthy children (p < 0.01), but there was no significant difference between children with atrial septal defect (0.25 +/- 0.13) and healthy children. The Tei index is a feasible approach to use when assessing global RV function in children with congenital heart disease.

Adolescent↗

PubMed1993

[Global and regional function in microvascular angina].

Because of the existing relation between myocardial blood flow and systolic function, various noninvasive techniques, capable of assessing regional and global left ventricular function, especially two-dimensional echocardiography, have been used in patients with chest pain, ECG evidence of myocardial ischemia and/or reduced coronary flow reserve and angiographically detected normal coronary vessels. The results, however, have been contradictory, while only few of them have reported stress-induced regional or global left ventricular dysfunction combined with ST-segment depression and/or angina. The reason for such discrepancy could be due to a diffuse but patchy distribution of myocardial ischemia, or to a non-ischemic origin of the clinical and instrumental features of this syndrome, relying on the effect of algogenic mediators, as suggested from recent metabolic studies. Even if the most recent theories agree on the functional involvement of the small coronary vessels, many points on microvascular angina remain confused. An agreement on the nosological classification of this syndrome would be welcome, given the high technological cost required for the study of coronary microcirculation.

Humans↗

PubMed2002

Interpersonal psychotherapy delivered over the telephone to recurrent depressives. A pilot study.

Rates of recurrent depression peak among women in their childbearing years, yet a large number of these women are not treated or do not seek maintenance treatment between episodes. Barriers to treatment include time constraints, demands of child care, and finances. A method for improving access to treatment of depression may be delivery of psychotherapy over the telephone. A 12-week pilot controlled clinical trial with random assignment was conducted to test the feasibility and efficacy of Interpersonal Psychotherapy delivered over the telephone (IPT-T) for depression in women (N=15 IPT-T and N=15 no treatment) with a life-time history of recurrent depression and low rates of previous treatment. Patients were interviewed at baseline and at 12 weeks by a blind and independent clinical evaluator to assess their symptom level and social functioning. IPT-T as compared to no treatment was significantly better in lowering symptoms of depression as measured by the Hamilton Rating Scale for Depression (p<.02), improving global functioning (GAS) (p<.02), and improving work and social functioning (p<.03-.05, respectively). These preliminary findings support the feasibility and helpfulness of IPT-T in preventing an increase in depressive symptoms among women with recurrent depression but current mild to moderately levels of depression.

Adult↗

PubMed1994

[Minor aplasia of the ear: anatomical findings and results of functional surgery].

We report a retrospective study of 57 cases of minor aplasia of the ear. Each case was analyzed according to the clinical presentation, audiometric results and preoperative radiography. Intra-operative classification of the malformation was obtained in 56 of the 57 cases. The post-operative anatomic and functional results were analyzed. Stapedectomy in type II malformations (stapedo-vestibular ankylosis) gave the best results but this procedure also carries the highest risk for the inner ear. Globally, functional results were good or average in 48% of the patients. These results may appear unsatisfactory but must be appreciated in light of the fact that half of the patients benefited from the operation (particularly in eliminating further use of an external hearing aid). Nevertheless, the long-term stability of these audition results is unknown.

Adolescent↗

PubMed1999

Diagnoses, psychosocial stressors and adaptive functioning in attempted suicide.

A systematic sample of 78 suicide attempters (37 men and 41 women), of whom 83% were hospitalized, were interviewed according to SCID I and II and Axes III-V according to DSM-III-R. Mood disorders were most common (56%). Forty-four suicide attempters (56%) suffered from comorbid diagnoses on Axis I-II. Borderline personality disorder was more common among women then men (56% vs. 24%, respectively, p = 0.01). Axis III disorders were confirmed for 45%. Sixty-two percent of the suicide attempters had severe psychosocial stressors (Axis IV). When comparing subjects with only Axis I disorders to those with Axis I and II disorders, no difference with respect to psychosocial stressor grade was observed. Moreover, those with only Axis I disorders were not impaired in their adaptive functioning (Axis V) even if severe psychosocial stressors were present. In contrast, an association (p = 0.02) was found between high stress and low functioning in patients with both Axis I and Axis II disorders. The data suggest that in clinical practice, beside evaluation of Axis I and Axis II disorders, also stressors and global functioning should be included in the assessment of suicide risk after attempted suicide.

Adaptation, Psychological↗

PubMed1989

Amitriptyline versus haloperidol in borderlines: final outcomes and predictors of response.

The authors report the final results of a 4-year study of amitriptyline and haloperidol in 90 symptomatic borderline inpatients. Medication trials were double-blind and placebo controlled and lasted 5 weeks. Haloperidol (4-16 mg/day) produced significant improvement over placebo in global functioning, depression, hostility, schizotypal symptoms, and impulsive behavior. Significant effects of amitriptyline (100-175 mg/day) were generally limited to measures of depression. Factor analysis identified three symptom change patterns: a global depression, hostile depression, and schizotypal symptom pattern. Medication effects favoring haloperidol were most prominent for hostile depression. Variables predicting favorable response to haloperidol included severity of schizotypal symptoms, hostility, and suspiciousness. Schizotypal symptoms and paranoia predicted poor outcome on both depression patterns with amitriptyline. Placebo effects were most prominent on acute state symptoms, with severe character traits predicting poor response.

Amitriptyline↗

PubMed2005

Functional correction of CNS phenotypes in a lysosomal storage disease model using adeno-associated virus type 4 vectors.

Lysosomal storage diseases (LSDs) represent a significant portion of inborn metabolic disorders. More than 60% of LSDs have CNS involvement. LSD therapies for systemic diseases have been developed, but efficacy does not extend to the CNS. In this study, we tested whether adeno-associated virus type 4 (AAV4) vectors could mediate global functional and pathological improvements in a murine model of mucopolysaccharidosis type VII (MPS VII) caused by beta-glucuronidase deficiency. Recombinant AAV4 vectors encoding beta-glucuronidase were injected unilaterally into the lateral ventricle of MPS VII mice with established disease. Transduced ependyma expressed high levels of recombinant enzyme, with secreted enzyme penetrating cerebral and cerebellar structures, as well as the brainstem. Immunohistochemical studies revealed close association of recombinant enzyme and brain microvasculature, indicating that beta-glucuronidase reached brain parenchyma via the perivascular spaces lining blood vessels. Aversive associative learning was tested by context fear conditioning. Compared with age-matched heterozygous controls, affected mice showed impaired conditioned fear response and context discrimination. This behavioral deficit was reversed 6 weeks after gene transfer in AAV4 beta-glucuronidase-treated MPS VII mice. Our data show that ependymal cells can serve as a source of enzyme secretion into the surrounding brain parenchyma and CSF. Secreted enzymes subsequently spread via various routes to reach structures throughout the brain and mediated pathological and functional disease correction. Together, our proof-of-principal experiments suggest a unique and efficient manner for treating the global CNS deficits in LSD patients.

Animals↗

PubMed2005

Effects of testosterone on cognition and mood in male patients with mild Alzheimer disease and healthy elderly men.

CONTEXT: There is a compelling need for therapies that prevent, defer the onset, slow the progression, or improve the symptoms of Alzheimer disease (AD). OBJECTIVE: To evaluate the effects of testosterone therapy on cognition, neuropsychiatric symptoms, and quality of life in male patients with mild AD and healthy elderly men. DESIGN: Twenty-four-week, randomized, double-blind, placebo-controlled, parallel-group study. SETTING: Memory disorders clinics as well as general neurology and medicine clinics from University of California medical centers at Los Angeles, San Francisco, and Irvine. PATIENTS OR OTHER PARTICIPANTS: Sixteen male patients with AD and 22 healthy male control subjects. Healthy elderly control men were recruited from the community through advertisements as well as through the university-based clinics. INTERVENTION: Testosterone and placebo, in the form of hydroalcoholic gel (75 mg), were applied daily to the skin of the participants. MAIN OUTCOME MEASURES: Instruments assessing cognitive functioning (Alzheimer's Disease Assessment Scale-Cognitive Subscale, California Verbal Learning Test, Block Design Subtest, Judgment of Line Orientation, Developmental Test of Visual-Motor Integration), neuropsychiatric symptoms (Neuropsychiatric Inventory), global functioning (Clinician's Interview-Based Impression of Change), and quality of life (Quality of Life-Alzheimer Disease Scale). RESULTS: For the patients with AD, the testosterone-treated group had significantly greater improvements in the scores on the caregiver version of the quality-of-life scale (P = .01). No significant treatment group differences were detected in the cognitive scores at end of study, although numerically greater improvement or less decline on measures of visuospatial functions was demonstrated with testosterone treatment compared with placebo. In the healthy control group, a nonsignificant trend toward greater improvement in self-rated quality of life was observed in the testosterone-treated group (P = .09) compared with placebo treatment. No difference between the treatment groups was detected in the remaining outcome measures. Testosterone treatment was well tolerated with few adverse effects relative to placebo. CONCLUSIONS: Results suggest that testosterone replacement therapy improved overall quality of life in patients with AD. Testosterone had minimal effects on cognition.

Affect↗

PubMed2002

Differential effect of environmental adversity by gender: Rutter's index of adversity in a group of boys and girls with and without ADHD.

OBJECTIVE: This study examined the effect of gender in mediating the association between environmental adversity and the risk of attention deficit hyperactivity disorder (ADHD) and associated impairments. METHOD: The authors studied 280 ADHD and 242 healthy comparison probands of both genders who were between the ages of 6 and 17 years. They tested the association between Rutter's indicators of adversity (including family conflict, social class, family size, maternal psychopathology, and paternal criminality) and ADHD, comorbidity, and functioning. RESULTS: Greater levels of environmental adversity were associated with a greater risk for ADHD and other comorbidity in both genders in a dose-dependent fashion. However, learning disability and global functioning were modified by gender, with more detrimental effects observed in boys than in girls. Low social class, maternal psychopathology, and family conflict were significantly associated with psychopathology and functional impairment in the probands, with control for gender, parental ADHD, proband ADHD status, and maternal smoking during pregnancy. CONCLUSIONS: Psychosocial adversity in general and low social class, maternal psychopathology, and family conflict in particular increased the risk for ADHD and associated morbidity independently of gender and other risk factors, but gender modified the risk for adverse cognitive and interpersonal outcomes; boys were more vulnerable to the disorder than girls. Because of the difficulties in separating the effects of genetics from environment, these results must be interpreted as provisional until confirmation from twin and adoption studies.

Adolescent↗

PubMed1981

Left ventricular size and function after subcutaneous administration of terbutaline.

To assess the response of the left ventricle to subcutaneously administered terbutaline sulfate, a proposed beta-2 selective agonist, we evaluated 12 patients who had suffered previous myocardial infarctions using equilibrium radionuclide angiography. Six patients (group 1) had normal global left ventricular ejection fraction at rest less than 0.49). All patients had a marked decline in end-diastolic volume and end-systolic volume with a significant (P less than 0.01) increase in ejection fraction after terbutaline injection. Cardiac output increased 30 percent in group 2 patients because of an increase in stroke volume, with little change in heart rate (plus or minus 3.1 beats per minute, P equals NS). Cardiac output increased 7 percent in the patients in groups 1, due primarily to an increase in heart rate in 7 beats per minute (+9 percent) with little change in stoke volume. Systemic vascular resistance decreased significantly more in the patients with compensated heart failure than the subjects in group 1 (342 plus or minus 84 vs 90 plus or minus 35 dynes-sec cm(-5), P less than 0.05). We conclude that terbutaline exerts its most beneficial effect on the left ventricle in patients with depressed resting global function, and may prove to be a useful agent in the treatment of congestive heart failure.

Aged↗

PubMed1993

Cost effectiveness of clozapine in neuroleptic-resistant schizophrenia.

OBJECTIVE: The goal of this study was to determine whether clozapine is a cost-effective treatment for treatment-resistant schizophrenia. METHOD: Data were collected on 96 treatment-resistant patients with schizophrenia for 2 years before they entered a clozapine treatment study and for at least 2 years after they entered the study. Information about the cost of inpatient and outpatient treatment, housing costs, other costs, and family burden through direct interview or questionnaire of these patients and their families were available for 47 of the 96 patients. Data on lost income and Social Security disability insurance were also obtained. Outcome measures included psychopathology, quality of life, global functioning, work function, and rehospitalization. RESULTS: The cost of treatment was significantly decreased in the patients who continued clozapine treatment for at least 2 years. This was primarily due to a dramatic decrease in the frequency and cost of rehospitalization. Costs were nonsignificantly lower in patients who dropped out of treatment. The estimated total 2-year cost for the 59 patients who continued clozapine treatment, the 34 patients who dropped out, and the three who interrupted treatment decreased from $7,390,206 to $5,719,463, a savings of $8,702/year per patient. There was a decrease in total costs of $22,936/year for the 37 patients who continued clozapine treatment for whom cost data were available. There were no significant changes in lost income or Social Security disability insurance payments in either group. Clozapine produced a marked improvement in Brief Psychiatric Rating Scale total scores as well as positive negative symptom scores, Global Assessment Scale scores, Quality of Life Scale scores, work functioning, capacity for independent living, and rehospitalization rates. CONCLUSIONS: Clozapine is a cost-effective treatment for treatment-resistant schizophrenic patients. Cost savings result almost exclusively from the reduced cost of hospitalization.

Adult↗

PubMed1984

Predictors of outcome at two years in patients with rheumatoid arthritis.

The prognostic value of clinical and laboratory measures in 72 patients with rheumatoid arthritis (RA), seen initially within 18 months of disease onset, in predicting function outcome after a further two years was assessed. Limitation of wrist extension was associated with a slow disease onset, a high articular index and a high latex titre. A reduction in global functional capacity, as measured by the Stanford Health Assessment Questionnaire, was associated with a high initial articular index and a high latex titre. Neither outcome was associated with the initial level of acute phase reactants nor with patient or physician's initial assessment of disease activity. It is concluded, first, that factors predicting early disability outcome in RA are not identical to those associated with continuing disease activity; and secondly, that patients' and physicians' judgment of disease activity at diagnosis do not carry any prognostic value for functional outcome two years later.

Adult↗

PubMed1988

[Interobserver comparison of quantitative analysis of local wall function of the left ventricle in stress cineventriculography].

During diagnostic heart catheterization biplane cineventriculograms of 46 patients at rest and directly after bicycle ergometry (72.8 +/- 27.8 W) were performed. The aim of the study was to determine the value of local wall motion analysis under physical exercise. Therefore two observers independently analyzed global and local left ventricular parameters. 38 patients had coronary artery disease, 23 with a history of myocardial infarction. Enddiastolic (EDV) and endsystolic volume (ESV) were evaluated and ejection fraction (EF) was calculated. Local wall motion was analyzed using a radial model with 60 radii in the 30 degrees RAO- and 60 degrees LAO-Projektion. A systolic segmental shortening was determined for the anterobasal (AB), anterolateral (AL), apical (AP), diaphragmatic (DP), posterobasal (PB) (30 degrees-RAO), septal (SE) and posterolateral (PL) area (60 degrees-LAO). Global functional parameters (EDV, ESV, EF) revealed good correlations between both observers with correlation coefficients (r) varying from 0.83 to 0.92. Local wall motion had sufficient correlations (r) at rest and during exercise (data in brackets) in the RAO-projektion: AB: 0.88 (0.73), AL: 0.69 (0.72), AP: 0.82 (0.78), DP: 0.77 (0.75), PB: 0.78 (0.78) and in the septal segment (LAO-projection): 0.69 (0.71). Less sufficient correlations were found in the posterolateral segment (LAO, especially at rest: 0.50 (0.69). Thus, global ventricular parameters can be determined at rest and during exercise independently of the observer. Local wall motion, too, can be quantified with sufficient accuracy with exception of the posterolateral area in the LAO-projektion.

Cardiac Output↗