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PubMed1975

[Pulmoscintigraphic long-term observations during postoperative irradiation of the mammary region (author's transl)].

The effect of ionizing rays on the pulmonary tissue during postoperative high-voltage therapy of breast cancer was investigated by a long-term study with the help of X-rays and nuclear techniques. The results prove that--in spite of optimal irradiation techniques--a local reduction of the pulmonary perfusion takes place as well as a shift of the cardiac output into other pulmonary areas, which are not exposed to the irradiation. Hereby, the pulmonary global function shows no significant change, as other authors have already pointed out. Likewise, no alteration was seen of the simple X-ray film after the use of this irradiation technique. In the pulmonary scintigram, however, a local reduction of the pulmonary perfusion was already seen after the application of 1500 rd, which increased still more in the posttherapeutic period. There were no signs of relapses within the observation period of more than 17 months.

Breast Neoplasms↗

PubMed1994

Cognitive behavior therapy for treatment-refractory panic disorder.

BACKGROUND: The purpose of this pilot study is to assess the efficacy of cognitive behavior therapy for the treatment of patients with panic disorder who experience an incomplete response to a trial of pharmacotherapy. METHOD: Fifteen consecutive patients with a DSM-III-R diagnosis of panic disorder referred for further treatment because of an incomplete response to pharmacotherapy were treated with 12-weeks of group cognitive behavior therapy. Patients were evaluated at baseline, endpoint, and at a mean of 2-months' follow-up to assess changes in panic attack frequency and global outcome. Eight of the 15 patients were deemed to have received an inadequate prior trial of medication at baseline, mainly because of a desire to control their symptoms without medication or fear of withdrawal and/or addiction. Seven of the patients were symptomatic at baseline despite an adequate prior trial of medication. RESULTS: Overall, patients experienced a significant improvement in global function at the end of the cognitive behavior therapy intervention, as well as a decrease in panic attack frequency. Improvement was maintained at follow-up. CONCLUSION: This study is consistent with a growing body of evidence that many patients with panic disorder remain symptomatic over time and are receiving inadequate pharmacotherapeutic treatment. Further, we observed that patients with panic disorder who are incompletely responsive or resistant to pharmacotherapeutic management may benefit from the addition of cognitive behavior therapy.

Adult↗

PubMed1994

Iodine-131-MIBG imaging to monitor chemotherapy response in advanced neuroblastoma: comparison with laboratory analysis.

UNLABELLED: The rationale of this study was the evaluation of response to chemotherapy in children with advanced neuroblastoma using currently available diagnostic modalities. METHODS: Iodine-131-metaiodobenzylguanidine (MIBG) imaging and 24-hr urinary vanillylmandelic acid (VMA) measurement were evaluated in 14 patients (7 males, 7 females, age range: 2-68 mo) with advanced neuroblastoma both pre- and postchemotherapy (5.6 +/- 2.8 mo) as well as serum ferritin (FER) and neuron-specific enolase (NSE) levels in 9 and 8 patients, respectively. MIBG images were qualitatively compared in each patient. RESULTS: Prechemotherapy, a total of 39 abnormal foci of MIBG uptake was detected. Postchemotherapy, 15 of these showed unchanged MIBG uptake, 7 had decreased uptake and 17 showed no uptake. In addition, four new abnormal foci of uptake were found. Postchemotherapy, a significant reduction of abnormal MIBG uptake (p < 0.01) was observed using a lesion-by-lesion analysis. When biochemical and MIBG postchemotherapy changes were compared, a significant relationship was found only between MIBG and VMA results (r = 0.84, p < 0.01). CONCLUSIONS: In postchemotherapy follow-up of children with advanced neuroblastoma, laboratory evaluation using VMA, FER and NSE measurements reflect only the global functional status of the disease, and are not helpful in defining the response of individual tumor lesions to treatment. Conversely, qualitative analysis using MIBG imaging may allow lesion-by-lesion evaluation of the heterogeneity of neuroblastoma response to chemotherapy. In this setting, changes in MIBG uptake are mirrored by the changes in catecholamine production, as measured by VMA levels.

3-Iodobenzylguanidine↗

PubMed1994

[Critical evaluation of phytothermotherapy ("hay baths") in degenerative arthropathies].

It is a traditional practice of the Alpine region of Trentino and Alto Adige to use phytothermotherapeutic treatment with fermenting grass ("hay baths") for chronic degenerative arthropathies. A marked lack of clinical validation is however to be found in current literature as to its efficacy and tolerability. To verify these two aspects 27 patients (mean age 59 +/- 8.7 years, range 43-82) with osteoarthritis (15 of them with a generalized form) were evaluated before and after a ten-day treatment with immersion of the whole body in a bed made with fermenting grass according to the traditional method. The following clinical features were considered: pain in affected joints evaluated by visual analog scale, presence of global subjective improvement (or lack of it) immediately and 6 months after treatment, degree of global functional impairment, stiffness duration, handgrip strength. The mean score at the affected joints (on the visual analog pain scale) was 2.51 +/- 0.71 before and 1.83 +/- 0.89 after treatment (p < 0.001), with improvement in 68% of patients. Morning stiffness was reduced from 38.9 +/- 30.5 to 17.5 +/- 17.2 minutes (p < 0.05), with improvement in 57% of patients. Grip strength measure went from 136 +/- 59.7 to 147 +/- 51 mmHg (p < 0.01), with improvement in 77% of patients. Forty-eight percent of the patients were reassigned to better class of functional capacity (p < 0.001). Patient general assessment signaled improvement in 72% of cases immediately after treatment, and in 80% after six months. Tolerability was high in 23 out of 25 patients, nobody was taken off treatment because of side effects, in two cases a one day interval due to asthenia was introduced. In conclusion, improvement rates were found higher when compared with controlled trials on efficacy of nonsteroidal antiinflammatory drugs. Noteworthy is also the persistence of improvement 6 months after treatment compared to the above mentioned drugs and usual physiokinesitherapeutic treatments.

Adult↗

PubMedDate not supplied

Mental deterioration in old age: results of two multicenter, clinical trials with nimodipine. The Nimodipine Study Group.

The efficacy and tolerability of nimodipine, a calcium antagonist selective for the central nervous system, was evaluated in old age dementias in two multicenter, clinical trials. A total of 755 elderly patients suffering from mental deterioration of degenerative or vascular origin were enrolled in the studies. In the first study, 352 patients received nimodipine 30 mg TID orally for 3 months; in the second study, 403 patients received the same treatment for 6 months. In both studies, psychobehavioral instruments showed a highly significant improvement of the global functional state. In hypertensive patients, nimodipine had a synergistic effect with the antihypertensive drugs. These results confirm the therapeutic efficacy and safety of nimodipine in the treatment of old age dementias.

Activities of Daily Living↗

PubMedDate not supplied

[Prevalence of obsessive-compulsive disorders in a large French patient population in psychiatric consultation].

Recent epidemiologic studies were conducted in general population, showing high rate prevalence of obsessive-compulsive disorder (OCD) (2-3%). Although more investigation of OCD prevalence in clinical population is still warranted. The prevalence of DSM III-R diagnosis of OCD and obsessive-compulsive syndromes (OCS) is reported in 4 364, 16-70 year old new consecutive patients, consulting in out-patient psychiatry. Point prevalence rates of 9.2% were recorded for OCD and 17% for OCS. Significantly different from non obsessional patients, it was observed in OCD and OCS patients more male representation (41% vs 37%, p = 0.007), a younger current age (36 y vs 39 y, p < 10(-4)) and age of disorder onset, higher rate of celibat (31.5% vs 28.6%) and lesser of separated or widowed (9.4% vs 16.2%, p = 0.003), more anxiety and depression comorbidity (50% vs 39%, p < 10(-4), a higher suicidal risk (17% vs 14%, p = 0.04--especially in OCS patients: 18.3%), more chronicity (mean current episode duration: 14.8 months vs 11.2 m., p < 10(-4)) and higher rate of global functioning impairment (score at GAF: 53.9 vs 57.9, p < 10(-4)). The results of the french survey confirmed the high prevalence of OCD and OCS in patients seeking psychiatric treatment. OCS (or subclinical OCD) seem to form a valid group (high rates of comorbidity and suicidal attempts) which need to be recognized and to receive adequate treatment.

Adolescent↗

PubMed1997

Sustained right ventricular dyskinesis complicated by right ventricular infarction.

We encountered a 66-yr-old man with acute left inferior and right ventricular infarction. Tomographic radionuclide ventriculography and Fourier analysis clearly demonstrated reduced wall motion in the inferior walls of both ventricles and markedly delayed phase angles in the inferior right ventricular segment, indicating dyskinesis, which was confirmed by two-dimensional echocardiography and contrast right ventriculography. Four years later, right ventricular dyskinesis was still present and corresponded to a right ventricular perfusion defect on 99mTc-labeled tetrofosmin tomogram. Right ventricular imaging with tomographic radionuclide ventriculography with Fourier analysis and 99mTc-labeled myocardial tomography demonstrates that, even after improved global function and hemodynamics, right ventricular dyskinesis related to right ventricular perfusion defect can be sustained for several years. Thus, these imaging techniques may contribute to diagnosing right ventricular infarction and investigating the pathophysiology.

Aged↗

PubMedDate not supplied

Metrifonate: overview of safety and efficacy.

Metrifonate is a cholinesterase inhibitor with a long-lasting inhibition that raises brain acetylcholine levels. It is well-absorbed and has limited binding to serum proteins. In preliminary studies of its utility in the treatment of Alzheimer disease's (AD), it led to improvements of cognition or reduced the rate of decline of cognition compared with placebo. It also benefited the global function of these patients. Side effects include nausea, cramping, and diarrhea. Metrifonate has promise as a well-tolerated treatment of the symptoms of AD.

Acetylcholine↗

PubMed1998

Evaluating response to metrifonate.

Metrifonate, administered orally to patients with probable Alzheimer's disease in a once-daily dose, readily enters the brain and inhibits brain acetylcholinesterase (AChE) activity in a dose-dependent fashion. Metrifonate is a prodrug, converted non-enzymatically to 2,2-dichlorovinyl dimethyl phosphate, a long-acting inhibitor of AChE that produces stable enzyme inhibition over time. In combination, these pharmacologic characteristics lead to a reduced side effect profile in comparison with several other cholinesterase inhibitors. Both preliminary and confirmatory pivotal studies have shown that significant cognitive improvement is achieved with this medication in comparison with placebo in patients with probable Alzheimer's disease. Moreover, these studies also have demonstrated that metrifonate benefits the global function--a measure comprising domains of cognition, function, activities of daily living, and behavior--of patients with Alzheimer's disease. The medication is generally well tolerated, and no significant laboratory abnormalities occur. Therefore, metrifonate is a useful treatment for the symptoms of Alzheimer's disease.

Administration, Oral↗

PubMed1998

[Antegrade or retrograde intramedullary nailing in diaphyseal or sub-capital humeral fractures in the adult].

The aim of this retrospective study was the evaluation of three current medullary nailing techniques and their approach related problems in diaphyseal and proximal humeral fractures. 28 patients (15 female, mean age 65 y; 13 male, mean age 53 y) with either diaphyseal (n = 22) or proximal humeral (n = 6) fractures treated with different nailing systems were reviewed (mean follow up 18.3 months). Two main groups were formed according to the surgical approach: an anterograde nailing group (AN), stabilized with Seidel (Howmedica) nails (n = 12) versus a retrograde nailing group (RN) with either Prévot (Landos) nails (n = 7) or Hackethal (Ulrich) nails (n = 9). The two groups were comparable regarding to age, follow up and fracture type. The subjective scores (global function, all day activity, pain, ROM) of the two groups (AN and RN) showed no statistically significant differences. Subacromial impingement led to reoperation in 50% (6/12) of the AN patients (Seidel nail). In 3/16 patients a reoperation was necessary due to secondary proximal or distal nail migration (Hackethal or Prévot nails). Delayed union was found either in one. Seidel or one Prévot nailed humerus. No postoperative infections or neurological problems (3 preoperative radial palsies recovered) due to the operative pro cedure were seen. The AN related subacromial impingement seems to be more disabling than RN related reduction of elbow function (extension deficit).

Adult↗

PubMedDate not supplied

Parkinson Psychosis Rating Scale: a practical instrument for grading psychosis in Parkinson's disease.

The Parkinson Psychosis Rating Scale (PPRS) was designed to assess the severity of specific symptoms of levodopa-induced psychosis in patients with Parkinson's disease. The scale is administered by the clinician and consists of six items, each rated from 1 (no symptoms) to 4 (extreme symptoms); total score ranges from 6-24 points. To test its reliability, validity, and stability, the authors administered the PPRS to 29 patients with parkinsonian psychosis before and after a 6-week course of treatment with the 5HT3 antagonist ondansetron. Each patient and their caregivers were interviewed by three raters. Results were compared with two other available psychotic symptom scales and one cognitive scale given to the same patients. It was found that the interrater reliability for the total PPRS scores and for each of the individual items was high (Spearman's rho = 0.80-0.99). A significant reduction in PPRS scores was obtained after ondansetron administration, concomitant with a decrease in the Global Functional Impairment score, which was assessed by the family. The changes in PPRS scores occurred irrespective of cognitive dysfunction, as measured by the Minimental State Examination. It appears that the PPRS is a relevant, reliable, valid, and easily-administered instrument for measuring the severity of parkinsonian psychosis. Further studies are needed to evaluate its utility in other organic psychoses and in the assessment of additional pharmacologic treatments for levodopa-induced psychosis.

Aged↗

PubMed1981

Effects of isolated interventricular septal ischemia on global and segmental function of the canine right and left ventricle.

The effects of isolated septal artery ligation wee studied in 17 dogs. Contraction of the interventricular septum (IVS) and the free walls of both ventricles was measured by implanting ultrasonic crystals. Global ventricular function was assessed by Starling function curves. Following septal artery ligation, IVS shortening was immediately replaced by systolic lengthening. Thirty minutes after septal artery ligation, the right ventricular (RV) stroke work (SW) was significantly depressed at end-diastolic pressure (EDP) of 8 and 8.5 mm Hg from control values of 7.6 +/- 0.4 and 8.6 +/- 0.6 gmM to 6.7 +/- 0.4 and 7.4 +/- 0.5gmM respectively. However, LVSW after septal artery ligation was similar to control values for EDP from 5 to 19 mm Hg. These changes were associated with unchanged RV free wall movement of 21 +/- 3% in the inflow region and 23 +/- 5% in the outflow region. LV free wall systolic shortening following septal artery ligation increased by 16 +/- 3%. It is concluded that canine septal artery ligation causes global dysfunction of the RV but not of the LV.

Animals↗

PubMed2006

Global organization and function of mammalian cytosolic proteasome pools: Implications for PA28 and 19S regulatory complexes.

Proteolytic activity of the 20S proteasome is regulated by activators that govern substrate movement into and out of the catalytic chamber. However, the physiological relationship between activators, and hence the relative role of different proteasome species, remains poorly understood. To address this problem, we characterized the total pool of cytosolic proteasomes in intact and functional form using a single-step method that bypasses the need for antibodies, proteasome modification, or column purification. Two-dimensional Blue Native(BN)/SDS-PAGE and tandem mass spectrometry simultaneously identified six native proteasome populations in untreated cytosol: 20S, singly and doubly PA28-capped, singly 19S-capped, hybrid, and doubly 19S-capped proteasomes. All proteasome species were highly dynamic as evidenced by recruitment and exchange of regulatory caps. In particular, proteasome inhibition with MG132 markedly stimulated PA28 binding to exposed 20S alpha-subunits and generated doubly PA28-capped and hybrid proteasomes. PA28 recruitment virtually eliminated free 20S particles and was blocked by ATP depletion. Moreover, inhibited proteasomes remained stably associated with distinct cohorts of partially degraded fragments derived from cytosolic and ER substrates. These data establish a versatile platform for analyzing substrate-specific proteasome function and indicate that PA28 and 19S activators cooperatively regulate global protein turnover while functioning at different stages of the degradation cycle.

Animals↗

PubMed2006

Quantification of global left ventricular function: comparison of multidetector computed tomography and magnetic resonance imaging. a meta-analysis and review of the current literature.

Cardiac morbidity and mortality are closely related to cardiac volumes and global left ventricular (LV) function, expressed as left ventricular ejection fraction. Accurate assessment of these parameters is required for the prediction of prognosis in individual patients as well as in entire cohorts. The current standard of reference for left ventricular function is analysis by short-axis magnetic resonance imaging. In recent years, major extensive technological improvements have been achieved in computed tomography. The most marked development has been the introduction of the multidetector CT (MDCT), which has significantly improved temporal and spatial resolutions. In order to assess the current status of MDCT for analysis of LV function, the current available literature on this subject was reviewed. The data presented in this review indicate that the global left ventricular functional parameters measured by contemporary multi-detector row systems combined with adequate reconstruction algorithms and post-processing tools show a narrow diagnostic window and are interchangeable with those obtained by MRI.

Humans↗

PubMed2004

Comparison of left ventricular-biventricular pacing on ventricular synchrony, mitral regurgitation, and global left ventricular function in patients with severe chronic heart failure.

We compared the effects of left ventricular and biventricular pacing in 16 patients (15 men and 1 woman; aged 64 +/- 8 years) with severe heart failure by conventional and tissue Doppler echocardiography. Intraventricular synchrony, regional and global systolic function, diastolic function and filling time, and the severity of secondary mitral regurgitation were similar between left ventricular and biventricular pacing.

Aged↗

PubMed1994

Axis V--Global Assessment of Functioning Scale. Evaluation of a self-report version.

The present study examines a self-report version of the Global Assessment of Functioning Scale according to Axis V (GAF self-report). The sample (n = 73) was a psychiatric outpatient population from a catchment area clinic. Patients with psychotic and organic mental disorders were not included. The diagnostic distribution on Axis I was similar to the findings from previous studies. Axis II disorders were identified among 47%, of whom a majority also had a concomitant Axis I disorder. The mean GAF expert score was 66.5 (range: 48-86). High complexity and severity of disorders and a high number of fulfilled Axis II criteria were significantly associated with low GAF scores. Independent expert ratings on GAF were correlated with the GAF self-report overall at r = 0.62, varying from 0.45 to 0.91 between different diagnostic groups. In general, the patients scored themselves lower (mean: -4.4 units) than expert ratings. Patients with depressive symptoms from an adjustment disorder or mood disorder were most prone to underestimation. Women also tended to score themselves lower than experts did. Conclusively, the GAF self-report turned out to be a valid and reliable unidimensional instrument measuring psychological, social and occupational functioning. The GAF is easy to handle, and with a self-report version as a complement, Axis V could be more frequently used in future clinical practice and research.

Activities of Daily Living↗

PubMed2006

Left ventricular morphology, global and longitudinal function in normal older individuals: a cardiac magnetic resonance study.

BACKGROUND: The heart transforms structurally and functionally with age but the nature and magnitude of reported changes appear inconsistent. This study was designed to assess left ventricular (LV) morphology, global and longitudinal function in healthy older men and women using cardiac magnetic resonance (CMR). METHODS: Ninety-five healthy subjects (age 62+/-16 years, range 22-91 years) underwent breath-hold cine CMR. LV end-diastolic volume (EDV), end-systolic volume (ESV), myocardial mass, ejection fraction (EF), mass-to-volume ratio, mean midventricular wall motion, thickness and thickening were calculated from short-axis data sets. Average mitral annular displacement was measured to assess longitudinal LV function. RESULTS: Subjects were divided according to age (< 65 and > or = 65 years) and sex. EDV and ESV indices (corrected for body surface area) decreased whilst EF increased with age. There was no difference in LV myocardial mass index between the age groups, but midventricular wall thickness was significantly higher in older people. Mass-to-volume ratio also increased with age. In contrast to EF, mitral annular displacement declined with age. Midventricular LV wall thickness, myocardial mass index and mass-to-volume ratio were higher in men than in women but there were no differences in measures of global and longitudinal LV systolic function. CONCLUSIONS: Due to smaller LV volumes but higher wall thickness, myocardial mass remains unchanged with age. We have found an age-related increase in EF and reduction in longitudinal LV function in apparently normal subjects. This must be borne in mind when assessing older patients with possible heart failure and normal LV systolic function. Men have higher myocardial mass than women.

Adult↗

PubMed2005

Relationship between the Global Assessment of Functioning and other DSM axes in routine clinical work.

OBJECTIVES: The aim of this study was to investigate the validity of the Global Assessment of Functioning (GAF) when routinely used in clinical work by focusing on the relations between the GAF, other axes in the DSM system, and some demographic variables conceptually derived on theoretical and clinical grounds. METHODS: A clinical database containing data for 5,538 patients assessed by 181 raters as a part of routine practice in psychiatric outpatient settings in Sweden was used. A hierarchical linear regression model and a variance component model were used to analyze the data. Regression models were also used to determine how the relation between the GAF and axis I depends on the selection of diagnostic groups in the sample. RESULTS: Seventeen percent of the systematic variance in GAF scores was explained by diagnostic differences as defined on DSM-IV axis I, and 5.1 percent was explained by psychosocial and environmental problems as measured on DSM-IV axis IV. Unexpectedly, the site of the investigation explained another 3.6 percent of the variance. CONCLUSIONS: The GAF can be used as a comprehensive measure of global mental health in routine clinical work for assessment and for outcome management.

Adolescent↗