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PubMed2004

Myocardial wall thickness predicts recovery of contractile function after primary coronary intervention for acute myocardial infarction.

OBJECTIVES: We sought to determine whether end-diastolic wall thickness (EDWT) can predict recovery of regional left ventricular contractile function after percutaneous coronary intervention (PCI). BACKGROUND: Regional contractile function does not recover in all patients after PCI for acute myocardial infarction (AMI). Prediction of functional recovery after AMI may help in clinical decision making. METHODS: Forty consecutive patients with AMI were studied with left ventricular contrast echocardiography for accurate wall thickness and function measurement and myocardial perfusion immediately after and two months following PCI. RESULTS: Out of 640 segments, 175 (27%) dysfunctional segments in the infarct territory were analyzed for EDWT, wall function, and perfusion. One hundred and three (59%) dysfunctional segments presented with an EDWT <11 mm and 72 (41%) presented with an EDWT > or =11 mm. Perfusion (partial or complete) was present in 63 segments with an EDWT <11 mm (61%) and 71 segments with an EDWT > or =11 mm (99%) (p < 0.001). At two months' follow-up, 66 of 72 segments with an EDWT > or =11 mm (92%) improved, whereas only 35 of 103 of the dysfunctional segments with an EDWT <11 mm (34%) improved (p < 0.0001). CONCLUSIONS: Wall thickness is an easy parameter to predict recovery of function after revascularization. Moreover, combining EDWT and perfusion, segments with an EDWT > or =11 mm, and presence of perfusion have the highest chance of recovery; segments with an EDWT <11 mm and perfusion have an intermediate chance of recovery. In segments with an EDWT <11 mm and no perfusion, chances of recovery are very low.

Adult↗

PubMed2005

Myocardial expression of fas and recovery of left ventricular function in patients with recent-onset cardiomyopathy.

OBJECTIVES: This study aimed to evaluate the role of gene expression for predicting myocardial recovery in recent-onset cardiomyopathy. BACKGROUND: Apoptosis may limit ventricular recovery. We examined the myocardial expression of Fas, Fas ligand (FasL), tumor necrosis factor (TNF)-alpha, and TNF receptor 1 (TNFR1), and myocardial recovery in patients from the multicenter Intervention in Myocarditis and Acute Cardiomyopathy (IMAC) study. METHODS: Endomyocardial biopsy samples were obtained in 20 patients with recent-onset (<6 months) idiopathic dilated cardiomyopathy (left ventricular ejection fraction [LVEF] < or =0.40). The LVEF was assessed at baseline and at 6 and 12 months by nuclear scans. Myocardial expression was assessed by ribonuclease (RNase) protection, normalized to a constitutively active gene (glyceraldehydes 3-phosphate dehydrogenase [GAPDH]) and reported as percent GAPDH expression. The change in LVEF at 6 and 12 months was compared by tertiles of expression. RESULTS: For all patients (14 men, 6 women; age 46.5 +/- 10.7 years), the mean LVEF was 0.28 +/- 0.05 at baseline and 0.40 +/- 0.14 at six months. Patients in the highest tertile of Fas expression had minimal improvement at six months (DeltaEF = 0.03 +/- 0.05) when compared with the intermediate (DeltaEF = 0.10 +/- 0.13) and lowest tertiles (DeltaEF = 0.21 +/- 0.11, change in LVEF by tertile, p = 0.006). A similar relationship was seen with TNFR1 expression (highest tertile, DeltaEF = 0.06 +/- 0.07; lowest tertile, DeltaEF = 0.21 +/- 0.11, p = 0.02). In contrast with Fas and TNFR1, expression of TNF-alpha and FasL did not predict recovery of LV function. CONCLUSIONS: In cardiomyopathy of recent onset, increased expression of Fas and TNFR1 was associated with minimal recovery of LV function. Apoptosis limits myocardial recovery, and represents a potential target for therapeutic intervention.

Adult↗

PubMed2006

Predictive role of single diseases and their combination on recovery of balance and gait in disabled elderly patients.

OBJECTIVES: In the elderly population, chronic diseases are common determinants of mobility limitations and comorbidity consistently shows a strong association with functional status. This study was designed to evaluate the role of single chronic diseases and of their combination on functional recovery after rehabilitative treatment in disabled elderly patients. DESIGN: With respect to the difference in magnitude of their disabling effect, diseases were classified into 2 groups: "more disabling" diseases (COPD, heart failure, peripheral artery diseases, diabetes, and not life-threatening cancer) and "less disabling" diseases (anemia, kidney, gastrointestinal, and liver diseases). SETTING: 35-bed Geriatric Evaluation and Rehabilitation Unit. PARTICIPANTS: We studied 710 patients (age 77.8 +/- 7.4 years, 76.2% females), consecutively admitted for stroke, Parkinson's disease, and osteoarthritis. MEASUREMENTS: A multidimensional evaluation for mobility (Tinetti-score), cognitive status (MMSE), and somatic health (Greenfield's Individual Disease Severity Index-IDS, Burden of diseases-BoD) was performed. Functional recovery was decided based on the Delta-Tinetti, which is the difference of the values between admission and discharge. RESULTS: We tested, in a multivariate regression model, the predictive role of single chronic conditions and of their combinations on functional recovery, after having adjusted for which diseases are direct causes of disability (stroke, Parkinson's disease, and osteoarthritis) and other potential predictors (age, sex, cognitive function, depressive symptoms, albumin, and c-reactive protein). A negative prediction of functional recovery was expressed by the "more disabling" diseases group. The determinants of poor recovery were characterized by the combination of "more disabling diseases" rather than single condition effects, independently by age, cognitive, and functional status on admission. CONCLUSION: Our study adds a new perspective about the role of COPD, heart failure, peripheral artery diseases, diabetes and not life-threatening cancer on functional recovery, emphasizing their combined impact in elderly people.

Activities of Daily Living↗

PubMed2005

Recovery and cognitive function after fentanyl or remifentanil administration for carotid endarterectomy.

STUDY OBJECTIVE: To compare recovery and restoration of cognitive function after fentanyl-propofol or remifentanil-propofol anesthesia administration in patients undergoing carotid endarterectomy. DESIGN: Randomized, double-blind, prospective study. SETTING: Department of Anesthesiology, University hospital. PATIENTS: Seventy patients with ASA physical statuses II and III (53 men and 17 women) undergoing elective carotid endarterectomy. INTERVENTIONS: Anesthetic technique and drugs were identical in the 2 groups, with the exception of remifentanil and fentanyl administration. Induction of anesthesia was obtained with a bolus dose of propofol (1-2 mg/kg), maintenance was achieved with a propofol infusion according to hemodynamics and nitrous oxide/oxygen (FIO(2), 0.50). Muscle relaxation was achieved with rocuronium. The remifentanil group received 1 microg/kg of remifentanil as a single dose during the induction of anesthesia and 0.5 microg/kg per minute as an infusion throughout the procedure. The fentanyl group received 2 microg/kg of fentanyl as a single dose during the induction of anesthesia. MEASUREMENTS: Intraoperative hemodynamic adverse events were recorded. All patients were also evaluated with regard to their recovery and the restoration of their cognitive function, recording the immediate recovery times and using the Aldrete score 15 and 60 minutes after surgery and the Hasegawa scale 6 hours after surgery. For evaluation of postoperative pain, the Numeric Pain Scale (0-10) was used. MAIN RESULTS: Patients receiving remifentanil had significantly (P < .05) fewer episodes of intraoperative hypertension and needed nitroglycerine administration less frequently (P < .05) than those receiving fentanyl. Immediate recovery was significantly earlier (P < .05) with remifentanil (eye opening, 5.1 +/- 1.3 [remifentanil] and 7.2 +/- 3.7 [fentanyl] minutes; extubation time, 5.4 +/- 1.9 [remifentanil] and 7.8 +/- 4.1 [fentanyl] minutes). The Hasegawa Dementia Scale scores 6 hours after surgery and Aldrete scores 15 and 60 minutes after surgery did not differ significantly between the 2 groups. Pain levels were also similar for patients taking remifentanil and fentanyl. CONCLUSIONS: Although intraoperative hemodynamics were better preserved and immediate recovery was more rapid with remifentanil, overall postoperative recovery and restoration of cognitive functions as well as postoperative pain intensity seem to be similar for patients receiving remifentanil and for those receiving fentanyl combined with propofol for carotid endarterectomy operations.

Aged↗

PubMed2005

"Roadblocks" revisited: neural change, stuttering treatment, and recovery from stuttering.

UNLABELLED: In light of emerging findings concerning untreated recovery and neural plasticity, this paper re-examines the viability of an NIH conference recommendation [Cooper, J. A. (1990). Research directions in stuttering: Consensus and conflict. In Cooper, J. A. (Ed.), Research needs in stuttering: Roadblocks and future directions (pp. 98-100). Rockville, MD: American Speech-Language-Hearing Association.] that adults who have recovered from stuttering might inform our understanding of the nature and treatment of persistent stuttering. It is suggested that those who have recovered could constitute a behavioral, cognitive, and neurophysiologic benchmark for evaluating stuttering treatment for adolescents and adults, while helping to identify the limits of recovery from a persistent disorder. This possibility seems especially promising because of findings from recent studies investigating untreated recovery during childhood and adulthood, the emerging evidence concerning neural plasticity and reorganization, and reports of neural system changes during stuttering treatment. Potential obstacles to applying findings from unassisted recovery to treatment do exist, but the benefits of attempts to fully understand stuttering certainly outweigh the difficulties. EDUCATIONAL OBJECTIVES: After completing this activity, the learner will be able to: (1) describe two complexities involved in determining whether recovery from stuttering was assisted or unassisted; (2) discuss the implications for stuttering research of two neural plasticity research findings from areas other than stuttering; and (3) evaluate the possible implications for stuttering treatment of a coordinated research program that addresses behavioral, cognitive, and neurological characteristics of assisted and unassisted recovery from stuttering.

Adolescent↗

PubMed2004

Perceptions of recovery and satisfaction in the short term after orthognathic surgery.

PURPOSE: A 2-arm, parallel-group, stratified-block, randomized clinical trial was designed to assess whether patients' perceptions of recovery and satisfaction 4 to 6 weeks after surgery were affected by 3 factors: preparation strategy (viewing a visual treatment simulation), attitudes (expectations about recovery), and psychologic distress (reported before surgery). PATIENTS AND METHODS: One hundred eighty-four patients with a dentofacial disharmony scheduled for orthognathic surgery were randomly assigned to 1 of 2 preparation strategy groups: a standard presurgical consultation with or without a computerized treatment simulation presentation. Psychologic well-being and expectations regarding recovery were obtained before surgery and perceptions of recovery, and satisfaction were assessed for 126 patients at 4 to 6 weeks after surgery. RESULTS: Viewing a treatment simulation before surgery did not affect patients' perceptions of postsurgical discomfort or satisfaction at 4 to 6 weeks after surgery. Patients who overestimated the discomfort or problems they would experience reported significantly lower average level of problems than those who did not overestimate. Patients who were psychologically distressed before surgery reported, on average, significantly more discomfort or difficulty with symptoms, social/self-concerns, general health, and overall recovery after surgery. CONCLUSION: Viewing a treatment simulation before surgery does not, on average, negatively affect perception of symptoms or satisfaction 4 to 6 weeks after surgery. Orthognathic surgery patients who are psychologically distressed before surgery tend to report a higher recovery burden overall and, on average, experience more difficulty with symptoms, social/self-concerns, and general health in the first 1 or 2 months after surgery.

Adolescent↗

PubMed2005

The impact of intravenous corticosteroids with third molar surgery in patients at high risk for delayed health-related quality of life and clinical recovery.

PURPOSE: To compare recovery for clinical and health-related quality of life (HRQOL) outcomes after third molar surgery in patients predicted to be at risk for delayed recovery, treated with or without intravenous (IV) corticosteroids at surgery. PATIENTS AND METHODS: Patients at least 18 years of age and with all 4 third molars below the occlusal plane were given IV corticosteroids just before third molar surgery. Clinical and HRQOL outcomes of these patients were compared with those of a nonconcurrent control group who did not receive corticosteroids. No antibiotics were administered. The control group was selected using the same criteria and treated under the same surgical protocol as the corticosteroid group. Differences between the groups were assessed with Cochran-Mantel-Haenszel row mean score statistics. RESULTS: Sixty patients were in each cohort. The incidence of delayed clinical recovery, a postsurgery visit with treatment, was higher in the control group compared with the corticosteroid group. In the corticosteroid group, 6 patients (10%) had 1 postsurgery visit with treatment. In the control group without corticosteroids, 17 patients (28%) had at least 1 postsurgery visit with treatment (P = .01). Compared with the control group, nausea tended to bother patients less on postsurgery day 1 (P = .07); sleep was improved on postsurgery days 1 through 4 (P < .05). Though not statistically significant, corticosteroids reduced the patients reported recovery by at least 1 day for pain, lifestyle, and oral function. CONCLUSION: Administration of IV corticosteroids before third molar surgery without antibiotics does not hamper clinical recovery even when healthy adult patients are predicted to have delayed recovery. Overall, IV corticosteroid administration had a limited, but beneficial effect on HRQOL outcomes.

Adrenal Cortex Hormones↗

PubMed2006

Synaptic plasticity modulates the spontaneous recovery of locomotion after spinal cord hemisection.

Several evidences have demonstrated that adult mammals could achieve a wide range of spontaneous sensory-motor recovery after spinal cord injury by means of various forms of neuroplasticity. In this study we evaluated the possibility that after low-thoracic spinal cord hemisection in the adult rat, significant hindlimb locomotor recovery could occur, and that this recovery may be driven, at least in part, by mechanisms of synaptic plasticity. In order to address these issues, we measured the expression levels of synapsin-I and brain-derived neurotrophic factor by Western blotting, at various time points after hemisection and correlated them with the motor performance on a grid walk test. Regression analysis showed that the expression of synapsin-I was strongly correlated with the spontaneous recovery of hindlimb locomotion (R=0.78). Conversely, neither the expression levels of synapsin-I nor the locomotor recovery were associated with the expression of brain-derived neurotrophic factor. Overall results indicate that after spinal cord hemisection, substantial recovery of hindlimb locomotion could occur spontaneously, and that synaptic plasticity within spinal circuitries below the level of the lesion, could be an important mechanism involved in these processes.

Analysis of Variance↗

PubMed1999

ST-segment elevation during dobutamine stress testing predicts functional recovery after acute myocardial infarction.

OBJECTIVES: The aims of this study were (1) to assess the relation between ST-segment elevation and wall motion response occurring during dobutamine testing and (2) to evaluate the usefulness of stress-induced ST-segment elevation for predicting functional recovery after acute myocardial infarction. BACKGROUND: Clinical significance of stress-induced ST-segment elevation after acute myocardial infarction remains controversial. According to previous studies, it may reflect a larger infarcted area, depressed left ventricular function, left ventricular aneurysm, stress-induced dyskinesia, residual myocardial ischemia, or viability in the affected region. Whether transient ST-segment elevation occurring during dobutamine testing may predict functional recovery is unknown. METHODS AND RESULTS: We studied 38 patients who underwent dobutamine stress testing early (5 +/- 2 days) after a first acute myocardial infarction. Dobutamine was infused at increasing doses from 5 to a maximum of 40 microg/kg per minute, with the addition of up to 1 mg of atropine if the target rate could not be reached by dobutamine alone. Twelve-lead electrocardiography and cross-sectional echocardiography were continuously monitored throughout the test. Dobutamine-induced ST-segment elevation was defined as a new or worsening >/=1 mm elevation, 80 ms after J point, in >/=2 infarct-related leads. Quantitative angiography was available in all patients before hospital discharge. Follow-up resting echocardiography was recorded in all patients 12 to 18 months after the acute event. ST-segment elevation was observed in 20 of the 38 patients. There were no significant differences between patients with and those without dobutamine-induced ST-segment elevation in age, site of infarction, peak level of total creatine kinase enzyme, and use of thrombolytic therapy, angioplasty, or both. Persistent akinesis without change during dobutamine stress testing was more frequently observed in patients without ST elevation (P <. 05). A biphasic response during dobutamine testing was more frequently observed in patients with ST-segment elevation (P =.01). Multivariate analysis selected 2 independent variables associated with ST-segment elevation: a biphasic response during dobutamine stress (chi-square = 7.3; P =.007) and the minimal lumen diameter of the infarct-related vessel at quantitative angiography (chi-square = 5.5; P <.02). Functional recovery was demonstrated in 26 patients. Sensitivity of ST-segment elevation for the prediction of functional recovery was 69%, specificity 83%, positive predictive value 90%, and accuracy 74%. Two independent variables predicting functional recovery were selected: dobutamine-induced ST-segment elevation (chi-square = 9.1; P =.003) and a biphasic response during stress (chi-square = 6.15; P =.013). CONCLUSIONS: Dobutamine-induced ST-segment elevation in the infarct-related leads is an ancillary sign of viable myocardium in jeopardy. It has a high specificity and an acceptable sensitivity for the prediction of functional recovery after acute myocardial infarction.

Adrenergic beta-Agonists↗

PubMed1999

Recovery of visual field function in the optic neuritis treatment trial.

PURPOSE: To assess the pattern of recovery of the visual field of patients with optic neuritis and to determine whether all affected portions of the visual field recover similarly or certain portions of the visual field have greater recovery. METHODS: We reviewed the Humphrey Visual Field (Allergan-Humphrey Inc, San Leandro, California) data from the initial and 6-month examination for the involved and fellow eyes of patients enrolled in the Optic Neuritis Treatment Trial (ONTT). The average threshold for each patient was calculated for the entire tested field and for locations within concentric rings having a radius 3, 9, 15, 21, and 27 degrees from fixation. The absolute amount of improvement and percentage improvement in average threshold between entry and the 6-month follow-up examination were determined for each patient. These measurements were compared within the concentric rings to assess patterns of recovery. RESULTS: Patients with localized defects recovered 86%+/-20% of their initial defect in average threshold, whereas those having diffuse defects recovered an average of 85%+/-23%. The area about fixation had the greatest relative recovery of threshold (87%+/-21% at 3 degrees); the relative recovery decreased with increasing eccentricity from fixation (P<.01). CONCLUSIONS: Patients with optic neuritis have a marked return of visual field function that does not appear to differ between patients with diffuse or localized field defects. The reduced redundancy of axons in the periphery of the field compared with near fixation may be responsible for the greater relative recovery of threshold near fixation.

Fixation, Ocular↗

PubMed2003

Effects of long-term theophylline exposure on recovery of respiratory function and expression of adenosine A1 mRNA in cervical spinal cord hemisected adult rats.

Our lab has previously shown that when administered acutely, the methylxanthine theophylline can activate a latent respiratory motor pathway to restore function to the hemidiaphragm paralyzed by an ipsilateral C2 spinal cord hemisection. The recovery is mediated by the antagonism of CNS adenosine A1 receptors. The objective of the present study was to assess quantitatively recovery after chronic theophylline administration, the effects of weaning from the drug, and the effects of the drug on adenosine A1 receptor mRNA expression in adult rats subjected to a C2 hemisection. Rats subjected to a left C2 hemisection received theophylline orally for 3, 7, 12, or 30 days and were classified as 3D, 7D, 12D, or 30D respectively. Separate groups of 3D animals were weaned from drug administration for 7, 12, and 30 days before assessment of respiratory recovery. Additional groups of 7D and 12D animals were also weaned from drug administration for 7 and 12 days prior to assessment. Sham-operated controls received theophylline vehicle for similar periods. Quantitative assessment of recovered respiratory activity was conducted under standardized electrophysiologic recording conditions approximately 18 h after each drug application period. Serum theophylline analysis was conducted at the end of electrophysiologic recordings. Adenosine A1 receptor mRNA expression in the phrenic nucleus was assessed with in situ hybridization and immunohistochemistry. Chronic theophylline induced a dose-dependent effect on respiratory recovery over a serum theophylline range of 1.2-1.9 microg/ml. Recovery was characterized as respiratory-related activity in the left phrenic nerve and expressed as a percentage of activity in the homolateral nerve in noninjured animals under similar recording conditions. Recovered activity was 34.13 +/- 2.07, 55.89 +/- 2.96, 74.78 +/- 1.93, and 79.12 +/- 1.75% respectively in the 3D, 7D, 12D, and 30D groups. Theophylline-induced recovered activity persisted for as long as 30 days when drug administration was stopped and serum levels of the drug were virtually undetected. Furthermore, recovered activity in 3D and 7D animals increased significantly as a function of duration of weaning. Adenosine A1 receptor mRNA expression was not significantly changed by theophylline administration. It is concluded that recovery of respiratory function in C2-hemisected rats induced by chronic theophylline is unrelated to adenosine A1 receptor mRNA expression. Recovered activity persists even when drug administration has been stopped. The significance of our results is that in the clinical application of theophylline to improve respiratory impairment, intermittent drug administration may be sufficient to engender and maintain the therapeutic benefits of the drug.

Administration, Oral↗

PubMed2003

Multinuclear NMR investigations on the metabolic recovery of the isolated perfused mouse liver after cold preservation.

This paper describes multinuclear NMR investigations on the isolated perfused mouse liver to optimize its recovery after cold preservation and normothermic reperfusion. The recovery of livers from fed is better than that from 24 h fasted animals. This better recovery is not due to a higher glycogen content before cold preservation. The recovery of livers from fasted animals is specifically enhanced by the presence of 8 mM alanine in the rinsing solution after cold preservation and in the perfusate of reperfusion. This property is not due to the ability of alanine to compensate for the lack of endogenous substrates since the amount, before cold preservation, of these substrates, is not significantly different in livers from fed and fasted animals. Furthermore, the beneficial effect of alanine is not due to an enhancement of the pyruvate dehydrogenase (PDH) activity in livers from fasted animals. In fact these livers have indeed a smaller PDH activity than the livers from fed animals but dichloroacetate, a known PDH activator has a rather deleterious effect on the recovery of fed and fasted livers. Furthermore alanine protects the fasted livers against this effect. So the beneficial effect of alanine should be due to other causes. Furthermore, we have found on a parallel model of rat isolated perfused liver, that the recovery of steatotic livers which is lower than that of normal fed livers is enhanced by a known vasodilator, pentoxifylin but not by alanine. So alanine does not either play its role through its action on microcirculation. The interaction of alanine with some membrane sodium transporters like that already reported for another protective aminoacid, glycine, is thus possible. A novel NMR method of (23)Na observation in living cells or organs should be of great interest to investigate this hypothesis.

Alanine↗

PubMed2001

Ibotenic acid lesions in the pedunculopontine region result in recovery of visual orienting in the hemianopic cat.

Cats rendered hemianopic by a unilateral visual cortical ablation can recover the visual orienting response in the hemianopic visual field following disruption of the caudal non-tectotectal containing half of the commissure of the superior colliculus. Ibotenic acid lesions of a small 'critical zone' in the contralateral substantia nigra result in a similar recovery effect. A conceptual framework developed by Wallace et al. (1990) [J. Comp. Neurol. 296, 222-252] proposed that elimination of contralateral substantia nigra 'critical zone' inhibition on the superior colliculus ipsilateral to a visual cortical lesion is responsible for the recovery. This model is insufficient, however, to explain the observation that hemi-decorticate cats with contralateral substantia nigra 'critical zone' lesions which include but extend beyond the 'critical zone' do not demonstrate the recovery. In these cats, subsequent transection of the commissure of the superior colliculus does lead to the recovery. We hypothesize that another projection through the caudal commissure of the superior colliculus, from the pedunculopontine nucleus, is involved in the recovery effect. Visual orienting behavior was recorded before and after ibotenic acid lesions made in the pedunculopontine nucleus region contralateral to a visual cortical ablation in 16 cats. Four cats with lesions in a small rostral region of the contralateral pedunculopontine nucleus recovered the visual orienting response in the previously hemianopic visual field. Contralateral tectal projections from the pedunculopontine nucleus are thought to be cholinergic and terminate as distinct patches in the intermediate gray layers of the superior colliculus. Since this region of the pedunculopontine nucleus also receives GABA-ergic afferents from the substantia nigra, we propose that a subcortical neural circuit including the substantia nigra, pedunculopontine nucleus, and superior colliculus is involved in the recovery of visual orienting.

Animals↗

PubMed2001

Acyclovir improves recovery rate of facial nerve palsy in Ramsay Hunt syndrome.

OBJECTIVE: Although the antiviral agent, acyclovir, is currently employed for the treatment in Ramsay Hunt syndrome, the benefit of acyclovir on facial nerve is still unknown and remains controversial. This study was designed to evaluate the effect of acyclovir in facial nerve recovery in Ramsay Hunt syndrome. METHODS: To evaluate drug effect on facial nerve function, evaluation of the facial voluntary movement and nerve excitability testing were performed. We have used an infusion therapy of acyclovir in combination with a high dose of steroid (AS), which was started within 7 days of onset of facial nerve palsy in 91 patients with Ramsay Hunt syndrome. The results were compared with those of 47 patients whose therapy was steroid alone started within 7 days of onset. RESULTS: Out of 91 patients treated with AS, nerve exitability was good in 68 (75%), while it was poor in 17 and absent in six. Of 47 patients treated with steroid alone, nerve exitability was good in 25 (53%), while it was poor in 11 and absent in 11. There was statistically significant difference between AS and steroid therapy in the posttreatment degree of nerve function. Complete recovery to grade I in facial voluntary movement was attained in 82 of 91 patients (90%) in the AS therapy, while out of 47 patients treated with steroid alone complete recovery to grade I was attained in only 30 (64%). A statistically significant difference in the recovery rate of facial nerve function was induced between AS and steroid therapy. CONCLUSION: The AS therapy was proved to keep good degree of nerve function indicated with nerve excitability testing and improve recovery rate of facial nerve in Ramsay Hunt syndrome. Based on this study, we now believe that the AS therapy is an advisable treatment modality to improve the recovery rate of facial nerve function in Ramsay Hunt syndrome.

Acyclovir↗

PubMed2000

Measurement of postsystolic shortening to assess viability and predict recovery of left ventricular function after acute myocardial infarction.

OBJECTIVES: We sought to determine whether left ventricular (LV) postsystolic shortening in the region of acute myocardial infarction (MI) predicts functional recovery after primary angioplasty. BACKGROUND: Previous studies in experimental animals have shown that postsystolic shortening during temporary coronary occlusion predicts functional recovery after reperfusion. METHODS: Contrast ventriculography was performed on 35 patients with acute MI before and immediately after angioplasty, and one day, one month, three months and one year later. The centerline method was used to measure regional LV wall motion at end systole from all six ventriculograms as well as motion during isovolumic relaxation (motion(iso)) and postsystolic shortening from end systole until the end of contraction. The ventriculograms of 23 patients with normal anatomy were similarly analyzed. RESULTS: Wall motion at end systole improved significantly from baseline to follow-up in the infarct region. Postsystolic shortening at baseline correlated most closely with the recovery of wall motion at three months in patients with anterior infarction (r = 0.69, n = 25, p = 0.0001) but also with recovery at one month and one year. The correlation was slightly less powerful for motion(iso). Functional recovery could not be predicted from assessment of motion(iso) and postsystolic shortening in patients with inferior infarction. CONCLUSIONS: In patients with acute anterior MI, analysis of postsystolic shortening in the infarct region predicts the recovery of systolic LV function after reperfusion. Postsystolic shortening represents active contraction and indicates viable myocardium.

Aged↗

PubMed2002

Effect of maintenance bolus on the recovery profile of a short-acting nondepolarizing muscle relaxant.

STUDY OBJECTIVE: To evaluate the effect of different maintenance boluses of a short-acting nondepolarizing neuromuscular blocking drug on its spontaneous recovery profile during anesthesia. DESIGN: Prospective, randomized, double-blind, dose-ranging study. SETTING: University-based medical center. PATIENTS: 69 ASA physical status I and II consenting adult outpatients undergoing general anesthesia with an anticipated duration of at least 2 hours. INTERVENTIONS: Patients were randomized to one of three study groups. Following induction of anesthesia with propofol and fentanyl, rapacuronium 1.5 mg x kg(-1) intravenously (i.v.), was administered to facilitate tracheal intubation. Anesthesia was maintained with desflurane 4% end-tidal in combination with nitrous oxide 67% in oxygen. When the first twitch (T(1)) in the train-of-four (TOF) returned to 25% of its baseline value, a maintenance dose of rapacuronium 0.25 mg x kg(-1) i.v. (Group 1), 0.5 mg. kg(-1) i.v. (Group 2), or 0.75 mg. kg(-1) i.v. (Group 3) was administered. The time course of neuromuscular block was monitored at the wrist using standard electromyography. MEASUREMENTS AND MAIN RESULTS: The times for recovery of the T(1) to 25% of the baseline value following different maintenance doses of rapacuronium were only 6.3 +/- 2.2, 7.5 +/- 2.3, and 9.6 +/- 2.5 minutes, in Groups 1, 2 and 3, respectively. However, the times for the TOF ratio to return to 0.7 were 44 +/- 15, 53 +/- 20, and 66 +/- 30 minutes in Groups 1, 2, and 3, respectively. Although recovery times were significantly longer after rapacuronium 0.75 mg x kg(-1) i.v. (Group 3), there were no significant differences in any of the recovery variables between Groups 1 and 2. CONCLUSIONS: Spontaneous recovery of the T(1) to 25% of the baseline value occurred 6 to 10 minutes after a maintenance bolus dose of rapacuronium 0.25 to 0.75 mg x kg(-1) i.v. However, recovery to a TOF>0.7 required 44 to 66 minutes during desflurane anesthesia.

Anesthesia Recovery Period↗

PubMed2001

Early recovery of oxygen kinetics after submaximal exercise test predicts functional capacity in patients with chronic heart failure.

BACKGROUND: Oxygen (O2) uptake at peak exercise (VO2 peak) is an objective measurement of functional capacity in patients with chronic heart failure (CHF). The significance of recovery O2 kinetics parameters in predicting exercise capacity, and the parameters of submaximal exercise testing have not been thoroughly examined. METHODS AND RESULTS: Thirty-six patients (mean age = 48+/-14 years) with CHF and New York Heart Association functional class I, II, or III, and eight healthy volunteers (mean age = 39+/-13 years) were studied with maximal and submaximal cardiopulmonary exercise testing (CPET). The first degree slope of O2 uptake decay during early recovery from maximal (VO2/t-slope), and submaximal exercise (VO2/t-slope)(sub), were calculated, along with VO2 half-time (T(1/2)VO2). Patients with CHF had a longer recovery of O2 uptake after exercise than healthy volunteers, expressed by a lower VO2/t-slope (0.616+/-0.317 vs. 0.956+/-0.347 l min(-1) min(-1), P=0.029) and greater T(1/2)VO2 (1.28+/-0.30 vs. 1.05+/-0.15 min, P = 0.005). VO2/t-slope correlated with the VO2 peak (r = 0.84, P<0.001), anaerobic threshold (r = 0.79, P<0.001), and T(1/2)VO2, a previously established estimate of recovery O2 kinetics (r = -0.59, P<0.001). (VO2/t-slope)(sub) was highly correlated with VO2/t-slope after maximal exercise (r=0.87, P<0.001), with the VO2 peak (r=0.87, P<0.001) and with T(1/2)VO2 after maximal exercise (r=-0.62, P<0.001). VO2/t-slope after maximal and submaximal exercise was reduced in patients with severe exercise intolerance (F=9.3, P<0.001 and F=12.8, P<0.001, respectively). CONCLUSIONS: Early recovery O2 kinetics parameters after maximal and submaximal exercise correlate closely with established indices of exercise capacity in patients with CHF and in healthy volunteers. These findings support the use of early recovery O2 kinetics after submaximal exercise testing as an index of functional capacity in patients with CHF.

Adult↗

PubMed2001

Influence of the emotional response to surgery on functional recovery during 6 months after hip arthroplasty.

We examined whether the emotional response to hip arthroplasty predicted functional recovery after controlling for preoperative function and surgical trauma. Mood and fatigue were measured in 102 consecutive patients preoperatively and 3 days postoperatively. Time of achievement of functional milestones indicated recovery in hospital, and functional status was measured preoperatively and 1 and 6 months postoperatively. Circulating C-reactive protein and interleukin-6 levels indicated trauma. Recovery in hospital was slower in patients with greater trauma. Recovery at follow-up was slower in patients with poorer preoperative function and with greater anxiety and fatigue, but the apparent influence of anxiety was explained by its association with preoperative function and fatigue. Whereas short-term recovery is predicted by surgical trauma, long-term recovery is predicted by preexisting function and the emotional response to surgery. However, the influence of the emotional response is small and the important aspect of emotion is fatigue rather than anxiety.

Aged↗