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PubMed2002

Estimation of left ventricular performance through temporal pressure variations measured by MR velocity and acceleration mappings.

PURPOSE: To describe a method for assessing pressure variation vs. time (dp/dt) using blood flow acceleration measured by MRI, and to demonstrate its applicability in estimating left ventricular (LV) function. MATERIALS AND METHODS: The method was tested in vitro using a pulsatile phantom, and a strong correlation was found between transducer and MRI determinations of dp/dt (r = 0.98). Selected aortic flow parameters were then measured in 10 patients and the results were compared with transducer measurements of the LV dp/dt. RESULTS: The correlation coefficients for the reference estimations of global myocardial function and MRI were 0.59 for aortic velocity, 0.74 for aortic acceleration, and 0.86 for aortic dp/dt. CONCLUSION: MR measurements of velocity and acceleration within the ascending aorta offer a noninvasive method for determining indices, such as the aortic dp/dt, that are closely correlated with the global myocardial contractility function.

Adult↗

PubMed2005

Infarct size reduction and attenuation of global left ventricular remodeling with the CorCap cardiac support device following acute myocardial infarction in sheep.

BACKGROUND: Whether mechanical restraint of the left ventricle (LV) can influence remodeling following myocardial infarction (MI) remains poorly understood. The following discussion details three studies examining the effects of surgically placing a cardiac support device (CSD) over the entire epicardial surface, on infarct expansion, global cardiac function and myocyte geometry and function post-MI. METHODS: The effects of passive constraint on infarct expansion and global cardiac function/myocardial energetics were investigated in 10 sheep (5 MI only; 5 MI + CSD) using pressure-volume analysis and magnetic resonance imaging (MRI). Additionally, 11 sheep (5 MI only; 6 MI + CSD) were used to study the effects of passive restraint on myocyte geometry and function post-MI, with 10 additional uninstrumented sheep serving as controls. Baseline data was collected followed by the creation of an anterior infarct. 1 week post-infarct the animals underwent a second set of data collection studies followed by placement of the CSD in the experimental groups. Additional data was collected at 2 and 3 months post-MI. The animals in the myocyte function group underwent additional studies immediately following the 3 month time point. RESULTS: Infarct expansion was diminished as a result of the CSD. At 1 week post-MI the akinetic area was similar in both groups. At the terminal time-point, the akinetic area in the control group was similar to the 1-week time-point whereas, in the CSD group, the area of akinesis decreased (P = 0.001). A comparison of the two groups at the terminal time-point demonstrates a significantly diminished area of akinesis in the CSD group (P = 0.004). The relative area of akinesis followed a similar pattern. The CSD group also exhibited a decrease in end-diastolic volume (control 110.3 +/- 19.8 mL vs. CSD 67.6 +/- 4.7 mL, P = .006) and an improved ejection fraction (control 15.5% +/- 5.7% vs. CSD 29.46% +/- 4.42%, P = .008) relative to the control group. Myocardial energetics were also enhanced in the CSD group as evidenced by significant improvements in potential energy (control 2,015 +/- 503 mL x mm Hg/beat vs. CSD 885 +/- 220 mL x Hg/beat, P = .006), efficiency (control 39.4% +/- 13.6% vs. CSD 59.8% +/- 8.5%, P = .044), and oxygen consumption (control 0.072 +/- 0.013 mL O(2)/beat vs. CSD 0.052 +/- 0.007 mL O(2)/beat, P = .034). Isolated LV myocyte shortening velocity was reduced by 35% from control values (P < 0.05) in both MI groups. LV myocyte beta-adrenergic response was reduced with MI, but normalized in the MI + CSD group. Relative collagen content was increased and matrix metalloproteinase-9 was decreased within the MI border region of the CSD group. CONCLUSIONS: The CorCap cardiac support device retarded infarct expansion, improved global and regional cardiac function and beneficially modified LV and myocyte remodeling post-MI. These findings provide evidence that non-pharmacological strategies can interrupt adverse LV remodeling post-MI.

Animals↗

PubMed1997

Psychopathology in male and female HIV-positive and negative injecting drug users: longitudinal course over 3 years.

OBJECTIVE: To evaluate the impact of HIV illness on psychiatric and psychosocial functioning over 3 years in a sample of male and female HIV-positive injecting drug users (IDU), with a comparison group of HIV-negative male and female IDU. DESIGN: As part of a multidisciplinary study, 121 men (69 HIV-positive, 52 HIV-negative) and 66 women (36 HIV-positive, 30 HIV-negative) were evaluated semiannually for seven visits. Attrition, unrelated to sex or serostatus, was 33%. RESULTS: At baseline, rates of major depression and dysthymia ranged from 15% (HIV-negative men) to 33% (HIV-positive men and HIV-negative women). Global impairment was in the range found in psychiatric patients (mean Global Assessment of Functioning scores, 46-51). Higher levels of social support and less social conflict were independently associated with decreased distress and improved global functioning among both men and women. For both HIV-positive groups, degree of improvement over time was related to degree to HIV progression: those who remained healthier in terms of CD4 count and illness stage showed more improvement. HIV-seronegative status was associated with less distress for men but not for women. Overall, women reported higher levels of psychiatric distress than men. CONCLUSIONS: High rates of psychopathology were found in this IDU cohort, independent of HIV status and sex. Although rates of psychopathology, injecting drug use and distress declined slightly during the study, they remained elevated; accordingly, psychiatric services are indicated for this population.

Cohort Studies↗

PubMed1982

Quantitation of left ventricular dimensions and function by digital video subtraction angiography.

Digital video subtraction angiography (DVSA) after central intravenous administration of contrast media was used in experimental animals and in patients with suspected coronary artery disease to quantitate left ventricular dimensions and regional and global contractile function. In animals, measurements of left ventricular (LV) volumes, wall thickness, ejection fraction, segmental contraction, and cardiac output correlated closely with sonocardiometry or thermodilution measurements. In patients, volumes and ejection fractions calculated from mask mode digital images correlated closely with direct left ventriculography. Global and segmental contractile function was displayed in patients by ejection shell images, stroke volume images, and time interval difference images. Central cardiovascular function was also quantitated by measurement of pulmonary transit time and calculation of pulmonary blood volume from digital fluoroscopic images. DVSA was shown to be useful and accurate in the quantitation of central cardiovascular physiology.

Angiocardiography↗

PubMed2006

Characteristics of HCV positive patients in an Italian urban psychiatric unit.

OBJECTIVES: 1) to assess the prevalence of hepatitis C virus (HCV) infection in a population of acute psychiatric in-patients; 2) to find out relationships between HCV comorbidity and clinical features of psychiatric patients. METHODS: Prospective observational study in a 6-year period. RESULTS: 2396 cases (1492 patients) were admitted in the considered period. Forty-two patients (2.8%) were affected by HCV infection. HCV infection was more frequent in patients with less years of education, lower social class, lower last year best Global Assessment of Functioning score, more hostile or violent behavior in hospital, with a lifetime history of previous suicide attempt, and with substance-related disorders. CONCLUSION: HCV infection in psychiatric patients constitutes a major threat to the health of psychiatric patients and is related with unfavorable social background, worse global functioning, hostile or violent behavior, substance-related disorders. It appears also to be a significant risk of suicidal behavior.

Journal Article↗

PubMed1998

[Evaluation of left ventricular contraction using heart tomography with technetium 99m tetrofosmin in synchrony with ECG. Correlation with bidimensional echocardiography].

BACKGROUND: Echocardiography is a standard method of evaluating segmental and global left ventricular function in clinical practice. The aim of this study was to determine if segmental and global ventricular function determined from Gated SPECT myocardial imaging adequately coincides with echocardiographic data. PATIENTS AND METHODS: We studied 23 patients with ischemic heart disease referred for clinical 99mTc tetrofosmin Gated SPECT imaging. The results were compared with those obtained using a standard rest echocardiographic assessment. Both studies were performed within a 24-48 hour period. Segmental results in both studies were analyzed by semiquantitative visual scoring using a two or three-point grading system and a summed score was obtained to determine global left ventricular function. RESULTS: There was a good segmental score agreement between both techniques for wall motion (77.5%; kappa = 0.49) and less for wall thickening (85%; kappa = 0.36). There were non significant statistical differences in the global left ventricular function with both techniques by wall motion (echocardiography 15.3 +/- 5.4 vs tetrofosmin 14.9 +/- 4.4; p = NS) and wall thickening (echocardiography 12.7 +/- 2.3 vs tetrofosmin 12.4 +/- 1.8; p = NS) scores. Correlation for global wall motion (r = 0.81; p < 0.0001) and wall thickening (r = 0.72; p = 0.0001) scores between the two modalities was good. CONCLUSIONS: Gated SPECT 99mTc tetrofosmin myocardial imaging is a valid method to assess segmental and global left ventricular function and agrees well with echocardiography.

Aged↗

PubMed1999

Intrafamilial variation of phenotype in Stargardt macular dystrophy-Fundus flavimaculatus.

PURPOSE: To evaluate the intrafamilial phenotypic variation in Stargardt macular dystrophy-Fundus flavimaculatus (SMD-FFM). METHODS: Thirty-one siblings from 15 families with SMD-FFM were examined. Age of onset, visual acuity, and clinical features on fundus examination and fundus autofluorescence images, including presence or absence of central and peripheral atrophy and distribution of flecks, were recorded. In addition, electrophysiological studies were undertaken. RESULTS: Large differences between siblings in age of onset (median, 12 years; range, 5-23 years) were observed in six of the 15 families studied, whereas in 9 families differences in age of onset between siblings were small (median, 1 year; range, 0-3 years). Visual acuity varied two or more lines among siblings in nine families. In 10 families (67%) siblings were found to have different clinical appearance on fundus examination and fundus autofluorescence images, whereas in 5 families (33%), affected siblings had similar clinical features. Electrodiagnostic tests were performed on affected members of 12 families and disclosed similar qualitative findings among siblings. In nine families there was loss of central function only; in two, global loss of cone function; and in one, global loss of cone and rod function. CONCLUSIONS: In this series, although differences in age of onset, visual acuity, and fundus appearance were observed between siblings, electrophysiological studies demonstrated intrafamilial homogeneity in retinal function. The findings are difficult to reconcile with expression studies showing ABCR transcripts in rod photoreceptors but not in cones.

Adolescent↗

PubMed1999

Left Ventricular Regional Diastolic Dysfunction in Patients with First Myocardial Infarction Determined by Diastolic Motion of the Atrioventricular Plane.

Motion of the left ventricular [left ventricle (LV)] atrioventricular (AV) plane has been used to assess systolic LV function. The method has not been used properly to assess diastolic function, especially after a first myocardial infarction (MI). The diastolic function was assessed in 47 previously healthy patients with a first MI assessed by echocardiographic diastolic motion of the LV AV plane. The motion of the AV plane was recorded at four different LV sites, that is, at the septal, anterior, lateral, and inferior walls. Two distinct phases of motion were noticed during diastole at all the sites: one at the early diastole caused by rapid filling of the LV and the other at late diastole during the atrial contraction. The contribution of left atrial contraction to LV filling at different LV sites was calculated by relating the magnitude of the motion caused by atrial contraction to the total diastolic AV plane motion at the respective sites. These left atrial contributions were regarded as the regional diastolic function of the respective LV sites. The global LV diastolic function was determined from the left atrial contribution to total AV plane motion from the above four sites. Patients with anterior MI had a significantly lower ejection fraction than those with inferior MI (41% and 49%, respectively; P < 0.01). Compared with age-matched healthy subjects, the regional atrial contribution to diastolic filling was significantly higher at the anterior wall in anterior MI (38% and 52%, respectively; P < 0.001) and at the inferior wall in inferior MI (43% and 53%, respectively; P < 0.01). The atrial contribution to global LV filling was increased in anterior MI (48% compared with 42% in healthy subjects; P < 0.05) but not in inferior MI. These findings suggest that the diastolic AV plane displacement (AVPD) may be used to assess both the regional and the global diastolic function in patients following an MI.

Journal Article↗

PubMed2005

Modeling and suppression of respiration-related physiological noise in echo-planar functional magnetic resonance imaging using global and one-dimensional navigator echo correction.

A major source of noise in functional magnetic resonance imaging (fMRI) arises from modulations in the local magnetic field in the head due to motion of the subject's chest through the respiratory cycle, and this physiologic noise can nullify the gains in statistical power expected by the use of higher magnetic fields for fMRI. In particular, fMRI data acquired using echo-planar imaging (EPI) are very sensitive to these spatially and temporally varying respiration-induced frequency offsets. In this study, accurate 3D magnetic field maps in the head were measured and used to determine the frequency offsets at the two extremes of the respiratory cycle. From these maps, spatially dependent frequency variations from about -1.0 Hz to +1.5 Hz were measured in the brain through the respiratory cycle. Simulations of a typical axial EPI fMRI experiment acquired in the presence of this measured field variation were performed, demonstrating regional image intensity variations between 1 and 5% in single pixel time series. The inadequacy of either global or 1D navigator echo corrections to measure and suppress respiratory-induced noise in fMRI time series is demonstrated. The nature of the spatial variations observed suggests that 2D approaches should be considered.

Brain Mapping↗

PubMed2000

Effects of lipids on the functional and metabolic recovery from global myocardial stunning in isolated rabbit hearts.

OBJECTIVES: High concentrations of free fatty acids may increase myocardial ischaemic damage. However, the administration of lipid emulsions during reperfusion improves the functional recovery of stunned myocardium. From this apparent controversy we hypothesise that the effect of lipids is related to the time of its administration: we compared the effects of pre- and post-ischaemic administration of Intralipid((R)) on stunned myocardium. We also examined the role of fatty acids and phospholipids, respectively, in the effect of lipid emulsions on stunned myocardium. METHODS: Myocardial stunning was produced by 15 min of ischaemia and 90 min of reperfusion in isolated blood perfused rabbit hearts. Intralipid((R)) was administered either prior to ischaemia or during reperfusion. Left ventricular pressure (LVP) and its first derivative (LVdP/dt) were measured to assess functional recovery. High energy phosphates were measured with HPLC. The effects of linoleic acid, phosphatidylcholine and their combination were also studied. RESULTS: Only when Intralipid((R)) was administered during reperfusion, it improved recovery from contractile function and increased high energy phosphate content in globally stunned myocardium. Both linoleic acid and phosphatidylcholine significantly improved myocardial function in stunned myocardium. CONCLUSIONS: The effect of lipids on the contractile performance and metabolic state of stunned myocardium depends mainly on the timing of its administration with regard to the ischaemia/reperfusion event. Both free fatty acids and phospholipids contribute to the beneficial effect of lipid emulsions on functional recovery of stunned myocardium.

Analysis of Variance↗

PubMed2000

[Different responses of right and left ventricular diastolic function to pulmonary resection: echocardiographic study with leg elevation for preload augmentation].

OBJECTIVES: The effects of pulmonary resection on cardiac function have not been well characterized. This study used Doppler echocardiography to evaluate preoperative and postoperative right and left ventricular function with preload augmentation by elevation of the legs. METHODS: Twenty-one patients (12 males, 9 females, mean age 64 +/- 11 years) undergoing pulmonary resection for lung cancer underwent concurrent examination of cardiac and pulmonary function at 1 week preoperation and 4 weeks postoperation. Cardiac function of right and left ventricles was assessed by Doppler echocardiography to record waveforms of transtricuspid flow and transmitral flow. Assessment was made in the supine position and with leg elevation 60 degrees to apply preload augmentation. We measured the interval between cessation and onset of transatrioventricular flow, ventricular ejection time and Tei index as an index of global ventricular function. Peak velocity of early filling (E) and atrial contraction (A) were measured from the transtricuspid and transmitral flows to calculate E/A of the right and left ventricles (ER/AR, EL/AL). Pulmonary function tests yielded the forced vital capacity expressed as the ratio to the predicted value as an index for the pulmonary vascular bed area. RESULTS: The postoperative cardiac function without preload augmentation was comparable to the preoperation function. With preload augmentation, the postoperative ER/AR was less than preoperation in the patients with postoperative forced vital capacity < or = 80% of the preoperation value. There was a significant correlation between the postoperation versus preoperation ratio of ER/AR and of forced vital capacity (r = 0.66, p = 0.0028) and ratio of right ventricular Tei index and of forced vital capacity (r = 0.61, p = 0.0034). There was a possibility that right ventricular Tei index indirectly indicated the state of pulmonary vascular bed area. CONCLUSIONS: The right ventricular Tei index is useful to estimate preoperation and postoperation global right ventricular function. No close relationship between ER/AR and EL/AL at preoperation (r = 0.70, p = 0.0004) was found in the patients with postoperative right ventricular Tei index > 0.1 greater than at preoperation. Pulmonary resection might affect the diastolic function of the right ventricle more than the left ventricle, possibly because of reduced compliance of the right ventricle indicated by an increased atrial contraction at postoperation with preload augmentation.

Diastole↗

PubMed2003

Significance of House-Brackmann facial nerve grading global score in the setting of differential facial nerve function.

OBJECTIVE: To determine the clinical significance of the House-Brackmann facial nerve grading scale (HBFNGS) in the setting of differential function along the branches of the facial nerve. STUDY DESIGN: Prospective study of 38 patients with facial palsy who demonstrated differential facial function. SETTING: Tertiary referral center. PATIENTS: Patients with facial nerve dysfunction from any cause. Patients with complete facial nerve paralysis (House-Brackmann Grade 6) were excluded. INTERVENTION: Physicians were provided with printed description of the HBFNGS and asked to report facial nerve function as a traditional global score and as a regional score based on the House-Brackmann scale for the forehead, eye, nose, and mouth. This was reported as F(w) E(x) N(y) M(z), where w, x, y, and z ranged from 1 to 6 based on the HBFNGS. Synkinesis was graded as none, mild, or severe. MAIN OUTCOME MEASURES: The traditional HBFNGS score was compared with a regional grading facial nerve grading system based on the HBFNGS for the forehead, eye, nose, and mouth. Agreement between the traditional global score and the regional scores was analyzed. RESULTS: In patients with variable facial weakness, the single House-Brackmann score did not fully communicate their facial function. Further, the single grade did not always correlate with the best or worst function along the four facial regions. The single House-Brackmann score most strongly correlated with the regional scoring of the eye (61%), followed by the nose/midface (40%), mouth (32%), and forehead (18%). The global score did not correlate with the worst regional score in 30 patients (79%). In 3 of 5 patients with synkinesis and an obligatory Grade 3 or higher in the global House-Brackmann grading system, the regional facial function was Grade 2 or better at one or more areas of the face. CONCLUSIONS: In patients with differential facial function, a single global number is inadequate to describe facial function and primarily reflects the function of the eye. Regional assessment using the HBFNGS and reported as F(w) E(x) N(y) M(z) more fully communicates facial function.

Adolescent↗

PubMed2002

Influence of left ventricular geometry on regional systolic and diastolic function in patients with essential hypertension.

OBJECTIVE: In essential hypertension, especially in concentric hypertrophy, global diastolic function is impaired. But, whether the left ventricular (LV) geometric pattern influences regional systolic and diastolic function or not, is unknown. This study was aimed to evaluate the influence of left ventricular geometric pattern on regional systolic and diastolic function in hypertensive patients. DESIGN: Ninety untreated mild to moderate hypertensive patients were studied. M-mode parameters, standard Doppler and PW tissue Doppler indices were measured. Patients were divided into four groups according to left ventricular mass index and relative wall thickness: normal geometry (n = 16), concentric remodeling (n = 16), eccentric hypertrophy (n = 32) and concentric hypertrophy (n = 26). RESULTS: Age, gender, body mass index, systolic and diastolic blood pressure were similar among groups. E/A ratio was significantly lower in the concentric hypertrophy group compared with the normal geometry group. Em velocity and Em/Am ratio in basal septum and Em velocity in basal inferior were statistically lower in the concentric hypertrophy group compared with the normal geometry group. In the concentric hypertrophy group, the number of segments with diastolic dysfunction was significantly higher compared with the normal geometry group. LV ejection fraction and regional S velocity could be compared among groups. CONCLUSION: LV regional diastolic function is being impaired in concentric hypertrophy. LV regional systolic function does not show a difference according to the LV geometric pattern.

Adult↗

PubMed2003

Homicidality in schizophrenia: a replication study.

This study attempted to replicate the results of R. C. Schwartz, S. Petersen, and J. L. Skaggs (2001) by testing predictors of homicidality in a new sample of participants with schizophrenia. Results of multiple regression analyses showed that manic symptoms and substance abuse were significantly positively correlated with more extreme homicidality. Global Assessment of Functioning scale ratings were significantly negatively correlated with ratings on homicidality. Finally, men displayed significantly heightened homicidality as compared with women. These findings lend support to the hypothesis that clinicians should pay particular attention to evaluating homicidality in patients who are male, have schizophrenia, who abuse substances, who show acute manic symptoms, and whose global functioning has recently declined.

Adolescent↗

PubMed1992

Alterations in myofibrillar function and protein profiles after complete global ischemia in rat hearts.

We studied changes in myofibrillar function and protein profiles after complete global ischemia with anoxia in rat hearts. Hearts were exposed to global ischemia and anoxia (CGI) for 30 or 60 minutes at 37 degrees C, and myofibrils were prepared for measurement of Ca(2+)-dependent Mg(2+)-ATPase activity at pH 7.0 and 6.5. Hearts incubated in cold saline (1 +/- 1 degrees C) and nonincubated hearts served as controls. Maximum ATPase activity was unchanged at pH 7.0 and pH 6.5 in myofibrils from hearts treated with 30 or 60 minutes of CGI. At pH 7.0, the Hill coefficient, which is an index of cooperative interactions among thin-filament proteins, was unchanged after 30 minutes of CGI but was significantly increased after 60 minutes of CGI. A similar trend for increased cooperativity was observed when myofibrillar ATPase activity was measured at pH 6.5 in myofibrils from rat hearts made ischemic for 30 or 60 minutes. Both 30 and 60 minutes of CGI resulted in increased pCa50 values (half-maximally activating free [Ca2+]) at pH 7.0 and pH 6.5. Densitometric analysis of myofibrillar proteins separated with sodium dodecyl sulfate-polyacrylamide gel electrophoresis indicated that troponin I and troponin T were degraded during 60 minutes of CGI. Two new protein bands appearing in ischemia-treated myofibrils were identified as partially degraded troponin I and troponin T with Western blots. The troponin I fragment could be phosphorylated by cAMP-dependent protein kinase. In addition, we observed phosphorylation of a protein band that corresponded to myosin light chain-2 in myofibrils from CGI-treated hearts. These results suggest that degradation of thin-filament proteins may contribute to the changes in cooperativity of Ca2+ regulation of ATPase activity observed in the myofibrils from rat hearts exposed to CGI.

Animals↗

PubMed2004

Cognitive-behavioral therapy for depression in adolescents with inflammatory bowel disease: a pilot study.

OBJECTIVE: To evaluate the safety and feasibility of cognitive-behavioral therapy (CBT) for depression in physically ill adolescents. METHOD: In an open trial, 11 adolescents (12-17 years) with inflammatory bowel disease and either major or minor depression underwent 12 sessions of a manual-based CBT enhanced by social skills, physical illness narrative, and family psychoeducation components. Standardized instruments assessed pre- to posttreatment changes in depression, physical health, global psychological functioning, and social functioning. Perceived helpfulness and satisfaction with CBT were assessed. RESULTS: There were significant reductions in DSM-IV depression diagnoses and depressive symptoms and improvements in global psychological and social functioning. Adolescents' perceptions of their general health and physical functioning improved, although illness severity measures were unchanged. High subject satisfaction and helpfulness ratings for CBT were found along with no adverse events and high subject adherence. CONCLUSIONS: A manual-based CBT approach adapted to treat depression in physically ill adolescents appears to be a safe, feasible, and promising intervention.

Adolescent↗

PubMed2005

A randomized, double-blind, placebo-controlled trial of pramipexole, a dopamine agonist, in patients with fibromyalgia receiving concomitant medications.

OBJECTIVE: To assess the efficacy and safety of pramipexole, a dopamine 3 receptor agonist, in patients with fibromyalgia. METHODS: In this 14-week, single-center, double-blind, placebo-controlled, parallel-group, escalating-dose trial, 60 patients with fibromyalgia were randomized 2:1 (pramipexole:placebo) to receive 4.5 mg of pramipexole or placebo orally every evening. The primary outcome was improvement in the pain score (10-cm visual analog scale [VAS]) at 14 weeks. Secondary outcome measures were the Fibromyalgia Impact Questionnaire (FIQ), the Multidimensional Health Assessment Questionnaire (MDHAQ), the pain improvement scale, the tender point score, the 17-question Hamilton Depression Inventory (HAM-d), and the Beck Anxiety Index (BAI). Patients with comorbidities and disability were not excluded. Stable dosages of concomitant medications, including analgesics, were allowed. RESULTS: Compared with the placebo group, patients receiving pramipexole experienced gradual and more significant improvement in measures of pain, fatigue, function, and global status. At 14 weeks, the VAS pain score decreased 36% in the pramipexole arm and 9% in the placebo arm (treatment difference -1.77 cm). Forty-two percent of patients receiving pramipexole and 14% of those receiving placebo achieved > or =50% decrease in pain. Secondary outcomes favoring pramipexole over placebo included the total FIQ score (treatment difference -9.57) and the percentages of improvement in function (22% versus 0%), fatigue (29% versus 7%), and global (38% versus 3%) scores on the MDHAQ. Compared with baseline, some outcomes showed a better trend for pramipexole treatment than for placebo, but failed to reach statistical significance, including improvement in the tender point score (51% versus 36%) and decreases in the MDHAQ psychiatric score (37% versus 28%), the BAI score (39% versus 27%), and the HAM-d score (29% versus 9%). No end points showed a better trend for the placebo arm. The most common adverse events associated with pramipexole were transient anxiety and weight loss. No patient withdrew from the study because of inefficacy or an adverse event related to pramipexole. CONCLUSION: In a subset of patients with fibromyalgia, approximately 50% of whom required narcotic analgesia and/or were disabled, treatment with pramipexole improved scores on assessments of pain, fatigue, function, and global status, and was safe and well-tolerated.

Adult↗

PubMed1988

[Global and regional left ventricular function following acute coronary artery occlusion and emergency aortocoronary venous bypass operation].

Complications following percutaneous transluminal coronary angioplasty (PTCA), such as coronary artery occlusion, spasm, or dissection, frequently require urgent surgical intervention. Out of 26 patients from our hospital, 12 who underwent emergency coronary bypass grafting because of balloon catheter complications with a total ischemic time of 100-255 min, were restudied in the late postoperative period by clinical examination and by coronary and left ventricular angiography. Left ventricular angiograms were evaluated quantitatively for global and regional function using the AVD system (Siemens Elema, Erlangen). Electronmicroscopic results from myocardial biopsy samples, taken intraoperatively from the presumed center of the ischemic zone, were compared with the clinical results. An improvement of left ventricular function parameters could be seen in patients with reperfusion intervals within 130 min. In the case of intermittent perfusion of the occluded vessel (catheter perfusion with arterial blood, intermittent spasm) operative revascularization proved to salvage jeopardized myocardium. There was a close correlation between the degree of left ventricular dysfunction and histological results, coronary morphology and clinical staging. In conclusion, the efficacy of myocardial protection by emergency bypass surgery depends mainly on coronary morphology and above all on reperfusion intervals.

Adult↗