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PubMed2002

Subsyndromal depression is associated with functional impairment in patients with bipolar disorder.

BACKGROUND: The purpose of this study was to assess whether a relationship exists between mild depressive symptoms and overall functioning in subjects with bipolar disorder. METHOD: Twenty-five male subjects with bipolar I disorder (DSM-III-R criteria), who had not experienced a DSM-III-R episode of mania, hypomania, or major depression for 3 months as determined using the Structured Clinical Interview for DSM-III-R, were evaluated for degree of depressive symptoms using the Hamilton Rating Scale for Depression (HAM-D) and for overall functional status using the Global Assessment of Functioning (GAF, DSM-IV Axis V). RESULTS: GAF scores were significantly negatively correlated with HAM-D scores (r = -0.61, df = 23, p = .001), despite the fact that no patient had a HAM-D score high enough to be considered clinically depressed. CONCLUSION: The results of this study support a relationship between subsyndromal depressive symptoms and functional impairment in bipolar subjects, despite their not meeting threshold criteria for a major depressive episode. These findings raise the possibility that in some patients with bipolar disorder subsyndromal depressive symptoms might contribute to ongoing functional impairment.

Adaptation, Psychological↗

PubMedDate not supplied

[Preoperative evaluation of the vascular patient].

Periferal vascular disease usually results from a systemic entity in which atherothrombosis develops in different vascular territories, having common risk factors. It is hence usual to find coexistent, often subclinical, coronary artery disease, which is responsible for most of perioperatory morbidity and mortality in patients submitted to vascular surgery. An adequate preoperatory risk stratification must be accomplished, having in mind the clinical manifestations, risk factors, comorbidities, functional capacity and global left ventricular systolic function of the patient. He should be included in one of three different subgroups: low, high or intermediate risk, which might reinforce the need for further testing, most often aiming at the detection of coronary artery disease and foresee the short, medium and long term outcome. This strategy is very important and it is in part due to it and to better medical/surgical and anesthetic care that the surgical results have markedly improved in recent years. In this paper a state of the art is done of the guidelines to follow and the results of several studies performed on this subject. The role of methods to detect coronary ischemia is remarked, using either nuclear or echocardiographic techniques for this purpose.

Humans↗

PubMed1990

Latissimus dorsi dynamic cardiomyoplasty of the right ventricle. Potential for use as a partial myocardial substitute.

Full-thickness right ventricular latissimus dorsi dynamic cardiomyoplasty with the Medtronic Cardiomyostimulator (Medtronic, Inc., Minneapolis, Minn.) was performed in a chronic canine model. In one group (n = 2) the latissimus dorsi was electrically preconditioned before cardiomyoplasty. In a second group (n = 3) cardiomyoplasty was performed and the muscle was progressively stimulated, with conditioning accomplished while the latissimus dorsi was functioning on the ventricle. The contribution of the stimulated latissimus dorsi to global ventricular function was assessed, and the effects of varying muscle stimulation parameters on latissimus dorsi function and hemodynamics were examined. Right ventricular systolic pressure increased 8%, from 23.2 +/- 0.95 to 25.1 +/- 1.5 mm Hg. The rate of pressure rise increased 37% from 226 +/- 13 to 309 +/- 12 mm Hg/sec. Right ventricular ejection fraction was measured in two dogs and increased 29% with latissimus dorsi stimulation, from 51.5% +/- 13.5% to 66.5% +/- 14.5%. Although the sample size was small, there was no difference observed between the preconditioned and nonpreconditioned groups. Right ventricular systolic pressure, rate of pressure rise, and percent latissimus dorsi fiber shortening increased as voltage and burst frequency of the muscle stimulus increased, whereas increasing the burst duration had little effect in two dogs so studied. Latissimus dorsi dynamic cardiomyoplasty can function as a partial myocardial replacement in a chronic canine model, apparently without preconditioning of the muscle. The degree of cardiac assist obtained with cardiomyoplasty appears to be influenced by the voltage and frequency of the stimulus applied to the muscle. Although it is unclear whether these results can be extrapolated to the left ventricle, this technique may find application in the treatment of ventricular aneurysm or ventricular tumor.

Animals↗

PubMed1989

[Hemodynamic importance of the left atrium in patients with essential hypertension].

Twenty-nine patients with essential hypertension and thirty-seven without cardiac disease were examined electrocardiographically, polycardiographically and echocardiographically. Both the proportion of the left atrial systole in the hemodynamics and the size of the left atrium were significantly greater in hypertonics compared to healthy subjects. The parameters of left ventricular systolic function did not differ significantly, the parameters of diastolic function were significantly lower in hypertonics. Evaluation of the size and function of the left atrium supplements the clinical assessment of the functional state of the left ventricle at a period of its normal global systolic function but diminished diastolic function. The insufficient informative value of the electrocardiographic criteria of changes in the size of the left atrium (so-called Morris's index) and of the presence of the 4th heart sound in evaluating the severity of hypertension is pointed out. Since the presence of the 4th heart sound is clinically incorrectly interpreted, the need for consistency in its interpretation is emphasized.

Adult↗

PubMed1984

[Radioisotopes in the exploration of upper urinary tract obstruction].

The authors describe the various possibilities offered by isotope studies in cases of obstruction of the upper urinary tract. This examination allows: -- exploration of the dilatation itself, -- and isotope study of renal function. The dilatation can be explored either by means of the nephrogram with hyperdiuresis or by measurement of the renal transit time. The nephrogram with hyperdiuresis will give a precise answer: definite obstruction or no obstruction. Intermediate forms are possible, in which a mathematical interpretation of the curves of decay of the renal radioactivity will help distinguish between hypotonia without obstruction and true obstruction with dilatation. A marked decrease in renal function or severe vesico-renal reflux can interfere with the interpretation of these curves. Measurement of the renal transit time with the mathematical calculation of deconvolution is a valuable application of isotopes, but it is less practical than the nephrogram with hyperdiuresis. The isotope study of renal function is a promising technique, as it is able to study the global clearance without the need for blood tests (this is true for both the glomerular filtration rate and for the measurement of renal blood flow). Furthermore, this technique should allow each kidney to be studied separately. Separate measurements do not provide an absolute value for each kidney, but evaluate the part played by each kidney in the global renal function, which can be measured simply by means of the isotope study.(ABSTRACT TRUNCATED AT 250 WORDS)

Dilatation, Pathologic↗

PubMed1994

Diagnostic reassessment and treatment response in schizophrenia.

BACKGROUND: The reasons for poor treatment response in some patients with schizophrenia remain unclear. It is possible that misdiagnosis of nonschizophrenic disorders as schizophrenia could result in suboptimal pharmacotherapy in some patients. METHOD: To assess this possibility, 110 severely ill, chronic patients with a referral diagnosis of schizophrenia were comprehensively assessed and rediagnosed according to DSM-III-R criteria. Global Assessment of Function (GAF) and Clinical Global Impressions (CGI) ratings were made at admission and at discharge from the ward, after the implementation of individualized treatment plans. RESULTS: The diagnosis of schizophrenia was confirmed in 80 patients (73%) and revised to another type of psychotic illness in 30 patients (27%). The GAF and CGI ratings were similar at admission in patients with confirmed and revised diagnoses. All patients improved by the time of discharge (p = .0001); however, patients with a revised diagnosis improved more than those with confirmed schizophrenia (p = .02). Patients with a revised diagnosis were less likely to require continued hospitalization on chronic care wards (p = .004). At admission, medication regimens were similar in the two groups of patients. At discharge, patients with a revised diagnosis were less likely to have received neuroleptics (p = .007) and more likely to have received antimanic drugs (p = .0002) or electroconvulsive therapy (p = .0004). CONCLUSION: These findings from a clinical sample suggest that diagnostic reassessment is an important first step in the management of apparently refractory schizophrenia.

Adolescent↗

PubMed1993

Hemodilution induces stable changes in global cardiovascular and regional myocardial function.

The cardiovascular responses associated with isovolemic hemodilution have been described. However, the stability of these responses over time remains controversial. We hypothesized that the hemodynamic responses to isovolemic hemodilution are stable over time. Nine fentanyl-midazolam-anesthetized dogs were monitored to follow global cardiovascular and regional myocardial function. Isovolemic hemodilution was performed to a moderate (hemoglobin = 7.5 g%) target hemodilutional state that was maintained for 4 h. Data were obtained at each hemodilutional state and each hour during the 4-h period of sustained moderate hemodilution. During acute hemodilution, cardiac output increased from 2.6 +/- 0.5 L/min to 3.0 +/- 0.5 L/min (P < 0.05) and mean coronary flow increased from 20.8 +/- 2.4 mL/min to 31.4 +/- 5.5 mL/min (P < 0.05). Cardiac output and mean coronary flow remained elevated during the extended hemodilutional period. In addition, norepinephrine increased from 586 +/- 152 pg/mL to 1135 +/- 247 pg/mL (P < 0.05) during acute isovolemic hemodilution and remained at this increased level during extended hemodilution. Epinephrine levels did not change with hemodilution. Compensatory mechanisms such as increases in cardiac output and mean coronary flow observed during acute hemodilution persist during extended periods of hemodilution.

Animals↗

PubMed1999

Nicardipine intravenous bolus dosing for acutely decreasing arterial blood pressure during general anesthesia for cardiac operations: pharmacokinetics, pharmacodynamics, and associated effects on left ventricular function.

UNLABELLED: The objective of this study was to evaluate the efficacy of nicardipine, a dihydropyridine calcium channel antagonist, administered as an IV bolus dose to acutely decrease arterial pressure in anesthetized cardiac surgical patients. We performed a double-blind, randomized, self-controlled, dose-ranging study in 40 adult cardiac surgical patients to determine the pharmacokinetics and pharmacodynamics of nicardipine 0.25 mg, 0.50 mg, 1.00 mg, and 2.00 mg administered as an IV bolus. Transesophageal echocardiography was used to assess left ventricular preload, afterload, and global systolic function. Plasma nicardipine concentration was measured using high-performance liquid chromatography. Nicardipine selectively decreased arterial pressure in a dose-dependent manner with a maximum response within 100 s and recovery to half the maximum response within 3-7 min without associated changes in heart rate. The decreases in arterial pressure were associated with only small decreases in left ventricular end-systolic wall stress and small increases in global left ventricular systolic function without changes in left ventricular end-diastolic cavity area or cardiac output. The time course for nicardipine bolus was consistent with a two-compartment pharmacokinetic model with rapid redistribution from a small central compartment. IMPLICATIONS: Nicardipine was effective for selectively decreasing arterial blood pressure acutely, but had no effects on ventricular preload or cardiac output. The absence of dose-dependent changes in cardiac output, left ventricular systolic performance, and left ventricular afterload despite significant decreases in arterial pressure suggested that nicardipine had a small negative inotropic action.

Aged↗

PubMed2006

Developing empirical models to enhance stroke rehabilitation.

PURPOSE: Models identifying functional indicators most strongly associated with favourable and unfavourable outcomes may bolster evidence to improve stroke rehabilitation assessment and intervention. This study examined the feasibility of decision analysis methods for developing data-driven models that examined associations between specific functional indicators and global disability. METHOD: Data were derived from functional assessment of 67 participants 3 months following stroke. Decision analysis methods were used to examine specific activity and body function indicators associated with global disability, and the degree of limitation or impairment that contributed to favourable and unfavourable outcomes, in 2 models. The feasibility of decision analysis methods was evaluated. RESULTS: Of the 26 activity indicators, dressing was most strongly associated with global disability, followed by bill mailing, shopping and sweeping. Of 15 body function indicators, facial weakness and mental functions were most strongly associated with global disability. The misclassification risk estimates were fair for the two models. CONCLUSIONS: Findings suggest that decision analysis methods show promise for developing models examining associations between specific functional indicators and disability. Further study with these methods may identify specific priorities for functional assessment and intervention in stroke rehabilitation.

Activities of Daily Living↗

PubMed2000

Hemodynamic monitoring of the postoperative adult cardiac surgical patient.

Surgery on the central blood pump, the heart, is performed either to prevent homeostatic compromise (ie, coronary artery disease potentially causing myocardial infarction and heart failure) or to treat actual homeostatic imbalance (ie, valvular disease causing heart failure). The cardiovascular homeostatic state is what we generally define as hemodynamics. The heart must deliver adequate oxygen and nutrients to all organs at appropriate pressures to allow optimal organ function. We monitor hemodynamic variables to assess the adequacy of a given cardiac repair and to detect any organ dysfunction that may independently coexist or be intimately related with the cardiac disease or its surgical repair. Hemodynamic monitoring initially relied on vital signs and periodic physical examination. The current monitoring capabilities have field expanded to include systemic and pulmonary arterial pressures, central venous pressures, cardiac output, systemic and pulmonary vascular resistance, and systemic and mixed venous oxygen saturation. These variables reflect a synthesis of global cardiac function and the peripheral or pulmonary vascular state. Arterial blood gas analysis further assesses the adequacy of overall oxygen delivery, carbon dioxide removal and acid-base balance. Echocardiography allows a qualitative and quantitative description of both global and regional cardiac function to better define the cardiac components of any hemodynamic state.

Adult↗

PubMed1992

[Complementary information from Doppler echocardiography in the electrocardiogram in the basic assessment of chronic coronary heart disease, especially following a myocardial infarct. Observations from an ambulatory cardiology clinic].

In chronic ischemic heart disease, Doppler echocardiography (DE) at rest permits semiquantitative evaluation of scarring and remodelling processes, global ventricular function and, frequently, regional wall motion state. Late complications are detected, namely infarct expansion, true and false ventricular aneurysm, mitral insufficiency, thrombus formation, and associated valvular and aortic diseases are discovered. We studied 100 patients with known chronic coronary artery disease referred for noninvasive evaluation, including electrocardiogram (ECG) and DE. In all patients, the global left-ventricular function was satisfactorily assessable. In roughly two thirds of the documented infarctions. DE confirmed the ECG diagnosis and permitted a more precise diagnosis in the majority of them in terms of localization and/or dimension of the necrosis. In one third of the patients. DE clarified inconclusive ECG tracings. Thus, the baseline noninvasive investigation with ECG and DE is a potent tool in the management of chronic ischemic heart disease, serving as a guide to further investigation and to treatment adjustments.

Adult↗

PubMed2002

Role of delta-opioid receptor agonists on infarct size reduction in swine.

Opioids are involved in cardiac ischemic preconditioning. Important species differences in cellular signaling mechanisms, antiarrhythmic, and antistunning effects have been described. The role of the delta-opioid receptor activation in swine remains unknown. Forty minutes before a 45-min occlusion and 180-min reperfusion of the left anterior descending coronary artery, open-chest, pentobarbital-anesthetized swine received either 1) saline (controls); 2) [D-Ala(2),D-Leu(5)]enkephalin (DADLE); 3) [D-Pen(2,5)]enkephalin (DPDPE); 4) deltorphin-D, a novel delta(2)-opioid agonist; or 5) ischemic preconditioning (IP). Assessed were 1) infarct size to area at risk (IS, triphenyltetrazolium staining), 2) regional and global myocardial function (sonomicrometry, ventricular pressure catheters), and 3) arrhythmias (electrocardiogram analyses). It was found that DPDPE and deltorphin-D pretreatment reduced IS from 64.7 +/- 5 to 36.5 +/- 6% and 27.4 +/- 11% (P < 0.01), respectively, whereas DADLE had no effect (66.8 +/- 3%). Both IP and DADLE had a proarrhythmic effect (P < 0.01). However, no differences in global or regional myocardial function or arrhythmia scores were observed between groups. This suggests that delta-receptor-specific opioids provide cardioprotection in swine.

Animals↗

PubMed1998

Angiogenic potential of perivascularly delivered aFGF in a porcine model of chronic myocardial ischemia.

A number of heparin-binding growth factors, including basic (bFGF) and acidic (aFGF) fibroblast growth factors have been shown to promote angiogenesis in vivo. In this study, we employed a sustained-release polymer extravascular delivery system to evaluate the angiogenic efficacy of a novel form of genetically modified aFGF in the setting of chronic myocardial ischemia. Fifteen Yorkshire pigs subjected to Ameroid occluder placement on the left circumflex (LCX) artery were treated with perivascularly administered aFGF in ethylene vinyl acetate (EVAc) polymer (10 micrograms, n = 7) or EVAc alone (controls, n = 8). Seven to nine weeks later, after coronary angiography to document Ameroid-induced coronary occlusion, all animals underwent studies of coronary flow and global and regional left ventricular function. Microsphere-determined coronary flow in the Ameroid-compromised territory was significantly increased in aFGF-treated compared with control animals, and this improvement in perfusion was maintained during ventricular pacing. Left ventricular function studies demonstrated improved global and regional function in aFGF-treated animals. We conclude that local perivascular delivery of genetically modified aFGF results in significant improvement in myocardial flow and regional and global left ventricular function.

Animals↗

PubMed1996

[Three-dimensional echocardiography in evaluation of left ventricular systolic function after mitral valve replacement for chronic mitral diseases with preservation of mitral apparatus].

OBJECTIVE: To assess the global left ventricular performance in 24 normal subjects, 24 patients suffered from mitral valve disease (MVD) with mitral valve replacement (MVR), and 20 patients with mitral valve replacement with preservation of mitral apparatus (MVRP). METHODS: 3DE was used in comparion with the findings of radiography (RNA), two-dimensional echocardiography (2DE), and m-mode (MME). RESULTS: EF in 10 patients with MVD as compared with RNA, 3DE showed a higher connection coefficient than 2DE and MME. The EF estimated by MME and 2DE showed no difference between NS and MVD groups, there were significant differences when compared with those examined by 3DE. Two, three months after opertion, the VED and VES in group of MVRP were significantly lower than those in group of MVR (P < 0.01), the EF of MVRP group was remarkably higher than that of MVR group (P < 0.05). CONCLUSION: 3DE has the ability to estimate the EF of left ventricle more accurately than 2DE and MMe, especially in the patients suffered from chronic MVD with LV shape deformation. The MVR with preservation of mitral apparatus for chronic MVD is beneficial to maintaining the global systolic function after surgery.

Adolescent↗

PubMed1991

Patterns of global and regional systolic and diastolic function in the normal right ventricle assessed by ultrafast computed tomography.

A detailed evaluation of global and regional systolic function and diastolic filling of the human right ventricle has not been previously reported. Ultrafast computed tomography enables simultaneous imaging of the right and left ventricles at an 8 mm slice thickness with a scanning rate of 17 frames/s (50 ms acquisition intervals). In 10 normal men (mean age 26 +/- 4 years) early diastolic filling data were fit to a third order polynomial curve and the peak rate of diastolic filling and time to peak filling were determined globally and regionally at three distinct ventricular levels (apex to base) within each ventricle. The right and left ventricular stroke volumes were not statistically different (89 +/- 8 ml and 90 +/- 8 ml, p = NS), neither were the peak filling rates as referenced to the stroke volume (4.9 +/- 0.9 and 5.3 +/- 0.8 stroke volumes/s, p = NS). Time to peak filling rate was not different between the two ventricles (154 +/- 33 and 161 +/- 18 ms, p = NS). However, reference of stroke volumes and absolute peak filling rates to end-diastolic volumes demonstrated lower dynamic values for the right ventricle (ejection fraction: right ventricle 57 +/- 4%; left ventricle 68 +/- 5%, p less than 0.05, and peak filling rate: right ventricle 2.7 +/- 0.4 end-diastolic volumes/s; left ventricle 3.6 +/- 0.5, p less than 0.05, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2001

Construction of a global assessment scale of family function, using a questionnaire.

Self-report questionnaires are commonly used in family research, but very little attention is paid to the specific measurement properties of the ordered categorical data recorded. The item responses of self-report questionnaires consist of ordered categories. The main property of this type of data is that the labels do not represent a mathematical value but only an order, i.e., one set of labels can be replaced by another set of increasing numbers of symbols. The non-additivity of categorical data means that sum scores cannot be used as a global assessment of the variable. The aims of this study were to further develop the third version of the self-report questionnaire Family Adaptability and Cohesion, Evaluation Scales (FACES), for use in Sweden and to construct a global scale of family function for the variables cohesion and adaptability. The statistical methods used take account of the rank-invariant properties of ordered categorical data.

Adaptation, Psychological↗

PubMed2001

Assessment of left ventricular systolic function using contrast two-dimensional echocardiography with a high-frequency transducer in the awake murine model of myocardial infarction.

The estimation of global left ventricular function using M-mode echocardiography has technical limitations in the murine model of myocardial infarction (MI), but the recent improvements in 2-dimensional (2-D) echocardiography using a high-frequency transducer provide more accessible images. Furthermore, intravenous injection of contrast agent has the additional benefit of enhancing the endocardial border in the murine heart. The present study was designed to evaluate the value of 2-D echocardiography with intravenous injection of contrast agent in the assessment of global systolic function of the murine heart with MI. Two-dimensional and M-mode echocardiography without and with intravenous injection of contrast agent (Optison, 0.1-0.15 ml) were performed in 76 awake mice 2 days before and 2 days after left coronary artery ligation. Fractional shortening (FS) was calculated from the end-diastolic and end-systolic diameters on M-mode echocardiography, and fractional area change (FAC) from the end-diastolic and end-systolic areas on 2-D echocardiography. Both FS and FAC were compared with the areas of hypoperfusion observed in the pathological samples. The use of contrast agent improved the number of hearts that could be evaluated by both the M-mode and 2-D method (M-mode: non-contrast 87% vs contrast 99%, p<0.01; 2-D: non-contrast 26% vs contrast 89%, p<0.001). FAC from the 2-D method correlated better with the region of hypoperfusion in the pathological samples than did FS from the M-mode method (FAC: r=0.84 vs FS: r=0.51). In conclusion, FAC obtained from 2-D contrast echocardiography is useful for noninvasive assessment of global systolic function in infarcted murine hearts and can be used to serially assess systolic function in various models of the murine heart.

Albumins↗

PubMed2003

Acetaminophen for osteoarthritis.

BACKGROUND: Osteoarthritis (OA) is the most common form of arthritis. Published guidelines and expert opinion are divided over the relative role of acetaminophen (also called paracetamol or Tylenol) and non-steroidal anti-inflammatory drugs (NSAIDs) as first-line pharmacologic therapy. The comparative safety of acetaminophen and NSAIDs is important to consider as NSAIDs have the potential for serious gastrointestinal, renal, and cardiovascular toxicities, and acetaminophen in high dosages (greater than or equal to 2 grams per day), may also have the potential for serious upper gastrointestinal toxicity. OBJECTIVES: To assess the efficacy and safety of acetaminophen versus placebo and versus NSAIDs (ibuprofen, arthrotec, celecoxib,naproxen, rofecoxib) for treating OA. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (Issue 3, 2002), MEDLINE (up to July 2002), and Current Contents (up to March 2002). Reference lists of identified RCTs and pertinent review articles were also hand searched. SELECTION CRITERIA: Published randomized controlled trials (RCTs) evaluating the efficacy and safety of acetaminophen alone in OA were considered for inclusion. DATA COLLECTION AND ANALYSIS: Pain, physical function and global assessment outcomes were reported. Results for continuous outcome measures were expressed as standardized mean differences. Dichotomous outcome measures were pooled using relative risk and the number needed to treat was calculated. MAIN RESULTS: Six RCTs and 1689 participants were included in the review. One study compared acetaminophen to placebo, and five compared acetaminophen to NSAIDs. In the placebo-controlled RCT, acetaminophen was shown to be clearly superior to placebo with a similar safety profile. The number needed to treat to achieve an improvement in pain was three. In the comparator-controlled RCTs, acetaminophen was less effective overall than NSAIDs in terms of pain reduction and global assessments but both drugs had similar efficacy in terms of improvements in functional status. No significant difference was found between the safety of acetaminophen and NSAIDs, although patients taking NSAIDS were more likely to withdraw due to GI events. REVIEWER'S CONCLUSIONS: The evidence to date suggests that NSAIDs are superior to acetaminophen for improving knee and hip pain in people with OA but have not been shown to be superior in improving function. The size of the treatment effect was modest, and the mean trial duration was only six weeks, therefore, additional considerations need to be factored in when making the decision between using acetaminophen or NSAIDs. In OA subjects with moderate-to-severe levels of pain, NSAIDs appear to be more effective than acetaminophen.

Acetaminophen↗