EEG evaluation of patients undergoing extracorporeal circulation under analgesic and electrohypoalgesia with auricular acupuncture

Electroencephalograms recorded 12 hours before and 12 hours after heart surgery in ECC and moderate hypothermia (30 degrees) are evaluated. Two groups of patients were studied: - the first group was composed of those undergoing analgesic anaesthesia; - the second group of those undergoing electroencephalograms by means of auricular acupuncture. In the first group the postoperative EEG was dominated by long "theta" and "delta" waves characteristic of the deep sedation of analgesic anaesthesia. In the second the EEG displayed a "theta" rhythm interspersed with trains of "alpha" waves, similar to that of a tired, but alert person. The pathological traces with signs of diffused, hemispheric or cerebral distress, do not bear any relationship to the type of anaesthesia, but to the type of disease, which had increased the probability of thrombo-embolic, and/or ischaemic risk.     

Coronary surgery without extracorporeal circulation. Indications, methods and results. Apropos of 224 cases

Coronary revascularization without cardiopulmonary bypass is evolving as an important technique. From January 1988 to September 1997, 224 patients underwent consecutively coronary artery bypass grafting without cardiopulmonary bypass in our institution. Indications for this type of revascularization were essentially: patients with a single coronary lesion and patients which presented an increased risk for extra-corporeal circulation. Follow-up was complete. The majority of patients were men (176) and the median age was 62 years. Most patients were in CCS III and IV (79%). Unstable angina was found in 19%, 4% had a recent trans mural infarction (< or = 48 hr), and 36% had an older infarct (> 48 hr). 8% were operated in emergency, 29% presented a restenosis following angioplasty, with 4% having a complication from angioplasty, and 0.8% were operated in cardiogenic shock. Redo surgery was seen in 4% of patients. 12% of patients had an ejection fraction less than 30%, 47% an ejection fraction between 30 et 49%, and 40% patients an ejection fraction greater than 50%. Mean Parsonnet score was 10. 185 patients (82.5%) underwent single bypass, and 39 patients (17%) multiple bypasses. Ten patients (4.4%) underwent hybrid revascularization with primarily surgical grafting followed by angioplasty. Postoperative outcome included: myocardial infarction in 16 patients (7.1%), 8 patients (3.5%) were reoperated for tamponade or bleeding, 2 patients (0.8%) developed a mediastinitis, and 1 patient (0.4%) had a neurological event. Hospital mortality was 4% (9 patients). Univariate and multivariate analysis identified two risks factors: age greater than 70 (OR 4.2, CI 1-18.4), and an ejection fraction less than 30% (OR 5, CI 1.2-21.6). Survival was 99.1% at 1 year, 94% at 3 years and 83.2% at 7 years. Post operative angina occurred in 33 patients, linked to a coronary anastomosis dysfunction in 9 patients (4.1%). A significant reduction of cost was found, compared to patients operated with extra-corporeal circulation. We conclude that coronary revascularization without cardiopulmonary bypass can provide satisfactory results, for patients with single coronary lesion, or for patients with an increased risk and multiple coronary lesions.     

Basic evaluation of post-anal preoperative pulmonary mechanism in heart surgery patients under extracorporeal circulation

Effects of clonidine on blood pressure, heart rate and rectal temperature in conscious rats were examined. Clonidine (0.1-1 mg/kg s.c.) caused a prevailing pressor response and dose-dependently a fall in heart rate and body temperature. The pressor response to clonidine (0.3 mg/kg s.c.) was completely reduced by phentolamine (10 mg/kg s.c.), chlorpromazine (10 mg/kg s.c.) but not by hexamethonium (30 mg/kg i.p.), guanethidine (30 mg/kg s.c.) or reserpine (5 mg/kg s.c. 18 hr + mg/kg i.p. 4 hr prior to clonidine). Conversely, a remarkable potentiation of the pressor response to clonidine was observed after treatment with reserpine. The bradycardia with clonidine (0.3 mg/kg s.c.) was significanlty reduced by phentolamine, chlorpromazine or atropine (5 mg/kg s.c.) but was potentiated by reserpine. The hypothermia with clonidine (0.3 mg/kg s.c.) was not influenced by phentolamine or atropine but was significanlty potentiated by chlorpromazine. From the above results it is suggested that the prevailing pressor response to clonidine in conscious rats is due to a stimulation of peripheral alpha-adrenoceptors, the bradycardia with clonidine is exerted through the sympathetic pathway and the baroceptor-vagal reflex, and that the hypothermia with clonidine is mainly due to the central mechanism.     

Coronary surgery on the beating heart under extracorporeal circulation in high-risk patients. An acceptable compromise?

Coronary artery surgery with cardioplegia in high risk patients carries a risk of myocardial ischaemia and, without cardiopulmonary bypass, is not always technically feasible. The authors assessed an alternative, surgery on the beating heart with haemodynamic assist by cardiopulmonary bypass in 43 consecutive patients with poor left ventricular function (mean ejection fraction: 0.26), evolving myocardial ischaemia or acute myocardial infarction, old age (mean: 79.5 years) and comorbid conditions. Results were assessed mainly on clinical criteria. In addition, 9 patients had pre- and post-cardiopulmonary bypass measurements of markers of myocardial ischaemia (troponine Ic) and systemic inflammation (interleukines 6 and 10, elastase). In 6 cases, right atrial biopsy was analysed for expression of messenger ribonucleic acid coding for heat shock protein (HSP) 70; the data were compared with those of patients operated under warm blood cardioplegia. There was one cardiac death and one myocardial infarction. Myocardial conservation was confirmed by the minimal increase in troponine Ic levels and the significant increase in HSP 70 in RNA suggesting myocardial adaptation to stress. On the other hand, the minimal concentrations of mediators of inflammation were not significantly changed. In selected high risk patients, coronary revascularisation on the beating heart under cardiopulmonary bypass could be a valuable alternative. It conserves the potentially deleterious effects of cardiopulmonary bypass but peroperative global myocardial ischaemia, an important factor in the aggressivity of cardiac surgery, is eliminated.     

Personal experience with management of extracorporeal circulation in patients with asymptomatic carotid arteriosclerosis

The authors describe in following paper their own group of patients with asymptomatic but hemodynamically significant carotid disease operated under cardiopulmonary bypass on. Current studies recommend the "alpha-stat" regime as the optimal strategy of CPB conduction to ensure intraoperative cerebral protection. This study was done to verify this idea. 284 consecutive patients admitted for elective coronary surgery underwent a non-invasive Doppler scanning of extracranial carotid arteries. Twenty seven patients (10%) had significant carotid disease. All patients underwent coronary surgery as the first procedure. There was no cerebral complication in this group of patients and neurological status of these patients postoperatively was the same as it was preoperatively. This study shows that CPB in patients with hemodynamically significant carotid disease can be achieved without impairment of central nervous system with "alpha-stat" regime of perfusion.     

Referral, intervention, and outcome in Canadian child abuse cases.

Investigated the course of referral, intervention, and outcome in Canadian child abuse cases by examining the characteristics of 422 cases seen at a hospital and known to the Children's Aid Society from 1973 to 1977. Through discriminant function analyses, variables that correctly predicted outcome were identified. Subsequent abuse was predicted by variables such as child behavior problems, parents having been abused as children, abuse of a sibling, and severity of the child's injury. Reasons for using caution in clinical applications of these predictors are discussed. Comparisons of the present study to the few previous Canadian ones are reported, and all were similar in 2 respects: Bruises were the most common injury type, and abusers were rarely taken to criminal court. Differences in the findings appeared to be due primarily to the ways the samples were selected and differences in available services and hospital or agency practices. (French abstract) (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of treatment outcome after nicergoline and pentoxifylline in patients with ischemic stroke

In this 4-year follow-up in vivo controlled study, 112 human permanent first molars from children between 6 and 11 years old were used to investigate the viability of the carbon dioxide (CO2) laser in promoting caries-free occlusal surfaces in permanent molars as an isolated form of treatment or associated with conventional fissure sealants. The findings suggest that occlusal caries prevention only by means of CO2 laser irradiation is not effective; that the utilization of photoactivated sealants, as well as its association with CO2 laser, applied over the occlusal fissures, are effective means of preventing occlusal caries, and that the application of CO2 laser over occlusal fissures prior to the application of a photoactivated fissure sealant improves the retention of the sealant.     

Biological markers, treatment outcome, and 1-year follow-up in endogenous depression: Electroencephalographic sleep studies and response to cognitive therapy.

Although there are now considerable data attesting to the efficacy of several forms of treatment for depression, there is surprisingly little information to guide the selection of the treatment most likely to benefit a given patient. Biologic markers of depression have received much attention for their potential to provide theoretically and clinically meaningful subgroups for specific treatments. The relationship between EEG sleep disturbances, treatment outcome, and 1-yr follow-up was examined for a sample of 53 patients with endogenous major depression receiving cognitive-behavioral therapy. Overall, there was little support for the prediction of a difference in short- or long-term outcome between patients with and without EEG sleep disturbances. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonpsychiatric medical comorbidity, health perceptions, and treatment outcome in patients with panic disorder.

Panic disorder is frequently complicated by high rates of co-occurring nonpsychiatric medical conditions. The present study examined the relationship between medical morbidity, perceived physical health, and treatment outcome in panic disorder Patients meeting the American Psychiatric Association's Diagnostic and Statistical Manual of mental disorders (1994) criteria for panic disorder (N?=?71) completed 12 sessions of cognitive-behavioral treatment and were assessed at posttreatment and 6-month follow-up. Medical comorbidity and perceived health were both found to be related to end-state functioning. Medical comorbidity did not uniquely predict outcome beyond its shared variance with perceived health. At posttreatment, 71% of patients who perceived their physical health as good met recovery criteria compared with only 35% of those who perceived their health as poor. At follow-up, 67% of those who perceived their physical health as good met composite recovery criteria compared with only 33% of those with perceived poor health. These findings offer preliminary support for the impact of physical health, both actual and perceived, on treatment outcome of patients with panic disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient and therapist values in psychotherapy: Perceived changes, assimilation, similarity, and outcome.

Investigated (1) the nature and extent of perceived changes in patients' values (reported retrospectively), (2) the relationship between patients' assimilation of their therapists' values and outcome, and (3) the relationship between the similarity of patient–therapist values (posttherapy) and outcome. A great deal of perceived values change was reported by the patients, but (contrary to expectations) not primarily in values concerning interpersonal morality. Values assimilation demonstrated a fairly substantial positive correlation with therapist's outcome assessment, but not with other measures of outcome, suggesting that the phenomenon may be related more to the therapist's rating bias than to genuine improvement. Patient–therapist dyads whose values were moderately similar showed the most improvement, indicating that an intermediate range of values similarity may function as a predictor of positive outcome. Secondary findings (including the seemingly unique role of religious values) and suggestions for future research directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Glucose metabolism in children undergoing extracorporeal circulation: its correlation with weight and the degree of hypothermia

INTRODUCTION: A prospective study has been carried out in 33 children with congenital heart disease, aged 5 days to 16 years, operated on with the aid of cardiopulmonary bypass (CPB), in order to evaluate intra and postoperative glycemia in relation to children's weight and intra-CPB perfusion temperature. MATERIAL AND METHODS: Plasmatic levels of glucose, lactate, insulin, C-peptide, growth hormone (GH) and cortisol were measured at five different times, from pre-CPB up to 18 hours post-CPB. Thirteen children weighing less than 10 kilograms (group I) were compared to 20 children weighing more than 10 kilograms (group II), and 15 children operated on with perfusion temperature below 27 degrees C (group A) were compared to 18 with perfusion temperature above 27 degrees C. RESULTS: All the cases showed intraoperative hyperglycemia. In relation to weight, evolution of glycemia was similar in both groups but anaerobic glycolysis was significantly higher in group I. In relation to temperature, glycemia, lactic acidemia intra- and post-CPB and serum C-peptide post-CPB were significantly higher in group A. Intraoperative insulin was decreased and GH serum levels were also higher in group I and A, but fell drastically post-CPB in all groups. CONCLUSIONS: Perioperative control of glycemia is important in children operated on with the aid of CPB. Control of lactic acidemia is also expedient. Carbohydrates metabolism and its hormonal regulation are more disturbed in infants and in children operated on with low perfusion temperature.