Technetium-99m sestamibi tomographic evaluation of residual ischemia after anterior myocardial infarction

OBJECTIVES: This study investigated the value of sestamibi scintigraphy in assessing residual ischemia after anterior myocardial infarction. BACKGROUND: Serial imaging with sestamibi, the uptake and retention of which correlate with regional myocardial blood flow and viability, has been used to estimate salvaged myocardium and risk area after acute infarction. We recently documented that recovery of perfusion and contraction in the infarcted area may continue well after the subacute phase, suggesting myocardial hibernation. Some underestimation of viability in the setting of hibernating myocardium by sestamibi imaging has been reported. METHODS: We studied 58 patients in stable condition after Q wave anterior infarction. Regional perfusion and function were quantitatively assessed by sestamibi tomography and two-dimensional echocardiography at 4 to 6 weeks and at 7 months after infarction. In sestamibi polar maps, abnormal areas with tracer uptake > 2.5 SD below our reference values were computed at rest and after symptom-limited exercise. On two-dimensional echocardiography the ejection fraction and extent of rest wall motion abnormalities were assessed by a computerized system. All patients had coronary angiography between the two studies. RESULTS: At 7 months the extent of rest sestamibi defect was significantly reduced in 40 patients (69%, group 1) and unchanged in 18 (31%, group 2). Rest wall motion abnormalities and ventricular ejection fraction significantly improved in group 1 but not in group 2. Underlying coronary disease, patency of the infarct-related vessel and rest sestamibi defect extent at 5 weeks were comparable between the two groups. At 7 months, an increase in the reversible (stress-rest defect) tracer defect was observed in group 1 (p < 0.05) despite a smaller stress-induced hypoperfusion (p < 0.05). Reversible sestamibi defects and stress hypoperfusion were unchanged in group 2. In 38 (95%) of 40 group 1 patients, the area showing reversible sestamibi defects at 7 months matched the area showing fixed hypoperfusion at 5 weeks. CONCLUSIONS: The reduction in the rest tracer uptake defect that can occur late after infarction may affect the assessment of ischemic burden by sestamibi imaging early after anterior myocardial infarction.     

Brain tumors with symptomatic onset in the first two years of life

Eighty children who in the first 2 years of life had signs and symptoms relating to a cerebral neoplasm were studied over an 18-year period (1970-1987), the mean follow-up being 8.2 years. In each case age at onset, clinical presentation, tumor location and pathological diagnosis, extent of surgical resection, postoperative mortality, adjuvant therapy length of survival and quality of life were assessed. Supratentorial tumors (59%) were more common than infratentorial. The most frequent clinical presenting feature (70%) was increased intracranial pressure. Sixty-three patients (79%) were operated on and in all of these cases a histological diagnosis was obtained. Astrocytomas (41%) and medulloblastomas (20%) were the most common oncotypes. Surgical mortality was 17.4% and the 5-year survival rate was 54%. Quality of life was assessed for all long-term surviving patients using a specifically designed protocol. Normal physical and intellectual performances were found in 46% of cases, and all together 75% of the patients had sufficient autonomy in daily life. The prognosis is more closely related to tumor location and type of treatment than to histological diagnosis or age at onset.     

Various personality traits of patients with psoriatic arthropathy

It is well known that patients affected by rheumatic diseases may present specific pathological trends in personality structure, as has been extensively reported in literature. Our study was aimed at investigating several aspects of the personality traits of 20 patients with psoriatic arthropathy, compared with a group of 20 patients with rheumatoid arthritis. All patients were evaluated with appropriate rating scales assigned in auto and hetero-administration. The study results points to a personality trait disturbance in psoriatic arthritis patients, which can be clearly differentiated from the anxious habitus and/or reactive-depressive state observed in patients with rheumatoid arthritis.     

The catalepsy test: Its ups and downs.

The typical catalepsy (CPSY) test consists of placing an animal in an unusual posture and recording the time taken to correct this posture. This time is regarded as an index of the intensity of CPSY. CPSY is a robust behavior, and the lack of standardization does not usually hinder its actual detection. However, the intensity of the cataleptic effect is influenced by minor methodological differences, and interpretation and comparison of results across laboratories are difficult. The behavioral CPSY test can use any of several different apparatus, including wire grids, parallel bars, platforms, or pegs, to situate the animals in unusual positions. The most common is the bar test (BT), and despite its wide use in psychopharmacological research, even parameters of this test are not standardized. The present article reviews parameters chosen by investigators that measure CPSY. The methodological issues of repeated testing, scaling of scores, apparatus, animal weight, maximal test duration, behavioral criteria, and other influences are discussed. A brief review of the neuropharmacological basis of CPSY is included. It is argued that a universal, standardized BT be adopted by researchers. New data on a novel automated BT in the Digiscan Activity Monitoring System is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Paraprofessional skill: Maintenance of empathic sensitivity after training.

Investigated changes in empathic sensitivity in paraprofessionals as a result of training and examined the maintenance of changes 6–24 mo after training. Also explored was the relationship of verbal intelligence to changes. 47 students in an associate degree mental health/human service program participated. Each S completed a 10-wk training course in 1 of 4 groups. Each was given the Recognition Assessment—Empathy (RA—E) on completion of the course and 6–24 mo later. Ss in 2 groups were also pretested on the RA—E. Empathetic sensitivity did increase after the course, confirming previous research, and changes were not only maintained but increased over time to a level comparable with a normative group of experienced clinicians. Course drop-out and selection effects were judged to be minimal. No significant relationship emerged between verbal intelligence and empathic sensitivity either before or after training. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)