Detection of patients with restenosis after PTCA by dipyridamole-atropine-stress-echocardiography

Stress-echocardiography (SE) has been proven to be a valuable method for the diagnosis of coronary artery disease. For patients who cannot exercise, pharmacological stress-echocardiography represents an alternative method for the induction of cardiovascular stress. Few studies exist concerning the value of dipyridamole-SE for the detection of restenosis in patients after primary successful PTCA. It has been demonstrated that the addition of atropine can significantly increase the diagnostic potential of dipyridamole-SE, especially in patients with 1- or 2-vessel disease. The purpose of our study was to investigate the diagnostic value of high-dose dipyridamole-SE plus atropine (DASE) for the detection of restenosis after primary successful PTCA. We investigated 65 patients 3–6 months after PTCA before a control angiography was performed. Restenosis was defined as > 70% lumen narrowing, determined by quantitative coronary angiography. In 20/27 patients with restenosis the DASE was pathologic (sensitivity 74%), in 34/38 patients without restenosis the DASE was normal or showed no induced WMA (specificity 89%). Patients with tight restenosis (> 90%) were always correctly detected by DASE. Concerning the different vessels, restenosis of the LAD was correctly predicted by DASE in 11/12 patients, restenosis of the LCX in 6/9 patients and restenosis of the RCA in 8/11 patients. Conclusions: From our results of our study we conclude that DASE is a reliable diagnostic method for the non-invasive evaluation of patients after PTCA. DASE can identify patients with relevant restenosis after PTCA and help to select those patients who will probably benefit from further coronary interventions.     

The reproducibility of electronic color measurements of the marginal gingiva

Clinical Oral Investigations - This study evaluated the reproducibility of electronic color determination system evaluations of the marginal gingiva, which could be important for adhesive cervical...     

Diagnosis of dementia in primary care: results of a representative survey in Lower Saxony,Germany

To investigate whether an early diagnosis of dementia is established, whether a differentiation is made between vascular and primary degenerative etiology, and whether treatable causes of dementia are considered in primary care, we performed a survey using three written sample case histories describing slight memory impairment (case 1) or moderate dementia (case 2a: vascular dementia; case 2b: degenerative dementia of Alzheimer type). The combinations 1 and 2a or 1 and 2b were randomly assigned and presented to ambulatory-care physicians (145 general practitioners and primary care internists and 14 neuropsychiatrists in private practice) in Göttingen and rural surroundings by a trained investigator who then performed a standardized interview. The study was representative (response rate 83.2%). For the sample case with slight memory complaints 13.8% of all physicians arrived at a primary diagnosis of depression and 44.0% considered depression for differential diagnosis. Senile dementia of Alzheimer type was considered less often. In the sample cases with moderate dementia according to established scientific criteria, there was a striking under-diagnosis of dementia, and in both cases an over-diagnosis of underlying vascular etiology. Treatable causes of dementia, such as possible drug interactions and substance abuse, were considered only by a minority of physicians. In conclusion, memory deficits seem to be regarded mainly as consequences of disturbed cerebral perfusion, and dementia as well as depression and drug adverse effects seem to be under-diagnosed in primary care.     

Effects of chronic treatment with methadone and naltrexone on sleep in addicts

Previous studies have described sleep disturbance secondary to chronic opiate use and abuse. Drug-dependency insomnia is of interest because chronic sleep disturbances can promote depressive symptoms which could lead to a drug relapse. For the first time we compared the polysomnographic parameters of 10 methadone-substituted outpatients and 10 naltrexone-treated outpatients. Methadone (-opioid agonist) produced a marked fragmentation of the sleep architecture with frequent awakenings and a decrease in EEG arousals. In comparison with methadone and controls, the naltrexone (-opioid antagonist) group showed the shortest sleep latency and the longest total sleep time. These data indicate that -agonists and -antagonists have different effects on sleep. The implications, especially the involvement of opioid-dopamine interactions on sleep and movements during sleep, are discussed.