Thoracoscopic Dorsal Sympathectomy for Upper Limb Buerger's Disease

Background and Objectives:

Thromboangiitis obliterans is a common peripheral vascular disease in India. This study was conducted to assess the efficacy of thoracoscopic dorsal sympathectomy as a treatment for Buerger disease of the upper extremities.

Methods:

Thirty thoracoscopic dorsal sympathectomies (17 left- and 13 right-sided) were performed in a tertiary medical center in 5 women and 20 men (mean age, 41 years) between July 2010 and February 2013.

Results:

The mean operative time was 30 minutes, and the mean hospital stay was 52 hours. There were no complications. All patients had improvement in pain and were relapse-free after a mean follow-up period of 11.63 months.

Discussion:

Thoracoscopic dorsal sympathectomy reduces pain significantly by reducing peripheral resistance and promoting collateral development. The increased magnification of the thoracoscopic approach permits better visualization, ensuring complete excision and therefore good results. Thoracoscopic dorsal sympathectomy for Buerger disease of the upper limb is a safe and effective treatment.     

Incident major depression does not affect neuropsychological functioning in HIV-infected men.

The diagnosis of lifetime major depressive disorders (MDDs) and of current major depressive episodes (MDEs) are relatively common in HIV-infected individuals, and often are assumed to influence neuropsychological (NP) performance. Although cross-sectional studies of HIV-infected individuals generally have found no systematic link between current MDE or depressive symptoms and NP performance, longitudinal studies are needed to clarify whether incident MDE may impact NP functioning in at least some cases. Two hundred twenty-seven human immunodeficiency virus (HIV)-infected adult men, who did not meet criteria for a current MDE at baseline, participated in a longitudinal NP study for an average of two years. Participants received repeated NP assessments, as well as structured psychiatric interviews to ascertain presence or absence of both lifetime MDD and current MDE. Ninety-eight participants had a lifetime history of MDD, and 23 participants met criteria for incident MDE at one of their follow-up evaluations. Groups with and without lifetime MDD and/or incident MDE had comparable demographics, HIV disease status and treatment histories at baseline, and numbers of intervening assessments between baseline and the final follow-up. Lifetime MDD was associated with greater complaints of cognitive difficulties in everyday life, and such complaints were increased at the times of incident MDE. However, detailed group comparisons revealed no NP performance differences in association with either lifetime or incident major depression. Finally, NP data from consistently nondepressed participants were used to develop "norms for change" and these findings failed to show any increased rates of NP worsening among individuals with incident MDE. Our results suggest that neurocognitive impairment and major depression should be considered as two independent processes.     

Reduced renal function and sleep-disordered breathing in community-dwelling elderly men

BACKGROUND: Sleep-disordered breathing (SDB) may increase the risk of cardiovascular disease (CVD) and death in chronic kidney disease (CKD). However, the association between mild reductions in renal function and SDB is uncertain. METHODS: We studied 508 community-dwelling men aged>or=67 years (mean 76.0+/-5.3) who were enrolled at the Minnesota site for the Minneapolis center of the Outcomes of Sleep Disorders in Older Men (MrOS) sleep study and had serum cystatin-C and creatinine measured coincident with overnight polysomnography. CKD was defined as estimated glomerular filtration rate (eGFR)<60 ml/min/1.73 m2 using Cockcroft-Gault (CG), modification of diet in renal disease (MDRD) and Mayo Clinic formulae. SDB was defined by a respiratory disturbance index (RDI)>or=15 events/h. RESULTS: Mean cystatin-C was 1.21+/-0.30 mg/L, and mean creatinine was 1.09+/-0.23 mg/dL. Median RDI was 7.0 events/h (range 0-73). Higher quartiles of cystatin-C were associated with higher mean RDI (p for trend=0.007). This association persisted after adjustment for age and race (p for trend=0.03), but not after adjustment for body mass index (BMI, p for trend=0.34). After adjusting for age, race, BMI, diabetes, hypertension, and CVD, CKD defined by the Mayo Clinic formula, but not CG or MDRD, was associated with a higher odds of SDB [odds ratio (OR) 1.95, 95% confidence interval (CI) 1.04-3.65, p=0.04]. CONCLUSIONS: Older men with reduced renal function as defined by higher cystatin-C concentration have higher average RDI. This effect is explained by higher BMI in men with higher cystatin-C. CKD defined by the Mayo Clinic formula is independently associated with twofold higher odds for SDB. Therefore, reduced renal function may be associated with SDB in older men.     

Post-op systemic hypertensive crises in an infant with total anomalous pulmonary venous connection

Systemic hypertension is not usually a complication following repair of total anomalous pulmonary venous connection (TAPVC). We report an infant with supracardiac TAPVC with hypertensive crises post-operatively resulting in pulmonary edema. We feel this might have been related to the pre-operative hemodynamics as described. Beta-blockers improved the hypertensive crises.     

Dissociations among daytime sleepiness,nighttime sleep,and cognitive status in Parkinson's disease

BackgroundDaytime and nighttime sleep disturbances and cognitive impairment occur frequently in Parkinson's disease (PD), but little is known about the interdependence of these non-motor complications. Thus, we examined the relationships among excessive daytime sleepiness, nighttime sleep quality and cognitive impairment in PD, including severity and specific cognitive deficits.MethodsNinety-three PD patients underwent clinical and neuropsychological evaluations including the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Patients were classified as having normal cognition (PD-NC), mild cognitive impairment (PD-MCI), or dementia (PDD) using recently proposed Movement Disorder Society PD-MCI and PDD criteria. Relationships between the sleep and cognitive measures and PD cognitive groups were examined.ResultsThe PD cohort included PD-NC (n = 28), PD-MCI (n = 40), and PDD (n = 25) patients. ESS scores, as a measure of daytime sleepiness, were significantly worse (p = 0.005) in cognitively impaired PD patients, particularly PDD patients. ESS scores correlated significantly with Mini-Mental State Examination scores and also with cognitive domain scores for attention/working memory, executive function, memory, and visuospatial function. In contrast, PSQI scores, as a measure of nighttime sleep quality, neither differed among cognitive groups nor correlated with any cognitive measures.ConclusionsDaytime sleepiness in PD, but not nighttime sleep problems, is associated with cognitive impairment in PD, especially in the setting of dementia, and attention/working memory, executive function, memory, and visuospatial deficits. The presence of nighttime sleep problems is pervasive across the PD cognitive spectrum, from normal cognition to dementia, and is not independently associated with cognitive impairment or deficits in cognitive domains.     

重症监护病房革兰阴性菌耐药现状研究

目的：了解我院重症监护病房分离菌株对常用抗生素的耐药现状。方法：采用琼脂双倍稀释法测定从我院重症监护病房分离的230株革兰阴性菌的最低抑菌浓度（MIC），并采用抑制剂增强的纸片扩散法测定大肠埃希菌和肺炎克雷伯菌超广谱β－内酰胺酶（ESBLs)。结果：50株肺炎克雷伯菌和17株大肠埃希菌中ESBLs阳性率为62．1％。阴沟肠杆菌、产ESBLs的大肠埃希菌和肺炎克雷伯菌对三代头孢、庆大霉素、阿米卡星的耐药率≥50％。而对碳青霉烯类非常敏感。铜绿假单胞菌对各种抗菌药物均有一定的耐药性。嗜麦芽寡养单胞菌对碳青霉烯类耐药率达100％。结论：受试的230株革兰阴性菌对三代头孢、复合青霉素、氨基糖苷类和环丙沙星的总耐药率≥30％。CPZ／SB和头孢吡肟、碳青霉烯类耐药率较低。     

氯化四乙基铵及维拉帕米对家兔缺血心肌不应期的影响

实验比较了K⁺通道阻断剂氯化四乙基铵(TEA)及Ca²⁺通道阻断剂维拉帕米(verapamil,Ver)对家兔缺血性心室肌不应期(ERP)的影响。结果表明,阻断冠脉10min及30min后,缺血中心区(CIZ)和缺血边缘区(BIZ)心肌ERP比缺血前均明显缩短,而TEA和Ver均能延长急性缺血性心肌的ERP,可能对心肌缺血引起的心律失常有预防作用。