Correlation of sleep macrostructure parameters and idiopathic epilepsies

Sleep and epilepsy share some common mechanisms. The objective of the present investigation was to study the macrostructure of sleep in patients with idiopathic epilepsies, focal and generalized, comparing these two groups to each other and to a control group of 12 individuals without epilepsy. A total of 35 polysomnographies were performed, 12 of them in the control group, 10 in patients with idiopathic generalized epilepsies, and 13 in patients with idiopathic focal epilepsies. Antiepileptic medications were maintained for ethical reasons. The group with idiopathic focal epilepsy showed an increase in the total recording time (p = 0.04) and the group with idiopathic generalized epilepsy had a reduction of phase 4 NREM sleep. The efficiency of total sleep period and of total sleep time was also lower in the group with idiopathic generalized epilepsy (p = 0.03 in both cases). We concluded that the group with idiopathic generalized epilepsy presents sleep of poorer quality, whereas the group with idiopathic focal epilepsy presents a tendency toward an excessive somnolence.     

Effect of high and low rates of fluid intake on post-exercise rehydration

The effect of a high (H) and a low (L) rate of post-exercise fluid consumption on plasma volume and fluid balance restoration was investigated. Eight well-trained cyclists were dehydrated at 3% of body weight (BW) by cycling at 28 degrees C. During the recovery period, they ingested a carbohydrate-electrolyte solution in a volume equivalent to 120% of BW loss. Randomly, they ingested 60%, 40%, and 20% in the 1st, 2nd, and 3rd hours of the recovery period, respectively (H), or 24% x h(-1) during 5 hours (L). BW loss was similar for both trials and resulted in a total drink intake of 2.6 +/- 0.1 kg. Urine output in H exceeded significantly that of L in the 2nd and 3rd hours. This was reversed in the 5th and 6th hours. Plasma volume and fluid balance increased more rapidly in H compared to L. After 6 hours this difference disappeared. It is concluded that H results in a faster rate of plasma volume and fluid balance restoration compared to L, despite a temporary large urine output.     

Instrumental inputs: moving the interpersonal theory of nursing into practice

Instrumental inputs, the units of energy that are passed from nurse to client in therapeutic encounters, stimulate the client to develop new competencies. This article develops the concept, part of the Interpersonal Theory of Nursing, and discusses its use in 2 clinical trials of an advanced practice psychiatric-mental health intervention with high-risk mothers with significant depressive symptoms. Systematic documentation of instrumental inputs in the strategic interactions between advanced practice psychiatric-mental health nurses and clients has provided cumulative empirical examples that are presented. The concept has great utility for clinical practice and research and continuing development and testing of the Interpersonal Theory of Nursing.     

Incidence of postdural puncture headache and backache, and success rate of dural puncture: comparison of two spinal needle designs

OBJECTIVES: The goal of this randomized study was to compare the incidence of postdural puncture headache (PDPH) and postdural puncture backache (PDPB), and the success rate between two small-gauge spinal needle designs used in women undergoing subarachnoid block anesthesia. METHODS: After Institutional Review Board approval, 215 patients presenting for tubal ligation were randomly assigned to have 26-gauge Atraucan (AT group) or 25-gauge Whitacre (WH group) spinal needles used in their spinal anesthesia. The number of attempts to successful cerebrospinal fluid return and the success rate of the spinal blockade were documented. Postoperatively, an investigator blinded to the study interviewed patients daily. RESULTS: The incidence of PDPH was similar between the AT group (3.9%) and the WH group (4.0%). The total duration of all PDPHs was 5 days for the AT group and 15 days for the WH group. Both groups had a similar one-attempt success rate of 61% (AT group) and 62% (WH group). Failure to obtain cerebrospinal fluid occurred in only one in the AT group and two in the WH group. The incidence of PDPB was similar and the severity was mild in both groups. CONCLUSIONS: The low complication and failure rates make these two types of smaller size spinal needle design good candidates for dural puncture procedures, such as spinal anesthesia, diagnostic lumbar punctures, and myelograms.     

Postischemic stunning after adenosine vasodilator stress

BACKGROUND: Ischemic left ventricular (LV) dysfunction may occur after exercise but is regarded as uncommon after vasodilator stress. We evaluated the prevalence of LV dysfunction after adenosine stress in relation to reversible perfusion defects and angiographic coronary artery disease (CAD). METHODS AND RESULTS: We studied 86 patients referred for clinically indicated adenosine dual-isotope gated single photon emission computed tomography: 43 with 1 or more reversible perfusion defects (reversible defect group) and 43 age- and sex-matched patients with no known CAD and normal LV perfusion and function (control group). Coronary angiography was performed in 36 of 43 patients (84%) in the reversible defect group. Perfusion was interpreted based on 20-segment/5-point summed rest and stress scores. The extent of reversibility was defined by the summed difference score. LV ejection fraction and volumes at rest and 60 minutes after adenosine and segmental wall thickening were quantified by QGS (Cedars-Sinai Medical Center, Los Angeles, Calif). In patients with extensive reversible perfusion defects (summed difference score > or =8), 8 of 25 (32%) demonstrated depressed post-adenosine LV ejection fraction, abnormal segmental wall thickening, end-systolic dilation, and extensive CAD. CONCLUSION: Adenosine is believed to be less likely than exercise to induce ischemia. However, myocardial stunning occurred in one third of the patients with severe reversible defects, consistent with ischemia.     

Cystatin C in cerebrospinal fluid is not a diagnostic test for pain in humans

A recent subtractive cDNA cloning study in rats demonstrated an unexpected increase in expression of the proteinase inhibitor, cystatin C in the spinal cord during acute peripheral inflammation, suggesting this protein may be involved in the pathogenesis of persistent pain. A subsequent study of 10 women suggested that prolonged labor pain resulted in increased cystatin C concentrations in cerebrospinal fluid, and that this could be used as a biomarker for pain. To confirm and extend these observations, we measured cystatin C concentrations in cerebrospinal fluid in 131 subjects: 30 normal volunteers without pain, 25 women at elective cesarean section without pain, 60 women in labor with severe pain, and 16 patients with chronic neuropathic pain and tactile allodynia. The median cystatin C concentration in normal volunteers, 2.2 microg/ml, was similar to that previously reported by multiple investigators, and cystatin C concentrations were increased in women in labor (3.9 microg/ml). However, contrary to the previous report, cystatin C concentrations in laboring women with pain did not differ from those of pregnant women without pain (3.7 microg/ml). There was no relationship between duration of painful labor and cystatin C concentration. Patients with neuropathic pain had similar cystatin C concentrations (2.4 microg/ml) to controls. Logistic regression analysis indicated that cystatin C concentrations could not be used to reliably predict the presence of pain in either acute or chronic settings. These data suggest that cystatin C concentration in cerebrospinal fluid is an unreliable diagnostic marker for pain in humans.