Hippocampal volumes and depression subtypes

Studies of depression and hippocampal volume have yielded inconsistent results. This inconsistency could stem from the heterogeneity of depressive disorders. We conducted cross-sectional and longitudinal analyses of hippocampal volumes in atypical depressive, melancholic depressive, and control subjects. We found no effect of depression subtype on hippocampal volume or memory performance.     

Temporal trends of outcomes for nonagenarians undergoing coronary artery bypass grafting, 1993 to 1999

Temporal trends in length of stay, discharge disposition, and long-term mortality outcomes were examined in nonagenarians who underwent coronary artery bypass grafting (CABG) from 1993 to 1999. A total of 4,224 fee-for-service Medicare beneficiaries (2,068 women, 2,156 men) aged>or=90 years underwent CABG from 1993 to 1999. The number of procedures increased from 325 in 1993 to 883 in 1999 among all fee-for-service Medicare patients aged>or=65 years. Approximately half of CABG procedures were performed on women each year. The mean length of stay decreased from 18.0+/-10.8 to 13.3+/-8.8 days from 1993 to 1999 but remained longer for women (p<0.001). A greater percentage of women than men were discharged to skilled nursing facilities. The overall crude mortality rates remained relatively stable at 13.5% at 30 days and 59.0% at 5 years. Men and women had comparable short-term mortality outcomes, but men had higher mortality rates for 2- to 5-year outcomes. In conclusion, the number of CABG procedures in nonagenarians is increasing, with a substantial portion attaining survivorship that is equivalent to projected life expectancy.     

Aortic root motion remodeling after aortic valve replacement--implications for late aortic dissection

Aortic root motion was previously identified as an additional risk factor for aortic dissection. This study analyzed if the magnitude of aortic root motion changed in patients after aortic valve replacement (AVR) and acute proximal aortic dissection. An institutional database (1984-2005) was used to measure the downward motion of the aortic root (perpendicular to the plane of the sinotubular junction) in contrast injections in 48 patients with aortic insufficiency (AI), aortic stenosis (AS) and proximal aortic dissection pre- and postoperatively, when available. Postoperative aortic root motion was significantly reduced after AVR for AI, while it was significantly increased after AVR for AS. By contrast, aortic root motion was unchanged when functional AI due to paravalvular leak was present post-AVR for AI. In patients with acute aortic dissection, both aortic root motion and aortic diameter were unchanged from pre-dissection. However, in patients who dissected again, aortic root motion was significantly smaller than pre-dissection, and the aortic diameter was significantly less than at first dissection. Removal of aortic stenosis was associated with increased aortic root motion, theoretically heightening the threat of dissection posed to the aortic wall by mechanical stress, although this was not confirmed by our study of dissection patients. Yet, mechanical principles command to include higher magnitude of aortic root motion during follow-up of patients after AVR as an additional risk factor for dissection.     

Effect of advanced age on the development of complications from intravesical bacillus Calmette-Guérin therapy

PURPOSE: Advanced age is considered a risk factor for complications in patients receiving intravesical bacillus Calmette-Guérin (BCG) therapy. However, there is no clear delineation of BCG-related complication rates relative to patient age. MATERIALS AND METHODS: We reviewed the clinical course of 58 consecutive men receiving maintenance BCG therapy from December 1999 to July 2004 for transitional cell carcinoma. Patients ranged in age from 51 to 92 years (mean 72.4). Age and BCG-related complications warranting discontinuance of therapy were documented. RESULTS: In our patient population, 22 of 58 (37.9%) patients experienced complications. The complication rate for patients <70 years old on intravesical BCG maintenance therapy was 17.6%. Patients >or=70 years old had a complication rate of 48.6%. Excluding patients taking anticoagulants, the complication rate in patients age 70 and older was 53.3%. Patients who had complications (mean age 76.0 years) were significantly older than those who had no complications (mean age 70.3 years) (P < 0.00001). The peak incidence of complications occurred with the third BCG course. CONCLUSIONS: Maintenance BCG therapy should be given with caution in patients over age 70 and should be avoided in patients over age 80. Elderly patients at high risk for TCC recurrence and progression may be better served with a single 6-week course of BCG or alternative intravesical agents. Anticoagulants may be somewhat protective against complications in elderly patients but have been shown to significantly decrease the effectiveness of intravesical BCG, further supporting the consideration of alternative agents.     

Effects of postnatal dexamethasone exposure on the developmental outcome of premature infants

Extremely low birth weight premature infants are at risk for poor neurodevelopmental outcome. Postnatal dexamethasone has often been used in premature infants to prevent or treat bronchopulmonary dysplasia, and this drug is thought by some to affect neurodevelopmental outcome. We retrospectively examined the effect of this steroid on early neurodevelopment. Dexamethasone exposure was associated with an adverse outcome and was a stronger predictor of outcome than other accepted risk factors. If used, dexamethasone should be used in these high-risk infants for as short a period as possible.