Aortic dissection: the tear that kills

Patient survival of aortic dissection hinges on timely diagnosis and treatment.     

Development and evaluation of iodinated tracers targeting amyloid plaques for SPECT imaging

Successful development of iodinated ligands for various neurotransmitter receptors prompted us to explore the feasability of having iodinated ligands to target amyloid plaques of Alzheimer’s disease. Several potential iodinated tracers based on various chemical backbone structures have been successfully prepared and evaluated toward this purpose. High binding affinities for Aβ aggregates were consistently observed for those ligands. However, the desirable in vivo properties were generally missing in the majority of those iodinated ligands. Only ligands with the promising in vitro and in vivo characteristics such as IMPY will likely warrant their success to be potential imaging agents mapping amyloid plaques in living human brain.     

Why wait? Reasons for delay and prompts to seek help for mental health problems in an Australian clinical sample

Abstract. Background: The initial delay to seek treatment accounts for a significant proportion of the unmet need for treatment of common psychiatric conditions. This study aimed to examine the barriers to initial help-seeking and factors that facilitate help-seeking for anxiety and depression. Methods: Help-seeking history was retrospectively self-reported by 233 patients at a specialist anxiety clinic, all of whom had delayed seeking professional treatment for at least one month. Data gathered included age at onset, age at help-seeking, primary reason for the delay, prompt to seek help and first professional contacted. Results: The most frequently endorsed reasons for the delay related to lack of knowledge about mental illness or available treatment. Increasing illness severity or disability was the primary prompt to seek help for the majority of respondents. Reason for the delay showed some relationship with length of the delay, but prompt to seek help did not. A general medical practitioner (GP) was the first professional contacted in 71% of cases. Conclusions: Lack of public mental health literacy contributes to slow problem recognition. Increasing illness severity eventually facilitates problem recognition and prompts help-seeking. Structural barriers to initial help-seeking are relatively unimportant within the Australian health care system. General practitioners play an important role as gate-keepers to appropriate mental health care.     

Neuropathology of seizures in the immature rabbit

Acute morphologic changes of brain due to chemically induced seizures are studied in developing rabbits. Accordingly, rabbits of postnatal days 6 and 7 (p6-7) and p10-12 are injected with a single dose of 1-6 mg/kg kainic acid (KA) intraperitoneally (i.p.) or injected with a single dose of 200-300 mg/kg pilocarpine subcutaneously (s.c.). Many animals developed seizures of varying severity and length. Histologic examination of brain 2 days following injection showed that KA-induced seizures did not cause neuronal death. Pilocarpine-induced seizures resulted in neuronal death mainly involving the CA1 region of hippocampus. In the p6-7 group, only a small number of brains were involved, lesions were mild and limited to CA1. In the p10-12 group, majority of the brains were damaged, lesions were relatively severe, and in some brains extended beyond the CA1 region involving the subiculum, CA3, cortex, and amygdala. Measurements of physiologic parameters indicate that these changes were not secondary to hypoxemia during seizures. However, there was hypotension and hyperthermia, both of which may contribute to brain damage during seizures. The findings suggest that pilocarpine-induced seizures during the second postnatal week in rabbits is a useful model to study the morphologic changes of brain due to seizure in the developing animal and also to assess the systemic physiologic alterations during seizures.     

Prevalence of leptospira antibodies in U.S. Army blood bank donors in Hawaii

Leptospirosis is a zoonotic infection of worldwide distribution that is commonly endemic in tropical regions. In the United States, the annual incidence rate in the state of Hawaii is approximately 30 times higher than that reported nationally. U.S. troops deployed to disease-endemic tropical environments and those training in the state of Hawaii are potentially at high risk for acquiring leptospirosis. Serum and risk factor data were obtained from 488 blood donors attending military-sponsored blood drives on the island of Oahu. Testing of sera for the presence of Leptospira-specific antibodies was performed with microscopic agglutination testing (MAT). Seven active duty U.S. Army soldiers were found to be seropositive by MAT (seroprevalence, 1.4%), 2 of 76 newly arrived residents (2.6%) and 5 of 412 established residents (1.2%). Positive MAT results were statistically more common among female subjects and those 18 to 30 years old. Seropositivity was not associated with specific exposures or prolonged residence in the state of Hawaii.     

Mitral and tricuspid valve repair in patients with previous mediastinal radiation therapy

Background

The purpose of this study was to evaluate outcomes of mitral and tricuspid valve repair after mediastinal radiation therapy.

Methods

From 1976 to 2001, 22 patients (mean age 61 ± 14 years) underwent mitral (n = 14), tricuspid (n = 6), or both (n = 2) valve repairs 15 ± 9 years after mediastinal radiation therapy. Concomitant procedures included coronary artery bypass graft, 11 patients; valve replacement, 6 patients (4 aortic, 3 mitral, 1 tricuspid, and 1 pulmonary); and pericardiectomy, 4 patients.

Results

Total follow-up was 82.5 patient-years (mean 3.7 ± 3.3 years). Early mortality was 3 patients. There were 7 late deaths, 4 of which were of cardiovascular origin. Of the 19 early survivors, 2 required subsequent valve replacements, and 1 required cardiac transplantation 3.4 ± 2.8 years after valve repair. One patient died after reoperation. In 4 patients who did not undergo reoperation, echocardiographic examinations showed progressive deterioration of their repaired valve function. Overall survival, freedom from cardiac death, and freedom from valve reoperation or cardiac transplantation at 5 years for early survivors was 66%, 85%, and 88%, respectively. New York Heart Association functional class at follow-up was I or II in 8 of the 12 late survivors.

Conclusions

Functional status was good in two-thirds of late survivors. However, severe dysfunction of the repaired valve developed in 32% of early survivors and 16% required further surgery. Valve repair is technically feasible in selected patients after mediastinal radiation therapy; however, the limited durability of repairs after mediastinal radiation in this series suggests that valve replacement might be preferable.