Relationship of coping styles with quality of life and depressive symptoms in older heart failure patients

This study examines the relationship between coping styles, quality of life, and depressive symptoms in older heart failure patients. Eighty heart failure patients seeking treatment in an outpatient heart failure or family practice clinic participated in a study examining depression, disability, and heart failure. Patients completed a clinical interview and questionnaires about mood, functional impairment, comorbid illness, quality of life, and coping. Heart failure severity and maladaptive coping styles, including denial, self-distraction, and self-blame, negatively affected quality of life and depressive symptoms. The use of maladaptive coping strategies involves efforts that divert attention from the illness and suggests the need to provide heart failure patients the skills to directly address the stress associated with their illness. Interventions that target these coping strategies may help patients take a more active role in their heart failure management and may improve psychological and cardiac outcomes.     

Combining Lithium and Anticonvulsants in Bipolar Disorder: A Review

While the benefits of lithium in bipolar disorder are evident, its limitations as monotherapy are well recognized, particularly in bipolar depression. This has propelled trials of combined lithium–anticonvulsant therapy in many bipolar patients. The present review of the English-language literature examines both controlled and open studies of such combination therapy, including the risk of drug–drug interactions. Trials of lithium plus either carbamazepine or divalproex have generally produced favorable results, although increased rates of adverse effects may reduce treatment adherence. More recent reports suggest that lithium may be safely and effectively combined with lamotrigine, and perhaps with topiramate, although controlled studies are required. The combined use of lithium with newer, putative mood stabilizers, such as zonisamide or levetiracetam, cannot yet be recommended, but is an important area for future research. Provisional recommendations for combined treatment are provided.     

Difficult cases in heart failure: Importance of patient selection in the use of intermittent inotrope infusions for advanced heart failure

Intermittent infusions of inotropes have been used with increasing frequency for patients with advanced heart failure (HF). The use of intermittent inotrope infusions remains controversial for several reasons. However, the effect, either positive or negative, of intermittent inotropes in refractory unstable HF patients is not well studied. While prior experience with chronic oral inotropes in stable, advanced HF raises substantial concerns, it may not be directly applicable to a critical evaluation of intermittent inotrope infusions in unstable patients. Further study demonstrating the safety and efficacy of this approach in these patients is imperative. The uncertainties surrounding this therapy, mandate the selection of appropriate candidates be made with substantial care. We report three patients with advanced HF despite conventional therapy, in whom intermittent inotropes were considered. These cases illustrate that this therapy can be avoided in many patients by acceleration of conventional medications, patient education, and aggressive follow up intermittent. However, outpatient inotrope infusions may be helpful in highly selected patients with refractory, unstable HF.     

Production of 21-deoxyaldosterone by rat adrenal tissue in vitro: evidence for an alternative biosynthetic pathway of aldosterone

Quartered rat adrenal glands transformed labelled 21-deoxyaldosterone into aldosterone in vitro. 21-deoxyaldosterone was released from the quartered rat adrenals in vitro in amounts 10 times lower than those of aldosterone and 18-hydroxycorticosterone. The production of all three steroids was qualitatively dependent on the same regulatory elements (electrolytes, ACTH, exogenous precursors, zonal specificity). However, quantitative differences could be observed. The results support a role for 21-deoxyaldosterone as a facultative precursor of aldosterone and indicate that the regulation of its production shows similarities to that of aldosterone.     

Ein Fall fraglicher Zinn-Vergiftung

Zusammenfassung Wir konnten in der Klinik einen Kranken beobachten, bei dem die Zinnausscheidung im Urin sehr gro? war. Es handelte sich um einen Dreher, der mit einer Legierung arbeitet, in der viel Zinn enthalten ist. Seine Klagen bestanden in Leibschmerzen und übelsein, ferner bestanden An?mie und Gewichtsverlust. Es mu? angenommen werden, da? es sich bei diesem Fall um eine Sch?digung durch Zinneinwirkung handelt. Wir m?chten durch diese Arbeit auf die M?glichkeit von Sch?digungen durch Zinn hinweisen und zu weiteren Beobachtungen in dieser Richtung anregen.     

Transcranial Doppler Monitoring in Parkinson’s Disease: Cerebrovascular Compensation of Orthostatic Hypotension

Despite of precipitous blood pressure falls in Parkinson’s Disease (PD) patients, they may not experience syncope or postural complaints. Can cerebral blood flow regulation explain why orthostatic hypotension (OH) has often no accompanying symptoms? In patients with PD and OH (18 asymptomatic; 8 symptomatic), arterial blood pressure (ABP) as well as Doppler-detected cerebral blood flow velocity (CBFV) in middle and posterior cerebral arteries (MCA and PCA) were monitored during head-up tilt and compared with 25 controls and eight non-PD-OH patients. Analysis included the transfer function between slow spontaneous pressure and flow-oscillations. ABP and CBFV were maintained at significantly higher levels in asymptomatic than symptomatic PD-OH (ABP: 85.7 ± 10.5 vs. 66.9 ± 12.5%; MCA-FV: 83.3 ± 9.3 vs. 66.1 ± 6.8%; PCA-FV: 84.4 ± 12.2 vs. 65.9 ± 9.3% of supine). When orthostatic complaints occurred, CBFV depended directly on ABP changes (MCA r² = 0.64; PCA r² = 0.62; both p < 0.05). Despite of a tilt-induced blood pressure instability in PD-OH, the transfer function parameters did not differ from normal [phase: MCA: 46.6 ± 20.5°; PCA 39.2 ± 28.8°, gain: MCA 2.0 ± 0.7; PCA 2.9 ± 1.6)]. Results showed a normal autoregulatory response to downward blood pressure shifts in PD. Moreover, orthostatic blood pressure instability is compensated equally sufficient in anterior and posterior parts of cerebral circulation. Whether in PD patients, OH becomes symptomatic rather seems to depend on blood pressure falling below the autoregulated range. (E-mail: Christina.Haubrich@t-online.de)