Evidence That Emotional Maladjustment Is Worse in Men Than in Women with Psychogenic Nonepileptic Seizures

The purpose of this study is to examine the effects of gender on adjustment and cognition in patients with psychogenic nonepileptic seizures (NES) and on patients with epilepsy. We compared 57 women and 27 men, all at least 16 years old, with only NES as documented by long-term EEG-video monitor studies, to equal numbers of randomly selected women and men with only epileptic seizures. Variables examined included age, age of onset, education, scales from the MMPI, the WAIS-R, and the number of tests outside normal limits from the Neuropsychological Battery for Epilepsy. We found no significant differences in mean age, intelligence, or percentage of neuropsychological tests outside normal limits across the four groups. Women and men with NES had significantly later age of onset of attacks compared with subjects of either gender with epilepsy (26 years vs 13 years, P < 0.001) and men with NES had greater educational achievement than women with NES or patients with epilepsy (P < 0.02). However, the most important findings were seen on the MMPI. Men with NES exhibited significantly greater elevations on multiple scales (especially Hysteria, Depression, Hypochondriasis, Psychoasthenia, Schizophrenia) compared with men with epilepsy or women with either epilepsy or NES. We conclude that men with NES have significantly worse patterns of emotional adjustment, as measured by the MMPI, than women with NES or subjects of either gender with epilepsy.     

Acute Emotional and Cardiovascular Effects of Stressful Mental Work During Aerobic Exercise

The acute effects of engaging in challenging mental work during a single session of aerobic exercise were examined on measures of subjective mood and cardiovascular function. Fifty-seven female subjects were randomly assigned to participate in either a 10-min aerobic exercise condition or a no-exercise control condition. Half of the subjects in each group performed digits backward problems during this time period, and no mental stressors were presented to the other subjects. The results indicated that the exercise and mental stress conditions had additive effects on subjective anxiety levels and on cardiovascular responses during exercise. Both exercise and mental stress increased heart rate. In addition, exercise had anti-anxiety and vasodilative effects, but both of these influences were attenuated by opposing main effects for mental stress exposure. No effects were found for exercise on measures of cardiovascular reactivity to a later digits backward stressor. The results are consistent with previous research in suggesting that exposure to mental stressors during aerobic exercise provides no acute psychological benefits but attenuates some of the mood improvements and vasodilative effects of the exercise activity.     

Serum Calcification Propensity Is a Strong and Independent Determinant of Cardiac and All‐Cause Mortality in Kidney Transplant Recipients

Calcification of the vasculature is associated with cardiovascular disease and death in kidney transplant recipients. A novel functional blood test measures calcification propensity by quantifying the transformation time (T₅₀) from primary to secondary calciprotein particles. Accelerated T₅₀ indicates a diminished ability of serum to resist calcification. We measured T₅₀ in 1435 patients 10 weeks after kidney transplantation during 2000–2003 (first era) and 2009–2012 (second era). Aortic pulse wave velocity (APWV) was measured at week 10 and after 1 year in 589 patients from the second era. Accelerated T₅₀ was associated with diabetes, deceased donor, first transplant, rejection, stronger immunosuppression, first era, higher serum phosphate and lower albumin. T₅₀ was not associated with progression of APWV. During a median follow‐up of 5.1 years, 283 patients died, 70 from myocardial infarction, cardiac failure or sudden death. In Cox regression models, accelerated T₅₀ was strongly and independently associated with both all‐cause and cardiac mortality, low versus high T₅₀ quartile: hazard ratio 1.60 (95% confidence interval [CI] 1.00–2.57), p_trend = 0.03, and 3.60 (95% CI 1.10–11.83), p_trend = 0.02, respectively. In conclusion, calcification propensity (T₅₀) was strongly associated with all‐cause and cardiac mortality of kidney transplant recipients, potentially via a cardiac nonAPWV‐related pathway. Whether therapeutic improvement of T₅₀ improves outcome awaits clarification in a randomized trial.     

A novel retroauricular fixed port for hemodialysis: surgical procedure and preliminary results of the clinical investigation

Background: Inspired by bone conduction implants, which have a low infection rate, a bone-anchored port (BAP) system for hemodialysis was designed.

Objectives: To demonstrate the surgical procedure for the BAP and to present preliminary results of the clinical investigation.

Materials and Methods: Patients with end-stage renal disease and contraindications for an arteriovenous forearm fistula were recruited for BAP implantation. A workflow specifically developed for implantation was followed. Postoperative evolution, the dialysis procedure, the functionality of the implant, and signs of infection were monitored.

Results: So far, five patients have been implanted with the BAP system. Hemodialysis with the BAP was unproblematic in all five patients, on average starting from the 9th day after implantation (range 2 to 15 days). Up to now, 1789 cumulative patient days (average 355 days, range 154 to 448 days) have been recorded. One patient died 14 months after implantation, from a cardiac arrest unrelated to the system. Dialysis was painless, and no catheter-related infections have occurred.

Conclusion: BAP implantation can be safely performed but requires an interdisciplinary team. No infections related to the device have occurred.

Significance: The presented system is a promising addition to the choices of vascular accesses for hemodialysis patients.     

Cave: Interskalenuskatheter

Die Anaesthesiologie - Interskalenäre Regionalanästhesie ist ein etabliertes hoch effektives Verfahren. Die birgt jedoch ein erhöhtes Risikopotenzial aufgrund der anatomischen...