ABSTRACT
BACKGROUND: Near-infrared spectroscopy (NIRS) is a noninvasive technique that allows continuous monitoring of regional hemoglobin oxygen saturation (rSo2). We evaluated its application to survey oxygenation of the spinal cord region during open thoracoabdominal aortic aneurysm (TAAA) repair and postoperatively in the intensive care unit (ICU). We also validated its association with motor-evoked potential (MEP) monitoring during the operation. METHODS: The rSo2 curves of 15 patients (8 men; mean age, 64.2 ± 7.7 years) were measured continuously with NIRS at spinal cord levels of the thoracic vertebrae T3 (optode 1, reference spot) and T12 (optode 2) during open TAAA repair. T12/T3 ratios were calculated. NIRS measurements were continued in the intensive care unit and stopped 24 hours after the operation. MEP monitoring was performed in all patients during the procedure. RESULTS: No clinical signs of spinal cord ischemia were documented in any of the patients. Continuous NIRS measurements were successfully performed in all patients during and after the operation. T12/T3 ratios were significantly lower in the MEP ratios that were less than 50% compared with the MEP ratios that were 50% or higher (p = 0.037). CONCLUSIONS: NIRS is an easily applicable noninvasive tool for continuous surveillance of oxygenation of the spinal cord region during TAAA repair and postoperatively in the intensive care unit. The rSo2 curves provide useful information concerning hemodynamic changes in oxygenation of the spinal cord region and might contribute to early detection of spinal cord ischemia. Further investigation is needed before broad clinical implementation.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Oxygen/blood , Spectroscopy, Near-Infrared/methods , Spinal Cord Ischemia/prevention & control , Vascular Surgical Procedures/adverse effects , Aged , Aortic Aneurysm, Thoracic/diagnostic imaging , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/methods , Cohort Studies , Elective Surgical Procedures/adverse effects , Elective Surgical Procedures/methods , Evoked Potentials, Motor , Female , Follow-Up Studies , Humans , Intensive Care Units , Male , Middle Aged , Monitoring, Intraoperative/methods , Netherlands , Patient Safety , Pilot Projects , Postoperative Care/methods , Spinal Cord Ischemia/etiology , Treatment Outcome , Ultrasonography , Vascular Surgical Procedures/methodsABSTRACT
The great majority of studies on repetitive transcranial magnetic stimulation (rTMS) as a therapeutic tool for auditory verbal hallucinations (AVH) have used 1-Hz stimulation with inconsistent results. Recently, it has been suggested that 20-Hz rTMS has strong therapeutic effects. It is conceivable that this 20-Hz stimulation is more effective than 1-Hz stimulation. The aim of this preliminary study is to investigate the efficacy of 20-Hz rTMS compared with 1-Hz rTMS as a treatment for AVH. Eighteen schizophrenia patients with medication-resistant AVH were randomized over two treatment groups. Each group received either 20 min of 1-Hz rTMS or 13 trains of 20-Hz rTMS daily over 1 week. After week 1, patients received a follow-up treatment once a week for 3 weeks. Stimulation location was based on individual AVH-related activation patterns identified with functional magnetic resonance imaging. Severity of AVH was monitored with the Auditory Hallucination Rating Scale (AHRS). Both groups showed a decrease in AVH after week 1 of rTMS. This decrease was significant for the 20-Hz group and the 1-Hz group. When the two treatment types were compared, no treatment type was superior. Based on these results we cannot conclude whether high frequency rTMS is more effective against AVH than is traditional 1-Hz rTMS. More research is needed to optimize stimulation parameters and to investigate potential target locations for stimulation.
Subject(s)
Hallucinations/therapy , Schizophrenia/therapy , Transcranial Magnetic Stimulation/methods , Adult , Female , Hallucinations/etiology , Humans , Male , Middle Aged , Pilot Projects , Random Allocation , Schizophrenia/complications , Treatment Outcome , Young AdultABSTRACT
PURPOSE: A recent genome-wide scan revealed a major susceptibility locus for idiopathic generalized epilepsies (IGEs) in the chromosomal region 8p12 in 32 IGE families without members with juvenile myoclonic epilepsy (JME). This study explored the presence of an IGE locus in the chromosomal region 8p12. METHODS: Our study included 176 multiplex families of probands with common IGE syndromes. Parametric and nonparametric multipoint linkage analyses were carried out between the IGE trait and six microsatellite polymorphisms encompassing the putative susceptibility locus. To explore the associated phenotype-genotype relation, two distinct subgroups of families were selected by the presence (n = 64) or absence (n = 112) of a family member with JME. To adjust the phenotypic spectrum toward adolescent-onset IGEs, a third subgroup of 28 families without JME was chosen through an IGE proband with seizure onset at age 10-20 years. RESULTS: Parametric and nonparametric multipoint linkage analyses provided no evidence for linkage between IGE and markers encompassing the putative IGE locus in the chromosomal region 8p12. Furthermore, we found no hint of linkage along the candidate region in any of the three family subgroups. CONCLUSIONS: We failed to provide evidence for a major IGE locus in the chromosomal region 8p12. On the contrary, these parametric linkage results provide strong evidence against linkage across the candidate region under a broad range of genetic models. If there is a susceptibility locus for IGE in the chromosomal region 8p12, then the size of the effect or the proportion of linked families is too small to detect linkage in the investigated family sample.
