Cognitive testing in patients undergoing carotid endarterectomy.

OBJECTIVES: To determine by literature review the effect of carotid endarterectomy (CEA) as a modulator of cognitive function in patients with carotid arterial disease. Derive recommendations for standardising cognitive testing of patients with carotid arterial disease. DESIGN AND METHODS: The English language literature was interrogated using a CD-ROM driven medline search using carotid endarterectomy and cognitive function as keywords between 1986-1995. These subsets were scanned and papers of direct relevance or commonality were selected. Cited papers prior to 1986 from these references were then sought directly. RESULTS: There are few controlled studies reporting on the effect of CEA. There is no consensus in the literature for the effect of CEA on cognition or which tests should be used. Studies reporting a benefit for CEA lack a control group and fail to eliminate the effect of practice. Reports suggesting cognitive impairment following CEA performed follow-up tests early. CONCLUSIONS: There are many methodological problems with the study of cognitive function before and after carotid endarterectomy and wide disagreement in the interpretation of results. Further studies should contain control groups, use tests resistant to practice and be performed when the effects of surgery and anaesthesia are passed.

Psychological effects of cardiac surgery: a review of the literature.

Cardiac surgery is now offered to more patients than ever before. Different age groups are affected by different forms of the disease and, as a result, patients range from new born infants to those in their eighties. In recent years attention has begun to focus on the psychological effects of such surgery. This article considers current research into the cognitive, psychiatric and psychological changes associated with cardiac surgery, with specific reference to coronary artery bypass grafting (CABG).

Psychological distress associated with algodystrophy.

We have carried out a prospective study of the level of psychological distress in patients with Colles' fractures. Those who developed algodystrophy did not show increased distress before the onset of the condition.

Disturbed mother-infant interaction in association with congenital heart disease.

OBJECTIVE: To investigate whether difficulties are experienced in the interaction between infants with congenital heart disease and their mothers and to identify infants who show compromised emotional development, in order to offer intervention during the early stages of postoperative compensatory growth. METHODS: 20 infants and their mothers were compared with 20 non-cardiac mother-infant pairs. Infants were filmed in interaction for 30 minutes two days before and six months after corrective surgery. Fifteen minutes of film were analysed in 180 5-s units. The emotional tone (affect) and the interpersonal engagement were classified as positive or negative by prespecified criteria. The percentages of positive scores were analysed. The mental health of the mothers was also assessed. RESULTS: Cardiac infants showed less positive affect and engagement than the noncardiac group at both sessions. There was no correlation between of positive affect or engagement and the severity of the condition in either group. Cardiac mothers showed less positive affect and engagement than the comparison group, and were psychologically distressed at both sessions. The engagement scores of the mothers of the cardiac infants were also more variable. CONCLUSIONS: Cardiac infants and their mothers have lower levels of positive affect and engagement than non-cardiac mother-infant pairs. Thus some mothers are unable to adapt to their infant. This leads to disordered interaction which is maintained at six months. This information can be used to offer intervention during the early stages of postoperative compensatory growth.