ABSTRACT
Emotional processing in coma remains an open question. Skin conductance responses to emotional and neutral auditory stimuli were recorded in 13 low-responsive patients (12 of whom were in coma). A differential response between emotional and neutral stimuli was found, which significantly correlated with the Glasgow Coma Scale and the Cook and Palma score. These correlations indicate that emotional processing can occur in coma patients with relatively high clinical scores of reactivity.
Subject(s)
Coma/psychology , Consciousness , Emotions , Galvanic Skin Response , Adolescent , Adult , Aged , Aged, 80 and over , Coma/physiopathology , Female , Humans , Male , Middle Aged , Young AdultABSTRACT
OBJECTIVES: To evaluate cortical information processing (particularly, semantic processing) in acute nontraumatic coma by means of event-related brain potentials (ERPs). METHODS: The tests included measures of obligatory auditory processing (N100), automatic (Mismatch Negativity) and controlled (P300) detection of stimulus deviance, and semantic processing (ERP effects in word pairs and sentences). The tests were presented to 20 healthy participants and 42 coma patients with Glasgow Coma Scale <9. RESULTS: Responders (ie, patients whose ERP data indicate that their brain was able to process the corresponding stimuli) were found in each ERP test, and their distribution was statistically different from that expected by chance. Particularly, 7 responders were found in the word pair paradigm and 3 responders in the sentence paradigm. The P300 responsiveness highly correlated with other ERP responses, with Glasgow Coma Scale and with the future development of coma (ie, P300 on day 4 was related to the clinical state on day 20). CONCLUSIONS: Results suggest a wide range of cortical information processing in coma, including semantic processing. The question is discussed of whether, and to what extent, these processing operations are related to conscious awareness of stimuli.
Subject(s)
Cerebral Cortex/physiology , Coma/physiopathology , Coma/psychology , Mental Processes/physiology , Adult , Aged , Aged, 80 and over , Auditory Perception/physiology , Consciousness , Data Interpretation, Statistical , Electroencephalography , Event-Related Potentials, P300 , Evoked Potentials/physiology , Female , Glasgow Coma Scale , Humans , Male , Middle Aged , Neuropsychological Tests , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: Drotrecogin alpha (activated) (DAA), or recombinant human activated protein C, is a new treatment in sepsis-induced multiple organ failure, leading to significant reduction in the mortality rate, thanks to its anticoagulant properties. It has been suggested that DAA has anti-inflammatory and antiapoptotic effects in sepsis animal models. This study investigates the potential actions of DAA on circulating mononuclear cells apoptosis in human septic shock. DESIGN: Prospective, cohort study. SETTING: Two intensive care wards and two research laboratories in a university hospital. PATIENTS: Twenty-two septic shock patients with DAA treatment (DAA+), 19 septic shock patients without DAA treatment (DAA-), and 14 healthy controls were successively enrolled, but only 20 DAA+ and 16 DAA- patients fulfilled criteria for statistical analysis. INTERVENTIONS: Blood samples were collected at inclusion and 24 hrs later. MEASUREMENTS AND MAIN RESULTS: Circulating mononuclear cell apoptosis levels were assessed by flow cytometry with annexin V, and variations of the apoptotic rheostats (Bax/Bcl-2 and Bax/Bcl-xl ratios) were analyzed by real-time reverse transcription-polymerase chain reaction. Apoptosis was significantly increased in septic shock patients (DAA+, 12 +/- 6.4%; DAA-, 10.4 +/- 5%) vs. healthy patients (3.4 +/- 2.1%, p < .001). Twenty-four hours after DAA infusion, apoptosis was significantly lower in the DAA+ group compared with DAA- ones (respectively, 11.7 +/- 5.3% and 16.2 +/- 7.6%, p < .001). At inclusion, DAA+ and DAA- groups showed comparable Bax/Bcl-2 ratio (DAA+, 0.92 +/- 0.9; DAA-, 1.32 +/- 0.87) and Bax/Bcl-xl ratio (DAA+, 2 +/- 1.04; DAA-, 1.31 +/- 0.93). In contrast, 24 hrs later we observed a significant decrease in these ratios, indicating an antiapoptotic effect in the DAA+ group (Bax/Bcl-2, 0.39 +/- 0.27; Bax/Bcl-xl, 0.68 +/- 0.35) compared with the DAA- group (Bax/Bcl-2, 1.81 +/- 1.1; Bax/Bcl-xl, 1.22 +/- 0.92, p = .001 and p = .039, respectively). CONCLUSIONS: In vivo, in human septic shock, DAA has antiapoptotic effects on circulating mononuclear cells, assessed by a significant decrease of both the Bax/Bcl-2 and Bax/Bcl-xl ratios.
Subject(s)
Anti-Infective Agents/therapeutic use , Leukocytes, Mononuclear/chemistry , Protein C/therapeutic use , Shock, Septic , bcl-2-Associated X Protein/drug effects , bcl-X Protein/drug effects , Adult , Aged , Aged, 80 and over , Analysis of Variance , Anti-Infective Agents/pharmacology , Apoptosis/drug effects , Apoptosis/genetics , Female , Flow Cytometry , Gene Expression/drug effects , Humans , Infusions, Intravenous , Leukocyte Count , Lod Score , Male , Middle Aged , Prospective Studies , Protein C/pharmacology , Recombinant Proteins/pharmacology , Recombinant Proteins/therapeutic use , Reverse Transcriptase Polymerase Chain Reaction , Shock, Septic/blood , Shock, Septic/drug therapy , bcl-2-Associated X Protein/analysis , bcl-2-Associated X Protein/genetics , bcl-X Protein/analysis , bcl-X Protein/geneticsSubject(s)
Legionnaires' Disease/diagnosis , Pancreatitis/microbiology , Acute Disease , Diagnosis, Differential , Humans , Male , Middle AgedABSTRACT
Os autores relatam o caso de uma paciente que apresentou superinfecçäo e rotura de um aneurisma da aorta abdominal, após septicemia por Salmonella dublin. As infecçöes endovasculares associadas a rotura de aneurismas preexistentes säo um risco potencial nos pacientes acima de 50 anos de idade, que apresentaram uma bacteremia ou septicemia por Salmonella sp. A alta mortalidade da aortite por salmonelose é devida a septicemia grave ou a rotura desses aneurismas. Qualquer tecido orgânico pode ser a sede de infecçöes metastáticas. Porém os locais mais susceptíveis säo os tecidos necróticos e as lesöes crônicas degenerativas. Enfim, os autores discutem a importância do diagnóstico precoce para reduzir a mortalidade dessa entidade
Subject(s)
Aged , Humans , Male , Female , Aortic Aneurysm/complications , Aortic Dissection/complications , Salmonella Infections/complications , Sepsis/complications , Aorta, AbdominalABSTRACT
Os autores relatam o caso de paciente de 66 anos, que apresentou superinfecçäo e rotura de aneurisma da aorta abdominal, após septicemia por Salmonella dublin. As infecçöes endovasculares associadas à rotura de aneurisma pré-existentes siao um rico potencial nos pacientes com mais de 50 anos de idade, que se apresentam bacteremia ou septicemia por Salmonella sp. A alta mortalidade da aortite por salmonelose é devida à septicemia grave ou à rotura desses aneurismas. Qualquer tecido orgânicos pode ser a sede de infecçöes metastáticas, porém os locais mais susceptíveis säo so tecidos necróticos e as lesöes crônicas degenerativas. Os autores discutem a importância do diagnóstico precoce para reduzir a mortalidade dessa entidade
