ABSTRACT
In a double-blind, randomized controlled study of electroconvulsive therapy (ECT) in patients with major depression, 7 of the 17 patients allocated to the right unilateral group failed to respond to treatment. The nonresponders were subsequently openly treated with bitemporal treatment, which produced an acceptable outcome in these cases of right unilateral treatment failure. This paper describes the clinical outcome, electrophysiological characteristics (impedence, estimated seizure threshold, and change in threshold), and the degree to which stimuli exceeded threshold in the responder and nonresponder groups. Responders had lower seizure thresholds and longer seizures than nonresponders. In comparison with nonresponders, responders showed trends toward greater impedance and treatment at a somewhat greater degree above threshold during the first few treatments. Threshold change with treatment was found not to be related to clinical outcome. Early identification of patients likely to respond to low-dose right unilateral ECT, together with the avoidance of benzodiazepine prescription during ECT, may permit many patients to receive low-dose right unilateral ECT successfully and with a minimum of cognitive impairment.
Subject(s)
Depressive Disorder, Major/therapy , Dominance, Cerebral , Electroconvulsive Therapy , Adult , Depressive Disorder, Major/physiopathology , Depressive Disorder, Major/psychology , Dominance, Cerebral/physiology , Double-Blind Method , Electroencephalography , Female , Follow-Up Studies , Humans , Male , Temporal Lobe/physiopathology , Treatment OutcomeABSTRACT
In patients allocated blindly and randomly to receive bitemporal, right unilateral, or bifrontal electroconvulsive therapy, seizure length, electrophysiologic characteristics (dynamic impedance, seizure threshold, and changes in threshold), and the degree of suprathreshold stimulation were recorded. The relations of these variables to clinical outcome and cognitive effects were determined. There were no differences in seizure length between groups, and there were no significant correlations between seizure length and any measure of clinical response. There were substantial differences between the groups in mean charge per treatment, with the right unilateral group receiving lower doses than either bilateral group. Convulsion time was inversely related to applied charge and the rate of increase in charge. There were no significant correlations between impedance, charge, energy, or rate of increase in charge on the one hand, and clinical improvement on the other. The increase in threshold during the course of treatment was not related to clinical change. Cognitive impairment was related to electrical dose only in the bifrontal group, which showed the least degree of treatment-induced intellectual dysfunction. Compared with bitemporal or right unilateral treatment, bifrontal electroconvulsive therapy yields the best ratio of benefits to side effects and should be given at threshold level to minimize cognitive loss.
Subject(s)
Depressive Disorder/therapy , Electroconvulsive Therapy , Seizures/etiology , Cognition Disorders/etiology , Electroconvulsive Therapy/adverse effects , Electroconvulsive Therapy/methods , Electrodes , Electroencephalography , Humans , Seizures/physiopathology , Single-Blind Method , Treatment OutcomeABSTRACT
Fifty-nine patients suffering from a major depressive episode, for whom electroconvulsive therapy (ECT) was clinically indicated, were randomly assigned to one of three electrode placement groups for treatment with brief pulse, threshold-level ECT: bitemporal (BT), right unilateral (RU) or bifrontal (BF). Comparison of these groups in terms of number of treatments, duration of treatment, or incidence of treatment failure, showed that the bilateral placements were superior to the unilateral; comparison of Hamilton, Montgomery-Asberg, and visual analogue scale scores showed that the bifrontal placement was superior to both bitemporal and unilateral treatment. Bitemporal treatment showed therapeutic results intermediate between BF and RU. Because BF ECT causes fewer cognitive side effects than either RU or BT, and is independently more effective, it should be considered as the first choice of electrode position in ECT.
Subject(s)
Depressive Disorder/therapy , Dominance, Cerebral/physiology , Electroconvulsive Therapy/methods , Frontal Lobe/physiopathology , Adult , Aged , Depressive Disorder/physiopathology , Evoked Potentials/physiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Personality Assessment , Temporal Lobe/physiopathologyABSTRACT
This paper describes a system for the quantitative analysis of posture and stance in the freely standing quadruped. The focal point of the system is a moving force platform operated by hydraulic servos under computer control. Cats are trained to stand on a support consisting of 4 force plates. Stance is perturbed by the controlled movement of the platform and the evoked postural responses are quantified in terms of the ground reaction forces, the activity of selected muscles, and the movements of the body segments. New developments that are described include: (1) the moving platform, (2) a miniature, triaxial force plate for detecting ground reaction forces under each paw, and (3) a new video camera capable of freezing rapid movements.
Subject(s)
Motor Activity/physiology , Physiology/methods , Posture , Animals , Biomechanical Phenomena , Cats , Electromyography , Muscles/physiology , Physiology/instrumentation , Videotape Recording/instrumentationABSTRACT
Fifteen severely disabled people residing in institutions were provided with a simple environmental control system which performed five different functions. The disabled people used the equipment an average of ten times a day. Two hours of nursing care by nursing staff would have been required to perform these functions. The cost of the equipment was $1.35 a day. Both the residents and the nursing staff reacted favorably to this innovation. The main benefits which resulted were a heightened sense of independence on the part of the disabled people and a reduction of frustration levels of both the residents and the nursing staff. A considerable savings in nursing care was also achieved.
Subject(s)
Environment, Controlled , Hospitals, Chronic Disease , Hospitals, Special , Nursing Homes , Self-Help Devices , Attitude , Attitude of Health Personnel , Cost-Benefit Analysis , Evaluation Studies as Topic , Humans , Nursing Staff , Self-Help Devices/economics , Surveys and QuestionnairesABSTRACT
Pars intermedia (PI) ACTH and melanocyte-stimulating hormone (MSH) content and pars distalis (PD) ACTH concentration were measured following 3 experimentally induced 'perturbations'. The feedback-induced increase in ACTH release following adrenalectomy is not accompanied by a change in PI ACTH and MSH contents, while the feedback-induced increase in gonadotropin secretion following gonadectomy is associated with significant changes in PI ACTH and MSH contents. A well-defined neurotropic (noise) stressor resulted in significant increases in PI ACTH and MSH. A striking finding in all of the studies was a positive correlation between PI ACTH and MSH contents. We conclude that PI ACTH and MSH secretion are altered with feedback-induced alterations in gonadotropin secretion and with neurotropic stressors.
Subject(s)
Adrenal Glands/physiology , Adrenocorticotropic Hormone/analysis , Gonads/physiology , Melanocyte-Stimulating Hormones/analysis , Pituitary Gland, Anterior/analysis , Stress, Psychological/physiology , Adrenalectomy , Adrenocorticotropic Hormone/metabolism , Animals , Female , Humans , Male , Melanocyte-Stimulating Hormones/metabolism , Noise , RatsSubject(s)
Communication , Quadriplegia/rehabilitation , Computers , Electronics, Medical , Humans , Male , Online SystemsABSTRACT
The effect of 10 mg. phentolamine intravenously on the urethral pressure profile was studied in male and female patients with lower urinary tract obstruction. A significant decrease of pressure occurred along the whole length of the urethra in both sexes, including the peak pressure zone in the male patient. This zone has been traditionally attributed to the external sphincter. It was concluded that the sympathetically innervated smooth muscle exerts a certain activity along the whole length of the proximal urethra. The phentolamine test may prove to be a useful adjunct to urethral profile studies in patients with lower urinary tract obstruction.
Subject(s)
Phentolamine , Urethra/innervation , Urethral Stricture/diagnosis , Adult , Female , Humans , Male , Manometry , Middle Aged , Sympathetic Nervous System/physiopathology , Urethral Stricture/physiopathologyABSTRACT
A surgical procedure is described in which the canine bladder was divided into body and base. The two-chambered bladder thus formed was used to assess the effect of sympathomimetic drugs in situ. Stimulation of either alpha- or beta-receptors produced a change in pressure in both chambers. The bladder base showed a greater sensitivity to alpha-receptor stimulation than did the body of the bladder. No difference in sensitivity to beta-receptor stimulation was noted between body and base.
Subject(s)
Sympathomimetics/pharmacology , Urinary Bladder/drug effects , Animals , Dogs , Female , Male , Models, Animal , Urinary Bladder/surgery , Urologic Surgical ProceduresSubject(s)
Atmosphere Exposure Chambers , Carbon Dioxide/blood , Animals , Dogs , Humidity , Stimulation, Chemical , TemperatureABSTRACT
Evaluation of the accuracy of computer interpretation of 2019 standard 12-lead ECG's has been carried out. In 762 records defined as normal by the cardiologist the computer agreed in 41%, found 49% with minor "abnormalities" and read 10% as having gross abnormalities.There were 1257 abnormal records. The computer read 43 of these as normal including five with infarction and three with LVH. Agreement in the various abnormal categories ranged from 31% to 85% and even after review disagreement remained in 33% of cases.
