Quality of life and behavioural adjustment in childhood hydrocephalus.

The aim of the paper is to describe parent and teacher reported behavioural outcomes and quality of life in childhood hydrocephalus, and to consider the implications for future service planning. A community sample of 235 school-aged children with hydrocephalus (5-16 years) were identified via a database of service users, held by the Scottish Spina Bifida Association. Parent and teacher reports of behaviour on the Strengths and Difficulties Questionnaire (SDQ), and parent reports of quality of life on the Paediatric Quality-of-Life Generic Core (PedsQL Core) and Paediatric Quality-of-Life Fatigue (PedsQL Fatigue) were obtained, as were reports of service use and satisfaction.  In total, 35% (n = 76) of parents and 86% (n = 47) of teachers who were contacted participated in the study. Parents reported behavioural difficulties in 57% and teachers in 33% of children. Quality of life was significantly reduced in comparison to published norms. Children whose parents reported unmet needs had poorer psychosocial outcomes, but families rarely accessed appropriate specialist services. In conclusion, hydrocephalus is associated with high rates of behaviour problems and markedly reduced quality of life. It is important to increase professional awareness of psychological need in this chronic neurological condition, and to increase access to appropriate psychosocial services.

Errors in self-report of post-traumatic stress disorder after severe traumatic brain injury.

Assessing PTSD by questionnaire can lead to false positive diagnosis after severe traumatic brain injury. Sumpter and McMillan, reported quantitative data on 34 people with severe TBI; 59% were PTSD 'cases' by questionnaire assessment, but only 3% using a structured interview. The present paper describes ways in which these individuals made errors on questionnaires. Some did not follow questionnaire instructions because of inattention and concrete thinking or instead reported effects of brain injury. Symptom overlap between TBI and PTSD, including insomnia, irritability and impaired concentration can cause errors. Brain injury can also provoke curiosity about loss of memory (during coma, retrograde and post-traumatic amnesia), decreased participation, social withdrawal and difficulty adjusting to injury that may be mistaken for fear-associated PTSD symptoms. Assessment of PTSD by questionnaire can lead to erroneous conclusions and factors related to brain injury must be carefully considered when investigating PTSD.

Analysis of unsaturated C27 sterols by nuclear magnetic resonance spectroscopy.

Complete 1H and 13C nuclear magnetic resonance (NMR) signal assignments have been established for 5 alpha-cholestan-3 beta-ol, 22 unsaturated C27 sterols, and their acetate derivatives. Assignments were made from a combination of 1D and 2D spectra and include stereochemical 1H assignments for the C-22 and C-23 protons of 5 alpha-cholesta-8,24-dien-3 beta-ol and other delta 24 sterols with a C8 side chain. At the temperature and concentration range described, chemical shifts were generally reproducible to +/- 0.01 ppm in 13C spectra and +/- 0.001 ppm in 1H spectra. Except for some overlapped or strongly coupled 1H resonances, chemical shifts are given to these precisions, which are an order of magnitude better than for most data given previously. Full 1H NMR data have been reported previously for only three of the 46 compounds, and 13C data were unavailable for many, including the previously undescribed cholesta-5,8(14)-dien-3 beta-ol. An extensive set of 1H-1H coupling constants for the unsaturated sterols indicated considerable conformational diversity, which was confirmed by molecular modeling. The conformational diversity together with other factors led to a complex pattern of 13C substituent-induced chemical shifts (SCS) that appeared to elude any simple empirical correlations with structure. By contrast, the 1H SCS correlated reasonably well with simple structural features. The high precision of the SCS revealed small but measurable effects of a double bond on 1H resonances up to 12 bonds away. Also discussed are the utility and limitations of NMR for the identification of unsaturated sterols, estimation of purity, and analysis of mixtures, with an emphasis on special problems encountered at a microgram level.

Non-cardiac surgery in patients with prior myocardial revascularization.

Patients who had undergone aorto-coronary bypass grafts (ACBG) were assessed for the incidence of cardiac complications in the postoperative period following subsequent non-cardiac surgery. One hundred and twenty-one patients had 13 complications (11 per cent). A significantly higher risk of cardiac complications (27 per cent) was found in patients undergoing non-cardiac procedures in the first month after ACBG. This remained higher (17 per cent) until the sixth month following ACBG. Significant factors which increased the risk of cardiac complications in the postoperative period included preoperative congestive heart failure (33 per cent), cardiac risk index score classification of III or IV (37 per cent), surgery on major vessels, and surgery necessitated because of a complication of the ACBG itself (17 per cent). No correlation was found between cardiac complication rates and recurrent angina, hypertension, the use of beta-blockers or digoxin, or anaesthetic technique. It is suggested that all but emergency surgery should be postponed in the first month following ACBG, and elective surgery be delayed for up to six months.

Propranolol and cardiac surgery: a problem for the anesthesiologist?

Propranolol therapy has been implicated as a cause of myocardial depression and increased morbidity and mortality in patients undergoing coronary artery surgery. The authors reviewed 169 consecutive patients undergoing cardiac surgery, of whom 143 had been taking propranolol, with regard to preoperative administration of propranolol and intraoperative or postoperative complications. Patients taking propranolol until 24 hours before surgery showed no increased incidence of hypotension or bradycardia before cardiopulmonary bypass. Hypotension after bypass was no more common in patients off propranolol 12 to 48 hours than in patients who either discontinued the drug over 48 hours before operation or had never taken the drug. Myocardial contractility as measured by systolic time intervals was normal 24 to 48 hours after stopping propranolol therapy. Five patients had preoperative myocardial infarctions within 48 hours of discontinuing the drug. The operative mortality rate was 4 percent in patients taking propranolol within 48 hours of surgery and 6 percent in all other patients. Seven risk factors, other than propranolol, were identified in those patients requiring inotropic support. The authors conclude that propranolol can be given safely within 24 to 48 hours of coronary artery surgery provided the patient is a satisfactory candidate for myocardial revascularization.