Measuring Activated Clotting Time during Cardiac Catheterization and PCI: The Effect of the Sampling Site.

RESULTS: In 100 patients (mean age 67.1, 65% male), no significant differences were observed in ACT values obtained from the guiding catheter and arterial sheath (mean difference (MD) -18.3 s; standard deviation (SD) 96 s; P=0.067). Contrarily, ACT values obtained from the intravenous line were significantly lower as compared to values obtained from the guiding catheter (MD 25.7 s; SD 75.5; P=0.003) and arterial sheath (MD 39 s; SD 102.8; P < 0.001). Furthermore, ACT measurements from the arterial sheath showed a statistically significant proportional bias when compared to the other sampling sites (sheath vs. catheter, r = 0.761, P=0.001; sheath vs. IVL, r = 1.013, P < 0.001). CONCLUSIONS: The present study shows statistical significance and possibly clinically relevant variations between ACT measurements from different sample sites. Bias in ACT measurements may be minimized by using uniform protocols for ACT measurement during cardiac catheterization.

Increases in extracellular serotonin and dopamine metabolite levels in the basal forebrain during sleep deprivation.

The basal forebrain (BF) is an important mediator of cortical arousal, which is innervated by all ascending arousal systems. During sleep deprivation (SD) a site-specific accumulation of sleep factors in the BF results in increased sleep pressure (Kalinchuk et al., 2006; Porkka-Heiskanen et al., 1997; Porkka-Heiskanen et al., 2000). However, animals are able to stay awake and even increase their neuronal activity in the BF and cortex during SD, suggesting increased activity of the ascending arousal systems to counteract the effect of sleep pressure. This study used in vivo microdialysis to measure the effect of a 6h SD, by "gentle handling" in freely moving rats, on the extracellular levels of serotonin and dopamine metabolites (5-HIAA, and DOPAC and HVA respectively) in the BF. Additionally, because glucocorticoids can interact with monoaminergic neurotransmission, and SD could be stressful, corticosterone levels were measured. We found an increase in extracellular serotonin and dopamine metabolite levels (n=8, p≤0.05). No interaction between corticosterone and the monoaminergic systems was apparent. Extracellular corticosterone levels showed no increase during the first 3h of SD, and the subsequent increase (n=8, p≤0.05) did not result in values exceeding the normal diurnal maximum, indicating that no substantial stress was induced. The results demonstrate that SD increases extracellular dopamine and serotonin metabolites in the BF, suggesting increased activity of the ascending arousal systems. It remains to be investigated what the specific roles of the dopaminergic and serotonergic ascending arousal systems are in BF-mediated cortical arousal.

Characterization of sleep-wake patterns in a novel transgenic mouse line overexpressing human prepro-orexin/hypocretin.

AIM: Orexin/hypocretin peptides are expressed in the lateral hypothalamus and involved in the regulation of autonomic functions, energy homeostasis and arousal states. The sleep disorder narcolepsy, which is characterized by excessive daytime sleepiness and occurrence of sudden rapid eye movement (REM) sleep, is associated with a loss of orexin neurones. Our study investigated the effects of orexins on sleep-wake patterns in a novel transgenic mouse line overexpressing the human prepro-orexin (hPPO) gene under the control of its endogenous promoter. METHODS: Orexin overexpression was investigated by PCR, Southern and Western blotting as well as immunohistochemistry. Polysomnographic recordings were performed for analyses of sleep-wake patterns and for electroencephalographic activity during 24 h baseline and during and after 6 h of sleep deprivation (SD). RESULTS: Transgenic hPPO mice had increased expression of human prepro-orexin (hPPO) and orexin-A in the hypothalamus. Transgene expression decreased endogenous orexin-2 receptors but not orexin-1 receptors in the hypothalamus without affecting orexin receptor levels in the basal forebrain, cortex or hippocampus. Transgenic mice compared with their wild type littermates showed small but significant differences in the amount of waking and slow wave sleep, particularly during the light-dark transition periods, in addition to a slight reduction in REM sleep during baseline and during recovery sleep after SD. CONCLUSION: The hPPO-overexpressing mice show a small reduction in REM sleep, in addition to differences in vigilance state amounts in the light/dark transition periods, but overall the sleep-wake patterns of hPPO-overexpressing mice do not significantly differ from their wild type littermates.

Quality of life assessment: a comparison of four questionnaires: for measuring improvements after total hip replacement.

Three experimental questionnaires were compared with the Influence of Rheumatic Diseases on Health and Lifestyle (IRGL) questionnaire, a Dutch version of the Arthritis Impact Measurement Scales. Sixty-two patients with osteoarthritis (OA) and 35 patients with rheumatoid arthritis (RA), all of whom underwent hip arthroplasty, completed the study. Results showed that visual analogue scales for pain, stiffness, fatigue, and anxiety were strongly correlated with a number of the IRGL scales. Patient preference scales were sensitive to change and provided additional information on aspects of the patients' quality of life (QOL) that were felt to be important by the patients themselves. The questionnaire on performance in various roles in life was insensitive to change. In existing questionnaires, there is an attempt to represent the concept of QOL in terms of its most important aspects. Such realizations of the concept of QOL are not entirely suitable for application in clinical trials. The IRGL is overly complex, and its sometimes comprehensive scales do not deal with the possible effects of treatment. Neither of these properties is conducive to sensitivity to change. Visual analogue scales reduce the complexity. A simpler representation of QOL that can evaluate aspects relevant to treatment is recommended.

Effects of total hip replacement on quality of life in patients with osteoarthritis and in patients with rheumatoid arthritis.

The effects of total hip replacement (THR) on quality of life were investigated in 62 patients with osteoarthrosis (OA) and 35 patients with rheumatoid arthritis (RA). Patients eligible for a first hip joint replacement were enrolled consecutively and examined at home before the operation and 3, 6, and 12 months after surgery. The IRGL (Influence of Rheumatic Diseases on Health and Lifestyle), a Dutch version of the AIMS (Arthritis Impact Measurement Scales), was used to operationalize quality of life in a questionnaire. Pain and mobility scores showed significant improvement among both OA and RA patients. The general mood of the OA patients also improved significantly, but the RA group showed only a favourable tendency in this respect. The interference of OA in several areas of life almost disappeared, whereas the impact of RA was only slightly reduced. There was no discernible effect on the social dimension in either group. A single THR apparently solves the main problem of most OA patients, but only one of a number of joint problems for most RA patients. The IRGL is complex and time-consuming and contains irrelevant scales. Its multidimensional evaluation of the quality of life is more informative than a purely somatic evaluation.

Components of health: an analysis in rheumatoid arthritis using quality of life questionnaires and clinical and laboratory variables.

OBJECTIVE: To gain insight into the overlap between additional information supplied by recently developed health status instruments for rheumatoid arthritis (RA) and traditional clinical and laboratory tests. METHODS: A cross sectional study of 282 outpatients with RA was made. From each patient, variables of clinical and laboratory measurements were obtained and the modified health assessment questionnaire (MHAQ) and a Dutch quality of life questionnaire, the IRGL, were completed. These variables were analysed for their interrelationship. RESULTS: Clinical and laboratory variables correlated significantly with the scales of the physical dimension and the disease impact scale of the IRGL. Their significant correlations with the IRGL psychological scales were weak. There were no significant correlations between any of the traditional variables and the IRGL social scales. Factor analysis yielded five factors: functionality, pain, depressive mood, social support, and laboratory. The laboratory factor is a measure of the disease process. The other four factors provide a health model. CONCLUSION: The results suggest that the IRGL questionnaire that was studied covers a complete health model that incorporates aspects of health that are not measured by clinical and laboratory tests. A simple questionnaire for the psychological and social dimension of health status, however, would probably be more cost effective and easier to use in clinical practice.

The computed tomographic spectrum of cerebral cysticercosis.

A review of the disease cerebral cysticercosis is presented. The pathogenesis, symptomatology, diagnosis, and treatment of this disease is discussed with an emphasis on the role of computed tomography in the diagnosis of cerebral cysticercosis.

Cerebral cysticercosis: surgical considerations.

Cerebral cysticercosis is no longer an uncommon disease in areas such as Southern California to which there is extensive travel and immigration from adjoining areas in which the disease is endemic. The diagnosis of cerebral cysticercosis should be entertained in patients from such an endemic area when they present with neurological symptoms and characteristic CT findings. There is no specific or definitive therapy for the disease; treatment should be directed at alleviating its manifestations. We recommend surgical consideration in those patients with hydrocephalus, intraventricular cysts, solitary cysts producing uncontrolled seizures, and solitary cysts producing significant mass lesion effect.

Sthenia, ambition and educational level in patients suffering from ankylosing spondylitis: a controlled study of personality features as compared to rheumatoid arthritis and unspecified low back pain.

As compared to control-groups of rheumatoid arthritis and chronic non-inflammatory low back pain, over a hundred polyclinical patients suffering from ankylosing spondylitis were assessed with respect to several personality characteristics by psychological testing and proved to be relatively sthenic and educated. In trying to explain these personality features some disease-related factors seem to be relevant in ankylosing spondylitis: a relatively mild course of disease, the relief of complaints by exercise and a long pre-diagnostic period.

Recurrent intracranial hypertension and a midbrain glioma.

At the age of 36, this patient's clinical picture satisfied the criteria for the diagnosis of benign intracranial hypertension. After an essentially symptom-free interval, she developed new symptoms 17 years later that proved to be the result of a associated with glial-lined cavities in the midbrain and malignant glioma in the splenium. The possibility of a relationship between these disparate events is considered.