The impact of physical and psychological comorbid conditions on the quality of life of patients with acute myocardial infarction: a multi-center, cross-sectional observational study from Turkey.

OBJECTIVE: Acute myocardial infarction (MI) has significant and detrimental effects on the lifestyles of the patients. It has been shown that quality of life (QoL) in patients with MI is impaired in every aspect. This study aims to evaluate the impact of depression and physical comorbidity on QoL in Turkish patients with acute first MI. METHOD: This multi-center cross-sectional study was carried out in 15 centers with 998 patients hospitalized for acute first MI. For detection of depression, Beck Depression Inventory (BDI) was used. For evaluation of QoL, World Health Organization Quality of Life Questionnaire (WHOQOL) was applied. RESULTS: The mean age of the patients was 57.5 +/- 10.1 years and 79.2 % (n = 792) of the patients were men. Patients with comorbid depression (BDI > or = 10) and comorbid medical conditions, and female patients had significantly lower scores in every domain of WHOQOL. In the regression analysis model, female gender, low education, comorbid medical conditions, especially comorbid hypertension, and BDI score were found to have a significant effect on the domains of WHOQOL. CONCLUSIONS: Female patients are more prone to impairment in quality of life after myocardial infarction. Both comorbid medical conditions and depression have a significant impact on the impairment of QoL in Turkish patients with acute MI. In order to improve the subjective wellbeing of post MI patients, both psychiatric and physical comorbidities must be detected and managed even in the short-term.

Evaluation of dysthymic disorder with technetium-99 m hexamethylpropylene amine oxime brain single-photon emission tomography.

Dysthymic disorder is a chronic disorder characterised by the presence of a depressed mood and is classified as a distinct category in DSM-IV, separately from major depression. Although brain imaging studies have been performed in major depressive disease, there have to date been no reports of such studies in dysthymic disorder. In this study 36 patients with dysthymic disorder were compared with 16 normal subjects using technetium-99m hexamethylpropylene amine oxime brain single-photon emission tomography. A relative blood flow ratio was calculated for each region of interest using the average tissue activity in the region divided by activity in the cerebellum. There were significant differences in the bilateral inferior frontal, bilateral parietal, right superior frontal and left posterior temporal regions in the patients with dysthymic disorder compared with the healthy controls. These findings support the hypothesis that the biological bases for dysthymic disorder and major depression are similar. Recognition of these regional abnormalities may have clinical utility in both the diagnosis and the treatment of dysthymic disorder. Further studies are needed to confirm our results and to assess the influence of treatment in patients with dysthymic disorder.

Multiple sclerosis presenting as an intramedullary cervical cord tumor.

We report a case of a 21-year-old white woman with a three-week history of rapidly progressive paresis and paresthesias of her extremities presenting as an intramedullary cervical cord lesion. Computer-assisted tomography and magnetic resonance imaging demonstrated a normal brain with a cervical cord enlargement suggestive of a primary spinal cord tumor. Her neurological deficits progressed despite dexamethasone; hence, laminectomy was performed with open biopsy of the cord lesion. The pathological specimens were sent to the Mayo Clinic and Kansas University for cell-type determination, due to their bizarre morphology. Both institutions concluded the biopsy specimens were demyelinated axonal plaques consistent with multiple sclerosis. This case illustrates that demyelinating disease can mimic spinal cord tumor, even with MRI scanning. Multiple sclerosis is a chronic demyelinating disease of the central nervous system. The clinical diagnosis requires documentation of lesions occurring on more than one occasion and at more than one site in the central nervous system. To improve the accuracy of the diagnosis of multiple sclerosis, spinal fluid analysis, visual and auditory evoked responses and radiologic imaging have been proposed. We report a patient with multiple sclerosis who presented with symptoms and physical findings suggesting a primary cervical cord tumor. Localized enlargement of the cervical cord was documented on magnetic resonance imaging. This is the first reported description of histopathologically confirmed spinal cord demyelination presenting as an intramedullary cervical cord tumor.

Studies on the location and release of cholecystokinin and vasoactive intestinal peptide in rat and cat spinal cord.

By radioimmunoassay vasoactive intestinal peptide (VIP) and cholecystokinin (CCK) are found in the cat lumbar spinal ganglion and spinal cord with levels in dorsal greater than ventral horn. Unilateral rhizotomy, but not cervical hemisection produced a significant but incomplete depletion of CCK and VIP immunoreactivity in dorsal, but not ventral horn. Intrathecal capsaicin (0.5 mg) had no effect on the levels of spinal VIP or CCK. Intrathecal colchicine (0.5 mg)produced a significant increase in the levels of VIP in the dorsal and ventral horn but had no effect on the levels of CCK. The present experiments, using a preparation which permits in situ superfusion of the spinal cord, demonstrated in the chloralose-urethanized cat and rat the presence of measurable levels of VIP and CCK. In rats, the addition of potassium (40 mM in excess) resulted in a 138% and 46% increase in the levels of CCK and VIP, respectively above resting levels (3.7 +/- 1.2 fmol/ml/10 min and 1.7 +/- 0.5 fmol/ml/10 min, respectively). The deletion of calcium and substitution of cobalt (2 mM) resulted in a significant reduction in the potassium-evoked release. Intrathecal picrotoxin doubled the levels of CCK, but had no effect on the levels of VIP in the spinal superfusates. Capsaicin (3 X 10(-4) M) had no effect on the levels of either peptide in rat spinal superfusate. In cats, bilateral electrical stimulation of the sciatic nerve at high, but not low intensity, resulted in a 218% and 132% increase above prestimulation baseline in the levels of CCK and VIP, respectively. Separation of immunoreactivity on a Sephadex G-50 superfine column of the spinal superfusates and the extracted material from cat spinal cord, revealed that the immunoreactive CCK species in tissue co-migrated with the 8 and 33 amino acid peptide fragments. In the release samples, however, all the radioimmunoassayable activity migrated with the peak corresponding with CCK. No other peaks were detected. Column separation of spinal cord and the superfusate obtained during basal and evoked release, revealed that all activity in both the tissue and perfusate samples, travelled in a single peak which co-migrated with authentic VIP.

Pineal tumors in children and adolescents. Treatment by CSF shunting and radiotherapy.

Tumors of the pineal region account for 3% to 8% of pediatric intracranial tumors. The treatment of such tumors has been in a state of flux between conservative therapy (cerebrospinal fluid shunting and radiotherapy) and direct surgical removal. A brief history and review of the literature with analysis of both approaches is given, and the Mayo Clinic's experience with conservative treatment of tumors in the pineal region in patients 20 years old and younger (27 cases) is studied and analyzed. The series comprises 21 boys and six girls, with an age range of 1 to 20 years (mean 13.7 years). Follow-up examinations are complete and range from 1 to 24 years, with a mean follow-up period of 7.8 years. The median survival time for these patients treated with shunt and radiotherapy is 17.7 years. There was no mortality from treatment and complications were rare. The details of the clinical presentation, diagnostic findings, pathology, therapy, recurrence, and survival are presented. All patients under 6 years of age (six cases) had recurrences, 50% in other areas in the brain and 50% in the spinal cord, perhaps pointing to the need for whole-brain and spinal-axis irradiation in patients in this age group. The results of this study of the conservative approach form a standard against which results of any other type of therapy may be compared.