[Alexithymia: important for understanding mood disorders with older adults?]. / Alexithymie bij depressieve ouderen: een relevante persoonlijkheidstrek?

Alexithymia (cognitive and affective emotion regulation) may be important for understanding mood disorders in older adults. In the present study it is examined whether alexithymia (i) acts as a stable personality trait, (ii) is independent from the Big Five personality traits, and (iii) is associated with the course and outcome of depressive disorder. Alexithymia was assessed at intake and after three months in older adults with a (sub)clinical depressive disorder using the The Bermond Vorst Alexithymia Questionnaire (BVAQ). The results show that alexithymia acts as a stable and independent personality trait. Alexithymia was no predictor for the outcome of depression after three months. It was concluded that alexithymia should be considered when assessing and treating depression in older adults. However, further research is necessary.

Therapeutic mild hypothermia improves outcome after out-of-hospital cardiac arrest.

Purpose. Therapeutic mild hypothermia (TMH) is indicated for comatose survivors of an out-ofhospital cardiac arrest (OHCA) to improve general outcome. Although widely used, there are not many reports on its use on a critical care unit (CCU) or on the comparison of cooling methods.Methods. In a retrospective analysis covering January 2005 to December 2006, 75 consecutive comatose subjects post-OHCA due to ventricular fibrillation and nonventricular fibrillation rhythms (asystole/pulseless electrical activity) were studied in a single tertiary PCI centre. Subjects treated with conventional post-resuscitation care without TMH served as controls (n=26; Jan 2005-Sep 2005). Outcome from controls at hospital discharge was compared with subjects treated with TMH (n=49; Oct 2005-Dec 2006). During the study period, TMH was induced by either external (n=25; Oct 2005-Feb 2006) or endovascular (n=24; Mar 2006-Dec 2006) approach.Results. Besides more females in the control group, there were no major differences in baseline characteristics present between all groups. TMH improved survival (OR 0.36 [0.13-0.95], p<0.05) and neurological outcome (OR 0.23 [0.07-0.70], p<0.01). After subanalysis, TMH-improved outcome did not differ between the two cooling methods used. However, the times to reach TMH and normothermia were shorter with the endovascular approach.Conclusion. TMH induced on a CCU improves survival and neurological outcome after post-OHCA coma. TMH by endovascular approach was more feasible compared with external cooling, but the two cooling methods did not result in a different outcome. (Neth Heart J 2009;17:378-84.).

[Stability of personality in later life]. / Stabiliteit van persoonlijkheid op latere leeftijd.

The relation of aging and the stability of personality in late life is evaluated by a literature review. The findings of six longitudinal studies reveal that rank-order consistency continues into old age. The mean-level stability reveals a concave curve for 'neuroticism' with an increase after age 80, a decrease for 'extraversion', and an increase for 'agreeableness'. The methodological and conceptual issues of personality assessment with old adults can be resolved by using a self report scale which corresponds to the capacities and the lifestyle of older adults and by involving age related variables into analyses.

Clinical effect of Bretschneider-HTK and St. Thomas cardioplegia on hemodynamic performance after bypass measured using an automatic datalogging database system.

A prospective consecutive study was undertaken to compare the hemodynamic effect of two cardioplegic solutions in CABG patients after bypass, and in relation to aorta occlusion time with the support of a automatic datalogging database. A total of 249 patients were randomized. One group received Bretschneider cardioplegic HTK solution (132 patients, group I) the other group received St. Thomas cardioplegic solution (117 patients, group II). The data was divided in four periods of aortic clamp time: less than or equal to 40 min (group I 26 patients, group II 32 patients); 41-60 min (group I 49 patients, group II 47 patients); 61-80 min (group I 30 patients, group II 29 patients); and greater than 80 minutes (group I 27 pts, group II 9 patients). Anesthesia regime and therapeutic drugs and infusions were given in both groups in similar dosages. Within both groups HR, CO, PAP, PCWP increased after bypass in relation to prebypass values. SVR decreased in both groups by 30%, MAP and PVR decreased only in group I. Between group I and II differences were found in the CI (3.0 vs. 3.3 l/min/m2), MAP (70 vs. 76 mmHg), PMAR (18 vs. 16 mHg), and SVR (827 vs. 954 dyn.sec.cm-5). In significantly more of the patients in group I, sinus rhythm started spontaneously after the release of the aorta clamp (39.5% vs. 20.4%, p less than 0.005). Patients in group I needed temporarily a pacemaker after bypass in 6.3% cases (in 1.1% of patients in group II,). There was no relation of the hemodynamic data in relation to aorta occlusion time within the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Experiences with an anesthesia protocol written by computer]. / Erfahrungen mit einem computergeschriebenen Anaesthesie-Protokoll.

Since December 1983, we have used a computer system for charting and data logging in cardiac and thoracic anesthesia. These computers, designed as stand-alone units, were developed at our hospital based on Motorola 6809 microprocessor systems. All measurements derived from anesthetic monitoring, ventilator, and heart-lung machine are automatically sampled at regular intervals and stored for later data management. Laboratory results are automatically received from the hospital computer system. The user communicates with the system via a terminal and a keyboard; this also facilitates the entering of all comments, medications, infusions, and fluid losses. All data are continuously displayed on an A3 format anesthetic chart using a multi-pen, flat-bed plotter. The operation of the system has proved to be simple and needs less time than charting by hand, while the result, the display on the chart, is far clearer and more complete than any handwritten document. Up to now 3,200 operations (corresponding to 12,500 anesthetic h) have been documented. The failure rate of the system, defined as an interruption of the documentation for more than 30 min is 2.1%. Further development of the system is discussed. A data base for processing the stored data has been developed and is being tested at present.

Controlled administration of oxygen with self inflating resuscitation bags.

Resuscitation bags were originally developed to ventilate patients under emergency conditions. Under circumstances where oxygen is available one should make full use of it. The problem of exact air enrichment for these bags has not been satisfactory solved until now. Therefore a system has been developed which furnishes controlled delivery of FIO2 during ventilation with self inflating resuscitation bags. This is obtained via a venturi device connected to the air inlet of the manual resuscitation bag. The FIO2 delivered to the patients from a self inflating bag was tested for values of 24, 30, 40 and 50% oxygen. The new system proved to be capable to delivery exact FIO2 in contrast with previously applied methods of oxygen delivery where this could never be achieved.