Finding hope in the midst of despair: my decade with Parkinson's disease and Lewy body dementia.

Living for 10 years with Parkinson's disease (PD) and Lewy body dementia (LBD) author Thomas B. Graboys, MD recounts the various losses - physical, emotional, social and intellectual - that ultimately add up to a loss of self inflicted by these progressive neurological diseases. No longer able to practice medicine, engage in athletics, or engage fully with his extended family, soon to include 11 grandchildren, Graboys nevertheless writes that there is one aspect of self PD and LBD cannot steal: the soul.

Long-term outcomes of optimized medical management of outpatients with stable coronary artery disease.

The objective of this study was to assess long-term clinical outcomes and their correlates in medically managed outpatients with stable angina pectoris, healed myocardial infarction (MI), or documented asymptomatic coronary artery disease (CAD). Management strategy emphasized maximally tolerated medical therapy and modification of coronary risk factors. Referral to invasive coronary interventions followed stricter criteria than standard published guidelines.

Usefulness of statin drugs in protecting against atrial fibrillation in patients with coronary artery disease.

Atrial fibrillation (AF) is prevalent in the elderly, in patients with hypertension, and in patients with coronary artery disease (CAD). We hypothesized that statin therapy might be effective in preventing AF in patients with CAD and examined this hypothesis in a sample of patients with chronic stable CAD without AF, followed prospectively at a large outpatient cardiology practice. The association between statin use and the risk of developing AF was examined univariately and then with adjustment for potential confounding factors.

Hand to hand.

Examination of the hands has the potential to transform the encounter between physician and patient. Taking the hands conveys a sense of warmth and connectedness and is a means to communicate the physician's mindfulness. The hands can focus the examination on the individual patient as a complete human being, and not merely a disease or a collection of symptoms.

Sildenafil in the cardiologist's office: patients' attitudes and physicians' practices toward discussions about sexual functioning.

Sildenafil is a medication increasingly prescribed to improve sexual function in patients who have erectile dysfunction. Because a major contraindication to the use of sildenafil is a history of coronary disease and the concomitant use of nitrates, it becomes increasingly important for cardiologists to prescribe this medication. We evaluated the nature of discussions in all 70 patients for whom sildenafil was prescribed in a cardiology practice between April and July 1998.

Development and validation of the ITG Health-Related Quality-of-Life Short-Form measure for use in patients with coronary artery disease. Integrated Therapeutics Group.

Background: Available coronary artery disease (CAD)-specific health-related quality-of-life (HRQL) measures are not ideally suited for routine clinical practice. We report development of a valid and reliable CAD-specific short-form measure.

Hypothesis: The Integrated Therapeutics Group (ITG) CAD-specific short-form HRQL measure is reliable and valid for assessing the health status of patients with CAD.

Exercise performance-based outcomes of medically treated patients with coronary artery disease and profound ST segment depression.

Objectives: We sought to determine the relationship between exercise duration and cardiovascular outcomes in patients with profound (> or =2 mm) ST segment depression during exercise treadmill testing (ETT).

Background: Patients with stable symptoms but profound ST segment depression during ETT are often referred for a coronary intervention on the basis that presumed severe coronary artery disease (CAD) will lead to unfavorable cardiovascular outcomes, irrespective of symptomatic and functional status. We hypothesized that good exercise tolerance in such patients treated medically is associated with favorable long-term outcomes.

Discrepancies in the use of medications: their extent and predictors in an outpatient practice.

Background: Misuse of medications is a major cause of morbidity and mortality. Few studies have examined the frequency of, and factors associated with, discrepancies between what doctors prescribe and what patients take in actual practice.

Patients And Methods: Patients' medication bottles and their reported use of medications were compared with physicians' records of outpatients seen between November 1997 and February 1998 in a private practice affiliated with an academic medical center in Boston, Mass.

Results of a second-opinion trial among patients recommended for coronary angiography.

Objective: To assess the feasibility of carrying out a second-opinion trial for patients urged to undergo coronary angiography and to assess the long-range outcome of such patients denied that procedure, and the criteria evolved for reaching such a conclusion.

Design: A case series of patients referred for a second opinion as to the need for coronary angiography. Patients were followed up by questionnaire, telephone call, and center visits.

The prevalence of proarrhythmic events during moricizine therapy and their relationship to ventricular function.

The prevalence of proarrhythmic events during moricizine therapy was studied in 144 patients who were treated for symptomatic ventricular tachycardia or ventricular fibrillation. The overall incidence of proarrhythmia was 15.3%.

Appropriate indications for ambulatory electrocardiographic monitoring. A clinical perspective.

This article summarizes the clinical indications for ambulatory monitoring using current information from the Cardiac Arrhythmia Suppression Trial and utility of the procedure to detect both drug efficacy and proarrhythmia. It also discusses silent ischemia detection and heart rate variability as an indicator of autonomic tone.

Effect of the combination of low-dose mexiletine and metoprolol on ventricular arrhythmia.

Antiarrhythmic drug therapy is often ineffective or poorly tolerated. Combining antiarrhythmic agents with different electrophysiologic properties may have a synergistic antiarrhythmic effect when compared with each drug alone. If a lower dose of each drug can be used, combination therapy may also result in lower incidence of side effects.

Ethics in cardiovascular medicine. Task Force II: The relation of cardiovascular specialists to patients, other physicians and physician-owned organizations.

1. The American College of Cardiology acknowledges the continuum of changing societal, medical and economic perspectives affecting traditional medical ethics. Primacy of patient responsibility remains paramount to the cardiovascular specialist who at the same time should participate in the development of broader societal programs.