Seizures in the elderly: impact on mental status, mood, and sleep.

Comorbidities of epilepsy have not been well explored in the elderly. Herein, we examined mental status, mood, and sleep in elderly patients with epilepsy, compared with age- and gender-matched community controls without epilepsy from the Einstein Aging Study. Testing included a mental status test, the Blessed Information Memory and Concentration (BIMC) test; Prime-MD Patient Health Questionnaire (PHQ) Depression and Anxiety Modules; and Medical Outcomes Study Sleep Scale.

Novel orphan nuclear receptors-coregulator interactions controlling anti-cancer drug metabolism.

In recent years, it has become clear that drug metabolizing enzymes and efflux transporters are directly under the control of tissue-specific orphan receptors, mainly pregnenolone x-receptor (PXR), and constitutive androstene receptor (CAR), that coordinately regulate their transcription. The consequences of xenobiotic activation of these receptors leads to unpredictability of drug kinetics and in some cases drug pharmacodynamics. Since receptor specific co-regulators are critically involved in this process, this review serves to highlight important new advances in this area of research.

ICRU reference dose in an era of intensity-modulated radiation therapy clinical trials: correlation with planning target volume mean dose and suitability for intensity-modulated radiation therapy dose prescription.

Background And Purpose: IMRT clinical trials lack dose prescription and specification standards similar to ICRU standards for two- and three-dimensional external beam planning. In this study, we analyzed dose distributions for patients whose treatment plans incorporated IMRT, and compared the dose determined at the ICRU reference point to the PTV doses determined from dose-volume histograms. Additionally, we evaluated if ICRU reference type single-point dose prescriptions are suitable for IMRT dose prescriptions.

Perimalleolar and pedal thromboembolectomy and bypasses to treat distal embolization during aortoiliac aneurysm repairs.

Objectives: Lower extremity embolization occurs during aortoiliac aneurysm repair and may require major amputation when distal arteries are occluded. Because nonoperative treatments are often ineffective, we evaluated an aggressive operative approach.

Methods: In the past 11 years, we performed 328 endovascular and 350 open aortoiliac aneurysm repairs.

Antithrombotic therapy in peripheral arterial disease.

The management of elderly patients with peripheral arterial disease requires a multidisciplinary and individualized approach, especially for patients requiring intervention and for those on antithrombotic therapy. Communication between the patient's primary physician, consulting medical specialists, and vascular surgeon is essential because all may contribute synergistically to deliver optimal care to the patient. This article reviews the pathophysiology of peripheral arterial disease and data regarding the use of antiplatelet and anticoagulant agents.

Value of routine screening for bone demineralization in an urban population of patients with epilepsy.

Background: Reduced bone mineral density (BMD) is increasingly recognized in patients receiving antiepileptic drug therapy. The precise prevalence is not known due to variability across populations studied. We set out to characterize the prevalence of abnormal BMD in an urban population of patients with epilepsy with the intent to determine the value of routine BMD screening.

Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism.

Context: Measurements from all age groups defined the upper limit of the TSH reference range in National Health and Nutrition Examination Survey III. The TSH median, 97.5 centile and prevalence of subclinical hypothyroidism (SCH), normal serum T(4) and TSH greater than 4.

Indicators of anesthesia safety and quality.

In 1999, the Institute of Medicine shocked the world by claiming that medical error was among the leading causes of death in the United States. In contrast, anesthesiology was cited as an area in which there have been impressive gains in safety and quality. The mechanisms to which these impressive gains have been attributed include practice guidelines, anesthesia simulators, and benchmarking.

Phase II clinical trial of parenteral hydroxyurea and hyper-fractionated, accelerated external beam radiation therapy in patients with advanced squamous cell carcinoma of the head and neck: toxicity and efficacy with continuous ribonucleoside reductase inhibition.

Background: Almost all concurrent chemoradiation regimens for head and neck are platinum based; however, cisplatin is associated with severe renal, oto-, and neurotoxicity. Hydroxyurea (HU) has been associated with fewer irreversible toxicities. We obtained HU in parenteral form to be administered continually during the radiation treatment.

Effects of cardioactive medications on retrograde conduction: continuing relevance for current devices.

Introduction: Retroconduction (ventriculo-atrial conduction) remains a problem for patients with implanted cardiac rhythm devices. Pacemaker algorithms can detect and terminate endless loop tachycardia (ELT), but actual prevention of ELT may require anti-arrhythmic drugs (AADs). Similarly, AADs can affect ICD rhythm discrimination algorithms that depend on atrio-ventricular ratios.

Incidence of and risk factors for genital human papillomavirus infection in women drug users.

A total of 230 women drug users were prospectively studied. At 6-month intervals, interviews, HIV testing, and cervicovaginal lavage sampling for human papillomavirus (HPV) were performed. HPV was detected and typed using a MY09/MY11 polymerase chain reaction system.

Chronic disorders with episodic manifestations: focus on epilepsy and migraine.

Epilepsy and migraine are chronic neurological disorders with episodic manifestations that are commonly treated in neurological practice and frequently occur together. In this review we examine similarities and contrasts between these disorders, with focus on epidemiology and classification, temporal coincidence, triggers, and mechanistically based therapeutic overlap. This investigation draws attention to unique aspects of both epilepsy and migraine, while identifying areas of crossover in which each specialty could benefit from the experience of the other.

Seizure clustering.

Seizure clusters, also known as repetitive or serial seizures, occur commonly in epilepsy. Clustering implies that the occurrence of one seizure may influence the probability of a subsequent seizure; thus, the investigation of the clustering phenomenon yields insights into both specific mechanisms of seizure clustering and more general concepts of seizure occurrence. Seizure clustering has been defined clinically as a number of seizures per unit time and, statistically, as a deviation from a random distribution, or interseizure interval dependence.

Subintimal angioplasty in the management of critical lower-extremity ischemia: value in limb salvage.

The interest in and overall usage of endovascular procedures for the treatment of lower extremity ischemia continues to grow at a rapid pace. An increasing number of centers throughout the world are gaining experience with subintimal angioplasty. Promising results have been reported and the application of the technique has been expanded to include the iliac and crural arteries.

Profound independent effects of left bundle branch block and heart rate during supraventricular tachycardia.

Left bundle branch block (LBBB) has negative hemodynamic effects. In the same patient, profound hypotension occurs during supraventricular tachycardia with LBBB but not at the same rate in the absence of LBBB. At slower rates, blood pressure is similar with and without LBBB.

Reconstruction of Hyman's second pacemaker.

Though journal articles and newspaper reports suggest that three Hyman pacemakers existed or were intended; a patent, descriptive photographs and a written description of an earlier model and only a photograph of a later model exist. A replica of the earlier has been made based on the patent and description, and a new replica of the second based on a critical deconstruction and analysis of the photograph of the second with a modern circuit duplicating the function of the earlier circuit. Both replicas were "operational" in that stimuli were mimicked though not delivered and neither could under any circumstances actually resuscitate the heart.

'Shine through' on dual tracer parathyroid scintigraphy: a potential pitfall in interpretation.

Dual tracer scintigraphy has become the procedure of choice for preoperative localization of parathyroid adenomas. The typical protocol used by most laboratories is to initially perform a Tc-99m sestamibi (MIBI) study with early and delayed (2-3 hours) washout phase images. This is followed by a thyroid-specific Tc-99m pertechnetate study.

Seizure clustering: risks and outcomes.

Purpose: Patients with epilepsy often experience seizures in clusters. In this preliminary study, we examined the prevalence of self-reported clustering and identified potential risk factors and outcomes associated with reported clustering for further analysis in an ongoing prospective diary study.

Methods: Detailed intake questionnaires were administered.

Easy surgical approach for completion of biventricular pacing.

Placement of a pacing lead into a branch of the coronary sinus for biventricular pacing sometimes is difficult or impossible. Surgical completion typically has included immediate or subsequent thoracotomy lead placement with hookup to the device at the time of chest surgery. We describe an alternative procedure of complete device-lead hookup and permanent pocket closure in the electrophysiology laboratory.

Pacemakers and implantable cardioverter defibrillators: device longevity is more important than smaller size: the patient's viewpoint.

The size of pacemakers and implantable cardioverter defibrillators (ICDs) has been diminishing progressively. If two devices are otherwise identical in components, features and technology, the one with a larger battery should have a longer service life. Therefore, patients who receive smaller devices may require more frequent surgery to replace the devices.

Treatment of cognitive dysfunction in psychiatric disorders.

Most people with severe and persistent psychiatric disorders have significant cognitive deficits. Both schizophrenia and affective disorders with psychosis are associated with problems in attention, memory, and executive functioning. These deficits are predictive of lower work status, impairments in social skills, and poorer response to psychosocial skills training.

Fate of collateral vessels following subintimal angioplasty.

Purpose: To evaluate the fate of collateral vessels adjacent to and within the target lesion following subintimal angioplasty (SIA).

Methods: Pre and postprocedural angiograms were reviewed for 29 patients undergoing SIA of the lower extremity arteries over a 3-year period. The number of patent collateral vessels View Article and Find Full Text PDF

Heart rate variability and diastolic heart failure.

Diastolic heart failure accounts for up to 40% of patients with congestive heart failure (CHF), and is associated with a better prognosis as compared to patients with systolic dysfunction. Nevertheless, patients with diastolic dysfunction have a significantly higher mortality as compared to the normal population. Reduced heart rate variability (HRV), a marker of autonomic dysfunction, is associated with increased mortality in patients with systolic heart failure.