Isolated LAD Revascularization in the Modern Era: Demographics and Preliminary Outcomes

Author Institution: Summa Health System, Northeast Ohio Universities College of Medicine ; The University of AkronRevascularization of the left anterior descending coronary artery is an important, evolving and controversial topic. There are differences in patient selection, hospital stay and readmission, and hospital cost

Osteoarthrosis causing altered mental status: a case report

INTRODUCTION: Cervical spondylosis as a cause of diaphragmatic weakness is an uncommon entity and has been reported primarily in the setting of cervical spinal cord compression. Cervical spondylosis most often causes respiratory failure from cervical myelopathy and damage to the ventral horn cells at spinal cord segments C3 to C5 from where the phrenic nerve arises. The manifestations are variable but there may be evidence of upper motor neuron signs and neurological deficits in the lower extremities along with Lhermitte’s sign. Here we report a rare case of cervical spondylosis causing phrenic nerve root compression from foraminal narrowing at C3, C4 and C5, leading to lower motor neuron paralysis of the phrenic nerve and respiratory failure, in the absence of spinal cord involvement. CASE PRESENTATION: An 87-year-old Caucasian man presented with recurrent episodes of hypercapnic respiratory failure and altered mental status requiring intubation. He was noted to have neurological deficits in his upper extremities with C5 radiculopathy deficits. An arterial blood gas showed a normal alveolar-arterial oxygen gradient with chronic respiratory acidosis, and pulmonary function testing showed restrictive lung mechanics with weakened neuromuscular apparatus and low maximum inspiratory and expiratory pressures. An extensive workup including electromyogram and magnetic resonance imaging showed evidence of phrenic neuropathy secondary to C3 to C5 neural foramina compression, from cervical spondylosis. He was treated conservatively with night-time bilevel positive airway pressure which rested his respiratory musculature with significant improvement. CONCLUSIONS: Cervical spondylosis leading to phrenic nerve root compression is a rare and underreported cause of chronic respiratory acidosis and must be considered in the differential diagnosis of chronic hypoventilation, particularly in the elderly. This case illustrates how a simple arterial blood gas and calculation of the alveolar-arterial oxygen gradient can help in the workup of chronic respiratory acidosis by identifying causes of hypoventilation, which are associated with a normal diffusing lung capacity and thereby a normal alveolar-arterial oxygen gradient

Cardiac Rehabilitation Intervention and Quality of Life Indicators: A Validation Estimate of Ware's Model

Author Institution: Dept. of Counseling & Mental Health Services, University of Toledo, OHAuthor Institution: Dept. of Educational Foundations & Leadership, University of Akron, OHAuthor Institution: Dept. of Counseling, Summa Health System, University of Akron, OHAuthor Institution: Cardiac Rehabilitation Institute, Summa Health System, University of Akron, OHThe present study tests Ware’s (1987, 1990) prediction that patient evaluations of quality of life (QOL) are related to physical ability. QOL data from 302 patients were collected prior to initiation and upon completion of a 12-week cardiac rehabilitation program. Physical ability was measured in metabolic equivalents (METS). Pearson product moment correlation coefficients were calculated for the variables under study. Multiple regression analyses were conducted to test these relationships covarying patient diagnosis, and pre-treatment QOL score and patient demographics. Significant improvements from pre- to post-CR were found for METs and all QOL variables. Improvements in physical ability were significantly correlated with improvements in physical health related QOL indices, but not with mental health QOL indices. These relationships were present even when moderating variables were co-varied. Improvements in physical ability were predictive of decreased expectations that physical health would interfere with work or other daily activities. As the physical capabilities of our patients increased, they reported feeling less physical pain and were less limited by any pain they did experience. And, increased physical ability was associated with a brighter outlook on current and expected future health status. These findings provide support for Ware’s theory of QOL

Administration of a Glycoprotein IIb/IIIa Receptor Blocker with a Thienopyridine Derivative Does Not Increase the Risk of Thrombocytopenia

Author Institution: Akron Cardiology Consulltants, OHAuthor Institution: Dept. of Educational Foundations & Leadership, University of Akron, OHAuthor Institution: Summa Health System, University of Akron, OHAuthor Institution: Dept. of Medicine, Northeast Ohio Universities College of Medicine, Rootstown, OHAuthor Institution: Cardiac Rehabilitation Institute, Summa Health Syste, University of Akron, OHThe combination of aspirin, a thienopyridine derivative, and a glycoprotein IIb/IIIa receptor inhibitor has become standard therapy for patients undergoing percutaneous coronary intervention (PCI). Recent studies have shown an increased incidence of thrombocytopenia in those patients receiving a high loading dose of clopidogrel (thienopyridine) with abciximab (IIb/IIIa receptor inhibitor) prior to coronary intervention. We reviewed the records of 504 patients who underwent PCI at a large tertiary care hospital and noted an incidence of thrombocytopenia of 4.8%, comparable to published historical controls who received abciximab without clopidogrel. In patients undergoing PCI, there was no difference in thrombocytopenia or bleeding complications between patients receiving a high or a low dose of a thienopyridine. We conclude that a high loading dose of a thienopyridine derivative prior to PCI may be administered safely and efficaciously in the setting of concomitant administration of abciximab without an undue risk of thrombocytopenia

Diversity and Modern Politics

Over the years, the concept of diversity has emerged to be an issue of concern in terms of political challenges across the globe. In this regard, it has been widely argued by the political thinkers that it typically stems from a number of intricate factors. The most prominent of these factors is considered to be globalization (Clarke 2008). Moreover, it has also been observed that there is a stark difference between the ancient and modern political theories that study the problems of diversity. The present study aims to highlight the aspects of modern approach to diversity with specific focus on the work of three renowned political thinkers

Cardiovascular fitness associated with cognitive performance in heart failure patients enrolled in cardiac rehabilitation

Abstract Background Reduced cognitive function is common in persons with heart failure (HF). Cardiovascular fitness is a known contributor to cognitive function in many patient populations, but has only been linked to cognition based on estimates of fitness in HF. The current study examined the relationship between fitness as measured by metabolic equivalents (METs) from a standardized stress test and cognition in persons with HF, as well as the validity of office-based predictors of fitness in this population. Methods Forty-one HF patients enrolled in cardiac rehabilitation completed a standardized exercise stress test protocol, a brief neuropsychological battery, the 2-minute step test (2MST), and a series of medical history and self-report questionnaires. Results Maximum METs from stress testing demonstrated incremental predictive validity for attention (β = .41,p = .03), executive function (β = .37,p = .04), and memory domains (β = .46,p = .04). Partial correlations accounting for key medical and demographic characteristics revealed greater METs was associated with the 2MST (r(32) = .41,p = .02) but not with the Duke Activity Status Index (DASI) (r(32) = .24,p = .17). Conclusion The current findings indicate that better fitness levels measured by METs is independently associated with better cognitive function in older adults with HF. Results also showed that METs was closely associated with one office-based measure of fitness (2MST), but not another (DASI). Prospective studies are needed to clarify the mechanisms linking fitness and cognitive function in HF

Transcriptional regulators of nestin in the rat central nervous system

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Biology, 1996.Includes bibliographical references (leaves 154-157).by Richard Eric Josephson.Ph.D

Current Perspectives on the Use of Meditation to Reduce Blood Pressure

Meditation techniques are increasingly popular practices that may be useful in preventing or reducing elevated blood pressure. We reviewed landmark studies and recent literature concerning the use of meditation for reducing blood pressure in pre-hypertensive and hypertensive individuals. We sought to highlight underlying assumptions, identify strengths and weaknesses of the research, and suggest avenues for further research, reporting of results, and dissemination of findings. Meditation techniques appear to produce small yet meaningful reductions in blood pressure either as monotherapy or in conjunction with traditional pharmacotherapy. Transcendental meditation and mindfulness-based stress reduction may produce clinically significant reductions in systolic and diastolic blood pressure. More randomized clinical trials are necessary before strong recommendations regarding the use of meditation for high BP can be made