Resumption of work after acute coronary syndrome or coronary artery bypass graft surgery.

BACKGROUND: Return to work is an important indicator of recovery after acute cardiac events. This study aimed to determine rates of work resumption and identify predictors of non-return to work and delayed resumption of work. METHODS: 401 currently employed patients consecutively admitted after acute coronary syndrome or to undergo coronary artery bypass graft surgery were recruited. Patient characteristics, perceptions and occupational outcomes were investigated via interviews and self-report questionnaires. RESULTS: Twenty-three patients were lost to follow-up. Of the 378 completers, 343 (90.7%) patients resumed work, while 35 (9.3%) did not. By four months, 309 (91.1%) patients had returned to work. At 12 months, 302 (79.9%) of the 378 patients were employed, 32 (8.5%) unemployed and 20 (5.3%) retired. The employment status of 24 (6.3%) patients was unknown. Non-return to work was significantly more likely if patients were not intending to return to work or were uncertain, had a negative perception of health, had a comorbidity other than diabetes and reported financial stress. Significant predictors of delayed return to work were cardiac rehabilitation attendance, longer hospital stay, past angina, having a manual job, physically active work, job dissatisfaction, no confidante and depression. CONCLUSIONS: Patients at risk of poor occupational outcomes can be identified early. Strategies to improve vocational rehabilitation require further investigation.

Diagnosis and treatment of voiding dysfunction caused by urethral obstruction after anti-incontinence surgery.

Voiding dysfunction after surgical treatment of stress incontinence may occur as a result of urethral obstruction secondary to hyperelevation of the bladder neck. The diagnosis of urethral obstruction after anti-incontinence surgery is often based upon patient symptomatology and physical examination without confirmation by urodynamic, endoscopic or other diagnostic studies. Urethrolysis seems effective in treating urethral obstruction and voiding dysfunction after surgical treatment of stress urinary incontinence. The reported high success rates of less-invasive procedures have not been confirmed by larger studies. Randomized prospective clinical trials are required to determine the optimal surgical treatment for prolonged voiding dysfunction after anti-incontinence procedures.

Stimulation of lateral hypothalamic AMPA receptors may induce feeding in rats.

Glutamate or its ionotropic receptor (iGluR) agonists, N-methyl-D-aspartate (NMDA), alpha-amino-3-hydroxy-5-methyl-4-isoxale propionate (AMPA), and kainate (KA) elicit feeding when microinjected into the lateral hypothalamus (LH) of satiated rats. In the present study we investigated the contributions of AMPA and KA receptors (AMPARs and KARs) to feeding initiation. Intense feeding was elicited by LH injection of RS-AMPA (1 and 10 nmol) but not by the isolated, inactive R-AMPA enantiomer (1 and 10 nmol). Further, LH pretreatment with either the non-selective AMPAR/KAR antagonist, 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX, 4 nmol) or the selective AMPAR antagonist, GYKI 52466 (10 nmol), suppressed AMPA-elicited food intake and, when combined, blocked AMPA-elicited food intake. These findings suggest that LH AMPARs mediate AMPA injection-elicited feeding with a possible contribution by KARs. In contrast, CNQX or GYKI 52466 injected into the LH at the onset of the nocturnal period or into fasted rats did not suppress the feeding produced by either condition. RS-AMPA injected into the LH of fasted or nocturnal feeding subjects elicited eating in both conditions; however, the magnitude of the increase was greater in fasted rats. These data suggest that selective stimulation of AMPAR in the LH is sufficient to elicit feeding. In contrast, the results did not provide evidence that AMPAR stimulation is necessary for deprivation-induced or nocturnal eating; however, they did suggest that modulatory interactions may exist between these receptors and these forms of naturally occurring eating behavior.