Differential reports of pain and depression differentiate mild cognitive impairment from cognitively intact elderly participants.

BACKGROUND: Positive associations between pain and depression in the general population have been well characterized; however, the interplay between pain, depression, and early cognitive decline, characterized as mild cognitive impairment (MCI), is poorly understood. METHODS: The current study examined the association of self-reported pain complaints (measured by the 36-item Short Form Health Survey) and self-reported depressive symptoms (measured by the 30-item Geriatric Depression Scale) in cognitively intact participants (n = 492) and participants with a clinical diagnosis of MCI (n = 83). RESULTS: Depressive symptoms and subjective reports of pain were significantly associated in the entire sample (r = .29; P < .0001). Multiple logistic regression modeling (adjusted for age, education, and APOE4 status as covariates) demonstrated that while depressive symptoms were positively associated with the diagnosis of MCI (P < .001), subjective pain reports were negatively associated with MCI (P < .002). CONCLUSION: While the negative association of subjective pain complaints with MCI might arguably be explained by the development of anosognosia, self-reports of depressive symptoms were actually increased in these participants, suggesting preserved insight into cognitive decline-associated symptoms. It is possible that preferential involvement of limbic circuitry in MCI could explain these findings. Future studies are needed to elucidate the reasons for the dissociation of pain and depressive symptoms in MCI described in the present article.

Recognition of acute cardiac allograft rejection from serial integrated backscatter analyses in human orthotopic heart transplant recipients. Comparison with conventional echocardiography.

BACKGROUND: Previous studies showed that moderate and severe acute cardiac rejection (AR) but not mild AR is associated with significant myocardial acoustic changes. This study examines whether serial measurements of end-diastolic two-dimensional integrated backscatter (2D-IB) enhance the diagnostic potential of ultrasonic tissue analysis in AR. METHODS AND RESULTS: Serial endomyocardial biopsies, conventional echocardiograms, and parasternal long-axis radiofrequency signals for determination of posterior wall and septal 2D-IB were performed in 52 transplant patients. Histology showed no AR in 155 biopsy samples, AR grade 1A in 25, AR grade 1B/2 in 27, and AR grade 3A/3B in 13. Whereas no significant 2D-IB changes occurred between AR-free studies and during AR grade 1A, posterior wall and septal 2D-IB increased during AR grade 1B/2 from -47.80 +/- 4.36 to -42.97 +/- 5.11 dB and from -36.72 +/- 7.45 to -32.52 +/- 7.98 dB (P < .001 and P < .05, respectively) and during AR grade 3A/3B from -47.96 +/- 4.74 to -38.25 +/- 5.32 dB and from -37.92 +/- 5.87 to -31.01 +/- 4.62 dB (P < .001 and P < .01, respectively). Changes in posterior wall and septal 2D-IB were greater during AR grade 3A/3B than during AR grade 1B/2 (P < .01 and P < .05). Increases of 1.5 dB in posterior wall or septal 2D-IB indicated AR grades > or = 1B with sensitivities of 88% and 83% and specificities of 89% and 85%; posterior wall and septal 2D-IB increases of 5.5 and 3.8 dB identified AR grades > or = 3A with sensitivities of 92% and 79% and specificities of 90% and 84%. Although a weak inverse correlation between posterior wall and septal 2D-IB changes and posterior wall and septal thickening (r = .41 and r = .39, both P < .001) and fractional diameter shortening (r = .35, P < .001) was found, significant 2D-IB increases also occurred in some rejecting patients with unaltered contraction. CONCLUSIONS: Increases in end-diastolic posterior wall and septal 2D-IB in serial studies permit reliable identification not only of moderate and severe AR but also of mild AR. Because 2D-IB increase significantly more in AR with myocyte damage than without such damage, an estimate of AR severity appears feasible. Significant myocardial acoustic changes during AR may occur independently of changes in contractile performance.

Intravenous Albunex during transesophageal echocardiography: quantitative assessment by videodensitometry and integrated backscatter analysis from unprocessed radiofrequency signals.

This study investigates the comparative sensitivity of video and radiofrequency imaging to detect changes of the myocardial acoustic properties after intravenous Albunex. Thirty-six patients received Albunex, 0.08 and 0.22 ml/kg intravenously, during transesophageal imaging of the ventricular short axis. Analysis of video images was performed in all patients and of radiofrequency data in 20 patients. Although myocardial videointensity remained unchanged, 57% of the myocardial backscatter plots demonstrated significant contrast enhancement. The study demonstrates that intravenous Albunex is capable of myocardial contrast enhancement and proves the diagnostic superiority of radiofrequency compared with video imaging. Ultrasonic radiofrequency imaging may provide a technical basis for future noninvasive assessment of myocardial perfusion.

Simultaneous transesophageal echocardiography and atrial pacing: assessment of the functional significance of coronary artery disease before surgical treatment of an abdominal aneurysm.

Conventional active stress tests for the evaluation of coronary artery disease are not feasible for patients in whom a significant blood pressure increase during a stress procedure should be avoided, for example, those with a coexisting aortic aneurysm. Transesophageal echocardiography (TEE) with simultaneous atrial pacing is a new, highly specific, and sensitive stress technique for the detection of coronary artery disease. Furthermore, TEE can be performed safely with only mild blood pressure increases. Therefore in the present case report of a 70-year-old male, application of combined TEE and atrial pacing was used successfully to exclude the hemodynamic significance of a circumflex artery stenosis and avoided a significant blood pressure increase before surgical correction of an abdominal aortic aneurysm.