Neuroanatomic pathways associated with poststroke affective and apathetic depression.

OBJECTIVES: Our goal was to localize lesions in poststroke depression patients using magnetic resonance imaging, based on the statistical parametric maps image analysis technique that can be used to combine image data from multiple participants and correlate these images with other data sets. METHODS: Magnetic resonance imaging acquisitions were obtained from 149 poststroke patients, who were assessed for affective and apathetic symptoms using the Hospital Anxiety and Depression Scale and the Apathy Scale, respectively. We created a statistical parametric map that displayed an association between lesion location and affective and apathetic symptoms. RESULTS: Among the patients with higher depressive scores, the lesion overlap centered on the brainstem, left basal ganglia, and left frontal cortex. Among the patients with higher apathy scores, the lesion overlap centered on the brainstem and bilateral striatum. The overlap lesion for both affective and apathetic depression centered mainly on the brainstem; however, the two types of depression often did not overlap. CONCLUSIONS: Two core symptoms that can occur after stroke, affective and apathetic symptoms, appear to be associated with different monoaminergic neuroanatomic pathways (serotonergic and dopaminergic).

[Regional medical support by management of Percutaneous Endoscopic Gastrostomy(PEG)].

Percutaneous endoscopic gastrostomy(PEG)is useful for not only enteral nutrition but an early rehabilitation of oral intake. We perform PEG and rehabilitation consistently, and we also exchange a catheter after the patient is discharged from our hospital. Most patients undergo changing a PEG catheter at our hospital. So we can follow them for a long-term. There are four techniques to exchange a PEG catheter. We performed exchanging a catheter for 156 patients. There were no major complications to the patients. Merit of the first method, sky-blue method, is that we could change by bed side with almost no invasion. However, we could not get an image of a catheter in the stomach. By the second method, fluoroscopy, we could make an exact image, but a patient had little invasion of moving to an X-ray room, accepting contrast medium, and having Xray exposure. The third method, oral endoscopy, is most reliable for a confirmation of a catheter, but it is most invasive. The fourth method, battery type endoscopy, is less invasive than the third method. We could change a catheter by bed side and use an endoscope as a guiding introducer, and get an image of inside the stomach. We need an imaging diagnosis for getting a confirmation. A battery type endoscopy, which is easily manipulated, is expected to be widely used both in the hospital care and the home nursing care.

Percutaneous Endoscopic Gastrostomy in a Patient With Continuous Intrathecal Baclofen Infusion Therapy.

Percutaneous endoscopic gastrostomy (PEG) is the method of choice in patients requiring long-term enteral tube feeding. In patients with intrathecal baclofen infusion therapy (IBT) pump implantation, infection via the skin and soft tissue may be an issue of concern. The introducer technique for gastrostomy tube insertion may be useful in reducing the risk of peristomal infection. Although the presence of a PEG tube has been reported as a risk factor for implantation site infection (for newly inserted IBT pumps), whether existing IBT pumps are at risk for infection during or after the placement of a PEG tube is not clear. We report a case where PEG was successfully performed using the introducer technique on a patient with an IBT pump implant.