Neurocognition and social cognition in youth and young adults at ultra-high-risk for psychosis and bipolar disorder.

BACKGROUND: Schizophrenia and bipolar disorder are associated with significant deficits in neurocognition and social cognition. Unlike the studies in chronic stages of these disorders, very limited information is available regarding neurocognitive and social-cognitive impairment before the onset of bipolar disorder. Our main aim was to investigate the differences in neurocognition and social cognition between individuals at ultra-high risk for psychosis (UHR-P) and bipolar disorder (UHR-BD). METHODS: This study included 152 help-seeking individuals identified as UHR-P (n = 78) and UHR-BD (n = 74), who were compared with a healthy control group (n = 43). A comprehensive neuropsychological battery was administered to all participants. RESULTS: UHR-P was associated with widespread deficits in all neurocognitive and social-cognitive domains. Effect sizes (Cohen's d) of these deficits ranged from -0.57 to -1.34. UHR-BD was associated with significant deficits in processing speed, executive functions, sustained attention and social cognition (d = -0.48 to-0.70, p < 0.05). UHR-P performed significantly worse than UHR-BD in social cognition, processing speed, verbal memory and executive function domains (d = -0.39 to-0.64, p < 0.05). Negative symptoms were associated with impaired social cognition in the UHR-P group and verbal memory deficits in the UHR-BD group. Cognitive impairment was associated with functional impairment in both groups. CONCLUSIONS: While UHR-P is associated with more widespread cognitive impairment, deficits in processing speed, executive functions, sustained attention and social cognition might be common features of both UHR groups. In early intervention services, cognition should be considered as a target for assessment and intervention not only for individuals at high risk for psychosis but also for bipolar disorder.

Social cognition and neurocognition in first-episode bipolar disorder and psychosis: The effect of negative and attenuated positive symptoms.

BACKGROUND: Schizophrenia and bipolar disorder are associated with neurocognitive and social-cognitive impairments. To date very few studies investigated social cognition in first-episode bipolar disorder (FEBD). Our main aim was to investigate the differences in social cognition and neurocognition between FEBD and first-episode psychosis (FEP). Another aim was to investigate neurocognitive correlates of negative symptoms and attenuated psychotic symptoms in FEBD. METHODS: This study included 55 FEBD, 64 FEP and 43 healthy controls. A comprehensive neuropsychological battery assessing social cognition, processing speed, verbal and visual memory, working memory, sustained attention, and executive functions was administered to all participants. RESULTS: Both FEBD and FEP were associated with widespread deficits in all neurocognitive domains and social cognition. Both FEP (d = -1.19) and FEBP (d = -0.88) were also impaired in social cognition. In FEP, effect sizes (Cohen's d) of neurocognitive deficits ranged from -0.71 to -1.56. FEBD was also associated with relatively milder but similar neurocognitive deficits (d = -0.61 to-1.17). FEBD group performed significantly better than FEP group in verbal and visual memory, processing speed, and executive function domains (d = -0.40 to-0.52). Negative symptoms and social functioning were associated with neuropsychological impairment in both groups. The severity of attenuated psychotic symptoms was associated with poorer verbal memory in FEBD (r = -0.39, p < 0.01). LIMITATIONS: The cross-sectional nature of the current study is the main limitation. CONCLUSIONS: Neurocognitive and social-cognitive deficits are evident in both FEBD and FEP. In FEBD, more severe memory deficits might be markers of clinical overlap and shared neurobiological vulnerability with psychotic disorders.

Relationship between carotid artery intima-media thickness and brachial artery flow-mediated dilation in peritoneal dialysis patients.

BACKGROUND AND AIM: Carotid artery intima-media thickness (CIMT) and brachial artery flow-mediated dilation percentage (FMD%) are two commonly used parameters for detecting subclinical atherosclerosis. However, studies investigating the relationship between CIMT and brachial artery FMD% in different populations have produced conflicting results. The aim of this study was to determine the relationship between CIMT and brachial artery FMD% in patients on peritoneal dialysis (PD) METHODS: Fifty-two PD patients without known cardiovascular disease and 30 age-gender matched controls were included in the study. Endothelial function was determined using ultrasonography (US) to measure the FMD of the brachial artery, and this parameter was expressed as the percentage change from the baseline diameter of the brachial artery (FMD%). We also measured CIMT by US and analysed the relationship between CIMT and brachial FMD%. RESULTS: The CIMT was significantly higher in patients than in the control group (0.84 +/- 0.08 vs. 0.75 +/- 0.06 mm, P < 0.01), whereas brachial artery FMD% was lower in patients than in the controls (8.2 +/- 5.0 vs. 11.7 +/- 5.5%, P < 0.01). There was no significant correlation between CIMT and FMD% (r = -0.004, P = 0.94). CONCLUSION: Although PD patients are known to be characterized by an impaired flow-mediated vasodilatation of brachial artery and increased in CIMT, we did not find a significant correlation between FMD% and CIMT in our PD patient cohort. One possible explanation for our results is that each method measures a different aspect and stage of atherosclerosis.

Ruptured aneurysm of noncoronary sinus of Valsalva: demonstration with magnetic resonance imaging.

There are few published reports regarding imaging findings of sinus of Valsalva aneurysms (SVA) with magnetic resonance imaging (MRI). We present an unusual form of ruptured SVA, emphasizing the diagnostic importance of MRI among a range of imaging techniques. This case report describes a case of idiopathic (thought to be congenital in origin), acutely symptomatic ruptured noncoronary SVA diagnosed by MRI and confirmed with conventional angiography and surgery. MRI accurately showed aneurysm size, location, and rupture into the right atrium and provided valuable information about this rare lesion.

Oxidative stress and asymmetric dimethylarginine is independently associated with carotid intima media thickness in peritoneal dialysis patients.

BACKGROUND: Oxidative stress (OS) and asymmetric dimethylarginine (ADMA) are accepted as nonclassical cardiovascular risk factors in end-stage renal disease patients. To clarify the role of these factors in the atherosclerotic process, we investigated if OS and ADMA are associated with common carotid artery intima media thickness (CIMT) in peritoneal dialysis (PD) patients. METHODS: Thirty PD patients without known atherosclerotic disease and classical cardiovascular risk factors as well as age- and gender-matched 30 healthy individuals were included. We measured serum thiobarbituric acid-reactive substances (TBARS), malondialdehyde (MDA), advanced glycation end product (AGE), pentosidine, advanced oxidation protein products (AOPP), ADMA and CIMT in each subjects. RESULTS: TBARS, MDA, AOPP, AGE, pentosidine and ADMA levels were significantly higher in PD patients than in controls (p < 0.001). CIMT in patients was higher than in the control group (0.83 +/- 0.09 vs. 0.77 +/- 0.06 mm; p < 0.01). CIMT was independently correlated with TBARS (beta = 0.33, p < 0.01), MDA (beta = 0.27, p < 0.01), AOPP (beta = 0.22, p < 0.02), AGE (beta = 0.45, p < 0.01), pentosidine (beta = 0.56, p < 0.01) and ADMA (beta = 0.54, p < 0.01). CONCLUSIONS: OS markers and serum ADMA levels independently predict the CIMT level in PD patients.

Plasma levels of homocysteine in patients with white-coat hypertension.

Elevated levels of plasma homocysteine (Hcy) is an independent risk factor for cardiovascular diseases. The risk profile of white-coat hypertension (WCHT) is not yet completely clear. In this study, we aim to determine the levels of plasma Hcy in a group of patients with WCHT, and to obtain clinical results by comparing WCHT group with hypertensive and healthy groups. Age, sex and body mass index were matched for 15 normal subjects, 15 patients with WCHT and 15 patients with essential hypertension, and they were included in the study. We measured levels of plasma Hcy in all groups. Levels of plasma Hcy were significantly higher in patients with sustained hypertension than in WCHT group (p = 0.03). They were also significantly higher in patients with WCHT than in control group (p = 0.02). Our data suggest that WCHT subjects are at an increased cardiovascular risk, although this was lower than the risk in patients with sustained hypertension.

Catecholamine response during haemodynamically stable upright posture in individuals with and without tilt-table induced vasovagal syncope.

AIM: Changes in circulating catecholamine concentrations during vasovagal faints have been the subject of considerable study. However, whether catecholamines are part of the triggering mechanism, or principally reflect attempted compensation for an evolving circulatory crisis is unknown. To address this issue, we determined whether the circulating catecholamine response to upright posture differs among patients with and without inducible vasovagal faints at a time when there is no detectable haemodynamic compromise. METHODS AND RESULTS: Blood samples for measurement of adrenaline and noradrenaline (Norepi) concentrations were obtained in the baseline state, and at both 2-3 min and 4-6 min of upright posture in 22 patients undergoing head-up tilt-table testing for evaluation of syncope of unknown cause. In 11 individuals tilt-testing induced syncope at >5 min head-up posture (Group 1). In 11 other individuals tilt testing did not result in syncope (Group 2). Supine arterial catecholamine levels were comparable in the two groups. However, adrenaline concentrations during upright posture tended to be greater at 2-3 min and were significantly greater at 4-6 min in Group 1 than in Group 2 (P< 0.01). These differences occurred in the absence of significant intergroup differences in mean arterial pressure or cardiac cycle lengths. Norepi concentrations also increased in both groups, but without significant differences. CONCLUSION: Circulating adrenaline concentrations in posturally induced vasovagal faints rise more rapidly in vasovagal fainters than in comparably posturally stressed non-fainters, and were significantly greater in fainters prior to either detectable haemodynamic compromise or diminution of circulating Norepi levels. These findings suggest that a premonitory rise in adrenaline concentrations occurs in vasovagal fainters unassociated with an evolving circulatory crisis.

Influence of treatment of type II leaks on the aneurysm surface area.

OBJECTIVE: to determine whether interventional treatment of type II endoleaks leads to a decrease in aneurysm surface area. MATERIAL AND METHOD: type II endoleaks were detected in a group of 14 male patients (median age: 70.2 years) following endovascular repair of a total number of 160 infrarenal aneurysms of the abdominal aorta. The surface area of the aneurysm was determined by computed tomography (CT) pre- and postoperatively and at subsequent follow-up examinations. If type II endoleaks were documented at CT, patients underwent treatment by means of coil embolisation. RESULTS: interventional treatment resulted in successful occlusion of type II endoleaks in eight patients. One of the cases exhibited spontaneous occlusion. Occlusion was associated with an average decrease in aneurysm surface area of 3.3 cm(2)( p =0.01). In one of these patients, treatment resulted in a temporary occlusion of the endoleak, also with associated decrease in aneurysm size. After recurrence of the type II endoleak, however, the patient experienced an increase in aneurysm surface area. In the remaining four patients the type II endoleaks persisted, resulting in a non significant increase in aneurysm surface area. CONCLUSION: only complete occlusion of endoleaks results in decrease in the size of the aneurysm sac. Because of endotension and the risk of rupture we favour an early interventional treatment of type II endoleaks.

Endoleaks after endovascular repair of aortic aneurysm: are they predictable?-initial results.

PURPOSE: To evaluate the predictability of endoleak. MATERIALS AND METHODS: Thirteen women and 60 men (mean age, 69.8 years) underwent transfemoral insertion of endoluminal stent-grafts for treatment of aortic aneurysms. Follow-up included helical computed tomography (CT) at 3-month intervals. In the cases of endoleak, angiography also was performed to document the number of leak sites, their size and position, the feeding artery, the size of the aneurysm, the amount of thrombus, and the visualization of the lumbar arteries and inferior mesenteric artery. These data were correlated (Student t test) with the probability of endoleak. RESULTS: A total of seven (10%) endoleaks were identified at CT in 68 patients. The feeding vessels were lumbar arteries in three cases, the inferior mesenteric artery in three cases, and the median sacral artery in one case. Of all factors, only the number of lumbar arteries visualized preoperatively (P <.005) had a significant correlation with probability of endoleak. In 71% (five of seven patients) of the cases of lumbar endoleak, four lumbar arteries were patent, whereas among the 61 patients with successfully repaired aneurysm, only eight (13%) had four patent lumbar arteries. Endoleaks were never found in the primarily thrombosed sections of an aneurysm. CONCLUSION: Prediction of endoleaks with absolute certainty remains elusive. The single correlating risk factor identified from the data was patency of four or more lumbar arteries visualized preoperatively at CT.

[Demographic and clinical features of coronary artery patients in the district of Antalya and comparison of them with Turkey's averages]. / Antalya bölgesindeki koroner arter hastalarinin demografik ve klinik özellikleri ve bu özelliklerinin Türkiye ortalamalari ile karsilastirilmasi.

OBJECTIVES: Many studies have proved high plasma cholesterol and triglyceride levels as determinant major risk factors for coronary artery disease. It is also well known that coronary artery disease incidence and related mortality and morbidity is low in communities applying Mediterranean diet. Turkey, having a high incidence of coronary artery disease, is unique because of the diversity of eating habits in different regions of the country. The inhabitants of Antalya region of interest in our study, are generally kept Mediterranean diet. We thought to determine the clinical and demographic features of the coronary artery disease patients living in the district of Antalya, and to find out if they correlate with Turkey's averages when compared. We also searched for the preventive effect of Mediterranean diet, if there was any. METHODS: 516 patients, who were admitted to the department of cardiology, were investigated in terms of age, sex, smoking habits, hypertension, hyperlipidemia, diabetes, family history, angina class, usage of aspirin and nitrates. RESULTS: The results revealed that clinical and demographical features of the coronary artery disease in the district of Antalya were similar with turkey's averages and that the benefits brought by the preventive effects of Mediterranean diet, might have been comprised by smoking.

Serum HbA1c levels and exercise capacity in diabetic patients.

It is well known that cardiovascular morbidity and mortality are high in diabetic patients. Cardiac involvement is silent and early and these diabetic patients generally complain of chronic fatigue. This study was designed to evaluate the relation between glycemic control and exercise capacity in 330 diabetic patients who have no cardiac symptoms by sustaining dynamic exercise. After a cardiac examination, patients with coronary heart disease, ECG abnormalities, cardiac failure, valvular disease, cerebrovascular disease, peripheral artery disease, anaemia and peripheral neuropathy were excluded. Plasma HbA1c and lipid levels were obtained and a symptom limited exercise test based on "Bruce Protocol" was performed on all patients. Plasma HbA1c levels were significantly increased in smokers and in hypercholesterolemic patients (p<0.001, p=0.006). A moderate correlation between exercise capacity and HbA1c levels, and a weak correlation between duration of diabetes, age, sex, hypertension and plasma lipids were obtained. Multivariant regression analys is revealed that only HbA1c and hypercholesterolemia affected exercise capacity independently (r=-0.54 r=-0.30). In conclusion, poor glycemic control in diabetic patients causes earlier cellular involvement. Because of the high affinity of HbA1c to oxygen, the energy metabolism of the cell is affected, with a clinical correlation between chronic fatigue and worsening exercise capacity.

Treatment of leaks after endovascular repair of aortic aneurysms.

PURPOSE: To evaluate leaks after the endovascular repair of aortic aneurysms and treat them with occlusive therapy. MATERIALS AND METHODS: Seventy patients (11 women, 59 men), aged 26-82 years (mean, 69.2 years), underwent transfemoral insertion of endoluminal stent-grafts for treatment of aortic aneurysms. Indications were traumatic pseudoaneurysms (n = 5) or arteriosclerotic aneurysms (n = 65). Aneurysms were thoracic (n = 5) or infrarenal (n = 65). To exclude the possibility of leaks, spiral computed tomography (CT) was performed at 3-month intervals. Patients with leaks that persisted unchanged longer than 3 months were referred for angiography and occlusive therapy. RESULTS: At CT, 21 leaks were identified in 17 of 70 patients (24%). Only 11 of those 17 patients (65%) had leaks identified with conventional aortography. Selective angiography, however, depicted all of these. Eighteen of 21 leaks proved amenable to occlusive treatment: surgery (n = 1), further stent implantation (n = 4), or embolization (n = 13). In one leak, spontaneous occlusion occurred after 3 months. Two leaks in either the iliolumbar or the median sacral artery were inaccessible; one remained untreated, and the other was unsuccessfully treated. Mean follow-up of occlusive therapy was 6.8 months (range, 2-14 months). CONCLUSION: Successful occlusion of perigraft leaks is feasible in most cases and can be performed without major complications.

Angiography of leaks after endovascular repair of infrarenal aortic aneurysms.

OBJECTIVE: We examined whether leaks that persist after stent grafting are associated with outflow arteries. SUBJECTS AND METHODS: Selective angiography was performed in 21 patients with persistent leaks after undergoing endovascular repair of infrarenal aneurysms of the abdominal aorta. Late leaks occurred in five patients whose prostheses were originally sealed. Before angiography, the size and position of leaks were determined with CT and color Doppler sonography. RESULTS: Superselective angiography was successful in 19 of 21 patients. In two patients, angiography was performed over the afferent artery supplying the leak. We found one outflow artery at the site of the leak in 10 patients (47%); two outflow arteries in five (23.8%); and as many as five outflow arteries in three (14%). Angiography overlooked outflow arteries in three patients (14%). The lumbar and inferior mesenteric, urethral, and testicular arteries were identified as outflow arteries. CONCLUSION: Other than feeder arteries, persistent leaks are associated with outflow vessels that contribute to the patency of leaks.

Does successful embolization of endoleaks lead to aneurysm sac shrinkage?

PURPOSE: To determine whether embolization of endoleaks after endovascular repair of aortic aneurysms is associated with a decrease in the diameter of the aneurysm. METHODS: Fifteen patients (13 men; median age 76 years) demonstrated primary endoleaks persisting > or =3 months after endovascular abdominal aortic aneurysm repair with a variety of commercial endografts. In 8 patients, coil embolization failed to completely obliterate the leak, whereas embolotherapy proved successful in the remaining 7 patients. Surveillance of endoleaks and the effect of their embolization on aneurysm size were followed with serial computed tomographic (CT) scans. Follow-up after embolization extended for at least 12 months. RESULTS: Patients with persistent leak exhibited a slight increase in mean aneurysm area from 21.41+/-4.25 to 22.47+/-6.70 cm2. Medians differed from 20.03 (range 16.59-28.73) to 23.03 (range 14.14-33.69) cm2 (p = 0.0078, 95% confidence interval [CI] = 0.0075 to 0.0081). Successfully treated patients, however, showed a mean decrease from 20.58+/-3.63 (median 19.87) to 16.36+/-6.46 cm2 (median 18.10) at 1 year (p = 0.0156, 95% CI = 0.0151 to 0.0160). The medians differed significantly between groups (p < 0.05). CONCLUSIONS: Persistent endoleaks after endovascular aortic aneurysm treatment led to an increase in the diameter of the aneurysm, whereas complete occlusion was associated with a significant decrease in aneurysm diameter.

Leakages after endovascular repair of aortic aneurysms: classification based on findings at CT, angiography, and radiography.

PURPOSE: To ascertain whether the configuration and location of leakages identified at computed tomography (CT) could provide evidence of their angiographically and fluoroscopically confirmed causes. MATERIALS AND METHODS: Fifty patients aged 26-79 years underwent endovascular repair of traumatic (n = 4) or arteriosclerotic (n = 46) aortic aneurysms (four thoracic, 46 infrarenal). Radiographic examinations in three planes and helical CT were performed 1 week after implantation and every 3 months thereafter. Angiography was performed when there was evidence of a leakage at CT. RESULTS: CT demonstrated evidence of leakages in 13 patients. Broad-based leakages immediately adjacent to the prosthesis were termed "perigraft leakages." If the area most affected by the leakage lay along the border of the aneurysm, then retrograde leakages were apparent at angiography. If the leakage was ventral to the prosthesis, then its source was the inferior mesenteric artery; if it was dorsolateral, then it was supplied by either the lumbar arteries or the median sacral artery through the hypogastric artery. One circumferential leakage could not be evaluated adequately at CT or angiography. Radiography depicted a rupture of the stent mesh in the middle of the prosthesis. Selective angiography demonstrated all types of leakages and permitted CT classification. CONCLUSION: The cause of a leakage can be determined with CT on the basis of its configuration and location in the majority of cases.

Concomitant use of intraaortic balloon counterpulsation and streptokinase in acute anterior myocardial infarction.

Using a prospective, nonrandomized design, the authors sought to determine whether concomitant use of intraaortic balloon counterpulsation (IABP) and streptokinase in acute anterior myocardial infarction (MI) would improve the in-hospital mortality rate and angiographic findings. The study included 45 patients with an acute anterior MI. All patients received intravenous streptokinase. Among these, 25 patients had concomitant IABP while the remaining 20 patients had streptokinase alone. All patients underwent cardiac catheterization. Patients treated with concomitant IABP had a significantly higher frequency of thrombolysis in myocardial infarction (TIMI) grade 3 flow (n: 11; 44% vs n: 1; 5%, p<0.05), and there was a trend toward a lower in-hospital mortality rate in the IABP group (n: 0; 0% vs n: 3; 15%, p=0.08). The angiographic presence of thrombus image and grade > or =2 coronary collateral circulation to the infarct-related coronary artery for the IABP and non-IABP groups did not differ significantly. The preliminary results of this study suggest that concomitant use of IABP and streptokinase in acute anterior MI increases the incidence of TIMI grade 3 flow and may have decreased the in-hospital mortality rate without unacceptable rates of vascular or hemorrhagic complications.

Effect of intraaortic balloon counter-pulsation on QT dispersion in acute anterior myocardial infarction.

The present prospective non-randomized study aimed to examine whether intraaortic balloon counter-pulsation (IABP) has a favorable effect on QT dispersion in patients with acute anterior MI. Patients with acute anterior MI who presented within 6 h after the symptom onset were assigned to the IABP + streptokinase or streptokinase (STK) group. The IABP + STK group was consisted of 26 men and two women (mean age 52.9+/-10.2). The STK group was consisted of 19 men and two women (mean age 54.4+/-10.8). In the IABP + STK group, mean QT interval dispersion significantly shortened 6 h after treatment (50.9+/-15.6 ms before STK, and 36+/-13.9 ms 6 h after STK; P = 0.001) and did not significantly change 24 h after STK (35.6+/-11.2 ms). In the STK group, mean QT interval dispersion did not vary significantly before and 6 h after STK (57.14+/-13.2 ms before STK, and 56.07+/-13.3 ms 6 h after STK; P > 0.05) but 24 h after STK it significantly shortened to 40.42+/-10.8 ms (P < 0.001). Before STK, mean QT interval dispersions in the IABP + STK and STK groups were 50.9+/-15.6 ms and 57.14+/-13.2 ms, respectively (P > 0.05), 6 h after STK, mean QT interval dispersions were 36+/-13.9 ms and 56.07+/-13.3 ms, respectively (P = 0.0001) and 24 h after STK, mean QT interval dispersions were 35.6+/-11.2 ms and 40.42+/-10.8 ms, respectively (P > 0.05). In conclusion this study demonstrates that the adjunct of IABP to thrombolytic therapy, in the setting of acute anterior MI, significantly decreases QT interval dispersion at 6 h and this effect might be secondary to accelerated reperfusion and/or other beneficial effects of IABP.