RESUMEN
The relationship between pretreatment regional cerebral glucose metabolism and eventual antidepressant drug response was measured using positron emission tomography (PET) in hospitalized patients with unipolar depression. Rostral anterior cingulate metabolism uniquely differentiated eventual treatment responders from non-responders. Hypometabolism characterized non-responders when compared with controls, in contrast to responders who were hypermetabolic. Metabolism in no other region discriminated the two groups, nor did associated demographic, clinical or behavioral measures, including motor speed, cognitive performance, depression severity or illness chronicity. Cingulate hypermetabolism may represent an important adaptive response to depression and failure of this response may underlie poor outcome. A critical role for rostral cingulate area 24a/b in the limbic-cortical network involved in abnormal mood states is proposed.
Asunto(s)
Encéfalo/diagnóstico por imagen , Encéfalo/metabolismo , Desoxiglucosa/análogos & derivados , Trastorno Depresivo/tratamiento farmacológico , Trastorno Depresivo/metabolismo , Glucosa/metabolismo , Giro del Cíngulo/diagnóstico por imagen , Giro del Cíngulo/metabolismo , Adulto , Análisis de Varianza , Ansiedad , Desoxiglucosa/farmacocinética , Trastorno Depresivo/diagnóstico por imagen , Femenino , Fluorodesoxiglucosa F18 , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Valor Predictivo de las Pruebas , Pronóstico , Valores de Referencia , Tomografía Computarizada de EmisiónRESUMEN
From my observations of snakebite over the last 22 years and the studies I have done, several things are important: (1) Pit viper envenomation is a surgical emergency as is any disease in which gangrene of human tissue occurs. (2) Severe pit viper envenomation causes complex problems similar to those seen in Gram-negative septicemia, and they require complex methods of treatment. (3) Early surgical inspection of the snakebite wound is as essential as early appendectomy in appendicitis. Its results are as gratifying. (4) Present knowledge of anesthesia, coagulation problems, infections and antibiotics, blood gas changes, electrolytes and fluid therapy, and other advances in the surgical field allow the physician to treat severe pit viper envenomation by scientific means rather than by hocus-pocus. (5) Crippling from pit viper envenomation is caused by too little treatment, too much first aid, or both.
