ABSTRACT
Alcohol-related cognitive impairments are largely underestimated in clinical practice, even though they could limit the benefit of alcohol treatment and hamper the patient's ability to remain abstinent or to respect his/her therapeutic contract. These neuropsychological deficits can impact the management of patients well before the development of the well-known Korsakoff's syndrome. Indeed, even in the absence of ostensible neurological complications, excessive and chronic alcohol consumption results in damage of brain structure and function. The frontocerebellar circuit and the circuit of Papez, respectively involved in motor and executive abilities and episodic memory, are mainly affected. Those brain dysfunctions are associated with neuropsychological deficits, including deficits of executive functions, episodic memory, social cognition, as well as visuospatial and motor abilities. Such cognitive disorders can interfere with the motivation process to abandon maladjusted drinking behavior in favor of a healthier lifestyle (such as abstinence or controlled alcohol consumption). They can also limit the patient's capacity to fully benefit from treatment (notably psychoeducation and cognitive-behavioural treatments) currently widely proposed in French Addiction departments. In addition, they may contribute to relapse which is multi-determinated. A neuropsychological assessment appears therefore crucial to take relevant clinical decisions. However, very few addiction departments have the human and financial resources to conduct an extensive neuropsychological examination of all patients with alcohol dependence. Some brief screening tools can be used, notably the MOntreal Cognitive Assessment and the Brief Evaluation of Alcohol-Related Neuropsychological Impairments, which has been especially designed to assess cognitive and motor deficits in alcoholism. These tools can be used by non-psychologist clinicians to detect alcohol-related cognitive deficits, which require an extensive cognitive examination conducted by a neuropsychologist. The presence of cognitive dysfunctions in patients early in abstinence should encourage clinicians to adjust the modalities of the treatment. The fact to favor recovery of cognitive functions and brain volumes with abstinence or drastic reduction of alcohol consumption could be a first way to make it possible for patients to be cognitively able to benefit from treatment. Further studies are required to determine whether specifically designed cognitive remediation could boost (accelerate or increase) the recovery of brain functioning. Additionally, a potential effect of thiamine to limit alcohol-related cognitive deficits before the development of neurological complications remains to be determined. In this review, we presented the pattern of structural brain damage and the associated cognitive and motor impairments in alcohol-dependent patients. We then emphasized the harmful effects of neuropsychological deficits in the management of these patients. We also pointed how relevant it is to screen patients with neuropsychological impairments and we focused on the presentation of two brief screening tools for cognitive impairments, especially designed for alcohol-related deficits or not. Finally, we reported how these neuropsychological impairments could be taken into consideration the treatment of alcohol addiction by adjusting its timing and modalities.
Subject(s)
Alcoholism/diagnosis , Alcoholism/psychology , Cognition Disorders/chemically induced , Cognition Disorders/psychology , Alcoholism/therapy , Cognition Disorders/therapy , Executive Function , Humans , Neuropsychological Tests , Quality ImprovementABSTRACT
Second-generation antipsychotic exposure, in both children and adults, carries significant risk for excessive weight gain that varies widely across individuals. We queried common variation in key energy balance genes (FTO, MC4R, LEP, CNR1, FAAH) for their association with weight gain during the initial 8 weeks in the two NIMH Research Units on Pediatric Psychopharmacology Autism Network trials (N=225) of risperidone for treatment of irritability in children/adolescents aged 4-17 years with autism spectrum disorders. Variants in the cannabinoid receptor (CNR)-1 promoter (P=1.0 × 10(-6)), CNR1 (P=9.6 × 10(-5)) and the leptin (LEP) promoter (P=1.4 × 10(-4)) conferred robust-independent risks for weight gain. A model combining these three variants was highly significant (P=1.3 × 10(-9)) with a 0.85 effect size between lowest and highest risk groups. All results survived correction for multiple testing and were not dependent on dose, plasma level or ethnicity. We found no evidence for association with a reported functional variant in the endocannabinoid metabolic enzyme, fatty acid amide hydrolase, whereas body mass index-associated single-nucleotide polymorphisms in FTO and MC4R showed only trend associations. These data suggest a substantial genetic contribution of common variants in energy balance regulatory genes to individual antipsychotic-associated weight gain in children and adolescents, which supersedes findings from prior adult studies. The effects are robust enough to be detected after only 8 weeks and are more prominent in this largely treatment naive population. This study highlights compelling directions for further exploration of the pharmacogenetic basis of this concerning multifactorial adverse event.
Subject(s)
Antipsychotic Agents/adverse effects , Body Weight/drug effects , Child Development Disorders, Pervasive/drug therapy , Risperidone/adverse effects , Weight Gain/genetics , Adolescent , Alpha-Ketoglutarate-Dependent Dioxygenase FTO , Amidohydrolases/genetics , Child , Child Development Disorders, Pervasive/psychology , Child, Preschool , Female , Genetic Predisposition to Disease , Humans , Leptin/genetics , Male , Proteins/genetics , Receptor, Cannabinoid, CB1/genetics , Receptor, Melanocortin, Type 4/genetics , Weight Gain/drug effectsABSTRACT
We have investigated the projection patterns of peptidergic small-diameter primary afferent fibers to the cat sacrocaudal spinal cord, a region associated with midline structures of the lower urogenital system and of the tail. Calcitonin gene-related peptide (CGRP)-immunoreactive (CGRP-IR) primary afferent fibers were observed within the superficial laminae, rostrally as the typical inverted U-shaped band that capped the separate dorsal horns (S1 to rostral S2) and caudally as a broad band that spanned the entire mediolateral extent of the fused dorsal horns (caudal S2 and caudal). Within the dorsal gray commissure, labeling was seen as a periodic vertical, midline band. CGRP-IR labeling was prevalent in an extensive mediolateral distribution at the base of the dorsal horn, originating from both lateral and medial collateral bundles that extend from the superficial dorsal horn. Some bundles, in part traveling within the dorsal commissure, conspicuously crossed the midline. In addition to the robust projection to the superficial dorsal horn, there was a more extensive distribution of CGRP-IR fibers within the deeper portions of the cat sacrocaudal dorsal horn than has been reported for other regions of the cat spinal cord. Presumably, these deep projections convey visceral information to projection or segmental neurons at the neck of the dorsal horn and in the region of the central canal. This deep distribution overlaps the reported projections of the pelvic and pudendal nerves. In addition, the contralateral projections of CGRP-IR fibers may form an anatomical substrate of the bilateral receptive fields for selective dorsal horn neurons. The density and variety of CGRP-IR projection patterns is a reflection of the functional attributes of the innervated structures.
Subject(s)
Axons/metabolism , Calcitonin Gene-Related Peptide/metabolism , Functional Laterality/physiology , Neurons, Afferent/cytology , Posterior Horn Cells/cytology , Sacrum/cytology , Spinal Nerve Roots/cytology , Animals , Axons/ultrastructure , Cats , Cell Size/physiology , Female , Immunohistochemistry , Nerve Fibers/metabolism , Nerve Fibers/ultrastructure , Neurons, Afferent/metabolism , Nociceptors/cytology , Nociceptors/metabolism , Pain/physiopathology , Posterior Horn Cells/metabolism , Sacrum/metabolism , Spinal Nerve Roots/metabolism , Touch/physiologyABSTRACT
BACKGROUND: Because breast-conserving surgery (BCS), mastectomy alone, and mastectomy with reconstruction are equally effective for the treatment of early stage breast carcinoma, women's choice among them often focuses on quality-of-life (QOL) issues. Information regarding QOL after these surgical treatments could help women with this decision. METHODS: Participants in this prospective study were women, age 30-85 years, with newly diagnosed breast carcinoma who underwent BCS (n = 103), mastectomy alone (n = 55), or mastectomy with reconstruction (n = 40). Quality of life was assessed after diagnosis (baseline) and at 1, 3, 6, 12, 18, and 24 months after baseline by using the Mischel Uncertainty in Illness Scale, Profile of Mood States, and Functional Assessment of Cancer Therapy for Breast Cancer. RESULTS: In multivariate regression analyses controlling for the QOL score obtained at baseline, age, and type of nonsurgical treatment, women who underwent mastectomy with reconstruction had greater mood disturbance (P = 0.002) and poorer well-being (P = 0.002) after baseline than women who had mastectomy alone; these differences remained 18 months after surgery. Although similar analyses also showed that women who underwent BCS had more mood disturbance than women who had mastectomy alone, this difference was significant only at 12 months after baseline. The BCS and mastectomy-only group did not differ significantly regarding well-being. CONCLUSIONS: Aspects of QOL other than body image are not better in women who undergo BCS or mastectomy with reconstruction than in women who have mastectomy alone. In fact, mastectomy with reconstruction is associated with greater mood disturbance and poorer well-being.
Subject(s)
Breast Neoplasms/psychology , Breast Neoplasms/surgery , Quality of Life , Adult , Affect , Aged , Aged, 80 and over , Female , Humans , Mammaplasty/psychology , Mastectomy/psychology , Mastectomy/rehabilitation , Mastectomy, Segmental/psychology , Middle Aged , Prospective Studies , Regression Analysis , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To describe the methodological challenges and decisions made in developing a multisite, controlled study of risperidone in children and adolescents with autism. METHODS: Review the design considerations for clinical trials in children with autistic disorder accompanied by severe tantrums, aggressive and/or self-injurious behaviors. These design considerations include the definition of inclusion criteria that are relevant to clinical practice and matching study design to the goal of evaluating short- and long-term effects. Additional ethical and scientific issues concern the length of trial and sample size. RESULTS: We undertook a short-term, placebo-controlled study to evaluate the efficacy and safety of risperidone in children and adolescents with autistic disorder. This trial design was followed by an extended open-label maintenance on risperidone to confirm durability of treatment effects and to monitor safety. Finally, a placebo-controlled discontinuation study tested the need for continuous treatment. CONCLUSIONS: In the absence of standard pharmacological treatment for children with autistic disorder, a placebo-controlled study remains the most appropriate method of testing efficacy and safety. The clinical relevance of this study is enhanced by the addition of an extended maintenance phase followed by a placebo discontinuation.
Subject(s)
Antipsychotic Agents/therapeutic use , Autistic Disorder/drug therapy , Controlled Clinical Trials as Topic , Multicenter Studies as Topic , Planning Techniques , Research Design , Risperidone/therapeutic use , Adolescent , Age Factors , Antipsychotic Agents/adverse effects , Child , Child, Preschool , Double-Blind Method , Female , Humans , Male , Risperidone/adverse effects , Time FactorsABSTRACT
PURPOSE/OBJECTIVES: To evaluate quality of life (QOL) and cost outcomes of advanced practice nurses' (APNs') interventions with women diagnosed with breast cancer. DESIGN: Randomized clinical trial. SETTING: Integrated healthcare system in a midwestern suburban community. SAMPLE: 210 women with newly diagnosed breast cancer with an age range of 30-85 years. METHODS: The control group (n = 104) received standard medical care. The intervention group (n = 106) received standard care plus APN interventions based on Brooten's cost-quality model and the Oncology Nursing Society's standards of advanced practice in oncology nursing QOL was measured using the Functional Assessment of Cancer Therapy, Mishel Uncertainty in Illness Scale and Profile of Mood States at seven intervals over two years. Information about costs (charges and reimbursement) was collected through billing systems. MAIN RESEARCH VARIABLES: Uncertainty, mood states, well-being, charges, and reimbursement. FINDINGS: Uncertainty decreased significantly more from baseline in the intervention versus control group at one, three, and six months after diagnosis (p = 0.001, 0.026, and 0.011, respectively), with the strongest effect on subscales of complexity, inconsistency, and unpredictability. Unmarried women and women with no family history of breast cancer benefited from nurse interventions in mood states and well-being. No significant cost differences were found. CONCLUSIONS: APN interventions improved some QOL indicators but did not raise or lower costs. IMPLICATIONS FOR NURSING PRACTICE: The first six months after breast cancer diagnosis is a critical time during which APN interventions can improve QOL outcomes. More research is necessary to define cost-effective interventions.
Subject(s)
Breast Neoplasms/nursing , Health Care Costs , Nurse Clinicians , Outcome Assessment, Health Care , Quality of Life , Adaptation, Psychological , Adult , Affect , Aged , Aged, 80 and over , Analysis of Variance , Breast Neoplasms/economics , Breast Neoplasms/psychology , Cost-Benefit Analysis , Female , Humans , Middle Aged , Midwestern United States , Nurse Clinicians/economics , Regression AnalysisABSTRACT
The objective of the present study was to determine if the generally accepted phylogenetic relationships in the tribe Bovini correspond to a phylogenetic scheme derived from polymorphisms at 20 bovine microsatellite loci. This study comprises 17 representative populations: eight Bos taurus, two Bos indicus, one Poëphagus, one Bibos, one Bison, three Bubalus and one Syncerus. Phylogenetic analyses using (delta mu)2 and chord (DC) distances revealed substantial divergence among species. Neighbor-joining trees with both distance measures showed only minor differences. Bos taurus and Bos indicus grouped first, followed by Bos frontalis (Mithan) and Bos grunniens (Yak), Bison bison branched off next and Bubalus bubalis and Syncerus caffer emerged as the two most divergent species from the Bos clade. These findings would suggest that Bos, Poëphagus, and Bibos should be integrated into the Bos genus with each group classified as a subgenus. On the other hand, Bison, Bubalus and Syncerus should each be considered a separate genus. Direct estimates of the divergence times were calculated using the (delta mu)2 genetic distance. Bos taurus and Bos indicus were estimated to have diverged 0.31-0.82 MYA, Bos and Poëphagus: 0.57-1.53 MYA, Bos and Bibos: 0.57-1.52 MYA, Bos and Bison: 0.46-1.23 MYA, Bos and Bubalus: 1.85-4.93 MYA and Bos and Syncerus: 0.98-2.61 MYA.
Subject(s)
Microsatellite Repeats , Phylogeny , Ruminants/genetics , Alleles , Animals , Bison/genetics , Buffaloes/genetics , Cattle/genetics , DNA/genetics , Evolution, Molecular , Gene Frequency , Polymorphism, Genetic , Species Specificity , Time FactorsABSTRACT
Assessment of autistic disorder (autism) symptoms, primary and secondary, poses more challenging problems than ordinarily found in multisite randomized clinical trial (RCT) assessments. For example, subjects may be uncommunicative and extremely heterogeneous in problem presentation, and current pharmacological treatments are not likely to alter most core features of autism. The Autism Research Units on Pediatric Psychopharmacology (RUPP Autism Network) resolved some of these problems during the design of a risperidone RCT in children/adolescents. The inappropriateness of the usual anchors for a Clinical Global Impression of Severity (CGI-S) was resolved by defining uncomplicated autism without secondary symptoms as a CGI-S of 3, mildly ill. The communication problems, compromising use of the patient as an informant, were addressed by several strategies, including careful questioning of care providers, rating scales, laboratory tests, and physical exams. The broad subject heterogeneity requires outcome measures sensitive to individual change over a wide spectrum of treatment response and side effects. The problems of neuropsychologically testing nonverbal, lower functioning, sometimes noncompliant subjects requires careful instrument selection/adaptation and flexible administration techniques. The problems of assessing low-end IQs, neglected by most standardized test developers, was resolved by an algorithm of test hierarchy. Scarcity of other autism-adapted cognitive and neuropsychological tests and lack of standardization required development of a new, specially adapted battery. Reliability on the Autism Diagnostic Interview (currently the most valid diagnostic instrument) and other clinician instruments required extensive cross-site training (in-person, videotape, and teleconference sessions). Definition of a treatment responder required focus on individually relevant target symptoms, synthesis of possible modest improvements in many domains, and acceptance of attainable though imperfect goals. The assessment strategy developed is implemented in a RCT of risperidone (McDougle et al., 2000) for which the design and other methodological challenges are described elsewhere (Scahill et al., 2000). Some of these problems and solutions are partially shared with RCTs of other treatments and other disorders.
Subject(s)
Antipsychotic Agents/therapeutic use , Autistic Disorder/drug therapy , Risperidone/therapeutic use , Antipsychotic Agents/adverse effects , Autistic Disorder/diagnosis , Child , Humans , Neuropsychological Tests/statistics & numerical data , Reproducibility of Results , Risperidone/adverse effects , Treatment OutcomeABSTRACT
This article has reviewed the background and rationale for the choice of risperidone as the first drug to be studied by the RUPP Autism Network. Risperidone has potent effects on 5-HT and DA neuronal systems, both of which have been implicated in the pathophysiology of autism. Unlike the typical antipsychotics, haloperidol and pimozide, which have been shown to be effective for reducing many of the maladaptive behaviors associated with autism, risperidone's 5-HT2A/DA D2 ratio of receptor blockade appears to produce a lower risk of acute and chronic extrapyramidal side effects, as well as enhanced efficacy for the "negative" symptoms of autism. Indirect clinical and preclinical evidence supports the use of risperidone to treat impaired social behavior, interfering repetitive phenomena, and aggression, targets of pharmacotherapy for many patients with autism. Numerous published open-label trials in children and adolescents with autism and related PDDs and one double-blind, placebo-controlled study in adults suggest that risperidone has promise for the treatment of children and adolescents with autism. Because most of these studies have been short-term, open-label trials in small samples, however, a large-scale controlled study of risperidone in children and adolescents with autism is needed to confirm these results. Finally, because it is likely that children who demonstrate short-term benefit from risperidone will remain on the medication indefinitely, the longer-term effectiveness and safety of risperidone in this population also needs to be determined. The design of this study and the assessments used are described separately.
Subject(s)
Antipsychotic Agents/therapeutic use , Autistic Disorder/drug therapy , Risperidone/therapeutic use , Adolescent , Adult , Antipsychotic Agents/adverse effects , Autistic Disorder/diagnosis , Autistic Disorder/psychology , Brain/drug effects , Child , Clinical Trials as Topic , Humans , Receptors, Dopamine/drug effects , Receptors, Serotonin/drug effects , Risperidone/adverse effectsABSTRACT
Reflex responses to electrocutaneous stimulation of the tail were characterized in awake cats, before and after transection of the spinal cord at sacrocaudal levels S3-Ca1. Consistent with effects of spinal transection at higher levels, postoperative cutaneous reflexes were initially depressed, and the tail was flaccid. Recovery ensued over the course of 70-90 days after sacrocaudal transection. Preoperative and chronic postlesion reflexes elicited by electrocutaneous stimulation were graded in amplitude as a function of stimulus intensity. Chronic postlesion testing of electrocutaneous reflexes revealed greater than normal peak amplitudes, peak latencies, total amplitudes (power), and durations, particularly for higher stimulus intensities. Thus, sacrocaudal transection produced effects representative of the spastic syndrome. In contrast, exaggerated reflex responsivity did not develop for a group of cats that received transplants of fetal spinal cord tissue within sacrocaudal transection cavities at the time of injury, in conjunction with long-term immunosuppression by cyclosporine. We conclude that gray matter replacement and potential neuroprotective actions of the grafts and/or immunosuppression prevent development of the spastic syndrome. This argues that the spastic syndrome does not result entirely from interruption of long spinal pathways.
Subject(s)
Decerebrate State/physiopathology , Fetal Tissue Transplantation/physiology , Spinal Cord/physiology , Spinal Cord/transplantation , Animals , Cats , Electric Stimulation , Female , Galvanic Skin Response , Reflex/physiology , Tail/innervationABSTRACT
STUDY OBJECTIVE: To determine the value of the level of anti-topoisomerase I (anti-topo I) to evaluate lung involvement defined by abnormal high-resolution computed tomography (HRCT) score and pulmonary function tests (PFTs) in systemic sclerosis (SS). PATIENTS: Forty-eight patients with SS, 20 with lung involvement and 28 with no lung involvement. DESIGN: PFT measurement, HRCT scoring of lung involvement, and anti-topo I assay by enzyme-linked immunosorbent assay. Normal anti-topo I level was defined as < 30. RESULTS: There was a significant association between cutaneous extent and anti-topo I level (6.5% of patients with limited cutaneous scleroderma had abnormal anti-topo I levels vs 70.6% of patients with diffuse cutaneous scleroderma, p = 0.0001). In patients with diffuse cutaneous scleroderma, pulmonary involvement was associated with a higher percentage of abnormal anti-topo I level: 91.7% vs 20% (p = 0.010). In patients with diffuse cutaneous scleroderma, a significant association was found between the class of anti-topoII level and total lung capacity (median, 69 in patients with abnormal anti-topo I level vs 87 in patients with normal anti-topo I level, p = 0.010), between the class of anti-topo I level and HRCT score (median, 12 in patients with abnormal anti-topo I level vs 5 in patients with normal anti-topo I level, p = 0.05). CONCLUSION: Anti-topo I can be considered as a marker of lung involvement in patients with diffuse cutaneous scleroderma.
Subject(s)
Antibodies, Antinuclear/blood , Biomarkers/blood , DNA Topoisomerases, Type I/immunology , Lung Diseases, Interstitial/diagnosis , Scleroderma, Systemic/immunology , Adult , Aged , Autoantibodies/blood , Centromere/immunology , Enzyme-Linked Immunosorbent Assay , Female , Humans , Lung/diagnostic imaging , Lung Diseases, Interstitial/complications , Lung Diseases, Interstitial/diagnostic imaging , Male , Middle Aged , Respiratory Function Tests , Scleroderma, Systemic/complications , Scleroderma, Systemic/diagnosis , Tomography, X-Ray ComputedABSTRACT
As the trend of surgical procedures shifting from inpatient to outpatient settings continues, outpatient-focused standardized care processes will become more of a necessity. A multidisciplinary critical pathway (CP) for breast cancer surgery can assist care providers in meeting patients' educational and psychosocial needs. The CP document discussed in this article takes into account the expedient nature of outpatient surgery and spans the continuum of care from the surgical clinic to the postoperative homecare visit. Integrating homecare nursing improves the quality and consistency of care.
Subject(s)
Ambulatory Surgical Procedures/methods , Ambulatory Surgical Procedures/nursing , Breast Neoplasms/nursing , Breast Neoplasms/surgery , Critical Pathways/organization & administration , Ambulatory Surgical Procedures/psychology , Breast Neoplasms/psychology , Continuity of Patient Care/organization & administration , Female , Humans , Patient Discharge , Patient Education as Topic , Perioperative Care/methods , Perioperative Care/nursing , Program EvaluationABSTRACT
To determine whether the tail of the domestic cat plays a role in balance during locomotion, four cats were trained to traverse a narrow beam. To challenge balancing ability, a sudden lateral displacement was imparted to the beam as the subject was crossing. Freeze-frame videotape analysis revealed that cats responded to beam movement by rapidly moving the tail in the opposite direction. Adjustment of the tail contributed to realignment of the hips over the beam and enabled the animal to remain aboard the beam. Following complete sacrocaudal spinal transection, that eliminated supraspinal control to only the tail, cats fell significantly more often in response to movements of the beam. The importance of the cat's tail for balance, and the utility of this system for modeling functional consequences of spinal cord injury and therapeutic interventions, are discussed.
Subject(s)
Postural Balance/physiology , Spinal Cord Injuries/physiopathology , Tail/innervation , Tail/physiology , Animals , Cats , Female , Locomotion/physiology , Spinal Cord Injuries/pathology , Tail/pathology , Videotape RecordingABSTRACT
Merging of nursing services led to key opportunities to identify nursing research priorities in the authors' institution. The literature suggested that a Delphi study would best accomplish these goals. Using a 110-member panel, a study was begun that identified two final topics that were focused on nursing administration research. Collecting these data served many purposes, including increased organizational awareness about nursing research and development of a nursing research council to facilitate future activities.
Subject(s)
Delivery of Health Care, Integrated , Nursing Administration Research , Delphi Technique , Humans , Minnesota , Nursing Administration Research/methods , Nursing Administration Research/statistics & numerical data , Nursing Service, Hospital/organization & administration , ResearchABSTRACT
PCR-based technology used for genotyping microsatellites is going to add new dimensions to parentage control in cattle. In the very near future the determination of microsatellite polymorphisms is expected to replace the former parentage control of conventional blood typing. Parentage control by microsatellite analysis is even more reliable than by the routine haemogenetic procedures. The potential of microsatellite polymorphisms to clarify family relationships is illustrated by 100 cases which could not be solved by conventional blood typing.
Subject(s)
Cattle/genetics , Polymerase Chain Reaction/veterinary , Polymorphism, Genetic , Animals , Base Sequence , Blood Grouping and Crossmatching , DNA Primers , DNA, Satellite/analysis , DNA, Satellite/genetics , Female , Genotype , Male , Molecular Sequence Data , Paternity , Polymerase Chain Reaction/methodsABSTRACT
STUDY OBJECTIVE: To identify the oncology patient population presenting to the emergency department and examine the causes and clinical management of oncology symptoms in the ED. DESIGN: Retrospective review of 5,640 adult patients, with the following variables identified for oncology patients presenting to the ED: age, sex, cancer type, cancer stage, previous cancer treatment, previous hospitalization, presenting symptoms, treatment provided in the ED, admission and discharge data, and day, time, and length of ED visit. SETTING: Community teaching hospital with annual ED census of 31,000. PARTICIPANTS: All adult oncology patients who presented to the ED during the study period. We identified these patients by cross-referencing ED logs and tumor registry records. RESULTS: Cancer history was identified for 284 of the 5,640 adult ED admissions (5%). Forty-three percent (n = 122) of the 284 patients with cancer history had an oncology-related ED visit. The most common symptoms of these patients were gastrointestinal (48%), pain (40%), neurologic (38%), cardiac (25%), and pulmonary (23%). Ten percent of patients with oncology-related ED visits died during the admission, and 48% died within 1 year of the ED visit. CONCLUSION: Oncology patients present to the ED with symptoms of undiagnosed malignancy, complications of cancer treatment, and acute disease-related symptoms. Knowledge of an individual's cancer history and ability to recognize oncologic symptoms are important to the management of oncology patients.
Subject(s)
Emergency Service, Hospital , Neoplasms/diagnosis , Aged , Aged, 80 and over , Female , Hospitalization , Humans , Male , Middle Aged , Neoplasms/complications , Neoplasms/therapy , Retrospective StudiesABSTRACT
The hypothesis that sacrocaudal dorsal horn neurons with crossed receptive field components on the tail have dendrites which cross to the contralateral dorsal horn was tested in a combined electrophysiological and morphological study. Dorsal horn cells in the sacrocaudal spinal cord of anesthetized cats were penetrated with horseradish peroxidase-filled microelectrodes. After mapping their low threshold mechanoreceptive fields, cells were iontophoretically injected with horseradish peroxidase. A sample of 16 well-stained cells was obtained in laminae III and IV. Cells with receptive fields crossing the dorsal midline of the tail (n = 8) had somata in the lateral ipsilateral dorsal horn, and some of these cells (5/8) had dendrites which crossed to the lateral contralateral dorsal horn. Cells with receptive fields spanning the ventral midline (n = 2) were located near the center of the fused dorsal horn, and one of these had bilateral dendrites in this region. Cells with receptive fields on the lateral tail, crossing neither the dorsal nor the ventral midline (n = 6), had cell bodies in the middle of the ipsilateral dorsal horn; half had only ipsilateral dendrites, and half had crossed dendritic branches. Although the relationship between cell receptive field (RF) location (RF center, expressed as distance from tips of toes) and mediolateral location of the cell body was statistically significant, the correlation between crossed RF components and crossed dendritic branches was not significant.
Subject(s)
Cats/anatomy & histology , Dendrites/ultrastructure , Spinal Cord/ultrastructure , Animals , Cats/physiology , Dendrites/physiology , Female , Male , Microelectrodes , Spinal Cord/physiology , TailABSTRACT
We have investigated the organizational and morphological features of motoneurons from cat sacrocaudal spinal cord, the portion of the neuraxis that innervates the tail. This information is pertinent for development of a new model of spinal cord injury. An understanding of sacrocaudal circuitry is essential for physiological and behavioral assessment of the effects of sacrocaudal lesions. Observations from Nissl-stained sections corroborated Rexed's cytoarchitectural scheme. Putative motoneurons were located within two regions of the ventral horn: the ventromedial nucleus (lamina IX) and the nucleus commissuralis. To map motoneuron pools, cholera toxin-horseradish peroxidase conjugate was injected into each dorsal tail muscle. The dorsomedial muscle was innervated by ipsilateral nucleus commissuralis motoneurons. The dorsolateral and intertransversarius muscles were innervated by ipsilateral lamina IX and nucleus commissuralis motoneurons. Cell bodies of retrogradely labeled sacrocaudal motoneurons ranged from 22 to 82 microns in diameter; the unimodal distributions peaked between 45 and 50 microns. Dendritic trees of motoneurons, revealed by retrograde labeling or by intracellular injection with horseradish peroxidase, were extensive. Five to eight primary dendrites originated from the cell body. Dendritic branches extended throughout the ipsilateral ventral gray matter, with processes spreading into the surrounding white matter and the base of the dorsal horn. Dendrites from motoneurons with their soma in the lateral portion of lamina IX formed a longitudinal plexus at the gray/white border. Medial dendrites from motoneurons in the nucleus commissuralis formed bundles in the ventral gray commissure and spread throughout the contralateral ventral horn. It is speculated that contralateral dendrites subserve synchronized co-contraction of medial muscles from both sides of the tail.
Subject(s)
Cats/anatomy & histology , Motor Neurons/ultrastructure , Spinal Cord/cytology , Animals , Cholera Toxin , Dendrites/ultrastructure , Female , Horseradish Peroxidase , Male , Tail/innervationSubject(s)
Periodontitis/diagnosis , Acute Disease , Adult , Follow-Up Studies , Gingival Recession/diagnosis , Gingival Recession/epidemiology , Gingival Recession/therapy , Gingivitis, Necrotizing Ulcerative/diagnosis , Gingivitis, Necrotizing Ulcerative/epidemiology , Gingivitis, Necrotizing Ulcerative/therapy , Humans , Male , Patient Care Planning , Periodontitis/epidemiology , Periodontitis/therapy , PrognosisABSTRACT
As part of our studies of the organization of the cat sacrocaudal spinal cord (S3-Ca7), the portion of the neuraxis that innervates the tail, we have begun to evaluate the behavioral effects of hemisection or complete transection at the level of Ca1. Clinical observations that the tail strongly deviated to the side of a hemisection indicated the presence of an ipsilateral hypertonia. After complete transection of the spinal cord, the tail became ventroflexed in a midline position and exhibited spasticity, i.e., hypertonia, hyperreflexia, and clonus. Bowel and bladder functions and hindlimb gait and reflexes remained intact following either lesion. Quantitative behavioral measures corroborated our clinical observations. With the tail tethered to a force transducer, tail muscle tone was measured after the tail was passively positioned. Following a transection, resistance to dorsiflexion of the tail was greater than resistance to ventroflexion. In addition, tonic deviation of the tail was documented with videotape analysis while cats walked on a plank. Normal cats walked with the tail sharply dorsiflexed and centered. In contrast, the tail deviated ipsilaterally in cats with a hemisection, and the tail was ventroflexed in cats with a transection. These observations indicate that the sacrocaudal spinal cord provides a model with special advantages for investigation of changes in segmental motor functions following spinal cord injury. The effects of lesions on the tail are quantifiable and can resemble that spasticity observed after spinal cord injury in humans. Importantly, minimal effects on locomotive and autonomic functions were observed following hemisection or transection of the sacrocaudal spinal cord.