Hypoplastic left heart syndrome: factors influencing therapeutic choice.

Parent's choices among therapeutic options for their infants born with hypoplastic left heart syndrome are difficult and controversial. Currently, management options include surgical reconstruction, cardiac transplantation, and comfort measures only. We retrospectively reviewed medical records of 47 patients (1989-1999) to create a database of clinical features of infants who received either an operation or comfort care only. Eleven families were interviewed by means of a structured questionnaire pertaining to their experience and reasons for their choice. Of the 47, 20 were prenatally diagnosed and nine of these (45%) aborted. The remaining 38 of the 47 were liveborns. Of the 38, 20/38 (53%) chose comfort care only. The other 18 chose operation. Although 17 were able to survive until first stage repair, only 8/17 (47%) survived beyond five months. At the time of last contact (ages one to 4.5 years), 5/17 (29%) remained alive. Over the nine years an increasing proportion of parents chose operative reconstruction; 8/11 (73%) for 1996-99 vs 10/27 (37%) for 1989-1995. Interviewed families who chose comfort care were more likely to believe the rate of survival following operation was poor, quality of life was diminished, and seemed concerned that their infant would suffer. Influence by optimistic physicians at surgical centers seemed important for an operative choice. Most suggested that provision of written materials, professional family counseling, and support groups of hypoplastic left heart syndrome families are or would be helpful.

Temporal measures of human finger tapping: effects of age.

A computerized finger-tapping test was used in which nonclinical subjects were asked to tap a telegraph key with their index finger as rapidly as possible during five 10-s trials. Comparisons were made between young (mean age = 18 years) and aged (mean age = 75 years) subjects. Consistent with previous findings, aged subjects performed significantly fewer taps than younger subjects. Computerized analysis of finger-tapping patterns in the present study allowed for the determination of novel temporal parameters of tapping responses. Response initiation time was defined as the time from the offset of one finger tap until the onset of the next finger tap. Aged subjects had significant and substantially longer response initiation times than younger subjects. Response duration times also were measured: this parameter was defined as the time from the onset of one finger tap until the offset of the same finger tap. Although the magnitude of the effect was small, aged subjects had significantly longer response duration times than younger subjects. Thus, although the deficit in response rate of a voluntary repetitive response in aged subjects was largely due to impairments in response initiation times, the response duration also contributes to the overall deficit in responding. Using these methods it is possible that greater insight into aging or extrapyramidal motor disorders, such as parkinsonism, may be obtained; it is also possible that these data may be useful as a research tool to aid in drug development and evaluation.