The Blalock-Taussig shunt. Low risk, effective palliation, and pulmonary artery growth.

The Blalock-Taussig shunt has been used at our institution in 64 infants with cyanotic congenital heart disease who required palliation. Thirty-one of these children were less than 2 months of age at the time of operation. There were no early shunt closures. There were two hospital deaths (3%). There was only one hospital death in the 31 patients less than 60 days old. According to a life-table analysis, 87% +/- 9% (+/- 95% confidence limits) of the shunts were functioning at 1 year and 78% +/- 12% at 2 years. Results are similar in the subgroup of children less than 60 days of age at the time of operation or in the subgroup of children weighing less than 3,999 gm at operation. In infants with small pulmonary arteries, pulmonary arterial growth was excellent (ipsilateral pulmonary artery/descending aorta ratio 0.70 leads to 0.95 in 550 days, p less than 0.001; contralateral ratio 0.73 leads to 0.99 in 550 days, p less than 0.001). The Blalock-Taussig shunt can be performed with low risk, provides excellent palliation, and is associated with excellent pulmonary artery growth.

Binaural auditory beats affect vigilance performance and mood.

When two tones of slightly different frequency are presented separately to the left and right ears the listener perceives a single tone that varies in amplitude at a frequency equal to the frequency difference between the two tones, a perceptual phenomenon known as the binaural auditory beat. Anecdotal reports suggest that binaural auditory beats within the electroencephalograph frequency range can entrain EEG activity and may affect states of consciousness, although few scientific studies have been published. This study compared the effects of binaural auditory beats in the EEG beta and EEG theta/delta frequency ranges on mood and on performance of a vigilance task to investigate their effects on subjective and objective measures of arousal. Participants (n = 29) performed a 30-min visual vigilance task on three different days while listening to pink noise containing simple tones or binaural beats either in the beta range (16 and 24 Hz) or the theta/delta range (1.5 and 4 Hz). However, participants were kept blind to the presence of binaural beats to control expectation effects. Presentation of beta-frequency binaural beats yielded more correct target detections and fewer false alarms than presentation of theta/delta frequency binaural beats. In addition, the beta-frequency beats were associated with less negative mood. Results suggest that the presentation of binaural auditory beats can affect psychomotor performance and mood. This technology may have applications for the control of attention and arousal and the enhancement of human performance.

Use of binaural beat tapes for treatment of anxiety: a pilot study of tape preference and outcomes.

CONTEXT: Recent studies and anecdotal reports suggest that binaural auditory beats can affect mood, performance on vigilance tasks, and anxiety. OBJECTIVE: To determine whether mildly anxious people would report decreased anxiety after listening daily for 1 month to tapes imbedded with tones that create binaural beats, and whether they would show a definite tape preference among 3 tapes. DESIGN: A 1-group pre-posttest pilot study. SETTING: Patients' homes. PARTICIPANTS: A volunteer sample of 15 mildly anxious patients seen in the Clinique Psyché, Montreal, Quebec. INTERVENTION: Participants were asked to listen at least 5 times weekly for 4 weeks to 1 or more of 3 music tapes containing tones that produce binaural beats in the electroencephalogram delta/theta frequency range. Participants also were asked to record tape usage, tape preference, and anxiety ratings in a journal before and after listening to the tape or tapes. MAIN OUTCOME MEASURES: Anxiety ratings before and after tape listening, pre- and post-study State-Trait Anxiety Inventory scores, and tape preferences documented in daily journals. RESULTS: Listening to the binaural beat tapes resulted in a significant reduction in the anxiety score reported daily in patients' diaries. The number of times participants listened to the tapes in 4 weeks ranged from 10 to 17 (an average of 1.4 to 2.4 times per week) for approximately 30 minutes per session. End-of-study tape preferences indicated that slightly more participants preferred tape B, with its pronounced and extended patterns of binaural beats, over tapes A and C. Changes in pre- and posttest listening State-Trait Anxiety Inventory scores trended toward a reduction of anxiety, but these differences were not statistically significant. CONCLUSIONS: Listening to binaural beat tapes in the delta/theta electroencephalogram range may be beneficial in reducing mild anxiety. Future studies should account for music preference among participants and include age as a factor in outcomes, incentives to foster tape listening, and a physiologic measure of anxiety reduction. A controlled trial that includes binaural beat tapes as an adjunctive treatment to conventional therapy for mild anxiety may be warranted.

Complementary and alternative medicine and psychologic factors: toward an individual differences model of complementary and alternative medicine use and outcomes.

CONTEXT: Complementary and alternative medicine (CAM) is in widespread use. Study of the psychologic factors associated with CAM use may provide descriptions of subgroups of health care consumers and give further insight into the reasons for using alternative therapies. OBJECTIVES: To see if the use of CAM is associated with psychologic factors in two outpatient samples and one community sample. SETTING: The University of Virginia Hospital and Charlottesville community. PATIENTS: Patients at the Cancer Center (60) and Pain Management Center (63) and adults from the Charlottesville community (63) for a total of 186 participants. DESIGN: A survey of CAM with psychologic assessment. MAIN MEASURES: Level of CAM use, effectiveness ratings of CAM, positive affect, negative affect, and the Absorption Scale, which measures a personality factor associated with the capacity for focused attention and mind-body awareness. RESULTS: Participants using six or fewer CAM scored an average of 13.9 on the Absorption Scale compared to participants using seven or more CAM, who scored an average of 21.4 on Absorption (F = 48.73, p < .0001). Higher effectiveness ratings of CAM were associated with greater positive affect. Pain Center patients rated alternative therapies as least effective, and reported lower positive affect and greater negative affect compared with the Cancer Center patients and community adults. CONCLUSIONS: Above average use of CAM is associated with higher education, greater well-being and higher Absorption. The personality traits associated with alternative therapies are compatible with participation in these therapies and may facilitate the capacity to benefit from them.

Gonococcal endocarditis: report of a case and review of the literature.

Gonococcal endocarditis may appear in the extremes of cardiogenic and septic shock. These patients must be quickly stabilized and evaluated by echocardiography and cardiac catheterization where possible. Urgent surgical intervention for valve replacement may be necessary before complete stabilization of the patient's cardiac hemodynamics status is accomplished. Although the aortic valve is most commonly involved with gonococcal endocarditis, the mitral valve is involved as well and may present as a true emergency situation. Right-sided valve infections may be treated by a more conservative medical means if the patient does not deteriorate into a hemodynamic instability. Deterioration of the patient requires immediate intervention with catheterization and surgery in the absence of positive blood cultures to confirm the diagnosis of gonococcal endocarditis. Once the need for emergency surgical valve replacement has been determined the rules of complete debridement of all infected tissues, insertion of sutures into healthy annular tissue, and selection of an appropriate mechanical valve apply. Long-term antibiotic therapy is included in post-operative management.

Assessment of paroxetine-induced sexual dysfunction using the Changes in Sexual Functioning Questionnaire.

The Changes in Sexual Functioning Questionnaire (see Appendix) was developed as a brief clinical and research instrument to measure sexual function changes accompanying illness or the administration of medications. In a pilot study of patients with major depression being treated with paroxetine, the instrument was useful in delineating three groups of patients: patients who reported increased libido without sexual dysfunction, patients who developed anorgasmia with possible spontaneous resolution (medication side effect and development of tolerance), and patients with long-term sexual dysfunction unaffected by the medication. Change scores accurately differentiated global elements, changes associated with specific factors of sexual response, and drug-specific side effects. All patients had a therapeutic response to treatment with experiences of sexual functioning that could be categorized into one of the three groups.

Features of "near-death experience" in relation to whether or not patients were near death.

The medical records of 58 patients, most of whom believed they were near death during an illness or after an injury and all of whom later remembered unusual experiences occurring at the time, were examined. 28 patients were judged to have been so close to death that they would have died without medical intervention; the other 30 patients were not in danger of dying although most of them thought they were. Patients of both groups reported closely similar experiences but patients who really were close to death were more likely than those who were not to report an enhanced perception of light and enhanced cognitive powers. The claim of enhancement of cognitive functions despite the likelihood that brain function had probably become disturbed and possibly diminished, deserves further investigation.