Pathological baroreceptor sensitivity in patients suffering from somatization disorders: do they correlate with symptoms?

We conducted a study to investigate whether patients with somatization disorders (ICD-10, F45.0) show abnormal values in autonomic testing.

PET-CT-guided interventions in the management of FDG-positive lesions in patients suffering from solid malignancies: initial experiences

Positron emission tomography-computed tomography (PET-CT) has gained widespread acceptance as a staging investigation in the diagnostic workup of malignant tumours and may be used to visualize metabolic changes before the evolution of morphological changes. To make histology of PET findings without distinctive structural changes available for treatment decisions, we developed a protocol for multimodal image-guided interventions using an integrated PET-CT machine. We report our first experience in 12 patients admitted for staging and restaging of breast cancer, non-small cell lung cancer, cervical cancer, soft tissue sarcoma, and osteosarcoma. Patients were repositioned according to the findings in PET-CT and intervention was planned based on a subsequent single-bed PET-CT acquisition of the region concerned. The needle was introduced under CT guidance in a step-by-step technique and correct needle position in the centre of the FDG avid lesion was assured by repetition of a single-bed PET-CT acquisition before sampling. The metabolically active part of lesions was accurately targeted in all patients and representative samples were obtained in 92%. No major adverse effects occurred. We conclude that PET-CT guidance for interventions is feasible and may be promising to optimize the diagnostic yield of CT-guided interventions and to make metabolically active lesions without morphological correlate accessible to percutaneous interventions.

The value of serial serum lactate measurements in predicting the extent of ischemic bowel and outcome of patients suffering acute mesenteric ischemia

BACKGROUND Acute mesenteric ischemia (AMI) is an emergency with a mortality rate up to 50 %. Detecting AMI continues to be a major challenge. This study assed the correlation of repeated preoperative serum lactate with bowel necrosis and to identify risk factors for a lethal outcome in patients with AMI. METHODS A retrospective study of 91 patients with clinically and pathologically confirmed AMI from January 2006 to December 2012 was performed. RESULTS In-hospital mortality rate was 42.9 %. Two hundred nine preoperative lactate measurements were analyzed (2.3 ± 1.1 values per patient). Less than or equal to six hours prior to surgery, the mean serum lactate level was significantly higher (4.97 ± 4.21 vs. 3.24 ± 3.05 mmol/L, p = 0.006) and the mean pH significantly lower (7.28 ± 0.12 vs. 7.37 ± 0.08, p = 0.001) compared to >6 h before surgery. Thirty-four patients had at least two lactate measurements within 24 h prior to surgery. In this subgroup, 17 patients (50 %) exhibited an increase, 17 patients (50 %) a decrease in lactate levels. Forward logistic regression analysis showed that length of necrotic bowel and the highest lactate value 24 h prior to surgery were independent risk factors for mortality (r (2)  = 0.329). CONCLUSION The value of serial lactate and pH measurements to predict the length of necrotic bowel is very limited. Length of necrotic bowel and lactate values are independent risk factors for mortality.

Donald Mowbray, Pain and suffering in medieval theology: Academic Debates at the University of Paris in the Thirteenth Century, Boydel and Brewer, Woodbridge, 2009; 192 p, ISBN 9781843834618.

Fil: Peretó Rivas, Rubén.

Clustering techniques for patients suffering acquired brain injury inneuro personal trainer

The study of the effectiveness of the cognitive rehabilitation processes and the identification of cognitive profiles, in order to define comparable populations, is a controversial area, but concurrently it is strongly needed in order to improve therapies. There is limited evidence about cognitive rehabilitation efficacy. Many of the trials conclude that in spite of an apparent clinical good response, differences do not show statistical significance. The common feature in all these trials is heterogeneity among populations. In this situation, observational studies on very well controlled cohort of studies, together with innovative methods in knowledge extraction, could provide methodological insights for the design of more accurate comparative trials. Some correlation studies between neuropsychological tests and patients capacities have been carried out -1---2- and also correlation between tests and morphological changes in the brain -3-. The procedures efficacy depends on three main factors: the affectation profile, the scheduled tasks and the execution results. The relationship between them makes up the cognitive rehabilitation as a discipline, but its structure is not properly defined. In this work we present a clustering method used in Neuro Personal Trainer (NPT) to group patients into cognitive profiles using data mining techniques. The system uses these clusters to personalize treatments, using the patients assigned cluster to select which tasks are more suitable for its concrete needs, by comparing the results obtained in the past by patients with the same profile.