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At least 1,387 records · Page 77Linked to original sources
PubMed1997

Dobutamine stress echocardiography. Stressing the indications for preoperative testing.

Poldermans et al have added important data to the body of literature supporting the use of dobutamine stress echocardiography to define long-term cardiac risk for patients undergoing major vascular surgery. In the application of this or any other noninvasive study, it will remain important to select the appropriate population for testing. In the case of noninvasive testing before vascular surgery, the population should consist of patients at intermediate risk of an adverse cardiac event rather than the whole population with known or suspected coronary artery disease. If this is done, testing can be restricted to a group for whom results will affect clinical decision making. Clinical assessment should remain the first method of patient screening. Among patients identified by clinical markers as at intermediate risk for a perioperative or late cardiac event, noninvasive testing such as dobutamine stress echocardiography may be used to better stratify risk and to help guide perioperative and subsequent cardiac management.

Coronary Disease↗
PubMed1992

Plasma beta-endorphin levels in post-traumatic stress disorder: a preliminary report on response to exercise-induced stress.

Post-traumatic stress disorder (PTSD) may be associated with changes in endogenous opioid peptide function. To test this hypothesis, 10 male Vietnam combat veterans with PTSD and 8 age-matched male controls underwent a standard grade-incremented exercise treadmill stress test. Plasma beta-endorphin measurements were obtained at rest and following maximal exercise. Resting plasma beta-endorphin levels were comparable between groups. Post-exercise plasma beta-endorphin levels were significantly higher than resting levels in the PTSD patients only (P less than 0.05). These pilot data suggest a differential alteration in plasma beta-endorphin response to exercise in PTSD.

Adult↗
PubMed1992

Myocardial ischemia in Kawasaki disease; evaluation by dipyridamole stress thallium-201 (Tl-201) myocardial imaging and exercise stress test.

The detection of myocardial ischemia is essential for evaluation of patients with Kawasaki disease, especially who have had coronary artery lesions. To evaluate the clinical efficacy of Tl-201 single photon emission computed tomography (SPECT) after dipyridamole infusion (maximum dose 0.70 mg/kg) for detecting myocardial ischemia, 44 patients with Kawasaki disease aged 7.7 +/- 4.8 years at the study and 10 age matched controls were observed. In the Kawasaki disease group, significant coronary artery stenosis was observed in 14, coronary aneurysm without stenosis in 18, the regression of the coronary aneurysms in 2 and without coronary lesions in 10 patients. In 22 of 44 patients, treadmill exercise stress test was also performed at the same period. Myocardial ischemic changes were observed in 11 patients, all combined with significant coronary artery stenosis. The sensitivity of SPECT for detection of overall coronary stenosis was 79%, contrary that of treadmill exercise test was only 33% (p < 0.001). Furthermore, among the patients having significant coronary stenosis, the severity score was significantly elevated in patients who had electrocardiographic abnormal Q wave compared to those without abnormal Q wave (51.0 +/- 38.8 versus 20.0 +/- 12.1, p < 0.05). These data suggest that the pharmacological stress scintigraphy using dipyridamole injection provides not only the accurate detection but quantitative evaluation of myocardial ischemia in these patients. This noninvasive technique may become one of the most useful index for detection and follow-up of myocardial ischemia in Kawasaki disease.

Adolescent↗
PubMed2004

Stress-induced p53 runs a direct mitochondrial death program: its role in physiologic and pathophysiologic stress responses in vivo.

It is now well established that a fraction of stress-induced wtp53 protein rapidly translocates to mitochondria in immortalized and transformed cells in culture. Mitochondrial p53 interacts with anti-apoptotic proteins of the Bcl 2 family at the outer mitochondrial membrane, resulting in membrane permeabilization, release of death effectors such as cytochrome C and subsequent rapid apoptosis. The significance and relevance of this direct mitochondrial p53 program to the overall p53-mediated stress response in vivo is underlined by a number of recent studies in animals and primary cells. They all support a role for this direct pathway in the physiologic and pathophysiologic response to genotoxic and hypoxic insults and occur precisely in those tissues where p53 plays a critical role in mediating apotpotis rather than cell cycle arrest.

Animals↗
PubMed2002

The latent structure of posttraumatic stress disorder: a taxometric investigation of reactions to extreme stress.

Mental health professionals have debated whether posttraumatic stress disorder (PTSD) can be qualitatively distinguished from normal reactions to traumatic events. This debate has been fueled by indications that many trauma-exposed individuals evidence partial presentations of PTSD that are associated with significant impairment and help-seeking behavior. The authors examined the latent structure of PTSD in a large sample of male combat veterans. Three taxometric procedures-MAMBAC, MAXEIG, and L-Mode-were performed with 3 indicator sets drawn from a clinical interview and a self-report measure of PTSD. Results across procedures, consistency tests, and analysis of simulated comparison data all converged on a dimensional solution, suggesting that PTSD reflects the upper end of a stress-response continuum rather than a discrete clinical syndrome.

Adult↗
PubMedDate not supplied

Effects of heat--stress in rats: Critical period and reduced survival of post-implantation heat-stress inducted in early gestation.

High ambient temperature (34.4 C degrees and 60-65% relative humidity (RH) did not affect foetal survival when bred female rats were exposed between day-8 and -18 (Day-0=day of breeding). Heat-stress at this intensity given on day-0 was critical for embryonic and/or foetal survival rate and more so, if the ambient temperature was increased to 36.6 C degrees and 70-75% RH than on day-1. Postimplantation foetal survival was reduced due to heat-stress given only during early gestation period.

Animals↗
PubMed1992

Pharmacologic myocardial perfusion stress tests. Adenosine thallium stress test.

Thallium-201 myocardial perfusion scintigraphy assists in detecting coronary artery disease and assessing the significance of known stenoses. An adenosine infusion protocol is discussed in conjunction with presentation of results obtained in a community hospital setting. Primary indications for pharmacologic stress maneuvers include: Evaluation of patients unable or unwilling to exercise to adequate levels of workload and patients undergoing preoperative evaluation (particularly in patients undergoing vascular surgery). Experience in a community hospital setting attests to the safety of this pharmacologic protocol while showing a diagnostic accuracy similar to results reported in peer review literature. The method has been readily received by referring internists and cardiologists and is associated with a 21% increase in nuclear myocardial perfusion stress tests during the first six months of 1991.

Adenosine↗
PubMed1991

Elementary teachers' perceptions of stressful events and stress-related teaching practices.

This study examined the relationships between stressful circumstances and self-reported teaching practices among 223 elementary teachers. Nine factors were identified as time control, relationships, curriculum concerns, students' motivation, career advancement, class size, role conflict, interference, and job security. The four stress reaction factors identified were burnout, reduction in work load, tolerance, and disengagement.

Adult↗
PubMed1990

Continuous fetal heart rate monitoring and tocodynamometry in routine obstetrical care, fetal stress and non-stress testing, and labor induction in the chimpanzee (Pan troglodytes).

The use of continuous fetal heart rate (FHR) and uterine pressure monitoring in the chimpanzee (Pan troglodytes) by external Doppler transducer and tocodynamometer is described in 1) the routine obstetrical assessment of fetal well-being, 2) oxytocin challenge (stress) testing (OCT) and non-stress testing (NST) for the diagnosis of in utero fetal distress, and 3) induction of labor by intravenous oxytocin infusion, by surgical rupture of the chorio-amniotic membranes (amniotomy), or by a combination of these techniques, as an alternative to Caesarean section for clinical, managemental, or experimental purposes. FHR traces were analyzed during a total of 57 term pregnancies for three basic characteristics: baseline rate, variability, and periodic pattern. Results indicated that continuous FHR monitoring in the chimpanzee can provide a valuable tool for fetal assessment and management of labor in any attempt to reduce the unacceptably high annual incidence of perinatal and neonatal infant mortality reported in the U.S.

Amnion↗
PubMedDate not supplied

[Value of antepartal cardiotocogram in risk pregnancies--comparative evaluation of the non-stress test and oxytocin stress test].

247 patients with risk of uteroplacental insufficiency were monitored by 434 oxytocin challenge tests (OCT) and non-stress-tests (NST). A non-reactive NST was found in 20% of the patients. Late decelerations in the OCT were observed in 19%. With respect to late decelerations and loss of reactivity in the OCT, the results of the stress tests were pathological in 29% of the patients. Based on the evaluation of late decelerations only, the OCT does not appear to be superior to the NST. Only when the reactivity criterion is additionally taken into account can the diagnostic rating of the OCT be given more value than that of the NST. Furthermore, it could be established that the loss of reactivity is of greater importance than late decelerations in the presence of reactivity.

Apgar Score↗
PubMed1984

[Comparison of T1201 stress scintigraphy and rest and stress ventriculography with respect to the degree of stenosis and collateral findings].

The influence of coronary obstructions and collaterals on the results of T1 201 myocardial scans and regional wall motion on ventriculography at rest and after pacing was examined with digital observer-independent methods, whereby criteria for positive and negative findings were defined in advance. The results indicate the high accuracy of 201-thallium scans in the detection of coronary artery disease in symptomatic single vessel disease, when the lesions obstruct greater than 60% of the vascular diameter. Cineventriculography at rest is inefficient as a test for this purpose. Ventriculography after pacing produced regional dysfunction in most of the patients and was comparable in its accuracy to T1 201 scans. A correlation of severity of stenoses and regional wall motion was not possible in the presented population. Collateral function is able to provide O2 supplies for normal myocardial function at rest and becomes insufficient during exercise and pacing. These results of T1201 stress scintigraphy correspond with results of stress ventriculography.

Adult↗
PubMed1995

Generation of a mammalian cell line deficient in glucose-regulated protein stress induction through targeted ribozyme driven by a stress-inducible promoter.

GRP94 is an endoplasmic reticulum (ER) localized glycoprotein with Ca2+ binding and protein chaperoning properties. Using a ribozyme driven by a stress-inducible promoter and targeted against grp94 mRNA, we have generated a cell line deficient in its ability to induce GRP94. The effect of the ribozyme is mediated by the cleavage of the grp94 message just downstream of the initiation codon, and not by an antisense effect, as determined by the level of intact grp94 mRNA. Unexpectedly, this cell line's ability to induce GRP78 is also impaired. Transient overexpression of recombinant human lysosomal hydrolase alpha-L-iduronidase in the ribozyme expressing cells indicates that the secretion ratio of this enzyme is reduced by about 6-fold. Additionally, the ribozyme expressing cells showed increased sensitivity to Ca2+ depletion from ER caused by either A23187 or thapsigargin, an ER-Ca(2+)-ATPase inhibitor, but not to tunicamycin. These combined results show that the induction of GRP94 may play important roles in ER to nuclear signaling, protein sorting and secretion, and specific protection against Ca2+ depletion stress.

Animals↗
PubMed1995

Comparison of stress echocardiography and stress myocardial perfusion scintigraphy for diagnosing coronary artery disease and assessing its severity.

The cumulative published literature dealing with the most frequently utilized noninvasive cardiac stress imaging modalities (radionuclide myocardial perfusion scintigraphy and echocardiography) was reviewed to gain insight on their comparative diagnostic accuracies. To be included, studies had to be performed in conjunction with exercise or a commonly used intravenous pharmacologic stress agent (dipyridamole, adenosine or dobutamine) and had to report temporally related coronary angiography findings. A total of > 75 studies were included, involving > 7,000 patients. Exercise single-photon emitted computed tomographic (SPECT) scintigraphy was more sensitive than exercise echocardiography for detecting coronary artery disease (CAD), localizing it to the proper coronary artery distribution and correctly identifying the presence of multivessel CAD. Adenosine, dipyridamole, and dobutamine provided similar diagnostic accuracy when performed in conjunction with SPECT scintigraphy, and all were more accurate than dobutamine echocardiography. Clinical specificity was similarly high with adenosine SPECT, dipyridamole echocardiography, and exercise echocardiography, and lower with exercise SPECT. Normalcy rate was high for exercise SPECT and similar to clinical specificity for echocardiography.

Coronary Disease↗
PubMed1994

[Dobutamine stress echocardiography. Use of dobutamine stress echocardiography in diagnosis and assessment of ischemic heart disease].

Dobutamine stress echocardiography (DSE) is a new diagnostic method for evaluation of patients with known or suspected coronary artery disease. We studied 30 consecutive patients referred for evaluation of chest pain. Coronary angiography was carried out in 28 patients. DSE was performed the following day. Readable echocardiographic recordings were obtained in all patients. Blinded wall motion analysis revealed a diagnostic sensitivity of 91% (95% confidence limits: 79-100%) for dobutamine stress echocardiography using coronary angiography as reference. No severe adverse events or arrhythmias occurred. It is concluded that DSE is well tolerated, feasible and has a high sensitivity for detecting coronary artery disease.

Adult↗
PubMedDate not supplied

The relationship of stressful life events, health status and stress-resistance resources in persons with AIDS.

Depression and hopelessness are major problems in persons with AIDS (PWAs). This study provides a paradigm for viewing these mental health states as outcomes that are dependent on stressors, physical health states, and stress-resistance resources. The sample consisted of 30 male, English-speaking PWAs with stage IV AIDS. A significant positive relationship was found between negative life events and the measure of depression, and number of complications and depression. Satisfaction with social support, intrapersonal hope, and global hope were all significantly, negatively associated with hopelessness. The findings support the importance of stress-resistance resources in promoting mental health in PWAs.

Acquired Immunodeficiency Syndrome↗
PubMed1998

[Detection of coronary artery disease by adenosine triphosphate stress echocardiography: comparison with adenosine triphosphate stress thallium myocardial scintigraphy and coronary angiography].

The clinical feasibility and usefulness of adenosine triphosphate-2Na (ATP) stress echocardiography for the detection of coronary artery disease (CAD) were assessed. Two-dimensional echocardiography and thallium-201 single photon emission computed tomography (SPECT) during ATP infusion were performed simultaneously in 58 consecutive patients (41 men and 17 women; mean age 66 +/- 12 years) with suspected CAD. ATP was infused intravenously at 0.16 mg/kg/min for 5 min and thallium was injected at 4 min. All patients underwent coronary angiography within 2 weeks of ATP echocardiography and ATP SPECT. An ischemic response during ATP infusion was detected by echocardiography as the development or worsening of a wall motion abnormality compared with the baseline and by SPECT as a perfusion defect that filled totally or partially during redistribution. Significant coronary artery stenosis was defined as > or = 75% diameter stenosis in a major epicardial vessel. The severity of the stenosis was classified as follows: Group A, lesions with significant coronary artery stenosis (> or = 75%, < 90%); Group B, lesions with severe coronary artery stenosis (> or = 90%) without collateral circulation; Group C, lesions with severe coronary artery stenosis (> or = 90%) with collateral circulation. Significant CAD was present in 43 of 58 patients. The overall sensitivity, specificity and accuracy of ATP echocardiography for detecting significant CAD were 70%, 100% and 78%, respectively, and those of ATP SPECT were 98%, 87% and 95%, respectively. In patients without previous myocardial infarction, the sensitivity of ATP echocardiography was 67%. The sensitivity of ATP echocardiography and ATP SPECT for detecting myocardial ischemia were 59% and 95% in patients with 1-vessel disease, 75% and 100% in those with 2-vessel disease, and 88% and 100% in those with 3-vessel disease, respectively. The induction of wall motion abnormality by ATP echocardiography was highly concordant with ATP SPECT imaging in patients with multivessel disease. Although the sensitivity of ATP echocardiography improved in patients with multivessel disease more than in those with single-vessel disease, detection of all diseased vessels was achieved in only 10% of patients with multivessel disease. The sensitivity of ATP echocardiography and ATP SPECT for detecting myocardial ischemia in individual vessels were: right coronary artery, 58% and 74%; left anterior descending artery, 59% and 97%; left circumflex artery, 27% and 68%. ATP-induced transient perfusion defects were associated with transient wall motion abnormality in only 57% of segments. The sensitivity of ATP echocardiography and ATP SPECT for detecting myocardial ischemia in patients with severe coronary stenosis were: Group A, 32% and 66%; Group B, 60% and 93%; Group C, 80% and 95%. The sensitivity of ATP echocardiography was significantly higher in the lesions with collateral circulation than in those without collateral circulation. ATP stress echocardiography is useful for detecting myocardial ischemia in patients with multivessel disease and in patients with severe coronary artery stenosis (> or = 90%). In particular, transient wall motion abnormality tends to be detected in the segments perfused by collateral circulation.

Adenosine Triphosphate↗
PubMed1996

Stress induced disorganization of circadian and ultradian rhythms: comparisons of effects of surgery and social stress.

Persistent autonomic disturbances following stressful events suggest that the rhythmical nature of homeostatic functioning may be disrupted by these experiences. We assessed the effects of two different stressors on circadian and ultradian rhythms of Long-Evans rats by using nonlinear multi-oscillator cosinor analysis. Heart rate and intraperitoneal temperature were monitored continuously in 5-min intervals in two groups of animals via radio-telemetry for 15 days after surgery (n = 9) and 15 days following social defeat (n = 6). Circadian amplitude of heart rate and temperature increased significantly for the first nine days of the recovery from surgery but only circadian temperature amplitude increased following social defeat. Circadian acrophase of temperature but not heart rate changed significantly for a similar period following the surgery but not after the social defeat. A mathematical model incorporating the first five harmonics of the circadian rhythm was found to fit the data significantly better than a circadian model alone with rhythms of 3 and 5 cycles/day in temperature and heart rate entraining significantly to the light-dark schedule. Full recovery of the circadian and ultradian rhythms did not occur until a minimum of nine to twelve days after surgery or social defeat. The results suggest that rhythms with multiple periodicities are involved in homeostatic functioning and that models incorporating these rhythms may aid in understanding an organisms adaptive response to surgical intervention and social defeat, long after the challenges have terminated.

Activity Cycles↗
PubMed2002

Finding a home for post-traumatic stress disorder in biological psychiatry. Is it a disorder of anxiety, mood, stress, or memory?

The collection of articles in this issue constitutes the most thorough review of posttraumatic stress disorder (PTSD) yet. At this point, the accumulated phenomenological, epidemiological, biological, and treatment evidence make it crystal clear that PTSD stands alone as a unique psychiatric disorder. It is not the same as depression, although many PTSD patients are also depressed, and it is not the same as the other anxiety disorders, although PTSD patients frequently also suffer with panic attacks, social avoidance, and obsessive ruminations.

Anxiety Disorders↗