Acute neuropsychological functioning following cardiosurgical interventions associated with the production of intraoperative cerebral microemboli

Coronary artery bypass graft (CABG) and valve replacement (VR) surgical patients underwent neuropsychological assessment 1-2 days prior to surgery; 7-10 days postsurgery; and 1 month following hospital discharge. A group of matched healthy controls was tested at identical intervals. Cerebral microemboli in both middle cerebral arteries were quantified during surgery using Doppler sonography. Neuropsychological testing results revealed that the CABG and VR groups did not differ from one another at any assessment point. However, surgical patients performed more poorly than healthy controls across all assessments. Surgical patients, as a group, demonstrated a mild decline in attentional functioning and learning efficiency at the 7-10 day follow-up, but these difficulties essentially returned to baseline by the 1-month follow-up. Intraoperative microemboli counts were not significantly associated with postsurgical neuropsychological functioning in either the CABG or VR group.

The assessment of unidimensionality of normal and lognormal data: a look at two nonparametric procedures

In this Monte Carlo study, the Type I error rate and the power of the Stout T procedure (DIMTEST) and the Holland-Rosenbaum procedure (HR) were examined for normal and lognormal data sets. Both procedures are based on a nonparametric item response model, where the key assumption is the item response function is monotonically nondecreasing. The two procedures performed adequately under certain conditions for both normal and lognormal data sets. Of the two, however, the Stout T procedure showed adequate power under more conditions than the Holland-Rosenbaum procedure.

Electroencephalographic, volumetric, and neuropsychological indicators of seizure focus lateralization in temporal lobe epilepsy

CONTEXT

Anterior temporal lobectomy is an effective treatment for medically intractable temporal lobe seizures. Identification of seizure focus is essential to surgical success.

OBJECTIVE

To examine the usefulness of presurgical electroencephalography (EEG), magnetic resonance imaging (MRI), and neuropsychological data in the lateralization of seizure focus.

DESIGN

Presurgical EEG, MRI, and neuropsychological data were entered, independently and in combination, as indicators of seizure focus lateralization in discriminant function analyses, yielding correct seizure lateralization rates for each set of indicators.

SETTING

Comprehensive Epilepsy Program, Shands Teaching Hospital, University of Florida, Gainesville.

PATIENTS

Forty-four right-handed adult patients who ultimately underwent successful anterior temporal lobectomy. Left-handed patients, those with less-than-optimal surgical outcome, and any patients with a history of neurological insult unrelated to seizure disorder were excluded from this study.

MAIN OUTCOME MEASURES

For each patient presurgical EEG was represented as a seizure lateralization index reflecting the numbers of seizures originating in the left hemisphere, right hemisphere, and those unable to be lateralized. Magnetic resonance imaging data were represented as left-right difference in hippocampal volume. Neuropsychological data consisted of mean scores in each of 5 cognitive domains.

RESULTS

The EEG was a better indicator of lateralization (89% correct) than MRI (86%), although not significantly. The EEG and MRI were significantly superior to neuropsychological data (66%) (P=.02 and .04, respectively). Combining EEG and MRI yielded a significantly higher lateralization rate (93%) than EEG alone (P<.01). Adding neuropsychological data improved this slightly (95%).

CONCLUSIONS

The EEG and MRI were of high lateralization value, while neuropsychological data were of limited use in this regard. Combining EEG, MRI, and neuropsychological improved focus lateralization relative to using these data independently.

Stage II breast cancer: differences between four coping patterns in side effects during adjuvant chemotherapy

Fifty-six women with stage II breast cancer receiving adjuvant chemotherapy were recruited for a study evaluating and comparing coping patterns for differences in physical and psychological side effects during treatment with adjuvant chemotherapy. Cluster analyses were used to split women into confrontive, avoidant-confrontive, avoidant-resigned, and resigned coping clusters. Side-effect measurements were taken on the day of adjuvant chemotherapy infusion and 3 and 7 days later. Repeated measures ANCOVAs indicated that coping clusters predicted significant variance in physical, psychological, and total side effects when variance in covariates was held constant. Confrontive subjects reported significantly fewer psychological and physical symptoms than avoidant-confrontive and avoidant-resigned copers. Confrontive copers also reported fewer side effects than resigned copers, but this difference was not significant when differences in covariate distributions were controlled. Particularly robust differences were noted when confrontive copers were compared with avoidant-confrontive copers. Results suggest that a critical component in optimal coping may be a willingness to discuss and think about illness.