Increased high-frequency NREM EEG power associated with mindfulness-based interventions for chronic insomnia: Preliminary findings from spectral analysis

OBJECTIVE

Mindfulness-based interventions (MBI) have been shown to reduce subjective symptoms of insomnia but the effects on objective measures remain unclear. The purpose of this study was to examine sleep EEG microarchitecture patterns from a randomized controlled trial of Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Therapy for Insomnia (MBTI).

METHODS

Sleep EEG spectral analysis was conducted on 36 participants with chronic insomnia (>6 months) randomized to 8-week MBSR, MBTI, or self-monitoring control (SM). Overnight polysomnography with 6-channel EEG was conducted at baseline, post-treatment, and 6-month follow-up. Spectral power averaged from channels C3/C4 across NREM epochs (excluding N1) was examined for within-group changes and relationships with self-report measures.

RESULTS

Increases in absolute NREM beta (16-25 Hz) power were observed from baseline to post-treatment (p = .02, d = 0.53) and maintained at 6-month follow-up (p = .01, d = 0.57) in the combined MBI groups, and additionally in the gamma (25-40 Hz) range at follow-up for the MBTI group only. No significant changes in these frequency bands were observed for SM. Following mindfulness intervention, NREM beta was positively associated with Five-Facet Mindfulness (FFM) score (rho = 0.37, p = .091) and negatively associated with Insomnia Severity Index (rho = -0.43, p = .047).

CONCLUSION

These results in people with insomnia corroborate prior reports of increased high-frequency sleep EEG power associated with mindfulness training. This change in beta EEG pattern merits further evaluation as a potential marker of the effects of mindfulness meditation on sleep, especially given the paradoxical findings in the context of insomnia.

CLINICAL TRIAL REGISTRATION

clinicaltrials.gov, NCT00768781.

Coping with loss of control in the practice of medicine

Although the quest for active control and mastery can be seen as a central thread that ties together important aspects of human experience, we are frequently confronted with the reality that much of what is encountered in life lies outside our active instrumental control. Control must involve finding healthy and life-affirming ways to exercise personal mastery, and identifying constructive ways to respond to the lack of control that pervades the human condition. In this article we explore a number of professional areas in which physicians may experience significant feelings of loss or lack of personal control-difficult encounters with patients, dealing with patient nonadherence, end-of-life care, confronting the uncertainty and ambiguity that are frequently a part of illness, as well as institutional and systemic factors that can result in loss of various forms of autonomy and control over decision-making. We then consider maladaptive ways in which physicians sometimes attempt to address such losses of control and suggest that personal stress and burnout and difficulty developing effective therapeutic relationships with patients may be the consequence, in part, of these efforts. Finally, we discuss an empirically derived, multidimensional theoretical model for better understanding control dynamics, and identifying more optimal strategies physicians can employ in their efforts to gain and regain a sense of control in caring for patients.

The contribution of mindfulness practice to a multicomponent behavioral sleep intervention following substance abuse treatment in adolescents: a treatment-development study

Poor sleep is common in substance use disorders (SUDs) and is a risk factor for relapse. Within the context of a multicomponent, mindfulness-based sleep intervention that included mindfulness meditation (MM) for adolescent outpatients with SUDs (n = 55), this analysis assessed the contributions of MM practice intensity to gains in sleep quality and self-efficacy related to SUDs. Eighteen adolescents completed a 6-session study intervention and questionnaires on psychological distress, sleep quality, mindfulness practice, and substance use at baseline, 8, 20, and 60 weeks postentry. Program participation was associated with improvements in sleep and emotional distress, and reduced substance use. MM practice frequency correlated with increased sleep duration and improvement in self-efficacy about substance use. Increased sleep duration was associated with improvements in psychological distress, relapse resistance, and substance use-related problems. These findings suggest that sleep is an important therapeutic target in substance abusing adolescents and that MM may be a useful component to promote improved sleep.

Light collection and harvesting processes in bacterial photosynthesis investigated on a picosecond time scale

Fluorescence lifetimes have been determined for four strains of Rhodopseudomonas sphaeroides. Chromatophore samples were excited with a single picosecond flash, and the fluorescence was detected with a streak camera. The decay times are 100 psec in strains 2.4.1 and Ga, and 300 psec in the carotenoidless strain R-26. These times are related to the transfer of energy from the light-harvesting antenna pigment molecules to the photochemical reaction center. In strain PM-8 dpl, which lacks reaction centers, the lifetime is 1.1 nsec. In addition, we have obtained curves relating the quantum yield of fluorescence to the photon density of the excitation pulse. These curves can be fit with a simple model that relates excitonic processes to properties of the photosynthetic unit and that qualitatively describes differences between the mutant strains.

The integration of mindfulness and psychology

As the field of psychology continues to expand and evolve, one fruitful avenue of exploration has been the integration of mindfulness into psychological theory and practice. Mindfulness is defined as the awareness that arises out of intentionally attending in an open and discerning way to whatever is arising in the present moment. Two decades of empirical research have generated considerable evidence supporting the efficacy of mindfulness-based interventions across a wide range of clinical and nonclinical populations, and these interventions have been incorporated into a variety of health care settings. Still, there are many unanswered questions and potential horizons to be investigated. This special issue endeavors to assist in this exploration. It presents a combination of articles concerning aspects of clinical and scientific integration of mindfulness within psychotherapy and psychoeducational settings. This commentary attempts to highlight the main findings of the featured articles as well as elucidate areas for future inquiry. Taken as a whole, the volume supports the importance and viability of the integration of mindfulness into psychology, and offers interesting and meaningful directions for future research.

Mindfulness meditation and cognitive behavioral therapy for insomnia: a naturalistic 12-month follow-up

A unique intervention combining mindfulness meditation with cognitive behavioral therapy for insomnia (CBT-I) has been shown to have acute benefits at posttreatment in an open label study. The aim of the present study was to examine the long-term effects of this integrated intervention on measures of sleep and sleep-related distress in an attempt to characterize the natural course of insomnia following this treatment and to identify predictors of poor long-term outcome. Analyses were conducted on 21 participants, who provided follow-up data at six and 12 months posttreatment. At each time point, participants completed one week of sleep and meditation diaries and questionnaires related to mindfulness, sleep, and sleep-related distress, including the Pre-Sleep Arousal Scale, the Glasgow Sleep Effort Scale, the Kentucky Inventory of Mindfulness Skills, and the Insomnia Episode Questionnaire. Analyses examining the pattern of change across time (baseline, end of treatment, six months, and 12 months) revealed that several sleep-related benefits were maintained during the 12-month follow-up period. Participants who reported at least one insomnia episode (>or=1 month) during the follow-up period had higher scores on the Pre-Sleep Arousal Scale (P < .05) and the Glasgow Sleep Effort Scale (P < .05) at end of treatment compared with those with no insomnia episodes. Correlations between mindfulness skills and insomnia symptoms revealed significant negative correlations (P < .05) between mindfulness skills and daytime sleepiness at each of the three time points but not with nocturnal symptoms of insomnia. These results suggest that most sleep-related benefits of an intervention combining CBT-I and mindfulness meditation were maintained during the 12-month follow-up period, with indications that higher presleep arousal and sleep effort at end of treatment constitute a risk for occurrence of insomnia during the 12 months following treatment.

Cultivating mindfulness: effects on well-being

There has been great interest in determining if mindfulness can be cultivated and if this cultivation leads to well-being. The current study offers preliminary evidence that at least one aspect of mindfulness, measured by the Mindful Attention and Awareness Scale (MAAS; K. W. Brown & R. M. Ryan, 2003), can be cultivated and does mediate positive outcomes. Further, adherence to the practices taught during the meditation-based interventions predicted positive outcomes. College undergraduates were randomly allocated between training in two distinct meditation-based interventions, Mindfulness Based Stress Reduction (MBSR; J. Kabat-Zinn, 1990; n=15) and E. Easwaran's (1978/1991) Eight Point Program (EPP; n=14), or a waitlist control (n=15). Pretest, posttest, and 8-week follow-up data were gathered on self-report outcome measures. Compared to controls, participants in both treatment groups (n=29) demonstrated increases in mindfulness at 8-week follow-up. Further, increases in mindfulness mediated reductions in perceived stress and rumination. These results suggest that distinct meditation-based practices can increase mindfulness as measured by the MAAS, which may partly mediate benefits. Implications and future directions are discussed.

Meditation lowers stress and supports forgiveness among college students: a randomized controlled trial

OBJECTIVE AND PARTICIPANTS

The authors evaluated the effects on stress, rumination, forgiveness, and hope of two 8-week, 90-min/wk training programs for college undergraduates in meditation-based stress-management tools.

METHODS

After a pretest, the authors randomly allocated college undergraduates to training in mindfulness-based stress reduction (MBSR; n = 15), Easwaran's Eight-Point Program (EPP; n = 14), or wait-list control (n = 15). The authors gathered pretest, posttest, and 8-week follow-up data on self-report outcome measures.

RESULTS

The authors observed no post-treatment differences between MBSR and EPP or between posttest and 8-week follow-up (p > .10). Compared with controls, treated participants (n = 29) demonstrated significant benefits for stress (p < .05, Cohen's d = -.45) and forgiveness (p < .05, d = .34) and marginal benefits for rumination (p < .10, d = -.34).

CONCLUSIONS

Evidence suggests that meditation-based stress-management practices reduce stress and enhance forgiveness among college undergraduates. Such programs merit further study as potential health-promotion tools for college populations.

A randomized controlled trial of mindfulness meditation versus relaxation training: Effects on distress, positive states of mind, rumination, and distraction

BACKGROUND

Although mindfulness meditation interventions have recently shown benefits for reducing stress in various populations, little is known about their relative efficacy compared with relaxation interventions.

PURPOSE

This randomized controlled trial examines the effects of a 1-month mindfulness meditation versus somatic relaxation training as compared to a control group in 83 students (M age = 25; 16 men and 67 women) reporting distress.

METHOD

Psychological distress, positive states of mind, distractive and ruminative thoughts and behaviors, and spiritual experience were measured, while controlling for social desirability.

RESULTS

Hierarchical linear modeling reveals that both meditation and relaxation groups experienced significant decreases in distress as well as increases in positive mood states over time, compared with the control group (p < .05 in all cases). There were no significant differences between meditation and relaxation on distress and positive mood states over time. Effect sizes for distress were large for both meditation and relaxation (Cohen's d = 1.36 and .91, respectively), whereas the meditation group showed a larger effect size for positive states of mind than relaxation (Cohen's d =.71 and .25, respectively). The meditation group also demonstrated significant pre-post decreases in both distractive and ruminative thoughts/behaviors compared with the control group (p < .04 in all cases; Cohen's d = .57 for rumination and .25 for distraction for the meditation group), with mediation models suggesting that mindfulness meditation's effects on reducing distress were partially mediated by reducing rumination. No significant effects were found for spiritual experience.

CONCLUSIONS

The data suggest that compared with a no-treatment control, brief training in mindfulness meditation or somatic relaxation reduces distress and improves positive mood states. However, mindfulness meditation may be specific in its ability to reduce distractive and ruminative thoughts and behaviors, and this ability may provide a unique mechanism by which mindfulness meditation reduces distress.

Mechanisms of mindfulness

Recently, the psychological construct mindfulness has received a great deal of attention. The majority of research has focused on clinical studies to evaluate the efficacy of mindfulness-based interventions. This line of research has led to promising data suggesting mindfulness-based interventions are effective for treatment of both psychological and physical symptoms. However, an equally important direction for future research is to investigate questions concerning mechanisms of action underlying mindfulness-based interventions. This theoretical paper proposes a model of mindfulness, in an effort to elucidate potential mechanisms to explain how mindfulness affects positive change. Potential implications and future directions for the empirical study of mechanisms involved in mindfulness are addressed.

The meeting of meditative disciplines and Western psychology: a mutually enriching dialogue

Meditation is now one of the most enduring, widespread, and researched of all psychotherapeutic methods. However, to date the meeting of the meditative disciplines and Western psychology has been marred by significant misunderstandings and by an assimilative integration in which much of the richness and uniqueness of meditation and its psychologies and philosophies have been overlooked. Also overlooked have been their major implications for an understanding of such central psychological issues as cognition and attention, mental training and development, health and pathology, and psychological capacities and potentials. Investigating meditative traditions with greater cultural and conceptual sensitivity opens the possibility of a mutual enrichment of both the meditative traditions and Western psychology, with far-reaching benefits for both.

Mental balance and well-being: Building bridges between Buddhism and Western psychology

Clinical psychology has focused primarily on the diagnosis and treatment of mental disease, and only recently has scientific attention turned to understanding and cultivating positive mental health. The Buddhist tradition, on the other hand, has focused for over 2,500 years on cultivating exceptional states of mental well-being as well as identifying and treating psychological problems. This article attempts to draw on centuries of Buddhist experiential and theoretical inquiry as well as current Western experimental research to highlight specific themes that are particularly relevant to exploring the nature of mental health. Specifically, the authors discuss the nature of mental well-being and then present an innovative model of how to attain such well-being through the cultivation of four types of mental balance: conative, attentional, cognitive, and affective.

Mind-body medicine: state of the science, implications for practice

BACKGROUND

Although emerging evidence during the past several decades suggests that psychosocial factors can directly influence both physiologic function and health outcomes, medicine had failed to move beyond the biomedical model, in part because of lack of exposure to the evidence base supporting the biopsychosocial model. The literature was reviewed to examine the efficacy of representative psychosocial-mind-body interventions, including relaxation, (cognitive) behavioral therapies, meditation, imagery, biofeedback, and hypnosis for several common clinical conditions.

METHODS

An electronic search was undertaken of the MEDLINE, PsycLIT, and the Cochrane Library databases and a manual search of the reference sections of relevant articles for related clinical trials and reviews of the literature. Studies examining mind-body interventions for psychological disorders were excluded. Owing to space limitations, studies examining more body-based therapies, such as yoga and tai chi chuan, were also not included. Data were extracted from relevant systematic reviews, meta-analyses, and randomized controlled trials.

RESULTS

Drawing principally from systematic reviews and meta-analyses, there is considerable evidence of efficacy for several mind-body therapies in the treatment of coronary artery disease (eg, cardiac rehabilitation), headaches, insomnia, incontinence, chronic low back pain, disease and treatment-related symptoms of cancer, and improving postsurgical outcomes. We found moderate evidence of efficacy for mind-body therapies in the areas of hypertension and arthritis. Additional research is required to clarify the relative efficacy of different mind-body therapies, factors (such as specific patient characteristics) that might predict more or less successful outcomes, and mechanisms of action. Research is also necessary to examine the cost offsets associated with mind-body therapies.

CONCLUSIONS

There is now considerable evidence that an array of mind-body therapies can be used as effective adjuncts to conventional medical treatment for a number of common clinical conditions.

The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: an exploratory study

OBJECTIVE

The diagnosis of breast cancer, the most common type of cancer among American women, elicits greater distress than any other diagnosis regardless of prognosis. Therefore, the present study examined the efficacy of a stress reduction intervention for women with breast cancer.

METHODS

As part of a larger, randomized, controlled study of the effects on measures of stress of a mindfulness-based stress reduction (MBSR) intervention for women with breast cancer, the current analyses examined the effects on sleep complaints.

RESULTS

Analyses of the data indicated that both MBSR and a free choice (FC) control condition produced significant improvement on daily diary sleep quality measures though neither showed significant improvement on sleep-efficiency. Participants in the MBSR who reported greater mindfulness practice improved significantly more on the sleep quality measure most strongly associated with distress.

CONCLUSION

MBSR appears to be a promising intervention to improve the quality of sleep in woman with breast cancer whose sleep complaints are due to stress.

Going quasi: the premature disclosure effect in a randomized clinical trial

This paper describes a randomized clinical trial investigating a stress management program for women with breast cancer, which inadvertently turned quasi-experimental. Due to logistical considerations, group assignment was disclosed to participants (n = 63) prior to baseline assessment. Analyses of baseline measures unexpectedly revealed statistically significant differences between groups on psychological functioning. We suggest that what appears to be failed randomization may in fact point toward an important phenomenon which we have termed premature disclosure effect (PDE). A hierarchical regression model, developed to help explain the PDE, accounted for 47% of the variance. The findings indicate the importance of considering participant belief, preferences, and attributes when designing research protocols and interventions. Potential implications of PDE for clinical research in behavioral medicine are discussed and specific statistical methodologies suggested.

Quality of life and breast cancer: relationship to psychosocial variables

The aim of this article is to shed more light on the relationship between quality of life and aspects of the psychosocial experience for women with breast cancer. The literature is briefly reviewed, including highlights of the psychosocial consequences of cancer, an exploration of the relationship of psychosocial variables to cancer, and a brief review of psychosocial interventions for cancer. Further, preliminary findings of an on-going NCI study are introduced. Finally, clinical implications are discussed. The purpose of this article is to provide a context and foundation on which future researchers and clinicians can build. Ultimately, we suggest that the biomedical model of disease, though crucial, does not take into account all of the complex factors involved in cancer. The current literature lends support to the argument that a broader, more integrative framework, which includes psychosocial factors, is needed.

Intentional systemic mindfulness: an integrative model for self-regulation and health

Self-regulation is the process whereby systems maintain stability of functioning and adaptability to change. Self-regulation is based on feedback loops which can be enhanced through attention. All self-regulation techniques, therefore, involve the cultivation of attention. However, the intention with which attention is directed may be crucial. In this paper, we explore intentional systemic mindfulness a model that explicitly introduces intention into self-regulation theory and practice. Intention as defined by this model is composed of the context of attention-systemic perspectives - and the quality of attention - mindfulness qualities. Intentional systemic mindfulness addresses both "why" (systemic perspectives) and "how" (mindfulness qualities) one directs attention, which may promote healing on multiple levels. Directions for research and implications for multiple levels of integrative health are considered.

Stress management in medical education: a review of the literature

PURPOSE

To review systematically clinical studies providing empirical data on stress-management programs in medical training.

METHOD

The authors searched Medline and PSYCHINFO from 1966 to 1999. Studies were included if they evaluated stress-management programs for medical trainees (medical students, interns, or residents); reported empirical data; and had been conducted at allopathic medical schools.

RESULTS

Although the search yielded over 600 articles discussing the importance of addressing the stress of medical education, only 24 studies reported intervention programs, and only six of those used rigorous scientific method. Results revealed that medical trainees participating in stress-management programs demonstrated (1) improved immunologic functioning, (2) decreases in depression and anxiety, (3) increased spirituality and empathy, (4) enhanced knowledge of alternative therapies for future referrals, (5) improved knowledge of the effects of stress, (6) greater use of positive coping skills, and (7) the ability to resolve role conflicts. Despite these promising results, the studies had many limitations.

CONCLUSION

The following considerations should be incorporated into future research: (1) rigorous study design, including randomization and control (comparison) groups, (2) measurement of moderator variables to determine which intervention works best for whom, (3) specificity of outcome measures, and (4) follow-up assessment, including effectiveness of future patient care.

r-Mode Oscillations in Rotating Magnetic Neutron Stars

We show that r-mode oscillations distort the magnetic fields of neutron stars and that their occurrence is likely to be limited by this interaction. If the field is greater, similar1016(Omega/OmegaB) G, where Omega and OmegaB are the angular velocities of the star and at which mass shedding occurs, r-mode oscillations cannot occur. Much weaker fields will prevent gravitational radiation from exciting r-mode oscillations or will damp them on a relatively short timescale by extracting energy from the modes faster than gravitational-wave emission can pump energy into them. For example, a 1010 G poloidal magnetic field that threads the star's superconducting core is likely to prevent the l=2 mode from being excited unless Omega exceeds 0.35OmegaB. If Omega is larger than 0.35OmegaB initially, the l=2 mode may be excited but is likely to decay rapidly once Omega falls below 0.35OmegaB, which happens in less, similar15 days if the saturation amplitude is greater, similar0.1. The r-mode oscillations may play an important role in determining the structure of neutron star magnetic fields.

On the Maximum Mass of Differentially Rotating Neutron Stars

We construct relativistic equilibrium models of differentially rotating neutron stars and show that they can support significantly more mass than their nonrotating or uniformly rotating counterparts. We dynamically evolve such "hypermassive" models in full general relativity and show that there do exist configurations that are dynamically stable against radial collapse and bar formation. Our results suggest that the remnant of binary neutron star coalescence may be temporarily stabilized by differential rotation, leading to delayed collapse and a delayed gravitational wave burst.

The construct of control in mind-body medicine: implications for healthcare

Research suggests that one of the principal reasons patients are attracted to alternative medicine is that they find many of these therapies more congruent with their philosophical orientation toward health. Many mind-body approaches, which are some of the most frequently used classifications of complementary and alternative therapies, grow out of research demonstrating the important role of psychological factors in treating and preventing illness. This article reviews research on one such factor--control--and its importance in health. Studies demonstrating the following are highlighted: (1) illness frequently results in feelings of loss of control; (2) gaining a sense of control can help patients to cope with illness; (3) whereas control may influence physiological function and health outcomes, the amount of active control we can exercise over physical functioning and health is limited; and (4) it is important to match control strategies to patient control styles and preferences. The implications of mind-body studies are also discussed.

Effects of mindfulness-based stress reduction on medical and premedical students

The inability to cope successfully with the enormous stress of medical education may lead to a cascade of consequences at both a personal and professional level. The present study examined the short-term effects of an 8-week meditation-based stress reduction intervention on premedical and medical students using a well-controlled statistical design. Findings indicate that participation in the intervention can effectively (1) reduce self-reported state and trait anxiety, (2) reduce reports of overall psychological distress including depression, (3) increase scores on overall empathy levels, and (4) increase scores on a measure of spiritual experiences assessed at termination of intervention. These results (5) replicated in the wait-list control group, (6) held across different experiments, and (7) were observed during the exam period. Future research should address potential long-term effects of mindfulness training for medical and premedical students.

Ultrasonographic diagnosis of recurrence after excision of an interdigital neuroma

We retrospectively reviewed the records of 20 patients (21 feet) with previous interdigital neuroma resections and symptoms suggestive for, but not diagnostic of, recurrent neuroma. Sonography was performed when clinical findings supplemented by local anesthetic block did not conclusively confirm the presence of recurrent neuroma. Studies performed in 13 patients (14 feet) were positive for recurrent neuromas. Three studies were indeterminate. The remaining four studies were negative for recurrent neuroma. The ultrasound studies were performed at an average of 19.2 months (range, 2-82 months) after the resection. Nine patients with 11 previous interdigital neuromas underwent ultrasonographic examination of the forefoot and subsequent revision neuroma resection. At surgery, gross and histologic findings were consistent with recurrent neuroma in 10 of 11 cases; one patient was found to have metatarsal-phalangeal synovitis. Ultrasonography appears to be a useful means for confirming neuroma recurrence in patients with symptoms after interdigital neurectomy when the diagnosis is not clear on physical examination.

Frequency of low level bacteremia in infants from birth to two months of age

BACKGROUND

The frequency of low level bacteremia (< or = 10 colony-forming units/ml) in infants from birth to 2 months of age and the optimal volume of blood and number of blood cultures to be collected have not been well-documented. During 1991 guidelines at this hospital for collection of blood for culture from these infants were revised.

METHODS

Blood from each infant with suspected bacteremia was usually inoculated into an Isolator 1.5 Microbial Tube (1.5 ml of blood) and a bottle of anaerobic broth (0.5 to 3.0 ml of blood). The use of a second Isolator tube and the total blood volume recommended for culture (2 to 6 ml) depended on the weight and total blood volume of each infant.

RESULTS

Forty-four bacterial pathogens were recovered from the blood of 40 (2.5%) of 1589 infants. Of 34 infants from whose blood the concentration of pathogens could be determined, 23 (68%) had low level bacteremia. Of 50 isolates of pathogens recovered from Isolator cultures, 32 (64%) were detected in counts of < or = 10 colony-forming units/ml. When 2 or 3 blood culture devices were inoculated with a total of 2 to 6 ml of blood from each infant, significantly more cases of bacteremia were detected (34 (3.0%) of 1126 infants had positive blood cultures) than when only one culture device containing < or = 1.5 ml of blood was used (2 (0.5%) of 398 infants had positive blood cultures; P = 0.008). However, when 4 or more culture devices were inoculated with a total of > 6 ml of blood from each infant (5 (7.7%) of 65 infants had positive blood cultures), the difference in recovery of pathogens compared with the culturing of from 2 to 6 ml of blood per infant was not significant (P = 0.089).

CONCLUSIONS

Low level bacteremia was common in our infants' patient population. The culturing of up to 6 ml of blood which represented up to 4.5% of an infant's total blood volume was required for detection of the pathogens.

Foreign bodies in small arteries after use of an infusion microcatheter

Over a 31-month period, we performed four neurointerventional procedures after which unexpected foreign bodies were noted in multiple arteries. All four procedures had in common the use of Fastracker-18 infusion microcatheters. Histologically, the intravascular debris looked strikingly similar to the hydrophilic coating on the catheter. An in vitro test mimicking clinical use of the microcatheter revealed that the hydrophilic coating can separate from the catheter. Until the coating is refined to make it more resistant to stripping, it may be advisable to reduce the amount of back-and-forth movement of these microcatheters if they have been positioned through guide catheters with small inner diameters and angled tips.

Sonographic evaluation of interdigital neuromas

Fifty surgical patients with symptoms suggestive of Morton's neuroma underwent preoperative ultrasound examination of the forefoot using a 7.5 MHz transducer. Fifty-five neuromas were excised. Of these, one neuroma had a ganglion associated with it and five neuromas were recurrent. Four feet had adjacent neuromas. Ultrasound accurately predicted the presence, location and size of the neuromas in 98% of the cases. There were no false positives. In all cases in which a neuroma was predicted by ultrasound, it was confirmed grossly at the time of surgery and later by histological exams. We conclude that ultrasound is an accurate technique in the diagnosis of interdigital neuromas.