PET and SPECT Imaging in Hyperkinetic Movement Disorders

Movement disorders can be classified in hypokinetic (e.g., Parkinson's disease, PD) and hyperkinetic disorders (e.g., dystonia, chorea, tremor, tics, myoclonus, and restless legs syndrome). In this chapter, we will discuss results from positron emission tomography (PET) and single photon emission computed tomography (SPECT) imaging studies in patients with tremor, tics, myoclonus, and restless legs syndrome. Most studies in patients with tremor included patients with essential tremor (ET): a bilateral, largely symmetric, postural or kinetic tremor mainly involving the upper limbs and sometimes the head. Other studies evaluated patients with orthostatic tremor (OT): an unusually high frequent tremor in the legs that mainly occurs when patients are standing still. Increased regional cerebral blood flow (rCBF) and increased glucose metabolism have been found in the cerebellum, sensorimotor cortex, and thalamus in both patients with ET and OT compared to controls. Both PET and SPECT studies have evaluated the dopamine system in patients with ET and OT. Most imaging studies in patients with ET showed no, or only subtle loss of striatal tracer binding to the dopamine transporter indicating that ET is not characterized by nigrostriatal cell loss. The serotonin and/or gamma-aminobutyric acid (GABA) systems may play a role in the pathophysiology of ET. PET and SPECT imaging of the dopamine and serotonin system in patients with OT showed no abnormalities. Tics, the clinical hallmark of Gilles de la Tourette syndrome (TS), are relatively brief and intermittent involuntary movements (motor tic) and sounds (phonic tic). The essential features of tics are that (1) they can be temporarily suppressed; after suppression a rebound usually occurs with a flurry of tics; (2) the patient experiences an urge to tic, and (3) the tic is followed by a short moment of relief. Using 18F-FDG PET, it was shown that TS is a network disorder where multiple brain areas are active or inactive at the same time. The exact composition of this network is yet to be determined. Using rCBF PET and SPECT many brain regions were found to be abnormal, however, tics mostly correlated with hypoperfusion of the caudate nucleus and cingulate cortex. Both dopamine and serotonin are likely to play a role in the pathophysiology of TS. It is hypothesized that TS is characterized by low serotonin levels that modulate increased phasic dopamine release. Myoclonus is defined as a brief muscle jerk and occurs in many neurologic and non-neurologic disorders. Imaging with PET and SPECT in patients with myoclonus mainly showed abnormalities consistent with the underlying disorder. We described PET and SPECT imaging results in patients in which myoclonus was a prominent symptom. Hypoperfusion and/or hypometabolism of the frontoparietal cortex was found in patients with negative epileptic myoclonus, Alzheimer's disease, corticobasal degeneration, Creutzfeldt-Jakob disease, fatal familiar insomnia, and posthypoxic myoclonus. Other findings that were frequently reported were decreased rCBF and/or glucose metabolism in the cerebellum and thalamus and abnormalities in the dopamine system. Restless legs syndrome (RLS) is defined as an urge to move the legs accompanied with an unpleasant sensation in the legs or in another body part that is especially present during the evening and night and that can be accompanied by periodic limb movements in sleep (PLMS). Imaging studies in these patients have mainly focused on the dopamine system. Most PET studies found decreased tracer binding to the dopamine transporter, although this was not found in SPECT studies. Both PET and SPECT studies showed conflicting results regarding dopamine D2/3 receptor binding: both increased and decreased tracer binding was reported. Furthermore, it is likely that the serotonin and opioid systems also play a role in the pathophysiology of RLS.</p

Nursing Activities Score as a predictor of family satisfaction in an adult Intensive Care Unit in Greece

Aim: To study family satisfaction with care in an Intensive Care Unit (ICU) and its association with nursing workload estimated by the Nursing Activities Score (NAS). Background: Few previous studies have investigated the association between workload in ICUs and family satisfaction. Methods: Family Satisfaction ICU 24 (FS ICU-24) questionnaires were distributed to 161 family members (106 respondents). Questionnaires&apos; score, NAS measurements and Simplified Acute Physiology Score II (SAPS-II) data were analysed. Results: The mean total level of family satisfaction was equal to 80.72% (±9.59). Family members were more satisfied with the level of care compared with decision making. NAS values revealed a shortage of nurses in the morning shift. Moreover, there was a statistically significant positive correlation between NAS and total satisfaction after adjusting for age, length of stay and SAPS-II. Conclusions: Improvements in clinical practice require the measurement of care quality which particularly includes family satisfaction. Our results indicated that family members were less satisfied with decision making. Implications for nursing management: Nurse managers should plan for the successful involvement of family members in the decision-making process. Higher levels of nurse staffing might improve the care provided. © 2013 John Wiley &amp; Sons Ltd

Evaluation of the side-effects of chemotherapy in patients with cancer

No abstract available

Evaluation of the side-effects of chemotherapy in patients with cancer

No abstract available

Evaluation of the side-effects of chemotherapy in patients with cancer

Background: Cytotoxic chemotherapy destroys not only cancer cells but also normal healthy cells, leading to the occurrence of multiple side effects, the nature and extent of which depend on several factors. Aim: The purpose of this study was to explore the type and the intensity of the side effects and symptoms produced by anticancer agents. Method: The study sample comprised 153 cancer patients undergoing chemotherapy who were attending a one-day clinic for the administration of their chemotherapeutic agents in a private hospital in Athens from January 2007 to January 2008. Data collection was conducted using the M.D. Anderson Symptom Inventory (MDASI). Statistical analysis was performed using x -test of the Statistical Package for Social Sciences (SPSS) 16. The statistical significance level adopted was p<0.05. Results: Of the 153 cancer patients who participated, 49% were men and 51% women. Regarding gender differences, men more frequently reported experiencing intense pain (p=0.031), intense nausea (p=0.046) and vomiting (p=0.010), respiratory symptoms, (p=0.003), memory problems (p=0.009), severe diarrhoea (p=0.001) and severe constipation (p=0.001), symptoms which significantly affected their ability to walk (p=0.004). Conversely, women reported feeling more intense sadness than men (p=0.007). Compared to postmenopausal women, perimenopausal female patients reported experiencing more severe pain (p=0.004), fatigue (p=0.013), nausea (p=0.001),anxiety (p=0.016), respiratory symptoms (p≤0.001), anorexia (p=0.005), sadness (p≤0.001) and diarrhoea (p=0.003). These symptoms exerted a negative effect on the perimenopausal women's general activity (p=0.001), mood (p=0.003), their work and housekeeping (p=0.002), interpersonal relationships (p=0.023), walking (p=0.003) and their capacity to enjoy life (p=0.003).Regarding the specific type of anticancer treatment, patients undergoing chemotherapy with concurrent radiotherapy more frequently reported mild pain (p=0.031) and intense nausea, anxiety and anorexia (p=0.042, p=0.022, p=0.021, respectively). Finally, regarding the type of the chemotherapy regime received, those patients receiving taxane-based regimes more often reported intense anorexia (p=0.032), a sense of dryness of the mouth (p=0.027) and severe cough (p=0.001). Conversely, patients undergoing platinum-based chemotherapy treatment reported memory deficits of greater severity (p=0.027). Conclusions: The most frequent side effects of chemotherapy that were reported by the respondents in the present study included fatigue, mouth dryness, nausea, constipation, anorexia, vomiting, pain, sadness and anxiety. All these side-effects should be taken seriously into consideration during the planning of treatment, and arrangements should be made for individual nursing treatment to be applied

Evaluation of the side-effects of chemotherapy in patients with cancer [Article in Greek]

Background: Cytotoxic chemotherapy destroys not only cancer cells but also normal healthy cells, leading to the occurrence of multiple side effects, the nature and extent of which depend on several factors. Aim: The purpose of this study was to explore the type and the intensity of the side effects and symptoms produced by anticancer agents. Method: The study sample comprised 153 cancer patients undergoing chemotherapy who were attending a one-day clinic for the administration of their chemotherapeutic agents in a private hospital in Athens from January 2007 to January 2008. Data collection was conducted using the M.D. Anderson Symptom Inventory (MDASI). Statistical analysis was performed using x -test of the Statistical Package for Social Sciences (SPSS) 16. The statistical significance level adopted was p<0.05. Results: Of the 153 cancer patients who participated, 49% were men and 51% women. Regarding gender differences, men more frequently reported experiencing intense pain (p=0.031), intense nausea (p=0.046) and vomiting (p=0.010), respiratory symptoms, (p=0.003), memory problems (p=0.009), severe diarrhoea (p=0.001) and severe constipation (p=0.001), symptoms which significantly affected their ability to walk (p=0.004). Conversely, women reported feeling more intense sadness than men (p=0.007). Compared to postmenopausal women, perimenopausal female patients reported experiencing more severe pain (p=0.004), fatigue (p=0.013), nausea (p=0.001),anxiety (p=0.016), respiratory symptoms (p≤0.001), anorexia (p=0.005), sadness (p≤0.001) and diarrhoea (p=0.003). These symptoms exerted a negative effect on the perimenopausal women's general activity (p=0.001), mood (p=0.003), their work and housekeeping (p=0.002), interpersonal relationships (p=0.023), walking (p=0.003) and their capacity to enjoy life (p=0.003).Regarding the specific type of anticancer treatment, patients undergoing chemotherapy with concurrent radiotherapy more frequently reported mild pain (p=0.031) and intense nausea, anxiety and anorexia (p=0.042, p=0.022, p=0.021, respectively). Finally, regarding the type of the chemotherapy regime received, those patients receiving taxane-based regimes more often reported intense anorexia (p=0.032), a sense of dryness of the mouth (p=0.027) and severe cough (p=0.001). Conversely, patients undergoing platinum-based chemotherapy treatment reported memory deficits of greater severity (p=0.027). Conclusions: The most frequent side effects of chemotherapy that were reported by the respondents in the present study included fatigue, mouth dryness, nausea, constipation, anorexia, vomiting, pain, sadness and anxiety. All these side-effects should be taken seriously into consideration during the planning of treatment, and arrangements should be made for individual nursing treatment to be applied