Scientists have been able to reach into the mind of a brain-damaged man and communicate with his thoughts. The research, carried out in the UK and Belgium, involved a new brain scanning method. Awareness was detected in three other patients previously diagnosed as being in a vegetative state. The study in the New England Journal of Medicine shows that scans can detect signs of awareness in patients thought to be closed off from the world. Patients in a vegetative state are awake, not in a coma, but have no awareness because of severe brain damage. The scientists used functional magnetic resonance imaging (fMRI) which shows brain activity in real time.
Brain imaging has allowed a man who was previously considered unconscious to answer a series of yes-or-no questions. The study, published this week in the New England Journal of Medicine1, challenges clinicians' definition of consciousness and provides an unprecedented opportunity to communicate with those who show no outward signs of awareness.
Background The differential diagnosis of disorders of consciousness is challenging. The rate of misdiagnosis is approximately 40%, and new methods are required to complement bedside testing, particularly if the patient's capacity to show behavioral signs of awareness is diminished. Conclusions These results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition. Careful clinical examination will result in reclassification of the state of consciousness in some of these patients. This technique may be useful in establishing basic communication with patients who appear to be unresponsive.
Despite the importance of diagnostic accuracy, the rate of misdiagnosis of VS has not substantially changed in the past 15 years. Standardized neurobehavioral assessment is a more sensitive means of establishing differential diagnosis in patients with disorders of consciousness when compared to diagnoses determined by clinical consensus.
Women and Heart Disease The Role of Diabetes and Hyperglycemia Elizabeth Barrett-Connor, MD; Elsa-Grace V. Giardina, MD; Anselm K. Gitt, MD; Uwe Gudat, MD; Helmut O. Steinberg, MD; Diethelm Tschoepe, MD Arch Intern Med. 2004;164:934-942.
The morbidity, mortality, expense and transient benefits of a high technology approach toward the coronary disease epidemic, has failed. It is time to realize that the answer to a faulty lifestyle epidemic is not drugs and technology – it is lifestyle.
Modern cardiology has given up on curing heart disease. Its aggressive interventions-- coronary artery bypass graft, atherectomy, angioplasty, and stenting--do not reduce the frequency of new heart attacks or prolong survival except in small subsets of pa
Our patient exemplified the challenges involved in a CTO, which included the length of the lesion, the lack of a proximal nipple, the presence of a side branch at the occlusion point, poor visualization of the distal vessel despite contralateral injection