• Lecture close
• Neuroinformatics close

Purpose: Over 140 000 Australians live with aphasia after stroke, with this number of people living with aphasia increasing significantly when aphasia arising from traumatic brain injury, neoplasm, and infectious and progressive neurological diseases is also included. The resulting communication disability frequently compromises every aspect of daily life, significantly impacting everyday activity, employment, social participation, mental health, identity, and family functioning. Rehabilitation services rarely meet the needs of this group who have, for example, poorer healthcare outcomes than stroke peers without aphasia, nor address long-term recovery and support needs.Method: In this discussion paper, I argue that given the broad impacts of aphasia, a biopsychosocial approach to aphasia rehabilitation is required. Rehabilitation must include: interventions to improve the communication environment; programs that directly target identity, wellbeing, and mental health; and therapies focusing on functional activity, communication participation, and long-term self-management.Result: The evidence for these approaches is mounting and includes strongly stated consumer needs. I discuss the need for multidisciplinary involvement and argue that for speech-language pathologists to achieve such comprehensive service provision, an expanded scope of practice is required.Conclusion: There is a need to rethink standard therapy approaches, timeframes, and funding mechanisms. It is time to reflect on our practice borders to ask what must change and define how change can be achieved.

Several methods of measuring coronary blood flow in intact conscious man are reviewed, on the basis of personal contributions or the experiences of our teams.It is important to distinguish between global, regional and transmural blood flow measurements. The advantages and limitations of the following methods are discussed: diffusible inert and radioactive tracers, dye dilution, roentgendensitometry, magnetic resonance imaging and contrast echocardiography. In interventional cardiology it is most important to be able to measure flow through single coronary vessels. Information on coronary artery Doppler velocity during vasodilation and at rest is less useful than the concept of fractional flow reserve. This is based on pressure measurements under maximal vasodilation to ascertain the presence of borderline flow-limiting lesions. This information is necessary in order to decide whether to proceed with angioplasty or not.The historical design of percutaneous coronary angioplasty and beta-irradiation of coronary restenosis, established under the author's guidance, are put into perspective. The author pays tribute to many excellent colleagues who worked with him at the Zurich and Geneva University Hospitals.

This is a review of the symposium entitled Controversial Topics in Shoulder Arthroscopy 2001, presented at the Arthroscopy Association of North America 20th Annual Meeting in Seattle, Washington in April of 2001. The covered topics include micro-instability, partial thickness rotator cuff tears, pathology of the biceps tendon, and thermal capsulorrhaphy.

Work in our laboratory has focused on the mechanisms by which cytokines can influence the brain and behavior in humans and non-human primates. Using administration of interferon (IFN)-alpha as a tool to unravel these mechanisms, we have expanded upon findings from the basic science literature implicating cytokine-induced changes in monoamine metabolism as a primary pathway to depression. More specifically, a role for serotonin metabolism has been supported by the clinical efficacy of serotonin reuptake inhibitors in blocking the development of IFN-alpha-induced depression, and the capacity of IFN-alpha to activate metabolic enzymes (indolamine 2,3 dioxygenase) and cytokine signaling pathways (p38 mitogen activated protein kinase) that can influence the synthesis and reuptake of serotonin. Our data also support a role for dopamine depletion as reflected by IFN-alpha-induced changes in behavior (psychomotor slowing and fatigue) and regional brain activity, which implicate the involvement of the basal ganglia, as well as the association of IFN-alpha-induced depressive-like behavior in rhesus monkeys with decreased cerebrospinal fluid concentrations of the dopamine metabolite, homovanillic acid. Neuroimaging data in IFN-alpha-treated patients also suggest that activation of neural circuits (dorsal anterior cingulate cortex) associated with anxiety and alarm may contribute to cytokine-induced behavioral changes. Taken together, these effects of cytokines on the brain and behavior appear to subserve competing evolutionary survival priorities that promote reduced activity to allow healing, and hypervigilance to protect against future attack. Depending on the relative balance between these behavioral accoutrements of an activated innate immune response, clinical presentations may be distinct and warrant individualized therapeutic approaches.

‘To keep in equilibrium’, one of the Oxford English Dictionary’s many definitions of balance, is a desirable target for anylife, but has special meaning for the life of a person with diabetes. Achieving balance—between hypo- and hyperglycaemia; between energy intake and energy consumption; between insulin action and insulin secretion; between attention to diabetes and attention to everything else—remains challenging, but progress has been made over the last three decades, both in our understanding of how nature achieves balance and in the tools we have to try to reproduce the actions of nature in disease states. In particular, the role of the brain in controlling diabetes, from glucose sensing to decision making, has been investigated. Physiological and neuro-imaging studies are finally being translated into patient benefit, with the aim of improving, as Dr Banting put it, the provision of ‘energy for the economic burdens of life’.

The correct diagnosis of epilepsy leads to an appropriate treatment.The first step is to distinguish epileptic seizures from nonepileptic attacks, and to make a precise seizure diagnosis and classification. The next step is to identify the etiology or basic disorders underlying the epilepsy by physical and neurologic examinations, laboratory tests, including EEGs and neuroradiologic examinations. Although the EEG is the most important laboratory examination for the diagnosis of epilepsy, limitations of EEG interpretations must be recognized.A syndromic classification of the patients, to determine whether they fit known syndromes, should be attempted. If patients do not match a described syndrome, a neurobiologic approach, utilizing genetic, neurophysiological, and neuropharmacologic knowledge, alternatively provides useful information to understand the neurobiologic background of epilepsy.Both approaches have advantages and disadvantages for diagnosing and treating epilepsy. Both approaches can be used interchangeably with patients with seizure disorders, depending upon their condition. The epilepsy diagnosis, etiology, and seizure-type diagnosis should be reevaluated when seizure control is insufficient with first- and second-line antiepileptic drugs.

Contains fulltext : 139156.pdf (Publisher’s version ) (Open Access) Inaugurele rede, 26 september 2013 22 p.