Low levels of high-density lipoprotein cholesterol are a marker of disability in the elderly.

BACKGROUND: In the elderly, high-density lipoprotein cholesterol (HDL-C) seems to have further clinical meanings besides the inverse relationship with coronary heart disease (CHD); indeed, low values have been found in elderly subjects with functional disability, chronic illness, and in severe clinical conditions. OBJECTIVE: To verify the hypothesis that low HDL-C might be a 'marker' for disability, we evaluated the relationship between lipoprotein parameters and functional status, over a period of 2 years, in a large sample of institutionalized elderly. METHODS: 344 institutionalized subjects aged over 65 years were studied. They were divided into two groups according to basal disability level: 'low-mild': class A-E, and 'high': class F-G of the Katz index. 124 survivors, independent in at least two basic activities of daily living (BADL) at enrollment, were divided into two groups on the basis of 2 years' modifications in functional status: stable/improved or worsened (lost >/=2 BADL). RESULTS: Total cholesterol, LDL-C, HDL-C, and apo A-I levels were lower in the high disability group, while no differences in triglycerides and apo B levels emerged. Multiple logistic regression analysis showed that severe disability was associated with HDL-C (II vs. III tertile: OR 2.01; CI 95% 1.04-3.91; I vs. III tertile: OR 2.52; CI 95% 1.23-5. 15), total cholesterol (I vs. III tertile: OR 2.35; CI 95% 1.14-4. 81), blood glucose (OR 0.98), and body mass index (OR 0.91), independently from uric acid, number of pathologies, number of drugs, body cell mass, vitamin B(12) and folic acid plasma levels, waist/hip ratio, age, and gender. Subjects who lost >/=2 BADL in the 2-year follow-up consistently showed lower basal HDL-C levels compared to subjects with stable/improved functional status, and this difference was significant after adjustment for basal Katz class, age, gender, number of pathologies, blood glucose, body mass index, and waist/hip ratio. CONCLUSIONS: The results of this study suggest that in the elderly severe disability is strongly associated with low HDL-C levels. Longitudinal data support the hypothesis that low HDL-C might be considered as a marker for 'ongoing' disability in BADL.

Disability is associated with malnutrition in institutionalized elderly people. The I.R.A. Study. Istituto di Riposo per Anziani.

Several factors, such as disability, malnutrition, weight loss, and the interactive effect of diseases and aging have been associated with morbidity and mortality in the elderly population. Nevertheless, the relationship between disability and biological parameters has not been extensively investigated as a primary focus. In a cross sectional survey, 344 institutionalized elderly subjects were evaluated. Disability was measured according to the Katz index, and patients were divided into three groups: low (0-1 lost ADL), mild (2-4 lost ADL), and severe (5-6 lost ADL). Anthropometric, metabolic, and nutritional parameters were assessed; age, gender, number of pathologies, and number of drugs were also recorded. Data were analyzed by multiple comparison of means according to Scheffé, and by multivariate logistic regression analysis. An impairment in functional status was associated with several modifications in biological parameters. Logistic regression analysis showed that severe disability (5-6 lost ADL) was associated with low waist/hip ratio (< 0.9 vs > 0.9, OR: 1.56, CI 95%: 1.08-2.25), high body resistance (> 625 vs < 575 omega, OR: 1.39, CI 95%: 1.38-1.39), low plasma albumin levels (< 3.5 vs > 4.0 g/dL, OR: 6.02, CI 95%: 5.18-6.85), and low plasma transferrin levels (< 200 vs > 250 mg/dL, OR: 5.47, CI 95%: 4.56-4.58) independently of age, gender, comorbidity, and other confounding factors. Our results indicate that severe disability in ADL is strongly associated with anthropometric and biohumoral parameters suggesting the presence of malnutrition. A careful evaluation of the nutritional state appears to be of primary importance, and efforts to improve nutritional status are needed in approaching disabled elderly patients.

Metastatic spread of benign intracranial meningioma.

A case of benign meningioma of the superior sagittal sinus is reported, which recurred three times during a period of six years. At the time of the first recurrence the overlying bone was eroded and the tumor grew subcutaneously; the second recurrence was associated with a pulmonary metastatic deposit of extraordinary size. The literature dealing with remote extracranial spread of meningiomas is briefly reviewed.

Intracranial microvascular decompression for "cryptogenic" hemifacial spasm, trigeminal and glossopharyngeal neuralgia, paroxysmal vertigo and tinnitus: I. Surgical technique and results.

Intracranial microvascular decompression was performed in 21 out of 24 patients with hyperactive dysfunction of cranial nerves: 8 cases of hemifacial spasm, 12 of trigeminal neuralgia, 3 of glossopharyngeal neuralgia and 1 case of paroxysmal vertigo and tinnitus. In 21 cases an abnormal vascular loop was found to impinge on the root entry zone of the nerve in the brainstem. Dissection of this loop with decompression of the nerve resulted in long-lasting relief of symptoms in all but two patients who presented early recurrence; in one of these a second procedure was eventually successful. In two patients with trigeminal neuralgia a benign tumor of the cerebellopontine angle that had escaped preoperative diagnosis was present. Finally, in one case no compressive lesions were found. From the data of the literature and from our present experience microvascular decompression can be considered a safe as well as an effective procedure, affording a high success rate in conditions often or usually resistant to medical treatment and erroneously considered "idiopathic".

Decreased phenytoin level during antineoplastic therapy: a case report.

We report a case of interaction between anticonvulsant and antineoplastic drugs in one male patient with seizures from brain tumour. The patient was treated with phenytoin (PHT), phenobarbital (PB), and an antineoplastic protocol based on a combination regimen with carmustine (BCNU), vinblastin (VLB), methotrexate (MTX), and radiotherapy. Plasma concentrations of PHT fell from 9.4 to 5.6 micrograms/ml 24 h after VLB administration, and remained low for at least 10 days. During this period, partial seizures occurred. Plasma concentrations of PB were unchanged during the period of observation. It is suggested that impaired absorption of PHT, caused by VLB or MTX or both, is responsible for this interaction.

Rare complication in the surgical therapy of hydrocephalus with ventriculo-peritoneal shunt.

Two cases of an unusual complication in ventriculo-peritoneal shunt for childhood's hydrocephalus are described. Migration of the distal part of shunt into peritoneal cavity was observed. Symptomatology, diagnostic and treatment are reported.