Cognitive and behavioural impairment among elderly people in institutions providing different levels of care.

OBJECTIVE: To compare the prevalence and degree of cognitive and behavioural impairment in elderly patients in institutions providing different levels of care. DESIGN: Prevalence study. SETTING: A nursing home, a home for the aged and psychogeriatric wards in a provincial psychiatric hospital. PATIENTS: Only subjects 65 years of age or older were eligible for inclusion. A random sample was selected comprising 25% of the residents in the nursing home and the home for the aged; of the 119 asked to participate 95 agreed (44 in the nursing home and 51 in the home for the aged). All 50 on the psychogeriatric wards agreed to participate. MAIN OUTCOME MEASURES: The Mini-Mental State Examination (MMSE) and the Kingston Dementia Rating Scale (KDRS). RESULTS: An MMSE score of less than 24 (cognitive impairment) was given to 37 (84%) of the residents in the nursing home, 43 (84%) of those in the home for the aged and 48 (96%) of the patients in the psychiatric hospital; the corresponding numbers for a KDRS score of more than 0 (cognitive impairment) were 41 (93%), 48 (94%) and 50 (100%). The seven patients receiving the highest level of care at the home for the aged (special care) had more behavioural problems than those in the psychiatric hospital did (p less than 0.001). CONCLUSIONS: Cognitive and behavioural impairment was widespread in the three institutions regardless of the level of care. When planning services and allocating resources government funding agencies should consider the degree and prevalence of such impairment among elderly people in institutions.

Long-term amiodarone administration protects against global myocardial ischemia.

Reports on the effects of amiodarone on cardiac function have been variable. This study addresses the effect of long-term amiodarone administration on recovery of cardiac function after a period of global ischemia. Normotensive and spontaneously hypertensive rats were used. Normotensive rats (n = 6) received 240 mg/kg amiodarone for 4 weeks, for a total of 72 +/- 3 mg. Hypertensive rats (n = 6) received 500 mg/kg amiodarone for 4 weeks, for a total of 116 +/- 5 mg. Final myocardial concentrations of amiodarone and desethylamiodarone were 1.85 +/- 1.75 and 0.50 +/- 0.61 micrograms/g wet weight for the normotensive rats and 1.30 +/- 0.58 and 0.31 +/- 0.17 micrograms/g for the hypertensive rats (p = nonsignificant). Equal numbers of controls received sterile saline solution for 4 weeks. The hearts were excised and perfused in a Langendorff apparatus. The results indicate that, after 15 minutes of normothermic ischemia, hearts treated with this relatively low dose of amiodarone recovered a greater percentage of preischemic work (97% +/- 13%) as compared with the controls (76% +/- 17%) (p less than 0.005).

Adolescent suicide: character traits of high-risk teenagers.

Adolescent suicide rates are increasing and are currently higher than ever recorded. Thus, it has become essential for health professionals, counselors, and parents to become familiar with characteristics of the high-risk teenager. This article examines personality traits and life circumstances which place an adolescent at higher risk for suicide. Among the variables examined are: depression, acute suicidal behavior, poor family relationships, alcohol and drug use, recent loss, failure in school, and other characteristics. As adolescents pass through difficult life stages successfully, teenage suicides will decrease. Professional helpers and parents must be able to recognize the signs which are discussed and take an active role in prevention and/or intervention.

Deep-penile-vein arterialization for arterial and venous impotence.

Eleven impotent men underwent deep-penile-vein arterialization after preoperative assessment by a multidisciplinary team. Penile Doppler pressures, testosterone levels, and nocturnal penile tumescence were used to establish a vasculogenic etiology. Cavernosography, artificial erection by saline infusion, and selective hypogastric arteriography were obtained to delineate whether arterial, venous, or mixed (arterial/venous) factors predominated. Penile revascularization consisted of femoral artery to deep-penile-vein saphenous bypass, with ligation of superficial veins at the base of the penis in patients with venous leakage. Cumulative graft patency was 91% up to 20 months. There were no deaths. The average preoperative flow requirement of values greater than 250 mL/min was reduced to 59 mL/min postoperatively. Follow-up results of nocturnal penile tumescence were excellent in four of four patients with venous (venous leakage), two of three patients with arterial, and one of four patients with mixed factors. Deep-penile-vein arterialization appears to be beneficial for impotence secondary to venous leakage, with inconsistent results for arterial and mixed factors.

Transfemoral placement of intraluminal polyurethane prosthesis for abdominal aortic aneurysm.

Because of the significant mortality associated with the conventional surgical approach to abdominal aortic aneurysms (AAA) in the high risk patients and in those with ruptured aneurysms, we have developed a new approach to this problem, intraluminal aneurysm exclusion. This was achieved by an intraluminal prosthesis which approximated the diameter of the aorta above and below the aneurysm and is inserted through the femoral artery. The prosthesis consisted of biomedical grade elastomeric polyurethane with a NITINOL and/or stainless steel frame and was designed in such a configuration that it could be compressed inside a 15 F catheter and then regain its original shape after being discharged inside the aorta. The polyurethane prosthesis tolerated static pressures in excess of 300 Torr. Aneurysmal aortas were created in three adult sheep using large knitted Dacron pathches (6 X 9 cm) sewn onto a longitudinal aortotomy. After 4-6 weeks, an intraluminal prosthesis was passed transfemorally to the location of the aortic aneurysm. Following satisfactory placement and expansion of the prosthesis, a laceration was produced in the aneurysmal wall. No bleeding developed, which confirmed the integrity of the prosthesis in excluding the aneurysm from the aorta proper. Pulsation in the iliac arteries indicated the presence of aortic blood flow through the prosthesis. Autopsy examination demonstrated directly that the prosthesis was open and that its two ends were fixed in the aorta above and below the aneurysm. The study has demonstrated that intraluminal AAA exclusion could be achieved with an intraluminal polyurethane prosthesis inserted through the femoral artery.

Dacron vs vein for femoropopliteal arterial bypass. Should the saphenous vein be spared?

The increasing need for the saphenous vein to bypass lesions of the coronary and other small arteries prompts a reconsideration of its routine use for femoropopliteal bypass. Evaluation after five years in 124 consecutive patients (135 procedures) demonstrated no significant difference in overall definitive patency between venous grafts (63%) and Dacron prostheses (65%). Dacron prostheses were avoided when below-knee anastomoses were required, but when the distal anastomoses were made above the knee, the five-year patency for veins and Dacron was equal (67%). Although the quality of the distal runoff influenced the long-term patency, effects were similar for veins and for Dacron. The data support the use of Dacron prostheses for femoropopliteal bypass proximal to the knee joint, allowing preservation of the saphenous vein for possible use elsewhere.

Effects of 2-ethylamino-1,3,4-thiadiazole on hepatic adenosine nucleotides in experimental hemorrhagic shock.

2-Ethylamino-1,3,4-thiadiazole (EAT), originally tested as a cancer chemotherapeutic agent, has been shown to increase the de novo synthesis of purines. To evaluate its effects on hepatic adenosine nucleotides in hemorrhagic shock, EAT was administered to dogs prior to bleeding. Concentrations of uric acid and allantoin in serum and lymph were also measured as additional indices of purine metabolism in the dog. During oligemia, the adenosine triphosphate (ATP) in serial liver biopsies fell to half of the control values in treated and untreated groups. After reinfusion, the APT and total adenosine nucleotides increased in both groups but were significantly higher in treated than in untreated control animals (P less than 0.05). In treated animals the hepatic ATP reached 93% and 109% of initial values at one and three hours after reinfusion, respectively. Corresponding values were 63% and 80% in surviving untreated control animals. During oligemia and after reinfusion, the uric acid was increased in both groups but remained significantly lower in treated than in untreated animals. The arterial pressure of treated animals remained higher after reinfusion than in untreated animals. Studies in oligemic rats demonstrated significantly greater survival in EAT-treated animals than in untreated controls. The data suggest that pretreatment with EAT results in improved recovery of the hepatic adenosine nucleotide pool and increased survival of oligemic animals, which may be related to the greater availability of substrates for synthesis of the adenosine nucleotides.

Septic shock: hemodynamics of endotoxin and inflammation.

PIP: Observations were made in 53 mongrel dogs, in which a nonseptic inflammatory lesion was induced by intramuscular injection of 10% calcium chloride into 1 thigh, to evaluate the relationship between bacterial endotoxin and the active hyperemia of inflammation. 4 days after lesion induction, the inflammatory lesion was associated with an increase in blood flow (91% greater than in normal limb) and a corresponding reduction in vascular resistance in the limb. The arteriovenous oxygen difference was decreased, and the calculated oxygen consumption was 26% greater than that in the normal limb. E. coli endotoxin administration (.2 mg/kg) was associated with a marked reduction in blood flow and increased vascular resistance in both inflamed and normal limbs. Prior administration of methylprednisolone (30 mg/kg) or phenoxybenzamine (1 mg/kg) did not greatly alter these changes. Expansion of the circulating blood volume with dextran -70 solution was followed by a marked increase in flow and reduction in vascular resistance in the normal and inflamed limbs. Therefore, the active hyperemia of inflammation may add significantly to demands on circulation. The hyperdynamic state is reduced after administration of endotoxin and returns when the circulating blood volume is increased above normal by the infusion of dextran. A discussion by a panel follows the article.^ieng