Severe dysosmia is specifically associated with Alzheimer-like memory deficits in nondemented elderly retirees.

OBJECTIVES: To determine whether or not (1) impaired olfactory function is associated with impaired memory on neuropsychological testing in healthy retirees, and if so then (2) whether memory impairment is most consistent with a mesiotemporal rather than frontal system disorder. METHODS: 173 independent residents of a continuing care retirement community were studied. Subjects completed the University of Pennsylvania Smell Identification Test (UPSIT) and a battery of both general and specific cognitive measures that included the Mini-Mental State Examination (MMSE) and the Executive Interview (EXIT25). Subjects were examined twice over 3 years. RESULTS: UPSIT performance was normal in 21% and in the 'anosmic' range in 25% of subjects. Anosmic UPSIT performance was associated with significantly worse performance on all cognitive tests. However, only short-term verbal memory was independently associated with UPSIT-defined anosmia. This association remained significant after adjusting for the other cognitive and sociodemographic variables. The memory deficits of anosmic subjects were qualitatively consistent with a cortical type (type 1) dementing illness such as Alzheimer's disease (AD). Over time, UPSIT-defined 'anosmic' cases suffered significantly greater declines on both the MMSE and the EXIT25, independently of baseline age, gender and MMSE score. CONCLUSIONS: Impaired odor identification in individuals without overt dementia is associated with an AD-like memory impairment and an increased rate of cognitive decline. The comorbid association of these deficits is consistent with the known hierarchical spread of preclinical AD pathology and may be a specific indicator of future clinical AD dementia.

El ejercicio físico en el manejo del fallo cardíaco: un nuevo paradigma / Physical exertion in the management of heart failure: a new paradigm

Reposo para el corazón y para el cuerpo, una medida general de supuesto gran valor en el tratamiento de pacientes con fallo cardíaco, es ahora ampliamente reconocida como un error, pues esto finalmente lleva a empeorar el deterioro clínico y funcional del paciente. Por el contrario, actualmente está bien demostrado que la prescripción adecuada de un programa de ejercicio no sólo mejora la capacidad del ejercicio y modifica varios parámetros de la fisiopatología de este síndrome, sino que además mejora la calidad de vida, y lo que es aún más importante, mejora el pronóstico al reducir la morbilidad y mortalidad en este grupo de pacientes. Todos estos conocimientos novedosos se han venido desarrollando durante los pasados 20 años, y actualmente no hay dudas acerca de los beneficios del entrenamiento con ejercicio en pacientes con fallo cardíaco, y por lo tanto, se convierte en un significativo cambio de paradigma sobre los conceptos clínicos, fisiopatológicos y terapéuticos de esta enfermedad. Con la evidencia presentada en este artículo, en el plan de manejo de cada paciente con fallo cardíaco debe estar incluido un programa de actividad física apropiadamente prescrito siempre y cuando no exista una contraindicación (AU)

Penetrating cardiac trauma: follow-up study including electrocardiography, echocardiography, and functional test.

A prospective study was carried out to analyze the evolution of patients who survived penetrating cardiac trauma. A total of 642 patients were evaluated. A 1-year follow-up, which included physical examinations, electrocardiography, echocardiography and stress tests, was completed in 192 patients. Data processing included calculation of average and percentage values. At follow-up, 90% of patients were asymptomatic at 2 days after surgery, with normal cardiac monitoring; baseline and control ECGs showed myocardial infarction in 9.1% of patients. Baseline ECGs showed pericarditis as well in 27% of patients and repolarization changes in 35.2%. The latter became normal within 1 to 6 months after the trauma. All (100%) of the patients had a functional status I stress test, and 56% had a normal echocardiography. In conclusion, the epidemiologic behavior of penetrating cardiac trauma is identical to that of general trauma. ECG is useful during the postsurgery period for diagnosis of traumatic myocardial infarction. Likewise, the stress test is useful in patients with myocardial infarction and echocardiography in the presence of either myocardial infarction or any symptom suggesting anatomic or functional alterations of the heart.

Clinical studies with d-TRP6-luteinizing hormone-releasing hormone in men with hypogonadotropic hypogonadism.

Three male patients, diagnosed to have hypogonadotopic hypogonadism, were treated with intramuscular injections of 10 microgram of D-Trp6-luteinizing hormone-releasing hormone (D-Trp6-LH-RH) every 8 hours for more than 90 days (13 to 17 weeks). The gonadotropin and testosterone concentrations reached levels twice as great during the treatment as those measured previously and on one occasion increased 5-fold. Before treatment, the patients were clinically in grade 1 on Tanner's scale (Growth at Adolescence, Second Edition. Oxford, Blackwell Scientific Publications, 1962) but after treatment they advanced to grades 2 to 4. Testicular sizes before treatment were between 2 and 2 according to the scales of Waaler et al. (Acta Paediatr Scand [Suppl]249:1, 1974) and afterwards between 4 and 10. The penis of one of the patients grew 3 cm. The testicular biopsy after treatment showed significant increases in the number of Leydig and Sertoli cells. After treatment, spermatogonia were present in increased number, together with a much higher population of cells corresponding to additional stages of development (spermatids). We are of the opinion that therapy with D-Trp6-LH-RH may be beneficial for such patients.

Clinical studies with d-Trp 6-luteinizing hormone-releasing hormone in anovulatory women.

Nine anovulatory patients with hypothalamic-pituitary dysfunction were treated with d-Trp6-luteinizing hormone-releasing hormone, an analog with far greater gonadotropin-releasing activity than luteinizing hormone-releasing hormone. Four of eight patients, who were formerly unsuccessfully treated with clomiphene, human chorionic gonadotropin, and human menopausal gonadotropin, ovulated after treatment with the peptide alone or with peptide preceded by clomiphene, and three became pregnant. The ninth patient, who had amenorrhea and anovulation due to excessive loss of weight caused by anorexia nervosa, also ovulated after treatment with the analog. These results demonstrate the effectiveness of this potent analog for induction of ovulation and pregnancy and point favorably toward clinical applications.

Levels of luteinizing hormone (LH), follicle-stimulating hormone, and 17 beta-estradiol in response to D-Trp6-LH-releasing hormone during different phases of the menstrual cycle in normal women.

PIP: The response of serum LH, FSH, and 17beta-estradiol (17b-E) to stimulation with D-Tryp6-LH-releasing hormone (LH-RH analog) was measured in 34 normal women. The analog was administered either by vein, muscle, or continuous iv infusion in doses from 1 to 50 mcg during different phases of the menstrual cycle. The increase in LH and FSH to 10 mcg analog was significant (p .05) in all phases of the menstrual cycle by 60 minutes postadministration and lasted for at least 8 hours. 17b-E increased significantly by 8 hours. LH-RH analog was 40 and 21 times more potent than LH-RH in the stimulation of LH and FSH, respectively, during the follicular phase. In the ovulatory phase, LH and FSH responses differed kinetically from their responses in the other phases, and gonadotropin release was both faster and greater. The gonadotropin responses of 3 men when compared with those of the female subjects were almost always smaller (p .05). Because of the greater potency of this LH-RH analog, it may be useful in the treatment of infertility.^ieng