Primary care intervention programme to improve early detection of hearing loss in the elderly.

OBJECTIVE: To improve audiology screening in general practice, using an intervention programme aiming to empower older adults and their general practitioners. METHODS: We conducted a quasi-experimental community study comparing 206 patients and two control groups (the first being 101 people registered with the same general practitioner, and the second 87 people registered with another general practitioner). Outcome measures were: rates of hearing tests in the six months before interview, and screening recommendation by the general practitioner. RESULTS: Amongst patients, there was a significant increase in numbers undergoing a hearing test, from 19 per cent before the intervention to 49 per cent two years later, while in the two control groups there was little change. Twenty-two per cent of patients and 19 per cent of the first control group reported that their physicians suggested undergoing a hearing test; the second control group subjects (whose general practitioners received no specific educational intervention) showed no change. CONCLUSION: The two crucial factors for improving hearing screening uptake in the elderly are general practitioner education and patient empowerment.

Intensive dietary intervention by a dietitian as a case manager among community dwelling older adults: the EDIT study.

BACKGROUND: Clinical trials that have assessed the best approach for treating under-nutrition in old age are scarce. OBJECTIVE: To determine the impact of an intensive nutritional intervention program led by a dietitian on the health and nutritional status of malnourished community dwelling older adults. METHODS: Sixty-eight eligible participants (age<75) were randomly assigned to a Dietetic Intervention Treatment (DIT), an intensive nutritional intervention led by a dietitian, or a Medical Treatment (MT), a physician-led standard care group, with an educational booklet regarding dietary requirements and recommendations for older adults. An additional 59 eligible participants who were unable to participate in the randomization were included as a non-randomized "untreated nutrition" group (UNG). RESULTS: Over the 6-month follow-up, the DIT group showed significant improvement in cognitive function (from 25.8±4.5 to 26.8±4, p=0.04), and depression score (from 7.3±3.9 to 5.4±3.9, p=0.04) compared with the change in the other 2 groups. The DIT group showed a significant improvement in intake of carbohydrates (+15% vs. +1% in the MT and +3% in the UNG), protein (+8% vs. +2% in the MT and -3% in the UNG), vitamin B6 (+20% vs. +7% in the MT and +8% in the UNG), and vitamin B1 (+22% vs. +11% in the MT and 0% in the UNG). The DIT group had a significantly lower cost of physician visits than the other 2 groups ($172.1±232.0 vs. $417.2±368.0 in the MT and $428.1±382.3 in the UNG, p=0.005). CONCLUSION: Intensive dietary intervention was moderately effective in lowering cost of services used and improving medical and nutritional status among community dwelling older adults.

Regression of transitional cell carcinoma of the bladder with radiotherapy: progression-free control in the bladder at 5 years.

The five-year survival and the local control in the bladder at 5 years were determined for 67 patients with transitional cell carcinoma of the bladder. These 67 patients had been included in a previous study of the regression of carcinoma of the bladder with radical radiotherapy. For these 67 patients treated with radiotherapy alone after transurethral biopsy or excision, the cause-specific 5-year survival was 38.4% (95% confidence interval (CI), 26.5-50.3%), with an overall survival of 31.1% (95% CI, 20-42.2%). The local control in the bladder was 42.6% (95% CI, 29.2-56.0%) at 5 years.

[Correlation between levels of prolactin in maternal serum, fetal serum and amniotic fluid in childbirth at term]. / Korelacija vrednosti nivoa prolaktina u serumu majke, serumu ploda i plodovoj vodi kod porodaja trudnice u terminu.

In 117 parturients with 38-41 gestation weeks, prolactin was analysed by the radioimmunologic method in the mother serum, the umbilical cord serum and vein, and in the amnionic fluid. Three groups of parturients and their newborns were examined: the group (n = 44) with the birth having started spontaneously with the appearance of labour pains 1/10 minutes, the group (n = 38) with a programmed birth induced by the infusion of oxytocin, and the group (n = 35) with the birth comprising elective cesarean section. The concentration of prolactin in the examined sera is characterized by considerable individual oscillations. The highest prolactin level was in the amnionic fluid (395.6 +/- 130.1 mu/L) and the lowest in the mother serum (174.6 +/- 84.1 mu/L) which shows a statistically significant difference (p less than 0.01). Prolactin values in the umbilical artery (244.6 +/- 98.3 mu/L) and vein (230.4 +/- 91.7 mu/L) are significantly (p less than 0.001) higher than the value in the mother sera and significantly lower (p less than 0.001) than the prolactin concentration in the amnionic fluid. The difference of the prolactin values in the sera of the umbilical cord blood vessels has no statistical significance (p greater than 0.05). Nor is there any statistically significant difference between prolactin concentrations in spontaneous and induced deliveries versus those in deliveries terminated with elective cesarean section (p greater than 0.05). A correlation analysis of the functional connection of prolactin in the sera of the mother, fetus, and amnionic fluid gives the correlation coefficient values of high statistical significance (0.482 less than r less than 0.906; p less than 0.001).

[Diagnostic characteristics of the CA-50 and CA 72-4 tumor markers in body fluids. Use in the diagnosis of malignant effusions]. / Ispitivanje dijagnostickih karakteristika tumorskih markera CA-50 i CA 72-4 u telesnim tecnostima. Primena u dijagnostici malignih izliva.

The paper presents the results of a comparative investigation of CA-50 and CA 72-4 in the serum and effusions of the control group and a group of patients with various localizations of malignant tumors. The diagnostic applicability of CA-50 in the serum is limited by a substantial extent of falsely positive results, which is not the case with CA 72-4. Malignant cells make a more intensive release of CA 72-4 into effusions than into the blood, and the situation with CA-50 is reverse. It has been established that CA-50 in the serum and that CA 72-4 in effusions are complementary parameters. Markers in effusions have more favorable diagnostic characteristics in relation to serum. Although CA 72-4 is of a more superior diagnostic reliability, the examining of both markers is of help in the differentiation of benign peritoneal and pleural effusions from the malignant ones. The persistence of these markers in body fluids does not indicate the primary origin of malignant tumors.

[Primary liver carcinoma in the Subotica City Hospital 1962-1990]. / Primarni karcinom jetre u bolnici grada Subotice u periodu od 1962. do 1990. godine.

The authors have presented their observations in 108 pathologically processed cases of primary hepatic carcinoma (PHC). The material includes the period from 1962 to 1990. The most frequent form of PHC was hepatocellular (67.5%), the cholangiocellular (29.5%) and rarest, the mixed hepato-cholangiocellular form (2.9%). X-ray diagnostics were applied (celiacography, arteriography), laparoscopy, ultrasonography, aimed and blind aspirational biopsy, and laboratory examinations (alkaline phosphatase, transaminases, bilirubin, gamma-CT and so on). Somewhat more attention is given to the problem of HBV infection as the cause of primary hepatic carcinoma development. Pre-existing liver tissue diseases are also pleaded for (chronic aggressive hepatitis, hepatic cirrhosis, ect.). Beside the many diagnostic procedures, the diagnosis of primary hepatic carcinoma is usually established too late, and the therapy still remains unsatisfactory.

[Prolactin in the serum of mothers and neonates and in the amniotic fluid of pregnant women with hypertensive disease]. / Prolaktin u serumu majke i novorodenceta i u plodovoj vodi kod porodaja trudnice sa hipertenzivnom bolescu.

In 106 pregnant women (32-41 gestation weeks) prolactin values were determined in the sera of mothers and fetuses and in the amniotic fluid by the radioimmunological method in m IU L. Four group of parturients and their newborns were examined: Group I (n = 18) contained parturients with hypertensive disease and pre-term delivery, group II (n = 27) parturients with pre-term delivery, group III (n = 25) parturients with hypertensive disease and at-term delivery, and group IV (n = 36) normal parturients with at-term delivery. Prolactin values (mean +/- SD) in the serum of parturients with pre-term delivery (group I 8,311 +/- 2,654 and group II 8,203 +/- 2,647) and in those with at-term delivery (group III 9,656 +/- 3,145 and group IV 9,873 +/- 3,062) showed no significant differences (p greater than 0.05). Prolactin values in the serum of the umbilical cord artery proved significantly higher (p less than 0.05) in parturients with pre-term delivery (group I 11,598 +/- 2,923, group II 9,632 +/- 3,009) and at-term delivery (group III 13,266 +/- 3,015, group IV 11,243 +/- 3,123) in hypertension-affected women. A significantly higher (p less than 0.01) prolactin value was recorded in the amniotic fluid of parturients with pre-term delivery (group I 23,367 +/- 3,896, group II 19,715 +/- 4,128) and at-term delivery (group III 22,755 +/- 4,938, group IV 18,638 +/- 4,724) affected by hypertensive disease. The difference between the prolactin level in parturients with the meconium and clear amniotic fluid (22,059 +/- 5,465 and 19,263 +/- 5,673) was not significant (p greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Five year experience using PTFE vascular grafts for lower limb ischaemia.

The 5 year results using polytetrafluoroethylene (PTFE-Gore-Tex) grafts mainly for superficial femoral occlusion have been reviewed. The majority of these grafts were inserted in an elderly poor risk group of patients with critical ischaemia of the lower limb. The overall cumulative patency at 2 years was 29% falling to 18% at 5 years. Further analyses were performed to take into account risk factors, namely, patient's age, diabetes, hypertension, continuation of smoking, peroperative angiographic findings and the site of the distal graft anastomosis. Peroperative angiographic run off was found to be the only risk factor significantly affecting the cumulative graft patency. The presence of diabetes was found to have a significant detrimental effect on limb salvage.

Alpha-feto protein in the serum of patients with primary gastric cancer and liver metastases.

The authors presented a patient with primary gastric cancer and liver metastases. They permanently observed the AFP concentrations before, during and after cytostatic therapy. At the same time they examined possible sites of AFP production. It is supposed that AFP neo-synthesis takes place in the secondary site with participation of altered liver cells. In such cases it is important to watch the AFP values, and this is also necessary when the primary source of the secondary liver cancer is not known. Cytostatic drugs act only in a palliative way i.e. AFP concentrations drop to a lower level and the patient feels temporarily better.