Lymphocyte transformation in elderly non-insulin-dependent diabetics before and after improved glycaemic control.

Mitogen-induced lymphocyte transformation was examined in 23 elderly patients with poorly controlled Type II diabetes before and after achieving improved glycaemic control with sulphonylureas and compared with 11 healthy controls of similar age. No difference between groups was seen after incubation of lymphocytes with phytohaemagglutinin (PHA). Lymphocyte transformation after 10 micrograms/ml concanavalin A (con A) was significantly greater in diabetic patients after improved control and when compared to healthy controls (p less than 0.025). The response to 5 micrograms/ml and 10 micrograms/ml pokeweed mitogen (PWM) was greatest in diabetic patients after effective metabolic control.

Leukocyte microbicidal activity assessed by chemiluminescence in elderly non-insulin dependent diabetes mellitus.

Leukocyte dysfunction may contribute to infection in the elderly diabetic. Leukocyte oxidative metabolism assessed by chemiluminescence, correlates with microbicidal activity, and may be impaired with hyperglycaemia and ageing. The leukocyte chemiluminescence response to zymosan +/- luminol was assessed in 12 healthy controls (3M, 9F), aged 69 +/- 5 (mean +/- SD) years and in 23 non-insulin dependent diabetics, aged 68 +/- 5 years, before and after improving glycaemic control with sulphonylureas, when the glycosylated haemoglobin fell from 11.2 +/- 2.3 to 7.9 +/- 1.4% (p less than 0.001). The onset of maximal chemiluminescence with zymosan was similar in controls and diabetics, although the actual counts after improved glycaemic control were less in diabetic patients at all time points than initially (p range less than 0.025-less than 0.001) or when compared to the controls (p range less than 0.05-less than 0.005). Following luminal enhancement the onset and magnitude of maximum chemiluminescence was similar in all groups although an increase early response was observed in diabetics initially. We suggest that sulphonylureas may modify chemiluminescence by suppressing superoxide radical generation. Hyperglycaemic elderly non-insulin dependent diabetics may have subtle disturbances of the leukocyte oxidative burst but in general behave in a similar fashion to healthy elderly controls.

'Silent' pyrexia in the elderly.

Simultaneous oral, rectal and axillary temperatures were measured in 73 elderly patients on a geriatric unit. Axillary and oral temperatures were significantly lower than rectal readings. If oral or axillary temperatures alone had been measured, pyrexia would have been missed in two thirds of patients with a rectal temperature of 37.5 degrees C or more, and about three quarters of those with a rectal temperature of 38 degrees C or more. These findings suggest that oral or axillary temperature measurements are inadequate screening tests for pyrexia in the elderly.

The role of chest radiography in the evaluation of the 'geriatric giants'.

Three hundred and eighty admissions to a geriatric assessment unit had a routine chest radiograph. Forty-four per cent presented atypically with one or more of Isaacs' 'geriatric giants'--falls, immobility, incontinence or deteriorating mental function. The chest radiograph was abnormal in 164 (44%), of whom 57 had no classical clinical cardiopulmonary features. The chest radiograph was especially useful in the investigation of the geriatric giants, where 22% had evidence of cardiopulmonary disease, in the absence of classical clinical features.

Golytely: a new approach to faecal impaction in old age.

Forty-five elderly subjects with faecal impaction were entered into a study of the efficacy of golytely. Twenty-three were treated with golytely 2 l/day for 2 days and then lactulose 30 ml b.d. and daily enemas. Twenty-two were treated with lactulose 30 ml b.d. and daily enemas alone. A good response was achieved in 13 (56%) within 1 week and in 20 (87%) within 2 weeks when golytely was used, as compared to only 5 (23%) within 1 week and 9 (41%) within 2 weeks when it was not used.

Changes in erythrocyte transketolase activity and the thiamine pyrophosphate effect during storage of blood.

Whole blood and washed erythrocytes from nutritionally normal and abnormal elderly patients were stored at room temperature, 4 degrees C and -20 degrees C for up to 14 days. In both groups, and under all storage conditions, the erythrocyte transketolase (ETK) activity and the thiamine pyrophosphate (TPP) effect decreased with time of storage. The ETK activity for specimens stored at -20 degrees C decreased significantly by day 14 (P less than 0.05). The TPP effect in specimens stored at -20 degrees C decreased significantly in the nutritionally abnormal group at 4 days (P less than 0.05) and in the nutritionally normal group by day 14 (P less than 0.05). These significant changes in ETK activity and TPP effect with storage can lead to misleading interpretation of thiamine nutritional status.

The frequency of physical signs usually attributed to meningeal irritation in elderly patients.

Nuchal rigidity, which may be a sign of meningitis, was found in 35 per cent of geriatric patients on acute-care and rehabilitation wards and in 13 per cent of younger patients on an acute-care ward. It was significantly associated with cerebrovascular disease, confusion, abnormal plantar responses, and primitive reflexes. Elderly patients who have nuchal rigidity with no history of neurologic or cognitive disorders should be investigated for meningitis.

Necropsies in the elderly.

A retrospective analysis of 332 necropsies in the over-65-year-olds and 129 necropsies in the over 85-year-olds (overall necropsy rate 35%) showed that the commonest cause of death in elderly patients admitted acutely to hospital was pneumonic illnesses. 27-31% of the necropsies revealed the presence of a potentially treatable contributory factor to death that was undiagnosed during life. In only 4.5% of the necropsies in the over-85-year-olds was the cause of death uncertain.

Gynecologic sepsis as a cause of covert infection in old age.

Three cases of endometritis, which presented covertly in elderly women, are described. All three patients were in a poor state of nutrition, and two had serious intercurrent disease. It is believed that cyclical shedding of the endometrium and "normal" vaginal flora (under the influence of estrogen) are the major defenses against infection. These are lost after the menopause, and were therefore absent in the three patients described here. The waning of the immune response associated with aging, particularly the progesterone-stimulated uptake of polymeric IgA in the endometrium, may be important, as may the immunosuppressive effect of malnutrition. It is suggested that a nonspecific deterioration in an elderly woman or infection of uncertain site should prompt a careful re-examination, including a thorough pelvic examination.

The white nails of old age (neapolitan nails).

Nail changes similar to those reported by Terry and Lindsay were defined in an elderly inpatient population. Two hundred fifty-eight patients were studied, and an overall incidence of 19 per cent was found. There was no significant difference between men and women. The only significant correlations in this study were with osteoporosis and thin skin. Eight men with nail changes were compared with seven men without such changes by calculating the metacarpal index of cortical bone mass. The index was much lower in patients with nail changes (t = 2.64; P less than 0.01). All patients with nail changes had thin skin. No correlations were found with serum albumin, liver function, or kidney function. These nail changes are less frequent in the "less frail" elderly living in the community. Changes of the Terry type are common in children but disappear by early adult life. It is suggested that the nail changes are age-related phenomena and that they may reflect an underlying disturbance of collagen being manifested as changes in the nail bed, skin, and bone.