Expression of CD40, CD44, bcl-2 antigens and rate of cell proliferation on fine needle aspirates from metastatic melanoma.

The clinical behaviour of melanoma is often unpredictable using clinical and histological criteria. Tumour cell markers related to cell cycle regulation, apoptosis, cell-cell interactions and cell proliferation might improve the possibility of predicting the clinical course of melanoma. The aim of the present study was to refine prognostic criteria by an immunocytochemical investigation of CD44, CD40, bcl-2 antigens and cell proliferation in tumour cells aspirated from metastases of malignant melanoma. CD40 is a cell surface receptor shown to be expressed by lymphomas as well as carcinomas, and is thought to play a central role in the process of tumour progression. CD44 is a transmembrane glycoprotein, which is involved in growth signal transmission of importance in the binding of tumour cells to endothelium, cell migration and enhancement of cell motility, which makes it of interest to study in relation to the metastasizing capacity of tumours. The bcl-2 protein is active in the process of programmed cell death (apoptosis) as an antiapoptotic agent and its expression may reflect tumour progression. Mean/median percentages of tumour cell positivity were 8.5/3.0 for CD40, 76.1/86.3 for CD44 and 7.4/3.3 for bcl-2. A significant correlation was observed between expression of apoptosis-associated bcl-2 antigen and overall survival (r = 0.33). The CD44 positive cell fraction was higher in patients with short overall survival than those with long survival but this difference was not statistically significant. The expression of CD40 did not correlate with overall survival. The mean/median proliferation fraction assessed by MIB-1 monoclonal antibody was 25.8/23.9 and showed a significant correlation with survival after diagnosis of melanoma metastasis (r = 0.32). Lack of bcl-2 expression and a high proportion of tumour cells expressing Ki-67 antigen are predictors of poor prognosis that are independent of the traditionally accepted Breslow's thickness of the primary melanomas.

Balance function and fall-related efficacy in patients with newly operated hip fracture.

OBJECTIVE: To investigate the relation between fall-related efficacy in daily-life activities and functional as well as instrumental tests of balance in patients with hip fracture. DESIGN: Analysis of different aspects of balance using the Falls Efficacy Scale, Swedish version FES(S), questions on fear of falling, Functional Reach (FR) and tests on a balance platform (Chattanooga). SUBJECTS: Fifty-five elderly inpatients (mean age 82.3) with newly operated hip fracture who were assessed during the last week in hospital before discharge. RESULTS: The results showed a significant relationship between the subjective ability measured with the FES(S) and the objectively measured balance in the Functional Reach test and also between fall-related efficacy measured with FES(S) and fear of falling. Very few significant correlations were found between the results from balance tests on the force platform and those obtained with FES(S) and FR. CONCLUSIONS: Both the Falls Efficacy Scale, Swedish version, and the Functional Reach have been shown to be useful in analysing balance function in elderly patients newly operated on for hip fracture. The Falls Efficacy Scale also indicates which of the daily activities the patient perceives as troublesome and thus require further training.

Double-blind comparison of zopiclone and flunitrazepam in elderly insomniacs with special focus on residual effects.

In a double-blind study of 102 patients with a mean age of 79 years, zopiclone was compared to flunitrazepam. The patients rated their sleep in a diary. There was no statistically significant difference between the relatively low dose of 5 mg zopiclone and 1 mg flunitrazepam for eleven out of the twelve variables measuring subjective sleep quality and quantity. There was no differences between the drugs as regards patients' feelings of being rested or alertness.

A community-based population study of vertebral fractures in 85-year-old men and women.

Radiographic examinations for the presence of vertebral fracture between T4 and L5 were performed in a random sample of 85-year-old women (n = 304) and men (n = 158) who participated in a longitudinal study in Gothenburg. A vertebral fracture was defined as an anterior/posterior (A/P) vertebral height ratio of 0.66 or less. A severe vertebral fracture was defined as a compression of vertebral height of more than 33% both at the anterior and posterior edges compared to the posterior edge of the adjacent vertebral body. Bone mineral density was measured with dual photon absorptiometry in the right calcaneus. The most common site for vertebral fractures was L1 in women and Th12 in men. Bone mineral density in men at the age of 75 showed a significant correlation with vertebral fractures at 85 years of age (p < 0.001). This was not the case for women. Stepwise logistic analysis revealed that women with vertebral fractures at 85 years of age had more significant back pain, shorter stature, and more often a history of another fracture and/or chronic treatment with corticosteroids. In men, muscle strength, marital status and body weight at age 85 were the only factors significantly associated with vertebral fractures.

Prevalence of vertebral fractures in 85-year-olds. Radiographic examination of 462 subjects.

Radiographic examinations for the presence of vertebral fracture between Th4-L5 were performed in a random sample of 85-year-old women (n 304) and men (n 158) who participated in a longitudinal population study. A moderate vertebral fracture was defined as an anterior/posterior vertebral height ratio of 0.66 or less. A severe vertebral fracture was defined as a compression of vertebral height of more than 33 percent both at the anterior and posterior edges compared to the posterior edge of the adjacent vertebral body. The prevalence of vertebral fractures was 25 percent in women and 13 percent in men. The ratio between moderate and severe grades of vertebral fracture was 1.5 for women and 2.1 for men. The most common site for vertebral fracture was L1 in women and Th12 in men. Women with vertebral fracture at 85 years of age had more back pain.

Falls in 84- to 85-year-old people living at home.

The present study is a part of the Swedish longitudinal population study "70-year-old people in Gothenburg". The aim of the present study was to analyse retrospectively incidence, circumstances, and consequences of falls during one year among 741 home-living people aged 84-85. A comparison of social and medical characteristics of fallers and non-fallers aged 85 was performed. Information was collected by interviews and clinical examinations. In 1986/1987, 732 home-living people (244 men and 488 women), aged 85 gave information about falls during the last year. Three hundred and one (41%), 97 men and 204 women, had fallen at least once during the last year, mainly indoors. No sex difference was found in incidence. The most dominant triggering causes of falls were stumbling, dizziness, and feebleness. In 80% of the falls an injury occurred, of which every fourth was a fracture. A multivariate regression procedure showed that dizziness, vertigo and unsteadiness, transient ischemic attacks, antidepressant drugs, and poor subjectively experienced health characterized the fallers. Mortality rate of those between 85 and 88 years of age showed no association with falls.

Accidents in the institutionalized elderly: injuries and consequences.

A total of 308 major and 519 minor accidents involving 588 patients occurred during one year at a somatic long-term care hospital and its associated nursing homes. In relation to the number of patients, the incidence of accidents was nearly three times higher in the nursing homes than in the hospital. The most prevalent injuries in female patients were fractures and hematomas, while open wounds were more frequent among male patients. Hip fractures were about as common in women as in men, while fractures of the extremities were three times more frequent in women. The majority of the accidents occurred during daytime, in the patient's room and in many cases soon after admission. Most of the injuries were caused by falls and in more than 90% no staff was present. Accidents were reported most frequently in October-December, and least often in July-September. Two thirds of the severely injured had to be transferred to an emergency hospital for surgery or other treatment. Patients who had had major accidents also had a higher mortality rate six months after the accidents as compared to a control group. The medical and functional consequences for the patients were considerable. Measures to reduce the number of accidents among geriatric patients are therefore urgently needed.

Individual evaluation of accident risks at nursing homes.

The purpose of the study was to find a practical applicable method for estimating risk of accidents among nursing home patients by localizing specified risk factors and recording accidents during a period of one year. During 1987-January-15 to 1988-January-14, a total of 153 accidents happened to 23 men and 76 women among 335 admitted patients. The strongest accident predictors suggested by a logistic regression procedure were: impaired balance, walking with device or human assistance, drugs influencing the central nervous system, dizziness and poor night-time sleep. The conclusion is reached that it will probably be possible to reduce accidents in the institutionalized elderly by education of staff, identification of risk patients, individual nursing planning and measurements.

Prevalence of fractures among 10,000 women from the 1900 to 1940 birth cohorts resident in Gothenburg.

The prevalence of fractures in women aged 45-86 years resident in the city of Gothenburg, Sweden, was investigated by means of a postal questionnaire. A sample of 10,000 women from seven birth cohorts (1900-1940) was obtained at random from the population register. The response rate was 70.1% in the 1900-1920 and 81.0% in the 1930 and 1940 birth cohorts. When the prevalence of fractures sustained between 25 and 46 years of age was analyzed a higher figure emerged for women from the 1930 and 1940 birth cohorts than for those from the 1900-1920 cohorts, indicating an increasing incidence of fractures over time. There was a significant independent correlation between early menopausal age and a high rate of fractures. Menopausal age decreased with increasing tobacco consumption. There was also a significant independent correlation between tobacco-smoking and a high fracture rate. The prevalence of tobacco-smoking increased from 30.0 to 38.1% between the 1930 and 1940 birth cohorts, which may further increase the fracture risk in future years. Despite increasing vitality and longevity among the elderly in Gothenburg, there are indications that the number of fractures will increase in the future.

Accidents in the institutionalized elderly: a risk analysis.

Among a total of 4,862 admittances to a Swedish geriatric hospital and its associated nursing homes, 827 accidents occurred in 588 patients during one year. The purpose of the present study was to establish the direct causes of these accidents and to identify possible risk factors. Information was collected from medical records, interviews with patients and staff, examination of the mental and physical state of the patients, and through reconstruction of the accidents. The investigation embraced 270 patients with 308 major accidents (fractures, sprains, open wounds, concussions and injuries to ligaments), and 318 patients with 519 minor accidents (bruises, contusions, abrasions and minor burns). Injury-free patients with nearest lower bed number in relation to patients with major accidents formed a control group. Patients with previous injuries, balance disturbances, and polypharmacy were at high risk, and intrinsic factors such as dizziness and impaired balance proved to be more significant as direct causes for the occurrence of accidents than environmental factors. The estimated risk for a patient with all these risk factors to have an accident during one year was 94%.

Osteoporosis and back pain in the elderly. A controlled epidemiologic and radiographic study.

The incidence of back pain was investigated in hip fracture patients, 50-99 years of age, and in 70-, 75-, and 81-year-old controls from the same population. The prevalence of vertebral fractures were evaluated from spinal radiographs. Eighty hip fracture patients and 103 controls, all between 70 and 75 years of age, were included in the radiographic study. The incidence of back pain of the controls was twice that of the hip fracture patients, 45-48% compared with 23-20%, respectively, for both female and male subjects. Conversely, vertebral fractures were radiographically shown in 43% of the hip fracture patients and in 22% of the controls. Thus, the major explanation for longstanding back pain in the elderly does not appear to be related to spinal osteoporosis.

Dual-photon absorptiometry for determination of bone mineral content in the calcaneus with correction for fat.

A portable dual-photon absorptiometry system for the determination of the bone mineral content BMC in vivo in the calcaneal bone is described. With knowledge of the total thickness of the heel at the measuring point the BMC can be corrected for fat and lean soft tissue. The system is capable of measuring the BMC in the heel bone with a precision of 1.2% in vitro and 1.8% in vivo at an absorbed dose to the skin of 0.2 mSv.

Osteoporosis after long-term corticosteroid treatment of giant cell arteritis.

The mineral content of the heel bone, and signs of osteoporosis on X-ray of the spine, were evaluated in 26 patients (20 women and 6 men) with giant cell arteritis (GCA), treated with prednisolone for an average period of 5 years. The mean age was 78 years (range 66-95 years). These results were compared with those obtained from a large population study of individuals aged 72, 75, 82 and 85 years. An increase of obvious and severe spinal osteoporosis from 16 to 85% was observed in the women in the population study between the ages of 72 and 85. No additional osteoporosis that could be attributed to the cortisone treatment was found among the GCA patients. The bone mineral content was not reduced in the patients compared to the general population. We conclude that there is no justification for attempting non-steroid treatment in GCA on account of the risk of osteoporosis. Corticosteroids are the only safe treatment for prevention of complications of GCA.

Functional capacity among the elderly in Sweden.

The author describes Swedish experience with an increasingly large elderly population, concentrating on problems relating to ADL, hygiene, housing and locomotion.

Dental health and parity in three 70-year-old cohorts.

In three cohorts of 70-yr-olds in Gothenburg, Sweden, born in 1901/02, 1906/07 and 1911/12, the relationship between oral health and parity was studied in 713 women and between oral health and the reported number of children in 660 men of the same cohorts. For women in all three cohorts, the number of teeth decreased in relation to increasing number of children that they had given birth to. Significantly more women with high parity were edentulous in one or both jaws compared to the other groups. Among parous compared to nulliparous women the age for becoming edentulous occurred earlier. The number of intact teeth was lower in parous compared to nulliparous women. Among the men no relation was found between oral health and the number of their children. When socioeconomic factors were taken into consideration the above described relations between declining dental health and increasing parity remained on about the same level of significance. Although pronounced cohort differences were found, a relationship between parity and dental health was found in all cohorts, indicating a general biological influence of repeated pregnancies.

Urinary incontinence in the elderly with implications for hospital care consumption and social disability.

837 geriatric patients were investigated on admission and 6 months later. Relatives and other involved persons were interviewed about background factors of importance for the patient's need of care. Every second male and every third female patient was urinary incontinent and it was evident that this was important for admission to hospital. A close relation was found between urinary incontinence and dementia, but the prevalence of somatic diseases was not greater than among continent patients. Six months after admission patients with urinary incontinence had a higher mortality rate or were living in nursing homes to a greater extent than continent patients. The study suggests that in many geriatric patients urinary incontinence is more closely related to general functional impairment than to specific medical conditions of the uro-genital organs and the central nervous system.

Incidence of hip fracture in western Sweden 1974-1982. Comparison of rural and urban populations.

Several epidemiological studies in northern Europe have shown that fractures in the elderly exceed the expected increase in the aging populations. We have compared the incidence of hip fracture in the rural county of Skaraborg and the city of Göteborg in Sweden. After adjustment for age changes in the population, the incidence of hip fracture in Skaraborg County was lower than in Göteborg during the period 1974-1984. The non-age-related increase in the incidence of fractures found in the city was not confirmed in the rural area.

Increased frequency of high serum IgM among mothers of infants with neonatal group-B streptococcal septicemia.

Total serum IgM levels were studied in 84 mothers of infants with group-B streptococcal (GBS) septicemia/meningitis and compared to IgM concentrations in 91 parturients who were urogenital carriers of GBS but nevertheless gave birth to healthy infants. In all, 22 (27%) in the study group showed IgM levels above the arbitrarily selected limit of 2.40 g/l, in contrast to 12 (13%) of 91 controls (p = 0.02). Among the study group members whose infants were infected with GBS type III, 8 of 34 (24%) were high in serum IgM, compared to only 2 of 34 (6%) of the corresponding controls (p = 0.04). The total serum IgG levels did not differ between the two groups.

The effect of tobacco smoking on the bone mineral content of the ageing skeleton.

The relationship between the bone mineral content (BMC) of the heel bone and cigarette smoking has been determined in representative samples of 409 men and 559 women at the age of 70, 75 and 79 in a longitudinal and cohort comparison study. The BMC was measured by dual photon absorptiometry with stationary geometry over the dorsal aspect of the heel bone. The mean values of the BMC for smokers compared to non-smokers were for men about 10-20% lower and for women 15-30% lower in all age groups studied. The difference in body weight between smokers and non-smokers could not explain the lower values of BMC for the smokers. No difference was found in physical activity between the groups.