Beta-haemolytic group A, B, C and G streptococcal septicaemia: a clinical study.

87 beta-haemolytic streptococcal septicaemias in adult patients during 1979-86 in a university hospital were reviewed. 25% were caused by group A streptococcus, 17% by group B, 14% by group C and 44% by group G streptococcus. 67% of the septicaemias due to group B streptococcus were nosocomial, whereas the group A, C or G septicaemias were in most cases community-acquired. Alcoholism was the most common underlying disease in group A (32%) and malignancy in group G streptococcal septicaemias (45%). The most common origin and focus of infection in group A, C and G streptococcal septicaemias was the skin. The total mortality in beta-haemolytic streptococcal septicaemias was 20%, higher in septicaemias caused by group A (32%) and group B (33%) than by group C (17%) and group G (8%) streptococci. Nevertheless, there were more patients in group G streptococcal septicaemias with severe underlying diseases than in other groups of beta-haemolytic streptococci. The present data seem to indicate that a septicaemia due to group G is a more benign disease than a septicaemia due to group A streptococcus.

Coronary artery disease and bile acid synthesis in familial hypercholesterolemia.

A cohort of 97 consecutive patients (mean age 43 years), heterozygous for familial hypercholesterolemia (FH) with tendon xanthomata, were studied to explore the possible association of coronary artery disease (CAD) with classical risk factors of CAD and parameters of cholesterol metabolism, including cholesterol and bile acid synthesis. Seventy percent of the patients had CAD. Male sex, advanced age (in females), increased blood pressure (in females), obesity (in males), short stature and clinical signs of tissue deposition of cholesterol were more common in the patients with than without CAD. Serum total and LDL-cholesterol and triglyceride levels were not associated with the presence of CAD. As compared with normolipidemic healthy subjects, studied under similar conditions, the bile acid synthesis was subnormal in FH. However, the low bile acid values were associated with CAD, especially in men, while the bile acid formation was within the normal limits in the healthy FH patients. The findings suggest that FH patients with a low bile acid synthesis have an increased risk to develop coronary heart disease by an unknown mechanism.

The long-term treatment of the aged. An assessment method.

The aim of this investigation was to construct three parameters and assess their value as admission criteria for long-term institutional care of the aged, viz. medical dependence, nursing dependence, and dementia. The material consisted of 200 applicants, of whom 150 were admitted to institutions. The need for personal care was measured by means of a test method developed at the Wasa Hospital, Gothenburg, Sweden, and the dementia test comprised five subtests, each of which measures a distinct field of mental function. Both dementia and nursing dependence were found to increase with age, and there was a highly significant correlation between nursing dependence and age. There was also a highly significant correlation between nursing dependence and degree of dementia. The changes in nursing dependence 3 and 6 months after admission showed a significant correlation with the test scores for dementia. The nursing dependence of the moderately or severely demented persons had increased in 6 months after admission by approximately 100%. The test results of dementia were used as the sole, decisive criterion in 24% of admissions; medical dependence alone decided the choice of institution in 22% and nursing dependence in 15%. Two or three parameters were used in 39% of admissions--all indicating the same type of institutional care. The simultaneous use of the three assessment criteria provides an extensive body of information as to the general need of care, and by means of this information the appropriate placement of the old will be made possible.