Body positions used by healthy and frail older adults to rise from the floor.

OBJECTIVE: The purpose of this study was to describe how older adults, particularly more physically impaired older adults, might differ from healthy controls in the body positions used to rise from the floor. DESIGN: Cross-sectional analysis of young, healthy older, and congregate housing older women. SETTING: University-based laboratory and congregate housing facility. PARTICIPANTS: Healthy young university student controls (n = 22, mean age 23 years); healthy old adults living independently in the community (n = 24, mean age 73 years); and congregate housing older adults (n = 29, mean age 81 years). INTERVENTION: Videotaping and timing of rising from a supine position on the floor to standing. MAIN OUTCOME MEASURES: In addition to the time taken to rise from the floor, 10 specific trunk and extremity positions used during the rise, termed Intermediate Positions (IP), were identified. RESULTS: The Young controls had the fastest rise time and used the fewest number of IP, whereas the Congregate residents had the slowest rise time and used the most IP, with the Healthy old adults intermediate in both time and IP use. Prevalence of certain IP, together with correlational and factor analyses, suggest that use of Sit and Crouch was the most preferred rise strategy for the Young controls, whereas use of Tuck, Crouch-Kneel, All Fours, and Bearwalk was the most preferred rise strategy among the Congregate residents. The Healthy old used IP common to both Young and Congregate residents, reflecting a rise strategy intermediate to the latter groups. A substantial subset of the Congregate residents (38%) were unable to rise without assistance and appeared to use certain preparatory positions (Sit, Kneel, Tuck) but were unable to get into presumably more challenging positions (Crouch-Kneel, All Fours, Bearwalk). CONCLUSIONS: With increasing age and physical impairment, body positions used during rising from the floor suggest a preference for maintaining upper and lower extremity contact with the floor, presumably minimizing the lower extremity strength requirements to rise and maximizing stability and postural control. These intermediate body positions may be useful as the basis for training older adults to rise from the floor.

Rising from the floor in older adults.

OBJECTIVE: The primary goal was to determine the ability of older adults to rise from the floor. A secondary goal was to explore how rise ability might differ based on initial body positions and with or without the use of an assistive device. DESIGN: Cross-sectional analysis of young, healthy older, and congregate housing older adults. SETTING: University-based laboratory and congregate housing facility. PARTICIPANTS: Young adult controls (12 men and 12 women, mean age 23 years), healthy older adults (12 men and 12 women, mean age 73 years), and congregate housing older adults (32 women and 6 men, mean age 80 years). The healthy older adult women (n = 12, mean age 75 years) and a subset of the congregate housing women (n = 27, mean age 81 years) were identified for further analyses. INTERVENTION: Videotaping and timing of rising from the floor from controlled initial body positions (supine, on side, prone, all fours, and sitting) and with or without the use of a furniture support. MAIN OUTCOME MEASURES: Whether subjects were successful in rising, and if they were, the time taken to rise. Subjects also rated their perceived difficulty of the task as compared to the reference task, rising from a supine position. RESULTS: Older adults have more difficulty rising from the floor than younger adults. The healthy old took twice as long as the young to rise, whereas the congregate old took two to three times as long as the healthy old to rise. Although all young and healthy old rose from every position, a subset of the congregate housing residents was unable to rise from any position, 24% when attempting to rise without a support and 13% when attempting to rise with a support. Congregate old were most likely to be successful when rising from a side-lying position while using the furniture for support. The more able congregate old, as well as the young and healthy old, rose more quickly and admitted to the least difficulty when rising from the all fours position. CONCLUSIONS: The inability to rise from the floor is relatively common in congregate housing older adults. Based on the differences between groups in time to complete the rise, determining the differences in rise strategies, and the underlying biomechanical requirements of rising from different positions with or without a support would appear to be useful. These data may serve as the foundation for future interventions to improve the ability to rise from the floor.

Fine-needle aspiration of breast masses.

Evaluation of breast masses is a frequent dilemma encountered by a primary care physician. Adding fine-needle aspiration biopsy to the work-up of these lesions adds an inexpensive, highly accurate test with high patient acceptance. At our institution a technique using a butterfly needle has yielded a sensitivity of 91% and a specificity of 100%.

[Determining the threshold level for sensibility responses to galvanic potentials in the oral cavity]. / Schwellenwertbestimmung für die Auslösung sensibler Reaktionen durch glavanische Potentiale in der Mundhöhle.

The presence of different alloys in the oral cavity may produce potential differences of up to 900 mV. In the majority of the patients this phenomenon presents no problems. Occasionally, however, disturbing sensations, such as "metallic taste", "twinging or stabbing" and "minute electric shock" are reported. In finding out on the threshold level for discomforting sensations due to galvanic potentials in different probands, a special battery operated device was developed. Using a pair of electrodes connected to metallic restorations in the mouth, this device enabled the application and adjustment of direct current voltage and a superimposed pulse spectrum to evoke sensible reactions. The trials were conducted with 102 probands. The mean value for the threshold of sensation was above 1000 mV. In solitary cases, however, the threshold level was as low as 250 mV. This method may be used as a diagnostic aid to the objective assessment of complaints due to galvanic effects in the oral cavity and for the selection of a suitable metal in sensitive patients.

[Retinoblastoma with suprasellar extension: report of a case]. / Retinoblastoma de extensão supra-selar: registro de um caso.

The authors discuss a case of a two-years-old girl, who had a unilateral previous enucleated retinoblastoma, that died with a suprasellar mass and distant metastasis.

[Neurocutaneous melanosis: autopsy study of a case]. / Melanose neurocutânea: estudo autópsico de um caso.

The clinical, radiological and autopsy features of a 5-month-old child with neurocutaneous melanosis are described. The patient had multiple disseminated benign cutaneous nevi. The pneumoencephalogram showed non-obstructive hydrocephalus. The patient died at the third day of hospitalization and autopsy was performed. A mild hydrocephalus and melanic specks in cerebellum and in the brainstem were disclosed.