[Anesthesia in geriatric patients. The determination of physiological variables for cognitive function in geriatric patients after regional or general anesthesia]. / Anästhesie bei geriatrischen Patienten. Die Bedeutung physiologischer Variablen für die kognitive Leistungsfähigkeit geriatrischer Patienten nach Regionaloder Allgemeinanästhesie.

OBJECTIVE: The aim of the present study was to show the influence of the parameters of gas exchange (arterial oxygen pressure paO2, arterial oxygen saturation SatO2) and haemodynamics (arterial systolic and mean blood pressure RRs and MAP) on the restitution of cognitive functions in geriatric patients scheduled for elective hip arthroplasty. METHODS: A total of 30 patients (70 years, ASA II) were randomized to be operated either in regional anaesthesia (n = 15) or general anaesthesia (n = 15). PaO2 (by capillary blood gas analysis), RRs and MAP (by oscillometry) were measured 15 and 90 minutes after arrival in the recovery unit (t1 and t2), 24 and 72 hours postoperatively (t3 and t4), and cognitive functions were tested. Intraoperatively, throughout the day and the first night after surgery we measured satO2 by continuous pulse oximetry. We recorded MAP and RRs by oscillometry every 3 minutes during the operation and every 15 minutes for the rest of that day and night. RESULTS: The parameters of gas exchange and haemodynamics did not differ among the groups. PaO2 was significantly reduced in both groups compared to baseline 24 hours postoperatively (t3) and remained low until 72 hours postoperatively (t4). Nearly all cognitive functions were significantly reduced in both groups compared to baseline 15 and 90 minutes after arrival in the recovery unit (t1 and t2), but recovered on the first postoperative day (t3). Both groups kept deficits in verbal memory and reading capacity up to the third postoperative day (t4). There was no correlation between the physiological parameters and the restitution of the tested cognitive functions. CONCLUSION: The restitution of cognitive functions during the first three postoperative days in geriatric patients scheduled for elective hip surgery does not depend on the anaesthetic technique. According to our results regional anaesthesia does not show any advantage for geriatric patients undergoing elective hip arthroplasty.

[Computer-assisted training in genetically-induced neuropsychological deficits. A case report of a patient with de Grouchy syndrome I (chromosome 18 p syndrome)]. / Computergestütztes Training bei genetisch bedingten neuropsychologischen Defiziten. Eine kasuistische Darstellung bei einem Patienten mit de-Grouchy-Syndrom I (Chromosom 18 p-Syndrom).

The present case study is a report on computer-based training approach in a male patient suffering from the de-Grouchy syndrome I (with a characteristic chromosomal deletion pattern), who along with psychotic symptoms displayed neuropsychological deficits. Participating in a well-established intervention programme aimed at a broad spectrum of psychological functions, the patient went through 36 training sessions. With regard to outcome assessments one focus was on improved performance in the training tasks, while the other one referred to transfer effects, as indexed by a neuropsychological test battery which was given before and after the entire programme. In both areas substantial gains from training emerged according to the collected data. In view of these results neuropsychological training approaches appear to have a perspective even in behavioural deficits with a genetic basis.

Activation of Ca(2+)-dependent K+ and Cl- currents by UTP and ATP in CFPAC-1 cells.

Activation of Cl- and K+ conductances by nucleotide receptor-operated mobilization of intracellular Ca2+ was investigated in CFPAC-1 cells with the perforated-patch technique. Adenosine 5'-triphosphate (ATP) and uridine 5'-triphosphate (UTP) caused a dose-dependent fast and transient membrane hyperpolarization. UTP was more effective than ATP. In voltage-clamped cells, two currents with different ionic permeability and kinetics were activated by the nucleotides. The first one was carried by Cl- ions, peaked in the first few seconds after addition of nucleotides, and lasted for 1 +/- 0.3 min. Its amplitude was about 2.7 nA at -100 mV with 100 mumol/l of either ATP or UTP. The second current was carried by K+ ions and was blocked by Cs+. This current peaked more slowly and had a mean duration of 4.6 +/- 0.7 min. Its amplitude was 0.9 nA and 0.5 nA at -20 mV with 100 mumol/l UTP and ATP, respectively. Activation of the nucleotide receptor caused a transient increase in intracellular Ca2+ concentration ([Ca2+]i) that was similar in the presence or absence of extracellular Ca2+. The ED50 for UTP was 24 mumol/l and that for ATP was 94 mumol/l. Depletion of the inositol 1,4,5-trisphosphate-sensitive Ca2+ store by thapsigargin prevented both the nucleotide-induced [Ca2+]i increase and the activation of membrane currents. Addition of 2 mmol/l Ca2+ to thapsigargin-treated cells produced a sustained increase of Cl- and K+ currents, which was reversed by Ca2+ removal. The present study demonstrates that CFPAC-1 cells respond to nucleotide receptor activation with a transient increase in [Ca2+]i that stimulates Ca(2+)-dependent Cl- and K+ currents.(ABSTRACT TRUNCATED AT 250 WORDS)