["Geri-Aktiv"--the activation of nursing home residents]. / "Geri-Aktiv"--die Aktivierung von Pflegeheimbewohnern.

Although being active is a central element of successful aging, we know little about activities which elderly people carry out in institutional environments. The first study's aim was to describe the importance of activation for the residents (n=255) and their nurses (n=171) using quantitative methods. To immerse into the subject we carried out qualitative interviews (n=61) to ascertain how an activation according to the needs of old people can be reached. With the background of activation and motivation theories and first results, a model was developed focusing on need-oriented activation. Considering the impairments in old age, offers for individual activation and attendance can be derived from this model.

[Activities offered in nursing homes--a study of usage and satisfaction]. / Aktivierungsangebote in Pflegeheimen. Eine Studie zur Inanspruchnahme und Zufriedenheit.

The following survey aims to ascertain the range of activities offered by different nursing homes, the extent to which residents use these activities as well as the satisfaction of residents and nursing staff concerning these activities. Focus is put on activating activities and activities of residents' own initiative. The analysis, which is based on 255 residents and 171 nursing staff from 11 nursing homes, shows a clear distinction between the various homes as to their ranges of activities. Activation in the home's everyday life is mainly done following the "watering-can principle", which means that it does not take into consideration the residents' individualities. The study provides clear evidence that the possibility to actively participate in the home's everyday life or to follow one's own interests makes residents feel highly satisfied. The fact that some residents as well as those nursing them place more importance on activities than others shows that the attitude towards aging is still characterized by the deficit model.

48-hour hemodynamic effects of octreotide on postprandial splanchnic hyperemia in patients with liver cirrhosis and portal hypertension: double-blind, placebo-controlled study.

Octreotide is effective during 48 h in the treatment of acute variceal bleeding, probably by reducing variceal blood flow and pressure. Its basal and postprandial effects on splanchnic and systemic hemodynamics, and hormonal changes over this time interval have not yet been studied. Twenty-four patients with cirrhosis and portal hypertension were randomized to receive a liquid meal and either octreotide (Oct, 100 microg bolus intravenous, followed after 2 h by a continuous infusion of 25 microg/hr for 20 hr) or placebo (Plac) given at three consecutive days. Splanchnic (Doppler ultrasound) and systemic hemodynamics (noninvasive cardiac monitoring) were assessed on four consecutive days (one control day and three treatment days) during 2 hr. The postprandial increase in mean blood velocity of the superior mesenteric artery (SMA-V(mean) +44%), portal blood velocity (PV-V(mean), +44%) and total hepatic blood flow (HBF, +40%) observed in the placebo group during the control day was abolished during the first day of treatment (SMA-V(mean), +3%, P < 0.01; PV-V(mean), +6%, P < 0.05; HBF, -25%, P < 0.01) and still reduced after 48 hr in the octreotide group (SMA-V(mean) +28%, P < 0.05; PV-V(mean), +22%, P > 0.05; HBF, -8%, P < 0.05). The postprandial increase in cardiac index (CI, + 10%) and decrease in systemic vascular resistance index (SVRI, -6%) were blunted after the initial injection of octreotide only (CI, -8%, P < 0.05; SVRI, +18%, P < 0.01). Endothelin-1-levels, which were increased at baseline (Plac 25 +/- 17, Oct 16 +/- 13 ng/liter, P > 0.05) decreased significantly after 48 hr of treatment with octreotide (Plac 27 +/- 20, Oct 8 +/- 4 ng/liter, P < 0.05). Octreotide is effective during 48 hr in the prevention of postprandial hyperemia in cirrhotics, even if its efficacy is decreasing over time. Moreover it may have positive effects on systemic vasodilation in cirrhotics. These findings suggest a potential role of this drug in the chronic treatment of portal hypertension.

Synergistic sedation with low-dose midazolam and propofol for colonoscopies.

BACKGROUND AND STUDY AIMS: Patients undergoing colonoscopy are often sedated with benzodiazepines and long-acting opiates. Since low-dose midazolam also acts synergistically with short-acting propofol, we compared this synergistic sedation with a standard combination of midazolam and the opioid nalbuphine for colonoscopies. PATIENTS AND METHODS: A total of 79 patients presenting for colonoscopies were randomly assigned to the following protocols. Patients in group I (n = 32) received a median dose of 9 mg midazolam (interquartile range [IQR] 6 to 12); 20 patients (59%) needed additional nalbuphine (median 20 mg, IQR 10 to 20). Patients in group II (n = 47) received 2 mg midazolam and repeated injections of propofol (median 100 mg, IQR 53 to 145) with a maximal bolus of 50 mg. RESULTS: Patients treated with the synergistic sedation (group II) recovered remarkably sooner after the procedure compared with those in group I, with a median time to discharge of 17 minutes vs. 93 minutes (P<0.001). Of the patients treated with analgosedation (group I), 28 % were unable to take part in a reaction time measurement and attention awareness test 1 hour after the procedure. All patients treated with the synergistic sedation were able to participate (P=0.002), and performed better. Despite a lower proportion of complete amnesia, patients treated with synergistic sedation more often rated the procedure as comfortable (81% vs. 50 %). Quality of sedation from the point of view of the endoscopist, and cardiorespiratory parameters, were similar in both groups. CONCLUSIONS: Low-dose midazolam combined with propofol is an effective and economic alternative to benzodiazepine-based analgosedation. It is associated with a high degree of patient comfort and rapid recovery times, and has a potential cost benefit concerning nursing care and bed facilities.

[Motility diagnosis in chronic constipation]. / Motilitätsdiagnostik bei chronischer Obstipation.

Scintigraphy is generally considered as gold-standard for the diagnosis of delayed gastric emptying. The 13C-acetate and -octanoate breath tests represent an alternative to this method, which has been extensively validated. Gastric and small bowel manometry are very important tools for the research of motility disorders. In clinical practice, this method has only few indications. Sonographic measurement of gastric emptying is a useful procedure for the diagnosis of delayed gastric emptying, provided that the investigation is done by an experienced person. It is not clear so far, whether MRI is an alternative to the methods mentioned above. If delayed gastric emptying is excluded, the H2-lactulose breath test is a simple screening test for the disorders of small bowel transit. Colonic transit time can reliably be measured with radiopaque markers. Anorectal disorders are diagnosed by manometry and defecography. MRI-defecography gives additional information compared to the conventional defecography. These methods have an important role in the evaluation of chronic constipation. The rational combination of the displayed methods is the most appropriate way to approach the patients' problems.

The postprandial portal flow is related to the severity of portal hypertension and liver cirrhosis.

BACKGROUND/AIMS: Diminished postprandial portal hyperemia has been demonstrated by echo-Doppler flowmetry in patients with liver cirrhosis, but its diagnostic role is unclear. This prospective study was therefore undertaken in patients with varying severity of portal hypertension and degree of liver cirrhosis. METHODS: Portal flowmetry was performed in 66 patients with cirrhosis and 20 healthy volunteers during fasting and 30 min after ingestion of a standardized meal. Hemodynamic parameters were related to the degree of esophageal varices, variceal bleeding, portal hypertensive gastropathy and Child-Pugh score. RESULTS: The postprandial portal blood velocity increment was low in patients with esophageal varices of any degree (22-24%), compared to patients without varices (49%, p<0.01) and healthy controls (65%, p<0.001), but was not different in patients with or without variceal bleeding (22% vs. 20%). In contrast, the congestion index (CI; ratio of portal vein cross-sectional area and portal blood velocity) pre-/postprandial decreased in the bleeding group only (CI pre/ CI post 1.30+/-0.23 (no bleeding) vs. 0.86+/-0.29 (bleeding); p<0.01). Portal hypertensive gastropathy was not related to any of the portal flow parameters. The portal blood velocity increment was comparable in controls (65%) and patients with Child-Pugh class A cirrhosis (56%), but lower in patients with class B (32%) and class C cirrhosis (15%, p<0.05 vs. class A). Also, there was no postprandial decrease in congestion index in patients with the most severe cirrhosis (p<0.01 class C vs. class A and B). CONCLUSIONS: The postprandial rise in portal flow is inversely related to the severity of portal hypertension and liver cirrhosis, and may be a valuable parameter with respect to the risk of variceal bleeding.

Evidence for central nervous effects of corticotropin-releasing hormone on gastric acid secretion in humans.

In animals, corticotropin-releasing hormone (CRH) has been shown to decrease gastric acid secretion after intracerebral administration. Evidence exists that in man peptides have a direct access to the brain upon intranasal administration. This study aimed at assessing brain-mediated effects of CRH on gastric pH after intranasal administration in humans. Eleven healthy men were tested on 2 occasions in a double-blind within-subject cross-over comparison during treatment with CRH (versus placebo) administered intranasally at a dose of 20 micrograms every 10 min. Gastric pH values were measured continuously by a gastral pH tube. After 2 h of intranasal treatment, 6 micrograms/kg pentagastrin was injected subcutaneously. The subject's mood was assessed by an adjective list (EWL-N) at the end of each experimental condition. Intranasal CRH increased pH baseline values from (mean +/- SE) 1.70 +/- 0.31 to 2.62 +/- 0.53 (corresponding to 54%), whereas during intranasal treatment with placebo pH values remained unchanged (p < 0.05). After injection of pentagastrin, pH values decreased to 0.73 +/- 0.04 during placebo and to 0.93 +/- 0.14 during CRH treatment (n.s.). During treatment with CRH, subjects felt less tired (p < 0.05) and deactivated (p < 0.05). Plasma cortisol and CRH levels were not affected by intranasal CRH, excluding mediation of the CRH effects via resorption into the bloodstream, and TSH levels were slightly decreased by the end of the treatment. Results confirm the notion of a pathway for CRH from the nose to the brain, initiating, via central nervous mechanisms, inhibition of gastric acid secretion and a change of mood in humans.

Treatment of pain in chronic pancreatitis by inhibition of pancreatic secretion with octreotide.

It has been suggested that pancreatic ductal hypertension, secondary to pancreatic outflow obstruction, is a cause of pain in chronic pancreatitis. This study investigated the effect of inhibiting pancreatic secretion with octreotide in chronic pancreatitis pain. Ten patients with chronic alcoholic pancreatitis and severe daily pain were included in an intraindividual double blind crossover study. All patients received octreotide (3 x 100 micrograms/day subcutaneously) and placebo (3 x 0.9% saline solution subcutaneously) for three days at random. Between both treatment phases a two day washout period was interposed. Intensity of pain (visual analogue scale) and analgesic consumption were carefully registered. Pancreatic secretion was monitored daily by measuring faecal chymotrypsin concentration. It was found that during the administration of octreotide, pancreatic secretion was strongly inhibited (faecal chymotrypsin mean (SD) 1.7 (0.6) U/g) with respect to placebo (9.6 (4.2) U/g) and washout (7.6 (3.1) U/g) periods (p < 0.001). Pain score (29.6 (4.5) v 28.7 (5.8)) and consumption of analgesics were no different during the octreotide and placebo periods. It is concluded that short term inhibition of pancreatic secretion does not result in pain relief in patients with chronic pancreatitis. This finding is in contrast with the hypothesis that outflow obstruction of pancreatic secretion with consequent ductal hypertension is an important cause of severe persistent pain in chronic pancreatitis.

[Technical methods and hydrogeological aspects of in situ sanitation measures in soil and groundwater areas]. / Verfahrenstechnische und hydrogeologische Aspekte von In-situ-Sanierungsmassnahmen im Boden- und Grundwasserbereich.

The contribution deals in general with the following aspects of remediation processes: --Hydrogeological parameters --Microbiological and engineering parameters --Engineering conceptions of biological in situ remediations --Analytical aspects and monitoring.

The effect of topically applied n-butylester of 2,4-dichlorophenoxyacetic acid on the immune response in mice.

Six-week-old female CD-1 mice were administered the n-butylester of 2,4-dichlorophenoxyacetic acid (2,4-D). The 2,4-D ester was applied dermally at dosages ranging from 0 to 500 mg/kg (2,4-D content) in the acute studies and 0 to 300 mg/kg in the 3 week subacute studies. Following acute exposure, antibody production against sheep red blood cells was suppressed at higher exposure levels. Evidence of clinical toxicity, myotonia and depression, and histopathological alterations in the central nervous system including perivascular edema and ganglial cell necrosis, was also seen in the mice. No alterations were observed in the T- and B-lymphocyte proliferative responses induced by concanavalin A, a T-lymphocyte mitogen, or Escherichia coli lipopolysaccharide, a B-lymphocyte mitogen. Subacute 2,4-D ester exposure which produced minimal clinical or pathological alterations, had no effect on antibody production, but did enhance the B- and T-lymphocyte proliferative responses. The immunosuppressive effects of acute 2,4-D ester exposure which were observed in this study, were unlikely a direct immunological alteration, but rather a secondary manifestation of the clinical syndrome. Since the subacute exposure levels may be more comparable to occupational or environmental exposure, it is unlikely that 2,4-D esters will have any major immunotoxicological significance in agricultural communities.

Granulomatous dermatitis in carnivores associated with dermatophyte infection.

Nine cases of granulomatous dermatitis in carnivores (eight dogs, one cat) are described. In three cases, in which there were no fungi in hair shafts, nor any other evidence of mycotic infection initially, fungal elements were demonstrated in the granulomas with the aid of special stains (PAS and Grocott). Granulomatous dermatitis in case of dermatophyte infections is thought to be an hypersensitivity reaction and has been reported to occur in a variety of mammals. It is suggested that pyogranulomatous skin reactions and trichogranulomas could be associated with dermatophytes and it is recommended to carry out further laboratory studies in order to detect fungi in such cases.

Correlation of microbiological and histological findings in bovine fibrinous pneumonia.

In a retrospective morphological and microbiological study, 39 of 55 cases of bovine fibrinous pneumonia were diagnosed as fibrinous pleuropneumonia. Twenty-nine of these 39 (74%) were associated with Pasteurella hemolytica, but only two cases (5%) with P. multocida. In contrast, of the 16 cases classified as fibrinous bronchopneumonia, one (6%) was associated with P. hemolytica, and nine (56%) with P. multocida. In eight cases Mycoplasma and Hemophilus somnus were found in association with either P. hemolytica or P. multocida but were never isolated alone. We concluded that the use of the term pasteurellosis, implying Pasteurella as the cause, is imprecise because lesions associated with P. hemolytica fulfill the criteria of a fibrinous pleuropneumonia, whereas P. multocida is more likely to cause a bronchopneumonia with moderate amounts of fibrin.

Studies on the occurrence and significance of bovine respiratory syncytial virus in Saskatchewan.

Seventy-six percent of 49 blood samples from Saskatchewan cattle had serum antibodies against bovine respiratory syncytial virus. Experimental infection of one week and seven month old calves with bovine respiratory syncytial virus (Iowa strain) caused transient fever, mucopurulent nasal discharge and coughing but no macroscopic or microscopic lesions attributable to bovine respiratory syncytial virus.

Morphologic effects of dietary plant and animal lipids rich in docosenoic acids on heart and skeletal muscle of cynomolgus monkeys.

Cynomolgi (Macaca fascicularis) were fed diets containing 25% rapeseed oil (RSO), partially hydrogenated herring oil (PHHO), or a 3:1 mixture of lard and corn oil as control for 4 months. The RSO contained approximately 25% of the fatty acids as erucic acid; the PHHO contained a similar concentration of mainly cetoleic acid. The control diet did not include such fatty acids. At the time of necropsy, the RSO- and PHHO-fed monkeys showed myocardial and skeletal muscle lipidosis. Foci of mononuclear cell infiltration, although infrequent, occurred in all three groups and were thought to be nonspecific. The only significant intergroup difference in serum biochemical or hematologic parameters was an increase in serum glutamic-oxaloacetic transaminase activity in both RSO and PHHO groups. Ultrastructural studies confirmed the presence of lipidosis in cardiac and skeletal muscle and revealed mild mitochondrial degeneration, causing a depression of the P/O ratio of the RSO group and a State III respiratory rate depression of the PHHO group. The difference in the exposure/life span ratio represented by this experiment may account for the absence of clear intergroup differences such as are reported in rats used in similar studies, but a true species difference in regard to dietary oils containing docosenoic acids has to be considered as well.

Effects of plant and animal lipids rich in docosenoic acids on the myocardium of Cynomolgus monkeys.

Cynomolgus monkeys (Macaca fascicularis) were fed diets containing 25% rapeseed oil (RSO), partially-hydrogenated herring oil (PHHO) or a 3:1 mixture of lard/corn oil as control (CON) for 4 months. The RSO contained approximately 25% of the fatty acids as erucic acid (cis-docos-13-enoic, 22:1w9) while the PHHO contained a similar concentration of mainly cetoleic acid (cis-docos-11-enoic, 22:1w11). The CON contained no 22:1 acids. The monkeys developed the expected myocardial lipidosis, somewhat more pronounced in the RSO than the PHHO group, but small foci of mononuclear cell infiltration, while infrequent, occurred in all three groups. Significant intergroup differences in biochemical or hematologic measurements of serum constituents were an increase in serum cholesterol concentration in the RSO group and an increase in serum glutamicoxaloacetic transaminase activity in both RSO and PHHO groups at certain intervals. The shorter proportion of M. fascicularis life span represented by this experiment may account for the absence of clear intergroup differences such as are reported in rats used in similar studies.