Delirium in clinical practice: experiences from a specialized delirium ward.

Geriatric patients with known dementia and suffering from an acute somatic disease are highly vulnerable to develop delirium. It is therefore essential to suspect and recognize delirium in these patients, especially in emergency wards. In the present study we evaluated activities on a dedicated delirium ward at a Swedish University Hospital. Over one and a half years 637 patients were treated for suspected delirium, the majority of patients being referred from the emergency ward at the same hospital. Infectious diseases were the main cause of delirium in 67% of cases. Other common causes were heart disease and stroke. Drug use as the only cause of delirium was found in less than 1% of cases. Approximately 70% of patients had cognitive disturbances, either dementia or mild cognitive impairment. The existence of multiple diseases as causative factors was frequent. Knowledge about delirium and how it is both diagnosed and treated is of great importance in all kinds of settings where acute somatic treatments are common.

The effect of antifibrinolytic agents on wound healing.

The effect on the tensile strength of healing wounds of 2 of the most commonly used antifibrinolytic substances, tranexamic acid and epsilon-aminocaproic acid, has been studied in white rats. 2 symmetrical linear lines were made on the dorsal skin, in 1 of which was injected 1 ml of the test solution. The incisions were closed with interrupted sutures, and after 7 days the animal was sacrificed, the wound excised and its tensile strength determined. The results showed tranexamic acid (1 ml of a solution containing 100 mg/ml) to have a positive effect on wound healing, whereas epsilon-aminocaproic acid (1 ml of a solution containing 400 mg/ml) had a negative effect. When both agents were compared in the same animal, wounds in tissue injected with tranexamic acid had a higher tensile strength than those made in tissue pre-treated with epsilon-aminocaproic acid. Even compared at the same ionic strength, similar results were obtained. It is clear from this investigation that, unlike epsilon-aminocaproic acid, tranexamic acid has a positive effect on wound healing, and that this effect is not due to the antifibrinolytic properties, as both are powerful fibrinolytic inhibitors.

Plasminogen activators in human xenografted oro-pharyngeal squamous cell carcinomas.

Specimens of squamous cell carcinomas of the head and neck established as xenografted tumour lines on nude mice were examined by the fibrin slide method for the presence of plasminogen activator(s). The fibrinolytic activity was partly quenched by antibodies against the vessel-related tissue plasminogen activator and partly by antibodies against urokinase. The results indicate that inactive pre-urokinase in tumour tissue is to some degree activated when the tumour tissue is transplanted to the nude mice. In organ culture of the tumours, urokinase of both low and high molecular form was secreted into the medium, but only traces of tissue plasminogen activator. Inhibition of urokinase activity might be an approach to hinder tumour growth.

Laryngeal cancer, aryl hydrocarbon hydroxylase inducibility and smoking. A follow-up study.

In 58 cases with laryngeal cancer (10 supraglottic and 48 glottic), aryl hydrocarbon hydroxylase (AHH) inducibility and smoking habits were studied. All but 2 were smokers and most of them heavy tobacco consumers. The AHH levels were divided into high, intermediate and low groups and were compared to a large healthy control material also divided into the aforementioned groups. A highly significant overrepresentation of patients with a high AHH level (p less than 0.0005) as well as a significant underrepresentation of low AHH levels (p less than 0.025) were found. Smokers with a high AHH level run a fourfold risk of developing laryngeal cancer as compared to non-smokers with low AHH levels. They also develop cancer earlier in life and get recurrences and secondary malignancies more frequently. As in oral and oropharyngeal cancer a high AHH inducibility seems to be of pathogenetic as well as of prognostic importance even in laryngeal cancer.

Plasminogen activators in alveolar bone in man.

Plasminogen activators in alveolar bone in man was studied in quenching experiments by a fibrin slide technique with addition of monospecific antibodies against tissue plasminogen activators (t-PA) and urokinase (u-PA). The plasminogen activator activity was quenched in the slides with anti-t-PA. No quenching was observed in the slides with anti-u-PA. This does not exclude the possibility that enzymatically inactive pre-urokinase is present.

[Smoking and induction of the enzyme aryl hydrocarbon hydroxylase in patients with laryngeal carcinomas and precancerous conditions]. / Rauchen und Induktion des Enzyms Arylhydroxkarbonhydroxylase bei Patienten mit Karzinomen und Präkanzerosen des Larynx.

The risk for a smoker of developing cancer of the larynx depends on the activity of the enzyme arylhydroxcarbonhydroxylase in his cells. The higher the genetically determined arylhydroxcarbonhydroxylase activity, the higher is the probability of developing the disease.

Oral and oropharyngeal cancer, aryl hydrocarbon hydroxylase inducibility and smoking. A follow-up study.

In a series of 50 consecutive cases with oral or oropharyngeal malignancies, aryl hydrocarbon hydroxylase (AHH) inducibility and smoking habits were studied. 82% of the patients were smokers. The AHH levels were divided into high, intermediate and low groups and were correlated to a healthy control material also divided into the groups mentioned. A significant overrepresentation of patients with a high AHH level (p less than 0.0005) as well as an underrepresentation of low AHH levels (p less than 0.01) was found. Smokers with a high AHH level run a sixfold risk of developing cancer in this area and develop it earlier in life than people with low or intermediate AHH levels. Recurrences or secondary malignancies in the upper digestive tract or airways were substantially higher in the high AHH level group as compared to the other. A high AHH inducibility level thus is of both pathogenetic as well as prognostic importance in oral and/or oropharyngeal cancer.

Immunological identification of plasminogen activators in normal and malignant tissues of the oral cavity in man.

Plasminogen-activator activity was examined qualitatively in normal and malignant mucosa of the oral cavity in humans, using an immunological histochemical fibrin slide technique. No fibrinolytic activity was observed in sections of normal mucosa when monospecific antibodies against a melanoma cell activator (anti-MA) were added. Antibodies against urokinase (anti-UK) did not react on the fibrinolytic activity which indicates that the activator is of tissue type. In malignant tissue, fibrinolytic activity was completely blocked by a mixture of anti-MA and anti-UK.

[Carcinoma and leukoplakia in the oral cavity in relation to AHH induction, smoking and dental status]. / Karzinome und Leukoplakien im Mundhöhlenbereich im Verhältnis zu AHH-Induktion, Rauchen und Zahnstatus.

Smoking habits, dental status and aryl-hydrocarbonhydroxylase (AHH) inducibility were studied in a series of 52 oral leucoplakias and 20 oral cancers. There was an obvious association between leucoplakia, cancer and smoking. A significant overrepresentation of high AHH and a corresponding underrepresentation of low AHH inducibility were found among the smokers with leucoplakia and in the oral carcinoma group. In both groups, however, the dental status was largely normal.

Surgical treatment of angular cheilosis.

A surgical method to treat angular cheilosis is described, which does not react favourably to conservative methods. 17 operations have been performed on 13 patients. Successful results were obtained in 9 patients. 4 patients had to be reoperated, with improved results, except in 1 case with total relapse. The observation time varied from 1 to 6 years.

Suppression of secondary antibody response by intravenous immunoglobulin in a patient with haemophilia b and antibodies.

A 39-year-old patient, suffering from severe haemophilia B and antibodies against factor IX, has twice been treated with extracorporeal protein A-Sepharose adsorption followed by conventional substitution therapy in combination with immunosuppression (cyclophosphamide). On both occasions, separated by a 2-year interval, the same procedure was followed except that, on the second, administration of i.v. immunoglobulin (Gammonativ. KabiVitrum) was added. Within a week of the first treatment the patient developed a 15-fold increase in the antibody titre. Following the second treatment described here, no secondary antibody response could be detected, and after a further 12 weeks only traces of antibodies are demonstrable. It seems that antibody synthesis was suppressed by the i.v. immunoglobulin. No evidence was found to demonstrate that the effect was due either to a non-specific suppression of the immune and reticuloendothelial systems or to the action of interfering antibodies. It has not yet been established whether or not the protein A-Sepharose adsorption technique, or the immunosuppressive treatment, contributed in any way to the result. The observations suggest a new approach to the treatment of haemophiliacs with antibodies of the high-responding type.

Metastases in the oral cavity. Case reports.

4 cases of metastases in the oral cavity are described. They were seen in patients with carcinoma of the renal pelvis, renal carcinoma, breast carcinoma and malignant melanoma. In 3 of the cases, the metastases were situated distally to the canines in the mandible, where Roentgen examination had revealed a radiolucent area, and in the 4th case, in the soft tissue in the upper jaw. The initial symptoms in all 4 cases were swelling, pain or decreased sensitivity. The metastases were diagnosed, on average, 7 years after diagnosis of the primary tumour.

Carcinoma of the oral cavity in relation to aryl hydrocarbon hydroxylase inducibility, smoking and dental status.

The authors investigated the smoking patterns in a consecutive series of 20 patients with oral cancer and at the same time assessed the aryl hydrocarbon hydroxylase (AHH) inducibility distribution and dental status. The AHH level proved high in 8 patients, intermediate in 7 and low in 5. High AHH inducibility was more common (p = less than 0.001) and low AHH inducibility less common (p = less than 0.001) than in the controls. Dental status was poor in only 2 patients. It is concluded that smoking is a prominent exogenous factor associated with the occurrence of cancer in the oral cavity. Poor dental status seems to be of minor importance.

Occurrence of VIP nerves in mammalian dental pulps.

Vasoactive intestinal polypeptide (VIP), a neuropeptide with possible neurotransmitter function, was demonstrating in nerves of dental pulps of several mammals including man. The VIP containing nerves were observed around blood vessels and as single terminals in the pulpal stroma. In view of the potent vasodilatory actions of VIP it is conceivable that pulpal VIP nerves take part in the regulation of local blood flow.