The effect of individualized activities on the sleep of nursing home residents who are cognitively impaired: a pilot study.

This pilot study investigated a program of individualized activities designed to enhance nocturnal sleep in five cognitively impaired veterans residing in a dementia care unit. Actigraphy documented 24-hour sleep-wake patterns of the residents for 3 days. Those meeting the criteria for inclusion then participated in an Individualized Activity Intervention timed to occur during peak napping times for 14 days. During the 10th, 12th, and 14th days of intervention, actigraphy provided a repeat measure of sleep-wake patterns. The results indicated an increase in nocturnal sleep with increased efficiency, as well as a decrease in daytime napping. This pilot study encourages further investigation of this potential method for enhancing nocturnal sleep in cognitively impaired elderly adults.

Effects of massage in acute and critical care.

This is a discussion of the results of a systematic review of 22 articles examining the effect of massage on relaxation, comfort, and sleep. The most consistent effect of massage was reduction in anxiety. Eight of 10 original research studies reported that massage significantly decreased anxiety or perception of tension. Seven of 10 studies found that massage produced physiologic relaxation, as indicated by significant changes in the expected direction in one or more physiologic indicators. In the three studies in which the effect of massage on discomfort was investigated, it was found to be effective in reducing pain. In only three studies was the effect of massage on sleep examined. The methods for measuring sleep were unclear in two of the studies, and results were inconclusive in the other. Further research is needed to investigate the effect of massage on discomfort and promoting sleep.

Inclusion body myositis long after dermatomyositis: a report of two cases.

Dermatomyositis, polymyositis, and inclusion body myositis are rare illnesses which appear to be distinct in clinical and pathologic features, pathogenesis, natural history, and response to therapy. We report two patients who first developed dermatomyositis, and then, after a disease-free interval of many years, developed inclusion body myositis. This may have useful therapeutic implications for patients with dermatomyositis whose illness bocomes refractory to treatment.

Effect of bromotetramisole on renal phosphate excretion.

Levamisole inhibits alkaline phosphatase (ALP) activity in kidney brush border membranes and increases phosphate excretion in vivo in dogs and rats. I-p-Bromotetramisole (I-BR) is a more potent analog of levamisole in regard to inhibition of ALP activity in vitro, but had no effect on phosphate transport by in vitro proximal tubules of the rabbit. Since its effect on phosphate excretion in vivo has not been studied, the present study tested the effects of infusion of I-BR on phosphate excretion in Sprague-Dawley rats. Fractional excretion of phosphate (FEPi) was measured in thyroparathyroidectomized Sprague-Dawley rats before and during a systemic infusion at 0.8 ml/min of 10 mM I-p-Bromotetramisole oxalate (I-BR, n = 6), or the inactive isomer d-p-Bromotetramisole oxalate (d-BR, n = 5). The FEPi increased significantly from 4.7% +/- 0.9% to 13.4% +/- 3.1% in response to I-BR whereas there were no changes in FEPi with inactive d-BR. In conclusion, systemic infusion of I-p-Bromotetramisole increases FEPi in Sprague-Dawley rats.

The combined effects of hypertension, hemodilution, and osmotherapy on the metabolic sequelae of acute experimental cerebral ischemia.

The effects of induced hypertension, hemodilution, and osmotherapy (mannitol) have been assessed singly and in combination on the metabolic sequelae 2 hr after middle cerebral artery (MCA) occlusion in the anesthetized rat. All regimes that included hypertension and monotherapy with mannitol significantly reduced the rise in hemispheric lactate produced by vessel occlusion. No treatment caused increase cerebral edema, and mannitol produced a slight reduction in the hemisphere water content. The significance of the results is discussed.

The effect of increased blood pressure on hemispheric lactate and water content during acute cerebral ischaemia in the rat and gerbil.

Infusions of metaraminol and angiotensin were used to test the effect of increased perfusion pressure on tissue metabolism and oedema after induction of regional cerebral ischaemia in the rat and the gerbil. An increase of mean arterial blood pressure of 30-40 mm Hg in the rat over the first 2 hours after diathermy of the middle cerebral artery prevented the 100% rise in hemisphere lactate seen in normotensive control animals. Angiotensin infusion also prevented early hemispheric oedema in this model. In the gerbil, 4 hours after placing a clip on one carotid artery, metaraminol-induced increases in blood pressure had no such protective effect on the metabolic changes or on oedema. When the clip was removed after 3 hours to permit 1 hour of reperfusion, lactate levels returned to normal but the degree of oedema was unchanged. Hypertension in this reperfusion model caused a slight but not statistically significant increase in oedema. The evidence suggests that moderate increases in blood pressure may be protective against the early metabolic sequelae of focal cerebral ischaemia, but there are potential problems with oedema formation. It is argued that a clinical trial should study the potentially beneficial effects of a brief early increase in blood pressure in the acute aftermath of ischaemic stroke.