Walking with its training effects on the fitness and activity patterns of 79-91 year old females.

BACKGROUND: Information is lacking about the physiological and psychosocial effects of exercise among very old persons. AIM: To investigate the effect of a twice-weekly, six-month progressive walking programme on 38 healthy women in their ninth decade, for evidence of the benefits of exercise. METHODS: Aerobic fitness, blood pressure, skinfold thickness and habitual activity patterns were studied in a randomised controlled trial. Women were chosen, as this is a group of increasing demographic importance for which studies are lacking. RESULTS: The training group and control group were not significantly different at baseline. However, after six months of progressive exercise the training group showed lower resting (p < 0.05) and working (p < 0.005) heart rates compared with non-exercising controls. ANCOVA analyses indicated higher scores for the training group compared with the control group for Maximum Current Activity and Normative Impairment Index (both p < 0.001), which are both components of the Habitual Activity Profile. Morale also significantly improved within the training group (p < 0.01). CONCLUSIONS: These data show the trainability of very old women and the positive impact a low frequency, progressive exercise programme can have on cardiorespiratory fitness and daily living activity patterns. Such improvements are likely to be indicative of an enhanced outlook for independence.

The effete in the heat: heat-related hospital presentations during a ten day heat wave.

BACKGROUND: Severe heat-related illness can result in hospitalisation and possibly death. These illnesses are potentially preventable; in Australia high environmental temperatures are common. AIMS: To identify (i) possible risk factors for hospital attendance with heat-related illness during a heat wave, (ii) problems with diagnosis and therapy, (iii) issues in prevention, and (iv) areas for further study. METHODS: A retrospective descriptive survey from four major teaching hospitals in Adelaide, South Australia (SA), was conducted during a ten day period of exceptional heat in February 1993, in order to review all emergency department presentations (i.e. deaths, casualty treatment or hospital admissions) with a heat-related illness as determined by attending doctors' documentation. Demographic, clinical, management and outcome data were collected. RESULTS: Ninety-four patients were classified as having a heat-related illness of whom 78% had heat exhaustion. Eighty-five per cent were age 60 years or over; 20% came from institutional care; 48% lived alone; 30% had poor mobility. Peak presentation followed high daily temperatures for four consecutive days. Severity was related to pre-existing cognitive impairment, diuretic use and presenting temperature, heart rate, blood pressure, plasma sodium and plasma creatinine. Treatment tended to be non-standardised. Mortality was 12%. Seventeen per cent required a more dependent level of residential care upon discharge. CONCLUSION: Problems were identified in accuracy of diagnosis and appropriate intervention. Awareness of the risk factor profile is needed among health workers, to ensure early preventative strategies. Populations to target for future prevention include elderly people (including those in institutional care), patients with cognitive impairment and patients taking diuretics, multiple medication and/or with other severe co-existing illnesses. Treatment could be more standardised.

A follow-up study on the effects of training on the fitness and habitual activity patterns of 60- to 70-year-old women.

This study investigated the aerobic fitness, body composition, spirometric variables, Human Activity Profile, and level of adherence to physical activity subsequent to completion of a progressive walking program of six month's duration (T1). Sixty-six women previously randomized to training (TG) and control (CG) groups were reassessed six months after finishing the six month walking program (T2). During the follow-up period, 77.8% of the TG subjects continued with exercise and maintained lower (p < 0.005) exercise heart rates compared to the CG. A Mann-Whitney U test on the difference scores (T2-T1) revealed no difference (p > 0.05) between the TG and CG for changes in Maximum Current Activity and Normative Impairment Index, which are both components of the Human Activity Profile, with the earlier increases (p < 0.05) in these parameters by the TG having been maintained. Participation in a previous low frequency training regimen therefore resulted in elderly women adopting and sustaining a higher level of habitual physical activity. This is important because a favorable modification of lifestyle factors is likely to be indicative of an enhanced outlook for independence.

Physical training effects on the fitness and habitual activity patterns of elderly women.

This study investigated the effect of a twice-weekly, six-month progressive walking program on 80 healthy women aged 60 to 70 years. Aerobic fitness, blood pressure, skinfold thickness, spirometric variables, and activity profile were studied. No significant differences existed between the training group (TG) and the control group (CG) at the commencement of the study. However, after 26 weeks of training, the TG registered significantly lower heart rates than the CG, both at rest (p = .019) and during the five to six minutes of an ergometer work test (p = .003). A Mann-Whitney U test on the difference scores (26 weeks-0 week) indicated higher scores for the TG compared with the CG for Maximum Current Activity (p = .001) and Normative Impairment Index (p = .002), which are both components of the Human Activity Profile. These data suggest that adherence to a low-frequency training program can elicit positive physiologic changes in elderly women. Furthermore, increased habitual activity patterns are likely to be indicative of improvements in functional ability, lifestyle, and independence.

Phenytoin and postoperative epilepsy. A double-blind study.

A double-blind trial of phenytoin therapy following craniotomy was performed to test the hypothesis that phenytoin is effective in reducing postoperative epilepsy. A significant reduction in the frequency of epilepsy was observed in the group receiving the active drug up to the 10th postoperative week. Half of the seizures occurred in the first 2 weeks and two-thirds within 1 month of cranial surgery. High rates of epilepsy were observed after surgery in patients with meningioma, metastasis, aneurysm, and head injury. Routine prophylaxis with phenytoin (in a dosage of 5 to 6 mg/kg/day) would seem to be indicated, particularly in high-risk patients and, where possible, this treatment should be started 1 week preoperatively. Seizure control is best when therapeutic levels of phenytoin are maintained.

A controlled study of amitriptyline in the treatment of chronic pain.

This paper reports a study in which a double-blind controlled cross-over study of amitriptyline vs. placebo was carried out in a group of patients referred to a multidisciplinary pain clinic for the management of chronic intractable pain for which no substantial organic cause could be demonstrated. Of 52 patients entering the 12-week trial, 20 withdrew before completion. No differences were found in terms of global improvement on either agent. Subjective reports indicated a greater reduction in pain at 2 and 4 weeks on amitriptyline, but no difference at 6 weeks. None of the baseline measures was predictive of response.

Stability of diluted heparin sodium stored in plastic syringes.

The stability of heparin diluted in 0.9% sodium chloride injection and stored in plastic syringes for a three-week period was studied. Heparin activity was assayed by the activated partial thromboplastin time (APTT) method. Heparin sodium (25,000 units/ml) was diluted to 500 units/ml and stored in 50-ml polypropylene syringes. Concentrations were compared in two brands of syringes stored at room temperature in the dark. In another experiment controlled for order-related assay errors, heparin was stored in one brand by syringe at either 0-4 degrees C or room temperature. There was a statistically decrease in heparin activity over three weeks in both syringes and at both 0-4 degrees C and room temperature. However, the overall drop in activity was only about 8%. Analysis of covariance confirmed significant regression with time at both temperatures. An unexpected finding was that heparin at 500 units/ml consistently assayed higher than this value. A study of the effect of glass and plastic showed that when heparin was diluted into either a glass or plastic container, there was significantly less heparin activity in the glass containers within two hours. One possible explantation for this phenomenon is absorption of heparin to glass surfaces. It was concluded that heparin can be stored in polypropylene syringe for up to three weeks without refrigeration. However, once diluted, heparin should not be stored in glass containers.

Atenolol in hypertension: follow-up of patients crossed over to this agent from propranolol, pindolol or metoprolol.

Thirty hypertensive patients treated with a drug regimen which contained a beta-receptor antagonist (either propranolol, pindolol or metoprolol) exhibited an improvement in blood pressure control when atenolol was substituted for the corresponding beta-blocker in the drug regimen. Additional benefits noted were a reduction in concomitant drug therapy and an improvement in reported side effects. Atenolol caused a significant decrease in heart rate in the group for which the mean follow-up period was 23.6 months.

Plasma potassium levels in hypertensive patients receiving fixed-combination diuretic therapy.

Among 54 patients attending a hospital hypertension clinic and receiving the fixed-combination diuretic Moduretic (hydrochlorothiazide 50 mg, amiloride 5 mg), there was a 44.4% incidence of hypokalaemia. The mean drop in plasma potassium level was 0.69 mmol/L (P less than 0.0001), the mean low level being 2.81 mmol/L. Seventy-four per cent of falls occurred within 52 weeks of the start of therapy, 19.5 weeks being the average period between a normal and a low plasma potassium level. There was no difference in the fall in potassium level between male and female subjects, and beta-blockers were not obviously protective, although there was a statistically significant smaller fall in potassium level in females treated with them. The clinical significance of the unexpected hypokalaemia is uncertain; but even with fixed-combination diuretics, it remains necessary to monitor the plasma potassium level regularly in order to avoid complicating situations. The results of the present study would cast doubt on the efficacy of 5 mg of amiloride with 50 mg of hydrochlorothiazide in fixed-combination form in preventing hypokalaemia in this clinical situation.

Postoperative epilepsy: a double-blind trial of phenytoin after craniotomy.

In a double-blind trial of phenytoin for the prevention of postoperative epilepsy in craniotomy patients, epilepsy was observed in 7.9% (8/101) of patients treated with phenytoin and in 16.7% (17/102) of those receiving placebo. Therapeutic drug levels were associated with a significant reduction in the frequency of epilepsy. Three-quarters of the fits occurred within a month of cranial surgery. High rates of epilepsy have been observed after cranial surgery in patients with meningioma, aneurysm, and head injury with or without intracranial clots, and routine prophylaxis with phenytoin would seem to be indicated in such patients.

Pindolol in orthostatic hypotension: possible therapy?

The association of recumbent hypertension with orthostatic hypotension provides a clinical situation which is extremely difficult to treat. The present report describes two patients who presented with this disorder and evaluates the use of pindolol in their management.

Adverse reactions to drugs: a 12-month hospital survey.

A formalised system of adverse drug reaction (ADR) reporting was instituted at the Royal Adelaide Hospital in August 1975. The present report reviews the results obtained from this system after a 12-month period of operation. A significant number of reports associated with the use of antibiotics and radiographic contrast media were received. The importance of "feed-back" of ADR information to prescribers is emphasised.

Salivary antipyrine kinetics in hepatic and renal disease and in patients on anticonvulsant therapy.

The effects in man of liver disease, renal failure and hepatic microsomal enzyme induction on the elimination kinetics of antipyrine in saliva have been examined. Antipyrine (10 mg/kg) was given orally and assayed in saliva by gas-liquid chromatography. The mean antipyrine half-life from saliva in nine epileptic subjects receiving long term anticonvulsant drug therapy (6 hr +/- 0-9 SEM) was significantly shorter than in twenty normal healthy volunteers (10-7 +/- 0-6). Therapy included phenytoin and phenobarbitone, two drugs known to induce hepatic microsomal enzymes. Five subjects with chronic renal failure exhibited no significant difference in salivary anti-pyrine half-life (11-7 +/- 1-9) compared to the control group, whereas six subjects with chronic liver disease and impaired hepatic function had significantly increased half-life values (42-4 +/- 10). The results suggest that differences in the activity of hepatic microsomal enzymes are reflected by changes in salivary antipyrine elimination kinetics. Chronic renal failure appeared to have no effect on the function of these enzymes.

Rebound hypertension after sudden discontinuation of methyldopa therapy.

A case of "rebound hypertension" resulting from the sudden cessation of methyldopa (Aldomet) therapy is described. The importance of educating patients about the possible outcome of abruptly withdrawing antihypertensive medication is emphasized.