In vitro validation of three-dimensional intravascular ultrasound for the evaluation of arterial injury after balloon angioplasty. The hypothesis of this study was that three-dimensional ultrasound imaging would facilitate the evaluation of arterial dissection after balloon angioplasty. The presence and extent of arterial dissection occurring at the time of balloon angioplasty may be important predictors of abrupt vessel closure or late restenosis. Forty-one human arterial segments obtained after death were imaged in an in vitro system at physiologic pressure (80 to 100 mm Hg) before and after balloon angioplasty. Images were acquired with a 20- to 30-MHz mechanical intravascular ultrasound imaging system (Cardiovascular Imaging Systems) with a constant pullback technique (1 mm/s). Standard 0.5-in. (1.27-cm) video tapes were used for data storage and later playback for analog to digital conversion. Digitized data were reconstructed to three-dimensional images with use of voxel space modeling. The vessels were opened longitudinally and subjected to pathologic examination, photographed and classified histologically as normal, fibrous or calcified. Dissection was defined as a disruption and separation of components of the arterial wall. The length and depth of arterial dissection were evaluated grossly and microscopically. Of the 41 arteries studied, 36 (88%) exhibited dissection on pathologic examination after balloon angioplasty. Three-dimensional reconstruction of intravascular ultrasound images identified dissection in 11 (92%) of 12 normal, 8 (100%) of 8 fibrous and 11 (69%) of 16 calcified arteries. Excellent agreement between ultrasound and pathologic findings was achieved in the evaluation of length and depth of dissection for histologically normal and fibrous arteries (kappa = 0.72 to 1.0). When the vessels were severely calcified, the agreement was not as good (kappa = 0.27 to 0.56), particularly in detection of small, non-raised intimal flaps. This histopathologic validation study suggests that three-dimensional intravascular ultrasound imaging facilitates the evaluation of both quantitative and morphologic features of arterial dissection induced by balloon angioplasty. The advantage of three-dimensional intravascular ultrasound is its ability to assess the length and morphology of arterial injury over an entire vessel segment.


Low energy conversion of atrial fibrillation in the sheep. In this study, the feasibility, efficacy and safety of low energy internal atrial cardioversion were investigated in a sheep model. The relation between the level of energy used for atrial defibrillation and the probability of successful cardioversion was examined. Atrial fibrillation is a common clinical arrhythmia that frequently recurs after termination with high energy external cardioversion. In some patients with drug-refractory and poorly tolerated atrial fibrillation, an automatic implantable cardioverter may prove useful by providing rapid restoration of sinus rhythm. In 16 pentobarbital-anesthetized sheep, a right atrial spring electrode was implanted percutaneously and a left thoracic cutaneous patch electrode was placed on the thorax. Sustained atrial fibrillation was induced by rapid atrial pacing and terminated by biphasic cathodal shocks synchronized to the R wave of the surface electrocardiogram (ECG). During 768 defibrillation attempts in 16 sheep, the percent of successful cardioversion attempts increased in a dose-response manner, reaching a plateau at the average energy level of 5 J. With greater than or equal to 1.5 and greater than or equal to 2.5 J energy levels, cardioversion was achieved, respectively, in greater than 50% and greater than 80% of attempts. Ventricular fibrillation occurred in 18 (2.4%) of 768 cardioversion attempts; in all 18 cases, the shock was poorly synchronized with the ECG R wave. Low energy cardioversion of atrial fibrillation to sinus rhythm is feasible with use of a right atrial spring/cutaneous patch electrode configuration. The percent of successful cardioversion attempts depends on the level of energy output, and there is a risk of ventricular fibrillation if cardioversion is poorly synchronized with ventricular depolarization.


The relationship between myocardial retention of technetium-99m teboroxime and myocardial blood flow. The aim of this study was to define the temporal changes in the relationship between technetium-99m teboroxime tissue retention and myocardial blood flow in a canine model. Technetium-99m teboroxime is a new neutral lipophilic myocardial perfusion agent. It is known to be highly extracted by the myocardium but to have a rapid clearance rate. A wide range of myocardial blood flow was induced in each experiment by regional coronary occlusion and dipyridamole infusion. Myocardial retention of technetium-99m teboroxime was determined by in vitro tissue counting at 1, 2 or 5 min after injection of the tracer. Tracer retention was correlated with microsphere-determined blood flow and the data were fitted to nonlinear functions. Correlation coefficients for these functions were 0.92, 0.95 and 0.95 at 1, 2, and 5 min, respectively. At 1 min after injection, the relationship of technetium-99m teboroxime retention to blood flow was linear over a wide flow range, becoming nonlinear at flow rates greater than 4.5 ml/min per g. After 5 min the retention-flow relationship was linear only to 2.5 ml/min per g, above which little change in retention was noted. Normalized myocardial retention, expressed as a percent of the retention at 1 ml/min per g, was also calculated. At flow rates of 1, 2, 3, 4 and 5 ml/min per g, normalized retention was 100, 169, 228, 277 and 317% at 1 min and 100, 171, 217, 239 and 237% at 5 min after injection. At 1 min after injection, the relationship of technetium-99m teboroxime myocardial retention to blood flow is well maintained over a wide range of flow. However, after only 5 min, tracer retention underestimates flow changes at moderate and high flow rates. Thus, rapid acquisition protocols are necessary to fully exploit the potential of this promising new tracer in the evaluation of myocardial perfusion.


Functional impact of remodeling during healing after non-Q wave versus Q wave anterior myocardial infarction in the dog. This study was undertaken to compare changes in left ventricular remodeling and function during healing after a first anterior non-Q wave versus a Q wave myocardial infarction in the dog. Whether ventricular remodeling is more severe after anterior Q wave than after anterior non-Q wave infarction has not been studied systematically. Serial remodeling and functional variables (two-dimensional echocardiography), electrocardiography and hemodynamic data were recorded over 6 weeks in 58 instrumented dogs subjected to left anterior descending coronary artery ligation or ligation plus collateral obliteration. Postmortem topography and transmurality (by planimetry) and infarct collagen (hydroxyproline) were measured at 6 weeks. At 6 weeks, infarct collagen was similarly increased in both groups, but the Q wave group had greater infarct size (7.2% vs. 4.5%, p less than 0.025) and greater transmurality (88% vs. 58%, p less than 0.001), higher left atrial pressures, more infarct expansion (expansion index 2.62 vs. 2.31, p less than 0.001), more thinning (thinning ratio 0.62 vs. 0.72, p less than 0.001), greater cavity dilation (diastolic volume 88 vs. 72 ml, p less than 0.001), more regional bulging in the short-axis view (depth 4.9 vs. 1.9 mm, p less than 0.001), more regional asynergy (18% vs. 7%, p less than 0.001), lower global ejection fraction (40% vs. 48%, p less than 0.001), more endocardial and epicardial bulging in the long-axis view and greater incidence of aneurysm (82% vs. 36%, p less than 0.005), left ventricular thrombus (64% vs. 0%, p less than 0.0005) and ventricular arrhythmias. Echocardiograms obtained during a 6-week period indicated that left ventricular topographic deterioration and dysfunction were present in the earliest postinfarction study at 2 days in both groups but were more frequent in the Q wave group. Regional myocardial blood flow (24 dogs) was lower in the Q wave than in the non-Q wave group. Scanning electron microscopy (10 dogs) revealed preservation of the epicardial collagen matrix in the non-Q wave but not the Q wave group. Anterior Q wave infarction is associated with greater transmurality and more postinfarction left ventricular remodeling and dysfunction than is non-Q wave infarction.


Clinical demonstration that catheter-delivered ultrasound energy reverses arterial vasoconstriction. This study was designed to describe the clinical effects of ultrasound energy on guide-wire-induced arterial vasoconstriction. We have previously shown that ultrasound energy (20 kHz) delivered by a wire probe produces dose-dependent, endothelium-independent smooth muscle relaxation capable of reversing both receptor-mediated and voltage-dependent vasoconstriction in vitro. A high intensity, low frequency ultrasound catheter system was used to recanalize total occlusions in the superficial femoral arteries of two patients. After recanalization, the proximal residual stenoses were each less than 15%. However, distal arterial vasospasm was found angiographically in a popliteal artery of one patient and in an anterior tibial artery of another. Subsequently, the ultrasound catheter probe was advanced to the sites of arterial vasospasm (diffuse in one, focal in one). After 30 and 90 s, respectively, of exposure to ultrasound energy with a frequency of 19.5 kHz, peak tip amplitude of 111 microns and power output at the transducer of 25 W, the vasospasm resolved in each arterial segment. Our findings are the first reported clinical cases documenting that catheter-delivered low frequency, high intensity ultrasound induces arterial vasodilation at the site of vasoconstriction. These biologic effects appear to be relatively unique for an angioplasty device and may have potential clinical importance.


Acute myocardial infarction in the diabetic patient: pathophysiology, clinical course and prognosis. Although there have been significant advances in the care of many of the extrapancreatic manifestations of diabetes, acute myocardial infarction continues to be a major cause of morbidity and mortality in diabetic patients. Factors unique to diabetes increase atherosclerotic plaque formation and thrombosis, thereby contributing to myocardial infarction. Autonomic neuropathy may predispose to infarction and result in atypical presenting symptoms in the diabetic patient, making diagnosis difficult and delaying treatment. The clinical course of myocardial infarction is frequently complicated and carries a higher mortality rate in the diabetic than in the nondiabetic patient. Although the course and pathophysiology of myocardial infarction differ to some degree in diabetic patients from those in patients without diabetes, much more remains to be known to formulate more effective treatment strategies in this high risk subgroup.


Comparison of dietary self-reports with energy expenditure measured using a whole-room indirect calorimeter. In this study we used a whole-room indirect calorimeter to evaluate the accuracy of self-reported food intake. Daily measured energy expenditure was compared with 2 weeks of self-reported food intake. Additionally, oxidation of each macronutrient was compared with its self-reported intake to assess the accuracy of self-reported dietary composition. Participants (23 through 60 years old) were eight dietitians, eight subjects who were trained in keeping dietary records, and eight subjects who were not trained. Physical activity in the calorimeter was matched to usual daily physical activity. Overall, measured energy expenditure was approximately 200 kcal/day higher than reported metabolizable energy intake. However, this was the result primarily of a few subjects whose self-reported food intake was considerably below measured energy expenditure. Subjects who were trained in record keeping did not differ from untrained subjects. Dietitians had the lowest difference between intake and expenditure; none of them had the large discrepancies between intake and expenditure seen in the other groups. In all groups, there was a much greater discrepancy between self-reported intake and oxidation of each macronutrient than between self-reported total energy intake and expenditure.


Salary discrepancies between male and female foodservice directors in JCAHO-accredited hospitals. This study profiles foodservice directors employed in US hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and examines the effect of gender and work-related characteristics on salary. A 37-item questionnaire was sent to 1,002 randomly selected directors of foodservice programs at JCAHO-accredited hospitals in the United States and Puerto Rico. Usable data were received from 663 directors, a response rate of 66%. Foodservice directors answered questions on background information, work-related information, academic and professional certification, and salary range. Findings indicate that foodservice directors are predominantly white, female, college graduates, and more than half are registered dietitians. On the average, foodservice directors had 16 years of experience in foodservice, had spent 9 years with their current employer and 6 years in their present position, and worked a mean of 48 hours each week; more than two thirds earned greater than $30,000. Salaries, however, were significantly higher for men than for women. When controlling for experience (employment in foodservice, years with present employer and in present position), size of hospital, academic preparation, and professional certification, salaries remained consistently higher for men. Although the dietetics profession is predominantly female, gender appears to be the major factor accounting for inequalities in salaries. These findings may alert hospital administrators of the need to review hiring practices and establish standards that promote equitable salary opportunities for persons most qualified for positions, regardless of gender.


Dietary and anthropometric assessment of adults with cerebral palsy. Research on nutrition and cerebral palsy (CP) has been directed at newborns and young children, leaving practitioners with a limited understanding of the nutritional status of the adult population. The purpose of this study was to determine the anthropometric profile and nutrient intakes of 86 adults with cerebral palsy. When compared with growth standards for healthy individuals, the mean body fat percentages and body mass indexes of both men and women with CP were within the normal range. However, 40% of the sample had heights below the 5th percentile for their age and gender, indicating permanent growth stunting. In general, the diets of these individuals were similar to the typical American diet. Both men and women had low nutrient adequacy ratios (NARs) for calcium (0.86 and 0.76, respectively); the women also had low NARs for iron (0.69) and niacin (0.86). Although nutrients obtained from supplements were not included in the NAR score, 26% of the men and 50% of the women reported using nutritional supplements. Fifty-five percent of the sample reported feeding problems. Multivariate analysis illustrated that individuals who participated in regular exercise programs had significantly higher mean adequacy ratios and lower body fat percentages than those who did not exercise regularly.


Reducing fat and sodium in school lunch programs: the LUNCHPOWER! Intervention Study. This study developed, implemented, and evaluated a healthful school lunch program that provided tasty food choices that were lower in fat and sodium. The LUNCHPOWER! Intervention Program was implemented in 34 elementary schools in four school districts that represented diverse geographic areas of Minnesota. A team of registered dietitians, foodservice directors, and cook managers reduced the fat and sodium content of school lunches by modifying recipes and food preparation methods and by identifying and selecting vendor products (prepared food products) that were lower in fat and sodium. Nutrition education messages for students and parents were developed for the 5-month intervention. Monthly menus were analyzed for fat, sodium, and energy content before and after the intervention. There was a significant decrease in both total grams of fat and percent of energy from fat between baseline and follow-up. At all 34 schools, mean daily amount of total fat in the lunch menu decreased 39% (from 32 g to 20 g) and percent of energy from fat decreased 29% (from 40% to 28%). We found that schools could serve lower-sodium and lower-fat meals and retain student participation in the school lunch program.


Short, thin, or obese? Comparing growth indexes of children from high- and low-poverty areas. This study compared the growth indexes of first-grade, white children living in geographic areas of high poverty (n = 281) and low poverty (n = 442) in the state of Washington. Obesity was the most common growth deviance observed in these children. In the low-poverty area, 18% of children had a weight for height greater than the 90th percentile on the National Center for Health Statistics (NCHS) growth standards, whereas only 12% of children from the high-poverty area were in this category. Neither area had high numbers of children with reduced weight for height (less than the 10th percentile on the NCHS growth standards), but children from the high-poverty area were almost twice as likely to be short for their age; 9% of children from the high-poverty area and 5% of children from the low-poverty area had height-for-age values less than the 10th percentile on the NCHS growth standards. Criteria used to determine students' eligibility for financial support for school lunch did not accurately identify children who were thin or short. The prevalence of obesity in these first-grade children suggests that school-based growth screening as well as weight management and physical fitness programs are needed to identify and avert childhood obesity.


Trends in prevalence and magnitude of vitamin and mineral supplement usage and correlation with health status. The 1980 Food and Drug Administration Vitamin and Mineral Supplement Use Survey and the 1986 National Health Interview Survey used similar questions and procedures to estimate and identify trends in the prevalence and magnitude of supplement usage in the United States. A comparison of the two surveys reveals that prevalence of supplement use among adults decreased slightly, from 42% in 1980 to 38% in 1986. The magnitude of supplement use has also decreased; users reported taking a mean of 2.15 supplements in 1980 compared with a mean of 1.77 in 1986. The prevalence of supplement users identified as light users increased from 42% in 1980 to 57% in 1986. Supplement usage was more likely and more intense among individuals who had one or more health problems and among individuals who perceived their health as very good or excellent. The findings indicate that supplement usage remains a widespread behavior linked to popular conceptions of good health and well-being but one that is susceptible to change.


Effect of nutrition on the health of the elderly. Nutrition may play a role in the progressive decline of several body functions with aging. Progressive decline in energy, lean body mass, and protein intake are also associated with aging. Many elderly (greater than 55 years old) drink less than the recommended amounts of water and consume less than the Recommended Dietary Allowances of calcium, iron, zinc, copper, thiamin, riboflavin, folate, and vitamins B-12 and D. Nutrition needs of the elderly to maintain activities of daily living are expected to increase in future years. Because diminished physical activity and old age disabilities cause the elderly to modify eating habits acquired at a younger age, dietary and other life-style changes should be implemented early in life so that optimal tissue function will be maintained. More research and development is needed in the areas of nutrient requirements for the elderly, effect of nutrition on chronic diseases, improved methods for assessing nutritional status and screening the elderly for nutritional risk, nutrient-nutrient and nutrient-drug interactions, and educational strategies to provide better nutrition and eliminate health fraud. Dietary interventions show promise, but must be monitored for effectiveness.


Malnutrition in the institutionalized older adult. Most older adults in the United States live at home and are well nourished. Approximately 5% to 6% reside in nursing homes, and this segment of the older population typically suffers from multiple diseases that contribute to a high incidence of malnutrition. Forty percent of hospital beds are occupied by older persons. This article addresses the causes of malnutrition in older persons institutionalized in long-term and acute-care facilities. The causes include changes in nutrient requirements secondary to disease processes and drug modalities in combination with low or marginal dietary intake. Infections are common and result in anorexia, poor dietary intake, and malnutrition, which predispose the patient to another infection. Occurrence of decubitus ulcers is related to nutritional status and presents a serious risk for older persons with limited mobility. Depression and dementia are commonly seen in older persons and are major contributors to poor appetite and malnutrition. Cancer cachexia accounts for about half of the cases of malnutrition in older institutionalized persons. Physiologic changes that occur with age and multiple drug use place older persons at a high risk for adverse drug reactions. Less body water in the older individual influences and complicates many aspects of treatment. Standards, methods, and interpretation of nutritional assessment measurements in older persons differ from those in younger adults. The nutrition care provider must carefully consider many complex physical, medical, and psychosocial factors to deliver individualized nutrition care.


Practice guidelines for nutrition care by dietetics practitioners for outpatients with non-insulin-dependent diabetes mellitus: consensus statement. In summary, nutrition practice guidelines for dietitians who provide outpatient care for persons with NIDDM provide a roadmap for nutrition care that allows for consistency in individualized care. A field test that compares care according to practice guidelines with usual or basic care can provide evidence, based on medical, education/behavior, and cost outcomes, that practice guidelines are not only reasonable and realistic but also effective.


Decline in physical function following hip fracture. The main objective of the study was to determine the change in physical function following hip fractures in a community-living elderly population. A secondary objective was the determination of baseline factors predictive of altered function following hip fracture. Prospective, cohort study. Urban, community-living elders. 120 members of a cohort of 2806 individuals age 65 and older in New Haven, CT who sustained a hip fracture from 1982 to 1988 and were treated in the two New Haven hospitals. Self-reported performance of dressing, transferring, walking across a room, climbing stairs, and walking one-half mile before the fracture occurred and 6 weeks and 6 months post-fracture. Baseline factors were assessed before the hip fracture occurred. Of the 120 cohort members who sustained a hip fracture in the 6-year study period, 22 died within 6 months of the fracture. Among survivors there was a sustained decline in function at 6 weeks after the fracture with little improvement by 6 months. At baseline, 86% could dress independently versus 49% at 6 months; 90% could transfer independently versus 32% at 6 months; 75% could walk across a room independently versus 15% at 6 months; 63% could climb a flight of stairs versus 8% at 6 months; and 41% could walk one-half mile versus 6% at 6 months. Physical function and mental status were the only baseline factors significantly associated with physical function at 6 months after the fracture in bivariate analysis, while physical function and depression were associated in multivariate analysis. We found a substantial decline in physical function following hip fracture in a prospectively followed community-living elderly population. Only pre-morbid physical and mental function predicted this decline.


Surgical results and complications in elderly patients with benign lesions of the spinal canal. To describe the long-term outcome and complications of spinal surgery in a population of elderly patients. Retrospective chart review and clinical follow-up. A 700-bed tertiary care midwestern hospital. Patients 70 years of age or older who underwent elective surgical procedures for the treatment of benign lesions of the spinal canal. Data obtained from chart review included age, sex, nature and duration of neurological symptoms, activities of daily living (ADL), associated illnesses, length of hospitalization, type of surgery, and complications attributable to surgery. Outcome measurements included changes in neurological symptoms and ADL and a standardized scale obtained from consecutive outpatient visits, telephone interviews, or written responses. Seventy-eight patients with lumbar canal stenosis or soft disc herniations underwent laminectomies, foraminotomies or discectomies. Eleven patients underwent cervical laminectomies for multilevel spondylitic myelopathy. Limb and spine pain were the most common neurological symptoms in patients with lumbar lesions; diminished ADLs were present in eight patients with cervical myelopathies. Six patients died of unrelated causes, and 78 were followed for an average of 27.1 months. Twenty-three (85.2%) of 27 patients with lumbar disc herniations reported improvements or resolution of limb pain while 35 (81.4%) of 43 patients with lumbar canal stenosis reported fair or good results. Five of eight patients with multilevel cervical spondylosis reported improvements of myelopathic symptoms. Twenty-six (28.6%) complications were attributable to 91 surgical procedures including five severe complications and one fatality. Patients with three or more associated illnesses demonstrated a significantly higher incidence of postoperative complications. Elderly patients with benign lesions of the spinal canal may achieve significant reduction in limb pain and increases in ADL following appropriate surgery, with a tolerable rate of severe complications. The preoperative physical condition of the elderly patient served as an indicator for operative morbidity.


Joint impairment and hand function in the elderly. To test the contribution of joint impairment to observed hand function (grip strength and Williams Test) in the elderly, using a multivariate model. Cross-sectional observational data (baseline data from an ongoing longitudinal study). Five hundred forty-one persons over age 60, including continuing care retirement community (n = 222), homebound (n = 72), and ambulatory (n = 247) respondents. Mean age at assessment 76.7, (SD = 9.0). Independent variables included sociodemographics, physician measures of upper joint impairment, an index of comorbidities derived from physical examination or chart abstract, self-assessed arthritis pain, depression, and anxiety. The dependent variables included grip strength and a modified Williams Test [Williams Test (M)]. The multiple regression explained 59% (Adjusted R2 = .59) of the variance in grip strength, with joint impairment accounting for a change in R2 of .07. Upper joint impairment and grip strength accounted for 3% and 5%, respectively, of the variance in the Williams Test (M) (total amount of explained variance = 45%). Demographics explain most of the variance in grip strength and performance on the Williams Test (M). Controlling for demographics, musculoskeletal disease represented by joint impairment is associated with diminished grip strength. Reduced grip strength is associated with poorer performance on the Williams Test (M).


Geriatricians' attitudes toward assisting suicide of dementia patients. To identify geriatricians' attitudes toward assisting suicide of dementia patients, with particular reference to the case of Janet Adkins/Dr. Kevorkian. Mailed questionnaire survey. Four distinct geographical regions of the US: Far West, Midwest, Southeast, and Northeast. All 1,381 ABIM-certified internist geriatricians in the four regions; 727 (52.6%) responded. Positive, negative, or unsure responses to questionnaire items; comparison of responses between geographical regions. Sixty-six percent of respondents felt that Dr. Kevorkian's assistance of Janet Adkins' suicide was not justifiable, while 14% stated it was morally justifiable. Twenty-nine percent felt Janet Adkins' decision to commit suicide was morally wrong, while 49% stated it was not morally wrong. If the responding geriatricians themselves were diagnosed as having a dementing illness, 41% would consider suicide a possible option; 39% would not consider suicide. Twenty-six percent favored easing restrictions on physician-assisted suicide of competent dementia patients, while 57% opposed this. If current restrictions were eased, 21% would consider assisting suicide of competent dementia patients, and 66% would not. Respondents' attitudes showed some significant (P less than or equal to 0.05) variations by geographical region. Where regional differences were observed, respondents in the Midwest tended to show more conservative attitudes toward physician-assisted suicide than those in the Far West and Northeast. Most responding geriatricians would not consider assisting suicide of dementia patients, and most oppose easing restrictions on physician-assisted suicide. Many, however, could accept the (unassisted) suicide of a competent dementia patient, and many would consider suicide themselves if stricken with dementia.


Comorbid mental and substance disorders among older psychiatric patients. To investigate the rate and configurations of current comorbid mental and substance disorders among older psychiatric patients. A descriptive, retrospective study. A non-acute, public residential psychiatric treatment facility for adults 55 years of age and older (mean length of stay: 3 months). 128 patients discharged during a 2-year period. DSM-III-R diagnoses, demographic and history data. The overall prevalence rate of concurrent mental and substance disorders during the present treatment episode was 21%. This is comparable to the 6-month rate of 19.8% found in the Epidemiological Catchment Area Study among adults in treatment (all ages). Nearly 50% of the dually diagnosed subsample received more than two diagnoses, with 60% of the subsample receiving a personality disorder diagnosis. Concurrent affective, alcohol, and personality disorder diagnoses were common. Older patients with comorbid substance-use and mental disorders may differ substantively from comorbid younger patients. Among older patients in an intermediate-term psychiatric facility, the triple occurrence of alcoholism personality disorder and depression was common.


Behavioral disturbance in severe Alzheimer's disease: a comparison of family member and nursing staff reporting. The purpose of this study is to describe the behavioral disturbances in a group of patients with severe Alzheimer's disease and to compare family members' and nursing staff members' perceptions regarding these behaviors. Cross-sectional survey. The 33 subjects resided in nine different long-term care facilities in the Rochester, NY area and were selected from a group of patients enrolled in a longitudinal research study of Alzheimer's disease, based on having severe disease. Caregivers were surveyed with a self-administered questionnaire. The primary outcome measures were the prevalences of 13 behaviors and the magnitude of caregiver concern reported by each group of caregivers. Compared with family members, nurses reported more concern with vegetative behaviors (incontinence, dietary change, and sleep disturbance; P = 0.055). There was statistical evidence that the number of behaviors reported by the nurses decreased with increasing disease severity (P = 0.002). Although not statistically significant, the magnitude of concern reported by the nurses also decreased with increasing disease severity (P = 0.063). Family members and nurses frequently disagreed about the presence of many behaviors exhibited by individual patients, and the responses of caregivers within the same group were highly variable. Institutionalized patients with severe Alzheimer's disease continue to exhibit troublesome behaviors although overall behavioral disturbance and concern appear to decrease with increasing disease severity. The assessment of these behaviors and their impact on caregivers can be very subjective, depending in part on the role of the caregiver.


A comparison of caregivers for elderly stroke and dementia victims. To compare elderly co-resident caregivers of stroke and dementia patients on measures of burden and psychological morbidity. Cohort study. Caregivers interviewed at home. Convenience sample, 99 co-resident caregivers of dementia and stroke patients registered with a community rehabilitation and geriatric service and who were 60 years or over. Caregiver burden as measured by self-administered questionnaire and subsequent interview, using the Relatives Stress Scale (RSS) and psychological morbidity as measured on the General Health Questionnaire (GHQ). Forty-six percent of caregivers had significant psychological morbidity (GHQ greater than 4). Mean RSS score was 12.2 (SD 5.4). No significant differences were found between stroke and dementia caregivers on these measures. Caregiver burden was significantly correlated with psychological morbidity in both caregiver groups. Behavior and mood disturbance in the patient was significantly correlated with burden (dementia caregivers r = 0.66; stroke caregivers r = 0.49, P less than 0.0001) and psychological morbidity (dementia caregivers r = 0.44, P less than 0.01; stroke caregivers r = 0.30, P less than 0.05). Caregiver's dissatisfaction with participation in life activities was correlated with burden (dementia caregivers r = 0.58; stroke caregivers r = 0.63, P less than 0.0001) and psychological morbidity (dementia caregivers r = 0.67, stroke caregivers r = 0.56, P, 0.0001). Elderly co-resident caregivers for stroke and dementia patients experience similar degrees of burden and high levels of psychological morbidity. Psychiatric aspects of chronic disability, rather than physical aspects, were found to be more stressful to caregivers. All assessments of the disabled elderly should include measures of caregiver burden and psychological distress.


Fluoxetine in elderly patients: is there cause for concern? To assess whether fluoxetine use is associated with significant weight loss or other side effects in depressed elderly patients with concomitant medical illness. A retrospective chart review. A tertiary care VA hospital. Five groups of outpatients were studied: (1) patients greater than 75 years old receiving fluoxetine (n = 15); (2) patients 60 to 71 years old receiving fluoxetine (n = 20); (3) patients greater than 75 years old receiving nortryptiline or desipramine (n = 20); (4) patients greater than 75 years old with a history of depression but on no antidepressant medication (n = 20); and (5) patients greater than 75 years old with no history of depression (n = 28). Mortality, change in weight, reports of anorexia or nausea, and serum sodium and glucose measurements. Patients greater than 75 years of age taking fluoxetine experienced significantly greater weight loss (average 4.6 kilograms, P = 0.0062) than the other groups. Both groups of patients taking fluoxetine were significantly more likely to report nausea (P = 0.0095) and anorexia (P = 0.0009). No significant differences were noted in mortality or the frequency of hypoglycemia or hyponatremia between groups. The frequency and degree of weight loss noted here in medically ill elderly receiving fluoxetine warrants further investigation.


Factors attenuating the validity of the Geriatric Depression Scale in a dementia population. The validity of the Geriatric Depression Scale (GDS) in cognitively impaired patients has been questioned. We investigated possible factors (memory loss, dementia severity, unawareness of illness) attenuating the validity of the GDS in patients with dementia. Eighty-three patients who met research diagnostic criteria for "probable Alzheimer's disease." Subjects with major depressive disorder were excluded. Dementia severity ranged from mild to moderate. Outpatient clinics, including institutional settings and private research settings. Depression--GDS; Hamilton Depression Scale. Memory--Wechsler Memory Scale; Benton Visual Retention Test. Dementia severity--Mini-Mental State Examination. Self-awareness of cognitive deficits--Difference score between a self-report memory questionnaire and an informant-rated memory questionnaire. Multiple regression analysis revealed that Hamilton scores were the major predictor of GDS scores. Memory scores and self-awareness scores were also significant predictors. Dementia severity scores were not a significant predictor. The GDS is a valid measure of mild-to-moderate depressive symptoms in Alzheimer patients with mild-to-moderate dementia. However, Alzheimer patients who disavow cognitive deficits also tend to disavow depressive symptoms, and the GDS should be used with caution in such patients. Finally, the argument that memory impairment precludes accurate self-report of recent mood is negated by our finding that many patients accurately reported depressive symptoms and that worse memory was associated with more self-reported depressive symptoms.


Modeling recovery from stumbles: preliminary data on variable selection and classification efficacy. The primary purpose of this preliminary investigation was to determine the functional relationship between selected information processing time and response execution variables and measures of postural stability in elderly women. A secondary purpose was to explore the efficacy of a neuromotor model using selected variables to retrospectively identify subjects with a self-reported history of falling. Descriptive, retrospective, cohort. General community. Convenience sample of 17 community-dwelling females with a mean age of 72.2 years. Postural stability variables included the amplitude and frequency of postural sway during static vision-aided no-vision conditions. Information processing and response execution variables were collected using a simple-choice reaction time paradigm for an isometric knee extension task. Postural stability and information processing variables were functionally independent. Based upon significant intergroup differences, simple and choice pre-motor reaction time and non-vision aided anterior posterior sway amplitude were selected for inclusion in a discriminant analysis. The resulting discriminant function was significant (P = 0.01), correctly categorizing all of the subjects with a self-reported history of falling and identifying six out of seven of the non-fallers. These preliminary results suggest that it is feasible to identify a predisposition to falling by detecting an inability to respond successfully to a postural disturbance.


The mini-mental state examination: a comprehensive review. The purpose of this paper is to provide a comprehensive review of information accumulated over the past 26 years regarding the psychometric properties and utility of the Mini-Mental State Examination (MMSE). The reviewed studies assessed a wide variety of subjects, ranging from cognitively intact community residents to those with severe cognitive impairment associated with various types of dementing illnesses. The validity of the MMSE was compared against a variety of gold standards, including DSM-III-R and NINCDS-ADRDA criteria, clinical diagnoses, Activities of Daily Living measures, and other tests that putatively identify and measure cognitive impairment. Reliability and construct validity were judged to be satisfactory. Measures of criterion validity showed high levels of sensitivity for moderate-to-severe cognitive impairment and lower levels for mild degrees of impairment. Content analyses revealed the MMSE was highly verbal, and not all items were equally sensitive to cognitive impairment. Items measuring language were judged to be relatively easy and lacked utility for identifying mild language deficits. Overall, MMSE scores were affected by age, education, and cultural background, but not gender. In general, the MMSE fulfilled its original goal of providing a brief screening test that quantitatively assesses the severity of cognitive impairment and documents cognitive changes occurring over time. The MMSE should not, by itself, be used as a diagnostic tool to identify dementia. Suggestions for the clinical use of the MMSE are made.


Research with Alzheimer's disease subjects: informed consent and proxy decision making. Because patients with Alzheimer's disease are on a path of declining capacity to give consent, advancement of research with Alzheimer's disease subjects presents challenging and perplexing ethical and legal dilemmas. Although generic regulations for the protection of human subjects apply, special considerations for cognitively impaired dementia subjects have depended on local Institutional Review Boards and relevant state laws and regulations, producing a lack of uniformity regarding encouragement of research and protection of subjects. Discussed are the dilemmas encountered in advancing research with Alzheimer's disease subjects, including (1) issues about informed consent, (2) determination of decision-making capacity (competency), (3) problems in dealing with subjects of mild and fluctuating impairment, and (4) proxy and advance consent measures for severely impaired subjects. Proposed is an agenda of ethical research needs for advancing biomedical research on Alzheimer's disease. Needed are empirical studies concerning recruitment of Alzheimer's disease subjects, the actual processes of informed consent, and the difficulties encountered by researchers, collaborative development of tests for both diagnosing Alzheimer's disease and assessing subjects' capacities to provide informed consent, and exploration of innovative uses of advance and proxy consents for participation in Alzheimer's disease research.


The impact of OBRA on medical practice within nursing facilities. Major changes in the federal oversight of nursing home care were passed by Congress and became law as the Nursing Home Reform Amendments of the Omnibus Budget Reconciliation Act of 1987 (OBRA 87). The final regulations to implement OBRA 87 were published in September, 1991. The intent of this article is to provide an overview of selected parts of the nursing home reform regulations, which have a direct impact on physician practice within nursing facilities, and to offer strategies for successful management of the changes that are required. A brief review of the origins of the legislation and the process by which law is turned into practice is provided as a context in which to understand the changes mandated by the Nursing Home Reform Amendments of OBRA 87.


Geriatric education. Part I: Efficacy of a mandatory clinical rotation for fourth year medical students. To describe the curriculum of a mandatory, fourth-year geriatrics clerkship and assess its impact on medical students' knowledge of geriatric medicine and attitudes toward the elderly. One group, before/after trial. Mount Sinai School of Medicine of the City University of New York. Entire fourth year class of medical students (n = 127). Four-week-long clinical geriatrics clerkship. Pre- and post-rotation: test of knowledge; Aging Semantic Differential (ASD) attitude scale; Modified Maxwell-Sullivan attitude scale; questionnaire. Seventy percent of students found the rotation to be educationally valuable; however, only one-third of students would have taken the clerkship had it not been required. Mean geriatric knowledge score increased by 18.7% (P less than 0.001). Mean ASD attitude score did not change significantly (130.5 +/- 19.2 pre-rotation versus 126.6 +/- 18.8 post-rotation, P = 0.15), but students started the rotation with a neutral attitude. Over 90% of students agreed they would welcome elderly into their future practice. If a national curricular goal is to improve medical students' knowledge of geriatric medicine, required rather than elective rotations may be in order.


Geriatric education. Part II: The effect of a well elderly program on medical student attitudes toward geriatric patients. To assess impact of exposure to healthy elderly on medical students' attitudes toward the elderly. Prospective, randomized, controlled intervention trial. Community-based Well Elderly Program. Ninety-three fourth year medical students on a required Geriatric Medicine clerkship who were assigned to either a tertiary care university medical center or a teaching nursing home. Thirty-five students were randomly assigned to participate in a Well Elderly Program and were compared to a control group of 58 students at equivalent sites who did not participate. Pre- and post-rotation, students were given the Aging Semantic Differential (ASD), a validated geriatric attitudinal scale. By repeated measures analysis of variance, the difference between pre- and post-rotation ASD scores were most significant for students who participated in the Well Elderly Program; site did not exert a significant interaction effect. These results underscore the importance of exposure to healthy older people on effecting positive attitude changes among medical students on geriatrics rotations.


The effect of head trauma on the visual system: the doctor of optometry as a member of the rehabilitation team. Brain injury results from either head trauma or strokes and causes many visual and visually related disturbances. Rehabilitation is aimed at developing skills that allow the patient to optimally function as a viable and independent member of society. Often the resultant visual deficits remain undiagnosed and untreated, which hinder the patient's total rehabilitation. Optometric evaluation of brain injured patients should routinely be performed as part of the transdisciplinary team approach to rehabilitation. Optometrists are uniquely qualified to diagnose and treat visual and functional deficits of the visual system in the brain injured population. The purpose of this paper is to present a rationale for optometric participation in the rehabilitation of head trauma and stroke patients.


An overview of head trauma for the primary care practitioner, Part I--Etiology, diagnosis, and consequences of head trauma. At some point in their careers, most primary care providers will encounter patients who have sustained some degree of traumatic head or brain injury. This article presents an overview of the causative mechanisms responsible for this trauma, the nature of the injuries sustained, some relevant initial medical diagnostic procedures performed, and possible consequences encountered. An emphasis has been placed on familiarizing the primary care provider with specific terminology associated with head trauma incidents.


An overview of head trauma for the primary care practitioner: Part II-Ocular damage associated with head trauma. The forces that produce head and brain trauma can also produce primary and secondary damage to the eye and vision. A brief overview of potential damage is presented for each structure of the eye to give the primary care practitioner or initial examining physician a familiarity with conditions that must be considered in the evaluation of the head trauma patient. Certain primary care therapies are also noted.


The primary care optometric evaluation of the traumatic brain injury patient. Traumatic brain injury can cause an assortment of visual problems for the patient. These problems, unless resolved, can hinder a patient's rehabilitative progress. This article discusses the characteristic visual deficits found after traumatic brain injury. It also explains how minor modifications made to a routine comprehensive optometric examination can tailor an examination to the head trauma patient.


The differential diagnosis of perceptual deficits in traumatic brain injury patients. This article describes a perceptual testing battery useful in the evaluation of the traumatic-brain-injury patient. Areas of visual perceptual deficits significant in this population are discussed. Key tests, familiar to optometrists, are indicated for the evaluation of these areas. A differential diagnosis based on the results of these tests can be made. This allows for an effective visual rehabilitation program to be developed for these patients.


Head trauma and low vision: clinical modifications for diagnosis and prescription. Head-trauma patients benefit from many optical and non-optical devices usually associated with low vision care. This article reviews the most common modifications of clinical examination techniques required to facilitate the evaluation of trauma patients who may benefit from or require low vision devices. A discussion of the importance of incorporating common optical and non-optical devices which can enhance the lives of traumatized patients will follow.


Optometric therapy for the left brain injured patient. This article discusses the role of optometric visual therapy in the rehabilitation of left head trauma patients. It overviews the functions of the left hemisphere and the consequences of traumatic brain injury. A patient who was helped by this perceptual therapy is presented. An overview of the therapy approach used for this patient is discussed.


Optometric management of binocular dysfunctions secondary to head trauma: case reports. Extropia, esotropia, hyper elements, visual sequencing problems, accommodative dysfunctions and inefficient Motor Planning are common consequences of head trauma. Optometric visual therapy is an effective treatment modality for these dysfunctions. Two case reports are presented in order to illustrate optometric management of patients exhibiting these problems secondary to head trauma.


The utilization of a temporal mirror coating on the back surface of the lens as a field enhancement device. A 37-year-old male had a right homonymous hemianopia due to trauma. During his initial low vision assessment, a small clip-on mirror was dispensed to help him compensate for his field loss. At follow-up, he reported satisfaction with the mirror. He also reported that novelty "look behind you" sunglasses were beneficial to him and less conspicuous than the clip-on mirror. He requested temporal mirror coating on otherwise clear lenses so that he could utilize the glasses at night or on cloudy days. We fabricated this for him and also mounted a small mirror nasally within the vertex distance behind his frame. The fabrication of the two devices will be discussed as well as a comparison of these three field enhancement devices.


Clinical research and statistical analysis of a visual field awareness system. This article discusses the clinical research and applications of the statistical analysis of a system called "The Visual Field Awareness System." This medical lens system allows patients with a visual field loss to 1) scan toward area of the loss, to see objects sooner and more clearly, and 2) demonstrate increased function and safety. Seventy-nine percent (27 of 34) of the patients in the sample received and accepted the prism treatment. Of this group, a minimum of 70 percent (19 of 27) continue to benefit from this treatment strategy. Statistically significant predictors of success are discussed. This study demonstrates that patients suffering visual field loss may show functional benefit by the utilization of this prism treatment along with vision rehabilitation.


Psychosocial aspects of vision loss associated with head trauma. The adjustment to sudden and severe vision loss is always difficult. However, when vision loss is the result of head trauma, additional psychological and psychosocial factors complicate the adjustment process. Patients often must cope with a variety of cognitive and personality changes that dramatically affect the ability to adapt to physical limitations.


Community resources and third party billing for patients who have had head trauma/head injuries. In order to render full scope care for head trauma patients, optometrists should be familiar with the community resources available for patients with such injuries. In addition, they should have an understanding of third party billing procedures needed to seek reimbursement for the diagnosis and treatment of patients who have suffered such accidents. This article will review each of these topics.


The role of occupational therapy in rehabilitating stroke patients. The role of the occupational therapist is outlined. An overview of occupational therapy evaluation and treatment is discussed. The goal of rehabilitation is aimed at helping the patient achieve the highest level of independence of which he is physically capable. A case report is presented.


Mitotic activity and cell deletion in ventral prostate epithelium of intact and castrated oxytocin-treated rats. Previous study has shown that oxytocin (OT) attenuated the postcastration regression of ventral prostate epithelium in rats. To decide if this effect is associated with stimulation of cell division or improvement of cell survival, metaphase index of secretory cells and frequency of apoptotic bodies in the epithelium, combined with stereological parameters, were determined in the present study. OT was injected subcutaneously in a dose of 0.25 IU/100 g/d during 5 postorchiectomal days and the same treatment was applied to intact rats. Only the prostate of castrated animals responded to OT. They had greater total volume of the epithelium, total number and metaphase index of secretory cells, but lower frequency of apoptotic bodies. These findings demonstrate the ability of OT to stimulate mitotic activity and to diminish mortality of secretory cells caused by orchiectomy.


Mutations of the human thyrotropin-beta subunit glycosylation site reduce thyrotropin synthesis independent of changes in glycosylation status. In recent studies, site-directed mutagenesis has been used to alter the tripeptide glycosylation recognition sequences of glycoprotein hormone subunits, thereby affecting their structure and function. However, it is not known whether these effects result from changes in glycosylation status, amino acid sequence, or both. We therefore studied the synthesis of wild-type and mutant recombinant human thyrotropins produced by transient transfection of a human cell line. Mutating the TSH-beta subunit glycosylation recognition sequence, Asn-Thr-Thr (codons 23-25), to either Gln-Thr-Thr or Asn-Thr-Tyr abolished subunit glycosylation, as demonstrated by the inability to incorporate 3H-carbohydrates. However, a third mutation (Asn-Thr-Ser) contained an intact glycosylation recognition sequence site, and was shown to retain glycosylation. The mutations that abolished TSH-beta subunit glycosylation resulted in greater than 90% decreases in TSH synthesis. However, the glycosylation recognition sequence mutant that retained beta subunit glycosylation exhibited a 70% decrease in TSH production. These decreases were not attributable to the intracellular accumulation of TSH or its free beta subunit. We also engineered two TSH-beta subunit mutations that did not alter the glycosylation recognition sequence. A glycine to arginine mutation adjacent to the glycosylation recognition sequence, in a region thought to be critical for heterodimer formation, abolished TSH production. In contrast, shortening the TSH-beta subunit carboxyterminus by six amino acids increased TSH synthesis.(ABSTRACT TRUNCATED AT 250 WORDS)


Prevalence and characteristics of post-partum thyroid dysfunction: results of a survey from Toronto, Canada. In order to determine the prevalence of post-partum thyroid dysfunction in our region, 1,376 randomly selected mothers were enrolled immediately post-partum and followed prospectively over a 2 year period in a large single-center survey. Beginning at delivery, sequential clinical and laboratory assessments were conducted at 6-8 week intervals up to 1 year post-partum and a questionnaire was administered at 3 months post-partum. Among the 1,376 mothers who qualified for entry into this study, 495 (36%) completed at least 3 months follow-up and 300 (22%) completed at least 1 year of follow-up. Abnormalities in post-partum thyroid function (PTD) were detected in 82 of the 1,376 enrolled mothers for an overall minimum prevalence rate of 6.0%. Hyperthyroidism confirmed to be associated with a low 24h radioactive iodine thyroid uptake (RAIU), compatible with the post-partum painless thyroiditis syndrome (PPT) was documented in 44 (3.2% minimum prevalence of typical PPT) of which 39 (89%) had a typical biphasic (hyperthyroid to hypothyroid) PTD while 5 (11%) had only a hyperthyroid phase with a suppressed RAIU without a subsequent hypothyroid phase. Another 17 (1.2%) had transient hyperthyroidism likely due to PPT but were not confirmed by an RAIU test and did not evolve to a detectable hypothyroid phase; and, 17 mothers (1.2%) had hypothyroidism between 5-7 months post-partum without preceding hyperthyroidism, resulting in an overall minimum prevalence of 5.7% for all variants of PPT. Graves' hyperthyroidism occurred in 3 (0.2%) and toxic nodular goiter was present in 1 (0.07%).(ABSTRACT TRUNCATED AT 250 WORDS)


Idiopathic reactive hypoglycemia: a role for glucagon? We previously reported that patients with idiopathic reactive hypoglycemia (plasma glucose concentration lower than 2.5 mmol/L 2-4 h after the ingestion of 75 g of glucose) display reduced or absent counterregulatory response of the glucagon secretion and increased insulin sensitivity. In order to examine the effect of glucagon on the increased insulin sensitivity in these patients, 12 subjects with idiopathic reactive hypoglycemia underwent a two-step hyperinsulinemic (1 mU/kg.min) euglycemic glucose clamp and were compared with 12 normal control subjects matched for age, weight and sex. During the first step of the glucose clamp (only insulin + glucose infusion) the patients with Idiopathic Reactive Hypoglycemia required higher glucose infusion rates to maintain euglycemia than normal subjects (9.09 +/- 0.29 mg/kg. min vs 7.61 mg/kg.min). When basal glucagon secretion was replaced (+ somatostatin and glucagon, second step of the clamp) the glucose infusion rates required to maintain euglycemia in patients with Idiopathic Reactive Hypoglycemia significantly decreased (to 7.17 +/- 0.40 mg/kg.min) and resulted similar to normal subjects (7.64 +/- 0.41 mg/kg.min). Thus, in patients affected by Idiopathic Reactive Hypoglycemia, glucagon secretion may play an important role in the pathogenesis of the increased insulin sensitivity and hypoglycemia.


Changes in central and peripheral nervous system function during hypoglycemia in man: an electro-physiological quantification. We measured somatosensory evoked potentials (SEP) in normal subjects during acute (group A) and moderately prolonged (group B) hypoglycemia. We considered the following parameters: peripheral conduction velocity (wrist-Erb CV), conduction time (CT) between brachial plexus and the cervical cord (Erb-N13) and central CT from the cervical cord/lower brainstem lemniscal pathway to the cortex (N13-N20). In group A, the electrophysiological parameters did not change significantly throughout the study. In group B, mean N13-N20 CT increased from a basal values of 5.82 +/- 0.11 to 6.22 +/- 0.11 msec at 105 min (p less than 0.02) and 6.33 +/- 0.11 msec at 120 min (p less than 0.05). This study indicates that neither acute nor moderately prolonged hypoglycemia influence the peripheral nerve function in normal subjects and provides evidence that hypoglycemia as low as 2.4 mmol/L, lasting more than 60 min, can significantly increase the conduction time of central somatosensory pathways.


Idiopathic anterior hypopituitarism: magnetic resonance imaging and clinical correlation. We describe the anatomical abnormalities in the hypothalamic-pituitary region revealed by magnetic resonance imaging (MRI) in 10 patients, 8 men and 2 women, affected by idiopathic anterior hypopituitarism (IAH). In all cases contiguous sagittal and coronal T-1 weighted images were obtained. In 9 patients the high-intensity posterior lobe was missing, in almost all patients the pituitary stalk was thin and/or transected, and in 8 a bright T-1 nodule was detected at the infundibular apex, near the tuber cinereum, in the median eminence. None had diabetes insipidus. MRI proves to be very useful in understanding the etiopathogenesis of IAH.


Thyroid ultrasonography related to clinical and laboratory findings in patients with silent thyroiditis. We summarized the clinical course of 10 patients with silent thyroiditis and evaluated the clinical usefulness of ultrasonography, in combination with clinical and laboratory findings, for the differentiation from Graves' disease. Serum T3 and T4 were increased in all cases, and the ratio of T3/T4 (ng/micrograms) was 17.8 +/- 3.6 (SD). But in 3 of 10 patients the ratio was greater that 20. TSH receptor antibody (TRAb) and thyroid stimulating antibody (TSAb) were negative in all cases. The estimated thyroid volume by ultrasonography was 18.4 +/- 5.5 ml, which was slightly increased but significantly lower than those in Graves' disease (p less than 0.05). The internal texture of the thyroid showed a decreased echogenicity with a mean echo level of 70.4 +/- 15.4. There was a weak positive correlation between the echo level at the onset of thyrotoxicosis and the lowest T3 level during the clinical course (p less than 0.05). It is suggested that ultrasonography gives a useful information to the diagnosis and outcome of patients with silent thyroiditis.


Comparison of Nb2 lymphoma cell bioassay with immunoassay for human prolactin: the role of estrogen. The Nb2 lymphoma cell bioassay (BA-PRL) is a sensitive measure of serum prolactin under physiologic conditions. Since estrogens prime the lactotroph, prolactin heterogeneity and hence bioassayable prolactin may be influenced. A study was performed to observe the effect on BA-PRL of changing estradiol (E2) concentrations. In 13 normal subjects clomiphene citrate was administered to stimulate ovarian activity and blood samples were obtained before and after stimulation. Estradiol, BA-PRL and immunoassayable prolactin (RIA-PRL) were measured. While there was a substantial increase in E2 post-stimulation (p less than 0.001), there was no significant change in BA-PRL, RIA-PRL or BA/RIA-PRL ratios. Despite the lack of change in the mean BA/RIA-PRL ratio over a wide range of E2 concentrations that include and exceed those normally seen in spontaneous menstrual cycles, it is difficult to drawn conclusions regarding an association between E2 and BA/RIA-PRL ratios as there was no discernible change in the concentration of prolactin (possibly due to the antiestrogenic effect of clomiphene citrate).


Iodine contamination in subjects admitted to a general hospital. Urinary iodine excretion was measured in 300 consecutive patients admitted to a general hospital for nonthyroidal disease. Iodine contamination (values greater than 300 micrograms l/g creatinine) was found in 29.3% of cases, mostly due to amiodarone and iodinated contrastographic agents. The source of iodine contamination was not detected in 23% of cases.


Excessive testicular progesterone secretion in aged male Fischer 344 rats: a potential cause of age-related gonadotropin suppression and confounding variable in aging studies. Previous studies have inconsistently reported elevated sex steroid levels in aging male F344 rats, which frequently develop testicular Leydig cell tumors. The aims of this study were to characterize circulating steroid levels and to determine the in vivo source and functional significance of altered steroid secretion in these animals. Progesterone (P) and to a lesser extent estradiol (E2) levels were increased, while gonadotropins and testosterone (T) were decreased, in intact 24-mo-old compared to 12-mo-old rats. P levels were inversely correlated with gonadotropins and T. All old rats demonstrated Leydig cell hyperplasia or tumors. After orchidectomy, P levels were markedly decreased. Gonadotropin levels were similar in orchidectomized 24-mo compared to 3-mo-old rats. We conclude that the testis is the source of excessive P and E2 secretion in vivo in old F344 rats. Increased P (or E2) negative feedback may contribute to the suppression of gonadotropins and reproductive function in aging male F344 rats. Finally, excessive P secretion may be a confounding pathological variable in aging studies using this rat model.


Aging changes the effects of cocaine on vigilance task performance of rats. To investigate age-related behavioral changes with the administration of cocaine, young (6-10 mo), middle-aged (12-18 mo), young-old (21-24 mo), and old (25-36 mo) rats that had been trained on a 2-choice, discrete trial vigilance task were tested under different doses of cocaine. The young and middle-aged rats exhibited significantly increased accuracy and decreased choice latencies following 2.5 mg/kg cocaine. A 15.0 mg/kg dose increased variability in these measures and increased food retrieval latencies. The young-old and old rats exhibited no significant changes in accuracy or choice latency to 1.25, 2.5, and 5.0 mg/kg cocaine; however, a dose of 15.0 mg/kg significantly reduced accuracy in both these groups and increased choice latencies in the old animals. Also, doses of 5.0 and 15.0 mg/kg tended to increase food retrieval latencies more in the two older groups than in the two younger groups. These results indicate that, rather than a simple increase or decrease in sensitivity, there is a qualitative change in cocaine's behavioral effects as rats age. These findings may reconcile long-standing discrepancies in the literature regarding age-related changes in the behavioral effects of amphetamine, with actions and effects very similar to those of cocaine.


Use of medications by persons 65 and over: data from the established populations for epidemiologic studies of the elderly. Data were analyzed from household interviews of four population-based cohorts comprising the Established Populations for Epidemiologic Studies of the Elderly to estimate the prevalence of prescription and nonprescription medication use among community-living elderly and to examine sociodemographic and health factors related to medication use. Prescription drugs were used by 60-68% of men and 68-78% of women. Nonprescription drugs were used by 52-68% of men and 64-76% of women. Use of prescription medications generally increased with age although use of nonprescription drugs was not associated with age. Men and women who smoked or used alcohol in the preceding year frequently took medications. Those who reported more depressive symptoms, impairments in physical functioning, hospitalizations, and had poorer self-perceived health status were most likely to take medications. However, 10-29% of respondents with fair or poor self-perceived health took no prescription medications, and 3-13% took neither prescription nor nonprescription medications. While further research appears warranted into potential overmedication of elders, particularly those with many depressive symptoms, these data suggest that studies of potential underuse among elders with poor health are equally important.


Nutrient intakes and dietary patterns of older Americans: a national study. To assess the dietary status of older Americans, a national household survey of food consumption practices of individuals 65 years of age and older was conducted in May-August, 1990. The design and methodology of the survey were modeled after those of the USDA's Continuing Survey of Food Intakes by Individuals (CSFII). Dietary information for 474 individuals (65 to 98 years of age) in 355 households was collected by interview (24-hour dietary recall). Analyzed indicators of dietary quality were energy (calorie) and nutrient intake, food group intake and frequency, and number of meals skipped. Results indicated that substantial percentages of those surveyed had inadequate intakes of energy and nutrients. Over 40% of men had intakes of vitamins A and E, calcium, and zinc below two-thirds the RDA. For women, over 40% had intakes of vitamin E, calcium, and zinc that were below two-thirds the RDA. Additionally, over 20% of older men and women skipped lunch. These data indicate that a large proportion of noninstitutionalized elderly Americans consume diets that fail to meet dietary standards.


The effects of visual factors and head orientation on postural steadiness in women 55 to 70 years of age. This study was designed to establish reference data for the effects of head position and visual conditions on the standing posture of healthy women ages 55 to 70. Center of pressure (CoP) data were analyzed using ANOVA models. Total CoP displacement was 45% greater (significant, p less than .05) when the subjects stood with their heads back and their eyes closed, as compared to standing looking straight ahead. Visual surrounds consisting of vertical visual cues resulted in less postural sway (PS) than surrounds made of horizontal visual cues (significant, p less than .05 for anteroposterior CoP range). Experimentally reduced visual acuity resulted in greater PS, while changes in ambient lighting and spatial frequency of visual cues affected PS minimally. These results suggest that a reduction in the height of shelving, and the provision of high-contrast visual cues and vertical geometric patterns are potential intervention strategies to optimize vestibular sensory input and visual orientational cues for the maintenance of stability during stance.


Age-related changes in postural responses preceding rapid self-paced and reaction time arm movements. The electromyographic responses in postural (thigh and trunk) and primary agonist (shoulder) muscles were examined in standing young and older adults prior to rapid self-paced (SP) and simple reaction time (RT) arm flexion movements. In contrast to younger subjects, older adults demonstrated significantly lower frequencies of trials for self-paced movements in which thigh muscle responses preceded the activation of the shoulder muscle. Furthermore, younger adults showed more frequent early lower limb postural responses for SP versus RT movements, whereas older subjects retained comparable frequencies between task conditions. Overall, a significantly shorter intermuscular timing interval between leg and arm muscle onsets was also found for the older group.


Bradykinin-induced venodilation is not impaired with aging in humans. The aim of this study was to determine whether there is an age-related decline in vascular responsiveness to bradykinin, whose vasodilatory action is mediated chiefly through endothelium-derived relaxing factor (EDRF). Dose-response curves for bradykinin were constructed using the dorsal hand vein compliance technique in veins preconstricted with phenylephrine in 27 volunteers (16 male, 11 female) aged 18 to 81 years. At the end of the bradykinin study, 12 subjects had a single infusion of a high dose of isoproterenol. There was no correlation between age and the EMAX or the log ED50 for bradykinin, although the same subjects showed a correlation between age and EMAX for isoproterenol, as previously found. There was no significant difference in either the EMAX or the log ED50 between male and female subjects. The results suggest that bradykinin-induced vasodilation is independent of age or gender.


Altered epithelial lining fluid parameters in old normal individuals. Pneumonia is a leading cause of morbidity and death in older patients, and immunosenescence is believed to contribute to their susceptibility. In order to investigate whether age-related changes occur on the epithelial surfaces of the lung, bronchoscopy and bronchoalveolar lavage (BAL) were performed without complication in 19 young (27.7 +/- 4.2 yrs), 6 middle-aged (49.8 +/- 3.5 yrs), and 8 old (74.1 +/- 4.3 yrs) normal, nonsmoking subjects. BAL was performed by instilling and retrieving five 20 ml aliquots of normal saline into three sites. The returns from the first aliquots (the bronchial sample) were analyzed separately from the returns from the subsequent aliquots (the distal sample). Lavage fluid cellularity was characterized and IgA, IgG, and albumin were measured by ELISA. Lavage fluid returns were lower in the elderly group and correlated with spirometric parameters. Significantly elevated numbers of neutrophils were recovered by the bronchial sample fluid from the old group. In contrast, no consistent difference in macrophage recovery by either the bronchial or distal sample was noted. In both the bronchial and distal samples, IgG, but not IgA or albumin, was elevated in the group of old subjects. Alterations occurring in BAL fluid with aging may reflect changes in local host defenses.


Improving memory and control beliefs through cognitive restructuring and self-generated strategies. Memory problems are a major source of concern among older adults. The goal of this research was to evaluate methods for improving memory performance and beliefs about memory ability and control. Men and women between the ages of 60 and 85 were randomly assigned to one of five treatment groups: (1) cognitive restructuring to promote adaptive beliefs about memory, (2) memory skills training, (3) combined cognitive restructuring and memory skills training, (4) practice on memory tasks, and (5) a no-contact control group. Beliefs about memory (ability and control) and memory performance (working memory, recall of text materials, categorizable word list, and names and faces) were assessed at a pretest and two posttests. As predicted, those receiving the combined treatment showed the greatest increases in their sense of control and perceived ability to improve memory. Results indicated that all groups improved equally on the memory tasks, although those who had received memory training were more likely to report at the second posttest that they had begun using new strategies for remembering things.


Providing support to others and well-being in later life. Although there is now a voluminous literature on supportive social relations in later life, most of this research has been concerned with assessing the beneficial effects of receiving support from others. The purpose of this study is to assess whether giving support to others within informal as well as formal settings might also benefit older help-providers. Findings from a recent nationwide survey of the elderly suggest that giving informal assistance to others (but not formal assistance) appears to bolster feelings of personal control in later life. The data further reveal that greater feelings of personal control are in turn related to lower levels of depressive symptomatology.


Long-term effects of a structured life review process. This study examined the long-term effects of a structured life review process in a group of 52 homebound elderly clients. Subjects in three groups were tested three times on four dependent variables. At 8 weeks the experimental group, after receiving the life review process, showed significant gains on two dependent variables, life satisfaction and psychological well-being, with analyses of covariance of F = 11.52, p less than .0001 and F = 9.90, p less than .003, respectively. Two other dependent variables, depression and activities of daily living, demonstrated no significant change at the 8 weeks posttest. Retesting 35 survivors at 1 year revealed little significant change for any group. There was, however, an upward trend in the experimental group on the outcome measure of life satisfaction and a downward trend in all groups on measures of activities of daily living and depression.


Correlates of life satisfaction among elderly African Americans. This study examined the correlates of Life Satisfaction among older African Americans. The sample consisted of 166 African Americans ranging in age from 65 to 88 years. There were 87 males and 79 females. Included as predictors of Life Satisfaction were self-rated health, self-perceived adequacy of income, weekly hours of participation in church activities, and family role involvement. The results of the study confirmed that family role involvement and participation in church activities were significant predictors of Life Satisfaction among African American elderly in general. Results also indicated significant sex differences. Females tended to manifest greater life satisfaction than males. Females also had higher mean scores on hours of church participation per week, scored higher on family role involvement, and were more likely than males to consider their incomes adequate. Therefore, separate correlation and regression analyses were run for male and female respondents. These analyses indicated that among males, family role involvement and hours of church participation were related significantly to life satisfaction, as were self-perceived adequacy of income, actual household income, educational level, and self-rated religiosity. Among females, only self-rated religiosity was a significant predictor of life satisfaction. This finding was attributed to the generally high levels of family role involvement and church participation among female respondents.


Age-related changes in natural spontaneous fluid ingestion and thirst in humans. Elderly humans have impaired responses to dehydration and overhydration when tested under experimental conditions. This study investigated whether under ad libitum conditions age-related changes in fluid intake and thirst could be detected. Adult humans (n = 262) maintained 7-day diaries of everything they ingested, the timing and conditions present, and subjective thirst, anxiety, depression, and activity. No differences were found in overall fluid intakes of subjects from 20 to 80 years of age, including equivalent fluid intake responses to solid food ingestion, subjective thirst, social stimuli, and stomach factors. However, fluid ingested in bouts increased slightly over the day for younger groups, whereas it declined markedly for elderly groups, producing a blunted diurnal rhythm. Also, elderly subjects ingested more coffee and less soda and alcohol. The findings indicate that elderly individuals, under ad libitum conditions, are able to obtain normal levels of fluid by the coingestion of fluids with solids.


Cognitive slowing in Alzheimer's disease and geriatric depression. Response slowing on psychological tasks is found both in Alzheimer's disease and depression. However, the underlying cause for this slowing may be different in the two disorders. This research examined whether the behavioral slowing found in Alzheimer patients results from a reduction in their rate of cognitive processing, whereas the slowing in depressed geriatric patients reflects a purely motor retardation. This hypothesis was tested using a task in which subjects had simply to determine the number of dots present in an array (i.e., enumeration). In all four subject groups (Alzheimer patients, depressed geriatric patients, healthy old controls, and healthy young controls), response time increased linearly with array size. The slope of this linear function (reflecting rate of enumeration) was the same in the normal and depressed patients, but was significantly greater in the Alzheimer patients, suggesting the presence of a cognitive slowing in Alzheimer's disease, but not in depression.


Prospective memory intervention in Alzheimer's disease. Four individuals with Alzheimer's disease were trained to remember and to implement an intention for future action. The training program utilized the spaced-retrieval method, which involves active attempts to recall information over expanding intervals of time. All participants learned to select a colored coupon from an array of distractors and offer it to the experimenter after a week's delay. Following one-week retention of the initial task, a different coupon became the new training target. All participants were able to shift to this new task requirement, and all learned three successive coupon colors successfully. These results indicate that individuals with Alzheimer's disease can learn a prospective memory task using spaced-retrieval practice and can make adjustments for changing task requirements.


Impact of adult age and Alzheimer's disease on levels of neural noise for letter matching. We tested healthy young and older adults as well as higher-scoring (Mini-Mental State Exam, MMSE, scores between 14-20) and lower-scoring patients diagnosed with probable Alzheimer's disease (AD) on a letter-matching task. Subjects were instructed to respond "same" if two simultaneously presented letters were identical, or "different" if the letters did not match. Healthy older adults showed a larger "fast-same" effect than healthy young adults. Also, higher-scoring AD patients showed a large "false-different" effect for errors, but lower-scoring AD patients showed a large "false-same" effect. These data indicate that older adults exhibit higher neural noise levels than younger adults. The cross-over error pattern for AD suggests that moderately demented AD patients show evidence of forming degraded visual percepts whereas more severely demented AD patients show evidence of forming incomplete percepts.


Adult age differences in the use of prosody for syntactic parsing and recall of spoken sentences. In this experiment, young and elderly adults listened to and recalled sentences that were varied in speech rate through computer-controlled time compression. Half of the sentences at each speech rate were presented with a normal prosodic pattern that reinforced the lexically defined syntactic structure of the sentences, and half were presented with a prosodic contour that conflicted with that structure. Both young and elderly subjects showed better recall for slower speech rates and when prosody was consistent with syntactic structure, but these effects were larger for elderly subjects. When syntax and prosody were placed in conflict, elderly subjects were more likely than the young to reconstruct the lexical content of the presented sentences to produce responses with a syntactic structure consistent with the prosody marking. Although elderly adults may be disadvantaged by rapid speech input rates, we show that they rely on normal prosody to aid syntactic parsing as a step toward language comprehension.


Educational attainment, occupational history, and stratification: determinants of later-life economic outcomes. Determinants of economic well-being among men 25-44, 45-64, and 65+ were examined using data from the 1984 panel of the Survey of Income and Program Participation. A path analysis explored race, education, and occupational history effects on income adjusted for annuitized assets, household composition, and underreporting of unearned income. Direct and total education effects were undiminished among elderly persons, whose income derived mainly from benefits and assets, as compared with the nonelderly subjects whose income was dominated by earnings; education explained more of the variance in adjusted income for the elderly group than for the nonelderly. While Social Security income exerts an equalizing effect across educational attainment groups, private pensions and other important retirement income sources were highly education-dependent, producing a high overall degree of stratification on early-established socioeconomic characteristics.


Racial and social correlates of age-related changes in functioning. Six waves of observations spanning a decade on a panel of 566 Black and 5,196 non-Black survivors were utilized to examine social and racial differences in age-related changes in functioning. An index consisting of three dimensions was used to assess functioning: physical functioning, self-care capacity, and self-rated well-being. Growth curve analysis was used to assess variations in trajectories of functional impairment across Black/non-Black, poor/nonpoor, male/female, and high-school/non-high-school graduate subpanels. Trajectories vary across social groups in the expected manner. However, we note that the trajectories are not linear and that substantial variability exists within both the Black and non-Black subpanels. Moreover, we note that Blacks report poorer functional status than non-Blacks even with income and education controlled. However, age changes do not differ across Black and non-Black subpanels, as predicted by the multiple-jeopardy hypothesis.


Are older people most afraid of crime? Reconsidering age differences in fear of victimization. The reasons why previous studies of fear of crime yield different conclusions regarding age differences are examined. Data from a national survey of adults are used to assess whether older adults manifest the highest levels of fear of crime. No significant relationship was found between age and the commonly used indicators of fear of crime in many previous studies when controlling for relevant factors. Using an alternative strategy for measuring fear of crime--based upon rating fear for 10 different victimizations--reveals that younger persons are more likely than older persons to be afraid of most types of crime. Women score higher on fear for all victimizations considered. A LISREL analysis indicates that the 10 victimizations are best characterized as either personal or property crime and that older adults' scores on these dimensions are below the grand mean; persons 75 years or older have the lowest scores on fear of property crime. These results question the existence of the "victimization/fear paradox."


An analysis of physician utilization by elderly persons: systematic differences between self-report and archival information. Elderly persons may over- or underreport their utilization of services, and systematic variance in this discrepancy may bias research findings. Therefore, this study analyzed the discrepancy between archival and self-report measures of physician utilization and examined the association of that discrepancy with health status and sociodemographic variables. Each older person underreported physician utilization by a net of .35 visits, but the total discrepancy was nearly two visits per person, or 65 percent of the number of self-reported visits. The multivariate findings indicate that underreports of utilization are smaller for those elderly persons with lower health status (as measured by disease history) and larger for those with higher levels of utilization. Those in poor health tend to overreport physician visits, and those with greater levels of utilization tend to have greater proportional reporting error. Self-reported measures of physician utilization should be considered in the context of the net error and the systematic nature of that error.


Health and geographic mobility among the recently widowed. The death of a spouse has been described as the most disruptive and difficult role transition that an individual confronts throughout the life course. Using data from the 1984 and 1986 waves of the Longitudinal Study of Aging conducted by the National Center for Health Statistics, we examined the probability of moving associated with changes in functional disability levels over a two-year period while controlling for recent widowhood. We found that the greater the increase in instrumental disability between 1984 and 1986, the greater the probability of a move. We also found that the event of becoming a widow greatly increases the probability of a move when health declines.


Epidemiological analysis of Klebsiella infections at a neonate department. At the Department of Obstetrics and Gynaecology of a Brno hospital, 133 Klebsiella strains were isolated from 23 mothers and 58 neonates during a period of increased incidence of Klebsiella and 73 strains were examined in the laboratory. The control group was comprised by 78 Klebsiella strains isolated at three other Brno hospitals. Four prevailing Klebsiella types were identified using bacteriocinotyping and phagotyping. Different bacteriocinotypes and phagotypes were found to prevail at certain intervals both at the examined clinic and in control patients from Brno hospitals. The findings suggest circulation of certain Klebsiella types and their introduction to hospitals. Most infants (37 out of 45, i.e. 82%) were colonized by Klebsiella, their mothers remaining without colonization. The factors influencing the onset and transmission of nosocomial infections in infants are discussed.


The incidence of conditionally pathogenic mycobacteria in the northern Moravia region in 1978-1987. The incidence of potential pathogenic mycobacteria (PPM) has been studied in the Northern Moravia since 1970. The present paper follows up a previous communication summing up the finding for the period 1970-1977 during which were isolated from 713 persons. In 1978-1987, 4,658 strains were isolated from 1,917 persons. The species most frequently isolated was M. gordonae. A significant increase was observed in the incidence of mycobacterioses due to M. kansasii, namely from 2.90/100,000 in 1970 to 17.70/100,000 in 1987 in the Karvina district, the centre of endemic area. PPM was isolated from 321 water samples.


Onchocerciasis in Plateau State; Nigeria: ecological background, local disease perception & treatment; and vector/parasite dynamics. The physico-biological ecological complex in Plateau State has by definition increased the potential of most rivers to support the breeding and dispersal of vector species as well as human acquisition and dissemination of the disease for several months in a year. Though villagers in endemic areas are of the know of the nuisance of blackfly bites, but the majority of them lacked the aetiological knowledge of onchocercal lesion. Hence disease management is misdirected towards consulting the oracle and appeasing the gods. The vectors of onchocerciasis in Plateau State, S. damnosum, and S. sirbanum are wet season breeders with their peak biting density occurring at the height of rainy season. However, biting flies carry more infective parasites at the beginning and end of rain. These vectors exhibit bimodal biting activity: a small one in the morning hours and a pronounced evening peak. Biting activity is at least influenced by two major climatic factors; illumination and temperature. However, the fastest changing climatic factor relative to an increase in the biting activity of flies was illumination. Microfilarial load in the skin of patients does not significantly change throughout the year or when biopsies are taken under shade throughout the day. Extreme temperatures, however, have significant reducing effect on the skin microfilarial. The epidemiological relevance of these in the ongoing MECTIZAN delivery in the State are discussed.


Human ecology and parasitic infections. 1. The effect of occupation on the prevalence of parasitic infections in Calabar, Nigeria. One thousand six hundred people belonging to three different occupational groups were randomly selected. Blood, urine and stool specimens were collected from them and processed for the detection of any parasitic infections. The results show 28.5% infection rate with one or more species of intestinal parasites; 50.7% in the school children, 17.3% among the farmers, and 12% among the soldiers. Results of blood examination showed 5.3%, 8.0% and 2.0% infection rates for P. falciparum in the school pupils, farmers and soldiers respectively, while 31.3% of the three groups were infected with the microfilaria of Dipetalonema perstans, and Loa loa. These were found in 60.7% of the farmers and none at all in the other two groups. Urine examination yielded no positive cases of urinary schistosomiasis and only one case of Trichomonas vaginalis. These results reflect the endemicity of the respective parasites, the degree of their sanitary awareness and their exposure frequencies to the pathogens as a result of their daily activities.


Field utility of phenolic glycolipid coated latex agglutination test for rapid detection of bacilliferous leprosy cases. Serum samples were collected from eighty-three leprosy patients and twenty-five healthy controls supposedly not exposed to Mycobacterium leprae infection. Phenolic glycolipid-1 coated latex agglutination test (PGL-LAT) was carried out with the serum samples to detect antibodies specific to M. leprae. Samples showing positive agglutination were 50% in the lepromatous leprosy (LL) group showing no erythema nodosum leprosum (ENL) complications, 66.6% in LL group with ENL complication, 60% in borderline lepromatous (BL) group, 50% in borderline (BB) and 33.3% in borderline tuberculoid (BT). The patients belonging to the tuberculoid (TT) group and most of the long-term treated patients were interestingly negative, and so were sera from all the healthy controls. PGL-LAT developed by us therefore is specific and a fairly sensitive technique to detect antibodies specific to M. leprae and will be very useful in field conditions.


Eosinophilia in murine ancylostomiasis.

Eosinophilia in murine ancylostomiasis. Eosinophil changes in the peripheral blood of singly and repeated infected mice were studied during murine ancylostomiasis. In singly infected animals, eosinophils began to rise on 1st day, reached a peak on 4th day and progressively declined from 9th to 30th day. In repeatedly infected animals, peak eosinophilia was observed during 3rd week of post infection and sustained upto 30th day with a slight decrease. These studies demonstrate that eosinophilia is induced due to antigen-antibody reactions in the host system and eosinophilia in helminthic infections is amnestic response.


Evaluation of enzyme linked immunosorbent--assay for the detection of anticysticercus antibodies in cerebrospinal fluid from patients with neurocysticercosis. Enzyme linked Immunosorbent Assay (ELISA) was done for the detection of antibodies to Cysticercus cellulosae in 135 cerebrospinal fluid (CSF) and 152 serum samples from patients suspected clinically of neurocysticercosis (NC), neurological disorders other than NC and controls by the use of crude cyst extract antigen. This assay was compared with the standard technique of indirect haemagglutination test (IHA). The results of the two techniques were matched with retrospective analysis of proven diagnosis of these patients. ELISA and IHA was found to be positive respectively in 88 and 84 percent of CSF and 92 and 87.2 percent of serum samples from proven NC patients. The IHA technique was found to be absolutely specific for the detection of antibodies in CSF samples while cross reactions were observed with ELISA technique in CSF from 5 patients, one each suffering from disappearing CT scan lesion, tubercular meningitis (culture negative), chronic meningitis, benign intracranial hypertension and non compressive myelopathy. However possibility of neurocysticercosis cannot be absolutely ruled out in such patients. Both the techniques were found to be highly non specific for the detection of antibodies in serum samples. The study suggests that either of the two techniques may be used for the detection of antibodies in CSF samples from clinically suspected NC patients with high degree of sensitivity and specificity.


The in vitro and in vivo effects of mefloquine on Trypanosoma brucei brucei. Blood stream forms of Trypanosoma brucei brucei were grown over mouse kidney (MK) cells in minimum essential medium with various concentrations of mefloquine. The drug was observed to inhibit multiplication of the parasites in vitro. Groups of male albino mice were treated with mefloquine at 24, 48 and hours after T. b. brucei infection. Mefloquine at 0.03 mg/kg body weight administered for 4 consecutive days cleared the infection. No trypanosomes were detected in the blood of these mice for 90 days and over after the clearance of parasite from the blood. The doses for both the in vitro and in vivo therapy, were well below those prescribed for humans.


Respiratory burst metabolic status of macrophages in experimental leprosy. Peritoneal macrophages from uninfected controls and Mycobacterium leprae infected Swiss albino mice were studied for their respiratory burst (RB) activity at different time intervals. The RB metabolic activity of macrophages declined significantly after 3 month infection using latex (p less than 0.001) and M. leprae (p less than 0.01) as stimuli. However, significant rise (p less than 0.001) in the oxidative metabolic activity was seen at 6 and 9 months postinfection period on stimulation with both the stimuli. The sharp rise in the oxidative metabolic status at peak period of infection in the experimental animals suggests that the macrophages are functionally normal though M. leprae is unable to trigger the respiratory burst sufficiently.


Classification of strains of Pragia fontium, Budvicia aquatica and of Leminorella by whole-cell protein pattern. SDS PAGE protein patterns of 37 H2S-positive strains of species belonging to the family Enterobacteriaceae including the genera Budvicia (11 strains) and Leminorella (L. grimontii--3 strains, L. richardii--4 strains) were compared with 10 strains of species Pragia fontium. All strains under study form well separated clusters with overall similarity C = .49. Clusters are separated in the range of C = .68-.83. They display high homogeneity, only one strain of Edwardsiella tarda clusters with budviciae. Strains of Pragia form two distinct clusters separated from other genera. Electrophoretograms of two strains which do not group as expected are analyzed and results discussed. Results support evidence that strains designated Pragia fontium deserve independent treatment as a new species.