Association of plasma homovanillic acid with behavioral symptoms in patients diagnosed with dementia: a preliminary report

Neuroleptic treatment of psychotic symptoms or agitated behavior in elderly patients diagnosed with dementia is associated with reduced efficacy and increased rates of neuroleptic-induced parkinsonism in comparison to younger patients with schizophrenia. We report the first study to examine the relationship between an in vivo measure of dopaminergic function, plasma homovanillic acid (pHVA), and ratings of psychosis, agitation, and parkinsonism before and after neuroleptic treatment in dementia patients. Pretreatment pHVA was significantly correlated with parkinsonian rigidity, with a trend observed with agitation and hostility. Though mean pHVA did not change during perphenazine treatment, intraindividual change in pHVA at day 15 was correlated with improvement in hostility, with a similar trend for improvement in agitation. These preliminary findings are consistent with reports associating dopaminergic function with agitated, but not psychotic, symptoms in patients diagnosed with dementia, and with a reduced responsivity of dopaminergic systems to neuroleptic treatment in these patients.     

Increased truncated form of plasma tissue factor pathway inhibitor levels in patients with disseminated intravascular coagulation

The purpose of this study was to evaluate the modification of the saline echo contrast method by mixing blood with agitated saline before intravenous injection. In 20 patients, contrast echocardiography was performed with a conventional technique from the apical 4-chamber view. We used 2 techniques: (1) the combination of blood (1 mL) withdrawn from the patients and air-agitated saline agitated, (2) air-agitated. In all patients, the blood combination technique was judged to make a greater contrast, with the agreement of all 3 reviewers. Peak echo intensity of the right ventricular cavity by the blood combination technique was significantly higher than that by agitated saline alone. In conclusion, the use of the combination of blood and agitated saline is superior to agitated saline alone for the opacification of the right atrium and ventricle in routine echocardiography.     

Zanoli''s procedure for overlapping fifth toe: retrospective study of 18 cases followed for 4-17 years

Five cases of acute anticholinergic poisoning presenting to an inner-city emergency department (ED) are discussed. All five patients presented with classic signs and symptoms of anticholinergic toxicity, which included tachycardia, hot, dry and flushed skin, markedly dilated and fixed pupils, and pronounced delirium. The patients were violently agitated, and physical restraint was required. Initial treatment with benzodiazepines did not diminish their combative behavior. Treatment with intravenous physostigmine salicylate resulted in a decrease in agitation within 15 to 20 minutes of therapy. No untoward effects occurred as a result of treatment with physostigmine.     

Hemodynamic responses to acute hematocrit and blood volume alterations in rats

The authors discuss briefly the main lesions produced during intensive therapy in 500 patients who died under treatment in the Intensive Care Unit of Padova during the period Dec. 13, 1971--Sept. 9, 1974. Specifically 36 cases of pneumothorax induced by automatic respiration are analyzed from a clinical and pathological viewpoint.     

Vascular disease and lipids in diabetes

Atherosclerosis kills more patients with diabetes than all other causes combined. Aggressive reversal and treatment of dyslipidemias is the only proven prevention for coronary events in the patient with type 2 diabetes. Glycemic control with diet, oral hypoglycemic agents, and insulin, when necessary, is often only partially effective in normalizing lipid values in type 2 diabetes. Intensive treatment with lipid-regulating agents, particularly HMG-CoA reductase inhibitors, is often necessary to normalize diabetes-associated dyslipidemias. HMG-CoA reductase inhibitors are also the only agents thus far shown in prospective multicenter trials to reduce the risk of coronary events in diabetic patients.     

Management of blood pressure instability in severe tetanus: the use of clonidine

OBJECTIVE: To evaluate the effectiveness of clonidine in the management of unstable blood pressure in severe tetanus. DESIGN: Patients with severe tetanus and blood pressure instability were treated with clonidine and the results were compared with those of other patients with severe tetanus who were not treated with clonidine. SETTING: Intensive care unit of the Chest Hospital of Athens. PATIENTS: We studied 27 patients with severe tetanus and autonomic dysfunction. INTERVENTIONS: Patients were managed according to a protocol. MEASUREMENTS AND RESULTS: Clonidine was administered until blood pressure stability was the fully restored and the dose was then gradually reduced. Five patients from the nonclonidine group and 2 from the clonidine group died. CONCLUSIONS: These results suggest that clonidine is effective in the treatment of blood pressure instability in severe tetanus.     

The computation of the velocity fields in mechanically agitated melts for turbulent and non-newtonian regimes

A mathematical model is developed to describe the behavior of melts, agitated by a flat blade impeller, mounted on a rotating shaft. The model was verified by testing against experimental results, obtained using water, where the flow was turbulent. However, the main objective of the work was to describe the velocity fields produced in melt-solid slurries, which are non Newtonian. By using a power-law expression for the viscosity, it was found that these systems can be adequately agitated using mechanical stirring. This is in contrast to previously published results, which indicate that by using conventional electromagnetic stirring arrangements, it would be difficult to agitate melt-solid slurries, particularly at high solid loading levels.     

Reactions of chronic schizophrenics to symptomatic behavior in others.

Presented videotaped scenes in which actors depicted depressed, hallucinatory, agitated, and asymptomatic behavior to 60 chronic and acute schizophrenics and normal Ss. Ss were administered a questionnaire measuring attributed symptomatology and credibility, and affiliation desire. The overall results reveal that all Ss differentiated among the categories and perceived the actors as falling along a sick–well dimension. Chronic patients expressed a greater desire to affiliate, though this was related to the level of symptomatology exhibited by the actor. The credibility of all the actors was consistently high for chronic patients only. Suggestions for increasing the social behaviors of chronic patients are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of sonographic contrast media on microcirculation in rats

In an open placebo-controlled study the influence of the injection of different sonographic contrast media on the microcirculation was proved. The study was performed in 7 Sprague-Dawley rats. In order to examine this query two different sonographic contrast media in comparison to agitated electrolyte solution (as the placebo) were injected into the abdominal aorta of 7 anaesthetized rats as a 2 ml/kg bolus at 10-min intervals. Examined were a newly developed agitated ultrasound solution (AK I: an aequeous solution of a vegetable phospholipid) and a radiographic contrast agent (AK II: 741 mg Ioversol or 350 mg iodine, respectively, per ml) which is used in an agitated form as ultrasound contrast agent, too. 1 min before and until 2 min after each injection the capillary perfusion of the same vessel area in the major omentum was measured (video-recording by use of intravital microscopy). The erythrocyte velocity was determined off-line by an image analysing system. Whereas the agitated X-ray contrast medium AK II decreases the mean capillary perfusion (temporary flow stagnation in single capillaries), AK I as well as agitated electrolyte solution did not influence the capillary erythrocyte velocity in the major omentum. The gaps which appeared immediately after the injection of AK I seem to have been brought about by spherosomes of AK I. Still the spherosomes are so small that they can pass through the capillaries, or if they are larger which cannot be determined using in vivo microscopy the flow force necessary for the deformation of the bubbles is so small that the capillary perfusion is not influenced. The injection of agitated AK I does not lead to significant changes of the microcirculation.     

Telencephalic lesions and behavior in the teleost, Macropodus opercularis: further analysis of reproductive and operant behavior in the male

The bacterial flora was studied in the bronchial, pharyngeal secretions and sputum of 80 children with Cystic Fibrosis (CF) and of 21 children with other chronic lung diseases, treated at the Pediatric Clinic (Respiratory Unit), University of Genoa. Staphylococcus aureus was found in 52% of patients, Pseudomonas aeruginosa in 48%, Proteus in 5%. According to the age, the patients have been distinguished into four groups; in the 6-10 and 11-15 year-old group Staphylococcus aureus was the commonest pathogen isolated, while Pseudomonas aeruginosa was found much more commonly in the 16-20 year-old group. Details are given of antibiotic-sensitivity for single strains grown. Intensive care programs, based on specific antibiotic-sensitivity, for in-patients and out-patients, are reported: positive results in treatment courses with Gentamicin, Cephalosporins and Tobramycin are presented.     

Behavioral approaches for reducing agitation in residents of long-term-care facilities: critical review and suggestions for future research

Many residents in long-term-care facilities demonstrate agitated behaviors. Research on behavioral approaches for reducing agitation in nursing home residents has been conducted during the past 25 years. This research is critically reviewed in this article and suggestions for future research are offered. Empirical evidence suggests that behavioral approaches are effective. Antecedent control strategies have been shown to reduce physically nonaggressive behaviors. Both aggressive and verbally agitated behaviors have been successfully treated by manipulating reinforcing consequences of these behaviors. Future research in this area needs to test behavioral treatments using randomized group designs, compare behavioral interventions to other treatments used alone or in combination, specify criteria for clinically significant improvement, diversify and ascertain the validity of assessment methods, and verify the maintenance of treatment effects over relatively long follow-up periods.     

Emotional response to long-term unemployment. A study in Lillesand

In recent years we are observing an increasing number of authors. The surgical results, in the elective cases, are improved drammatically, and now, in many Centers, the mortality rate is less than 5%. We haven't observed the same improvements for the emergency cases. In this setting the mortality rate is still around 50% or more. What we are facing, however, is the changing of the clinical picture of this patients. In the most part of cases, the patient dies in the Intensive Care Unit, after a long and complex post-operative course, and not more in the Operating Room. Still, this could be considered a good result, expression of a better surgical experience. The way to obtain higher survival, at the moment, is linked to a better understanding of the physiologic derangements in the Intensive Care Unit. The authors discuss the organizative and technical changes the permitted to achieve this results.     

Modified treatment concept in fractures of the humeral head in elderly patients

Between 1990 and 1994, 94 patients over 65 years with subcapital humerus fractures were treated by plate osteosynthesis. All patients were operated on within 48 h after trauma. Intensive physical exercising was begun in the early postoperative period. Three months after the operation all osteosynthesis materials were removed with differentiated treatment of the subacromial area. If deemed necessary on the basis of the intraoperative findings (i.e. symptoms of impingement) treatment included a Neer acromioplasty. Sixty-nine of the 94 patients were followed up, including clinical, radiological and ultrasonographic examinations. Twenty-two patients showed an excellent, 26 a good, 9 a satisfactory and 12 an unsatisfactory result, i.e. in more than 82% of patients functional result was excellent to satisfactory. Therefore, we recommended plate osteosynthesis of subcapital humerus fractures in the elderly, in combination with our standard postoperative regimen.     

Impact of advances in diabetes care on dental treatment of the diabetic patient

In medicine and dentistry, studies are published periodically that have a potentially wide-ranging impact on patient health and management. One such study is the Diabetes Control and Complications Trial (DCCT), which offers new hope for millions of individuals with diabetes and has begun to significantly alter medical management of these patients. Advances in the medical treatment of diabetes require a heightened awareness by dental practitioners of the various treatment regimens of their patients with diabetes, especially because of potential complications associated with diabetes care. Intensive medical treatment with oral agents and exogenous insulin injection promises to decrease the long-term risks of major complications of diabetes, but these treatments increase the risk of medical emergencies, especially hypoglycemia. This article reviews the findings of the DCCT, diabetes treatment regimens that might be encountered in a dental practice, and potential alterations to dental treatment protocols.     

The use of central administration of the delta1- and delta2-opiate receptor agonists for prevention of the experimental adrenal arrhythmias]

BACKGROUND: Incidence of meningococcal diseases and sepsis caused by a new invasive strain of Neisseria meningitidis group C: 2a: P 1,2 has been observed in the Czech republic within the last 3 years. In 1994 the highest incidence of this disease was in the West region. Ten of the most critically ill patients were treated at the Department of Anaesthesiology and Intensive Care. The aim of this work was to present principles of the treatment of this disease. METHODS AND RESULTS: In 1994 we treated 10 patients, 8 male and 2 female with average age of 11 years (range from 5 months to 20 years). Causing strain identification was done in 9 patients, in one patient causing strain was not identified. All patients had typical clinical symptoms of the disease. All of them were treated according to the same protocol of the invasive complex treatment including artificial ventilation, circulation support, Ceftriaxon combined with potassium salt of benzylpenicillin, i.v. immunoglobulins, fresh frozen plasma, heparin, fibrinogen and antitrombin III. Average length of the stay in the Intensive Care Unit was 5 days (range from 1.5 hour to 10 days). Survival in our group was 70%. CONCLUSIONS: Early started complex therapy is a decisive factor of its success. A uniform protocol of treatment and its wide publication even to the first contact level can increase a chance for survival.     

Congenital encephalocele of the medial skull base

Intensive case management for severely psychiatrically ill patients is a relatively new phenomenon in the private sector. The authors describe a comprehensive case management program designed at Blue Cross Blue Shield of Massachusetts to meet the needs of the most severely ill psychiatric patients in a private managed care environment. The case management program emphasizes involvement of patients in creating comprehensive treatment plans; development of a relationship between case managers, patients and their families, and providers; and clinical coordination between the public and private sectors to create individualized treatment plans. The program's case managers are able to flex the benefit limitations of a managed care or indemnity plan to integrate public and private services and can enlist providers outside a managed care network. The paper describes service utilization by the first 33 patients who participated in the program for one year.     

Clinical utility of clozapine in 16 patients with neurological disease

Patients who develop psychosis or agitated behavior secondary to neurological disorders present a therapeutic dilemma. The authors review clinical efficacy and side effect profiles of clozapine in a cohort of 16 patients with various neurobehavioral disorders. One-third showed a marked decrease in symptoms while on clozapine. However, one-quarter developed an acute confusional state; of these, all had diffuse slowing on their baseline EEG prior to starting the drug.     

The resource implications of severe necrotizing pancreatitis treated by necrosectomy

This study reviews the resource utilization of patients admitted to the Intensive Care Unit (ICU) with severe necrotizing pancreatitis treated by early necrosectomy. For 21 patients there was a total of 221 abdominal operations, 2365 hospital days, 565 ICU days and 1185 days of parenteral nutrition. The mortality rate was 43%. The treatment for patients with necrotizing pancreatitis is 10 times more resource intense than other admissions to the ICU. The implications of necrotizing pancreatitis treated by necosectomy in the context of a Diagnosis-Related Groups Prospective Payment model of hospital funding are discussed.     

Experiences with physostigmine in the reversal of adverse post-anaesthetic effects

Physostigmine salicylate has proved to be a very useful agent for use in the recovery room. All but two of our first 110 patients receiving it were returned to full consciousness, whether they had been comatose or agitated. In our hands it has been used to reverse the adverse central effects of tranquilizers, antihistamines and belladonna alkaloids.     

When to start cholesterol-lowering therapy in patients with coronary heart disease. A statement for healthcare professionals from the American Heart Association Task Force on Risk Reduction

At present a large number of patients with atherosclerotic disease are not receiving aggressive cholesterol-lowering therapy. Consequently they are being deprived of a cost-effective, risk-reducing treatment. Every physician who treats patients with clinical atherosclerotic disease should become fully informed about the results of cholesterol-lowering trials in patients at high risk. All physicians who care for high-risk patients should take responsibility for cholesterol management, including primary care physicians and cardiovascular specialists. Highly effective and generally safe drugs for cholesterol lowering are available. The benefits of therapy for reducing recurrent CHD and prolonging life are considerable. There is no justification for unduly delaying institution of therapy for the majority of patients. The many advantages of nonpharmaceutical therapy call for its use in almost all patients, but drug treatment should not be postponed if the target for LDL cholesterol lowering (< or = 100 mg/dL) is unlikely to be achieved in the near term by a nonpharmaceutical approach alone. The view that patients with CHD or other forms of atherosclerotic disease do not receive substantial clinical benefits from aggressive cholesterol-lowering therapy is no longer warranted. Intensive cholesterol reduction, initiated immediately, has the potential to significantly reduce both morbidity and mortality. Cholesterol-lowering therapy thus should become a routine part of clinical management to reduce risk of future coronary events and to prolong life in patients with CHD or other forms of atherosclerotic disease.