Resistance to care

Resisting care is defined as any patient behavior which prevents or interferes with the care provider performing or assisting with ADLs for the patient, including bathing, eating, toileting, dressing and grooming. Significant consequences of resisting care include malnutrition, skin breakdown, dehydration, constipation and weight loss. Creativity, flexibility and patience are key components of any intervention. Due to the lability of the person with cognitive impairment, a plan that works perfectly one day may never work again.     

Comparative study of chronic aluminum-induced neurofilamentous aggregates with intracytoplasmic inclusions of amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is characterized neuropathologically by chromatolysis, Bunina bodies, hyaline inclusions, skein-like inclusions and axonal spheroids. Aluminum, a known neurotoxin, is the cause of dialysis encephalopathy and is considered to be a causative agent in high incidence foci of ALS in the western Pacific. We have developed an experimental model of motor neuron degeneration in New Zealand white rabbits using chronic low-dose intracisternal administration of aluminum and compared the clinical and neuropathological changes to those of human ALS. Aluminum-inoculated rabbits developed progressive hyperreflexia, hypertonia, limb splaying, gait impairment, muscle wasting, hindlimb paralysis and impaired tonic immobility responses without overt encephalopathic features over a 14-month period. Examination of spinal cords from these animals demonstrated the frequent occurrence and progressive development of anterior horn cell lesions that included small, round, argentophilic perikaryal inclusions similar to hyaline inclusions seen in human ALS. Other inclusions were more condensed and eosinophilic, while still others had neurofibrillary tangle-like morphologies. Axonal spheroids and neuritic thickenings were also prominent and were identical to those seen in human ALS. We believe that the similar and progressive development of neuropathological changes observed in the chronic aluminum-intoxication model, compared to human ALS, warrants further study to aid in understanding the cellular and molecular mechanisms of human motor neuron disease.     

Vesiculobullous Hailey-Hailey disease: successful treatment with oral retinoids

A 56-year-old male presented with a pruritic, generalized vesiculobullous eruption. His past history revealed classical symptoms of limited Hailey-Hailey disease for 34 years. Clinically, vesicles, bullae and occasional pustules were present and multiple biopsies confirmed this to be an unusual presentation of Hailey-Hailey disease. Various therapeutic modalities including topical and oral antibiotics, oral prednisone and dapsone failed to achieve sustained remission. Treatment with low-dose oral etretinate (25 mg daily) produced marked clinical improvement with complete suppression of new vesicle formation after 6 weeks.     

Effects of angiotensin converting enzyme inhibition on vascular remodelling of resistance vessels in hypertensive patients

BACKGROUND: Essential hypertension is known to be associated with a decrease in the lumen diameter and an increase in the wall thickness-to-lumen diameter ratio of the resistance vessels. Recently, it has been clarified that this alteration does not necessarily involve vascular growth, but could be due to a rearrangement of the same amount of material, a phenomenon now termed 'eutrophic remodelling'. OBJECTIVES: This review summarizes work aimed at determining the extent to which angiotensin converting enzyme (ACE) inhibitor treatment is able to normalize these abnormalities, and whether this is desirable. RESULTS: In essential hypertension, the changes seen in subcutaneous resistance vessels appear to be mainly due to eutrophic remodelling and only a small portion to growth. In addition, rat studies indicate that eutrophic remodelling, rather than growth, is found in all vascular beds. Antihypertensive treatment of hypertensive rats with ACE inhibitors causes a dose-dependent regression of the media: lumen ratio. Clinical studies have now confirmed these findings, showing that when previously untreated essential hypertensive patients are treated with the ACE inhibitor perindopril the abnormal structure of resistance vessels regresses towards normal values; in contrast, treatment with a beta-blocker does not affect the abnormal vascular structure. CONCLUSION: The available evidence indicates that ACE inhibitors are able to normalize the abnormal resistance vessel structure seen in essential hypertension, and suggests that this effect may not only be dependent on their ability to reduce blood pressure.     

Unsuspected aortic valve vegetation detected during intraoperative transesophageal echocardiographic monitoring for coronary artery bypass grafting

The literature at this time does not give convincing evidence for use of pyridoxine as the sole treatment when confronted with a patient with idiopathic CTS. It may be of value as an adjunct in conservative therapy through altered perception of pain and increased pain threshold. For patients not responsive to conservative therapy, surgical decompression of the carpal canal is the treatment of choice.     

Juvenile xanthogranuloma of the iris with bilateral spontaneous hyphema

Lengthening of the mandible by gradual distraction and ear reconstruction using tissue expanders were performed on nine young patients (6-11 years old) with unilateral hemifacial microsomia. The technique holds promise for reconstruction of ear and mandible at the same time. This is essentially a pilot clinical project. A late follow-up of these patients is necessary.     

Tumor necrosis factor-alpha-induced apoptosis in a human keratinocyte cell line (HaCaT) is counteracted by transforming growth factor-alpha

Pulmonary surfactant is a complex mixture of lipids and proteins that functions to keep alveoli from collapsing at the end of expiration. Dipalmitoylphosphatidylcholine has been identified as the most important component for lowering surface tension at the air-liquid interface. Hydrophobic surfactant apoproteins, SP-B and SP-C, play essential roles in the biophysical functions of the surfactant phospholipids. Hydrophilic surfactant apoproteins (SP-A and SP-D) that are members of C-type lectin superfamily, interact with phospholipids and glycolipids and modulate host defense functions in the lung. SP-A also plays an important role in regulating phospholipid homeostasis in the alveolar spaces. Recent advances in genetics and molecular biology have clarified the structure-function relationship of surfactant apoproteins.     

Carbohydrate chromatography: towards yoctomole sensitivity

Ward atmosphere was assessed with the help of the Ward Atmosphere Scale (WAS) by patients, nurses and physicians on 8 admission units before and after the introduction of the partial open door system. On average, on 45% of the days on which the units could have been potentially open, they were indeed at least temporarily open. Several significant changes in the WAS scores, mostly in desirable direction, were registered. However, close relationship with the partial opening of the units could be substantiated only with regard to the scale "praxis orientation"; still a positive result. No unequivocal relationships could be demonstrated between the introduction of the partial open door system and the changes in the frequency of "special events".