bluuebunny/crossref_metadata_2025 huggingface dataset:
Diverticulitis Presenting as a Strangulated Inguinal Hernia
Authors: Girotto John A. , Shaikh Arif Y. , Freeswick Paul D. , Todd Lynette B. , Harmon John W.
Published: April 2003

Background/Aim: Inguinal hernia is a common diagnosis for patients presenting with a painful groin mass; other potentially dangerous diagnoses may mimic a groin hernia. We present 3 unusual cases of diverticulitis with perforation. The resulting abscess presented clinically as an atypical strangulated inguinal hernia. Methods/Results: From July 1, 1999, to June 30, 2000, 344 patients were admitted to the Johns Hopkins Bayview Medical Center with the diagnosis of diverticulitis. Of these patients, 44 (12.8%) required surgical intervention. We report here 3 cases in that academic year of diverticulitis complicated by perforation and abscess formation that presented as atypical strangulated inguinal hernias. In addition to being rare and difficult to diagnose, such cases illustrate that a tender inguinal mass may not represent a hernia. Conclusions: The diagnosis of strangulated inguinal hernias remains primarily one of clinical suspicion. Radiologic and laboratory studies should augment, not replace, one’s clinical diagnosis. In addition, the differential diagnosis of inguinal masses is discussed.
Disturbed Anastomotic Healing after Esophagectomy: A Novel Treatment of a Benign Tracheo-Neo-Esophageal Fistula
Authors: Buskens C.J. , van Coevorden F. , Obertop H. , van Lanschot J.J.B.
Published: April 2003

In this report a 65-year-old man is presented who developed a benign tracheo-neo-esophageal fistula 1 month after esophageal resection due to confined leakage of the cervical anastomosis. After unsuccessful conservative treatment, the fistula was partly excised via a cervical approach and a T-drain was inserted in the esophagus, thus creating a new fistula to the skin. Over a period of 8 weeks, the long mediastinal fistula track obliterated, and after removal of the T-drain the (neo-)esophagocutaneous fistula closed rapidly.
A Review of Therapeutic Potentials in Ischemic Stroke
Authors: Qin Zhen
Published: April 2003

Stroke is one of the leading causes of death in the world. There are as yet no effective treatments for the ischemic cerebral lesion itself. Nevertheless, five potential therapeutic objectives can be identified. For cerebral infarction, the best treatment is prevention, including targeted preventive treatments for specific subsets of patients or individuals with different risk factors. Incidence rates and mortality rates of stroke have been successfully reduced in certain developed countries by adoption of a public health approach to the prevention and control of risk factors. To rescue the still viable but injured nerve cells, within the ischemic penumbra, effective therapy should be begun at the earliest possible time. Measures to halt or reverse programmed cell death, to enhance the intrinsic autoprotective and repair mechanisms, are under active study. The existence of down-regulated brain regions, where normal nerve cells have far less activities to perform due to interruption of information exchange with the infarct area, and the possibility to reactivate them are worthy of attention.
Pharmacological Features of an Almitrine-Raubasine Combination
Authors: Benzi G.
Published: April 2003

Treatment with the combination of almitrine-raubasine increases both arterial oxygen partial pressure and haemoglobin oxygen saturation, reflecting an actual increase in the oxygen content of arterial blood. Furthermore, at the trans-cerebral carotid artery/internal jugular vein level, the treatment increases cerebral arterio-venous oxygen and glucose differences, suggesting an actual increase both in oxygen and glucose availability and uptake in cerebral tissues. The increased glucose transfer to the brain is supported also by enhancement of the 3H-deoxyglucose uptake induced by drug pre-treatment both in normoxia and hypoxia. Both almitrine and raubasine act at cerebral mitochondrial levels by decreasing the ‘loss’ of the ‘biological’ free energy for phosphorylation supported by the age-related drop in the cerebral enzyme activities, such as phosphofructokinase, pyruvate dehydrogenase and citrate synthase. Furthermore, the components interfere with the alterations induced by peroxidative stress acting at the level of cytochrome c, cytochrome c oxidase and succinate dehydrogenase. Treatment with the combination almitrine-raubasine increases the concentration of noradrenaline metabolites, while alteration of the dopaminergic system is less important. The interference with the noradrenergic system is possibly linked to the electroencephalographic changes induced by drug treatment: increasing α-rhythm distribution and reactivity, and increases in β-rhythm amplitude. Pharmacological effects of almitrine-raubasine, obtained in experimental conditions, correlate with clinical therapeutic efficacy, e.g., in the treatment of cognitive disorders associated with ageing and other cerebral and neurosensory impairments. It is difficult to summarise, in a few pages, the large number of papers related to the cerebral pharmacometabolic and pharmacodynamic activities of the almitrine-raubasine combination. Thus, this review presents in sequential steps some of the interrelated research in humans and laboratory animals which describes in a critical way preclinical to clinical results.
Aberrant Pyramidal Tract in the Medial Lemniscus of the Human Brainstem:Normal Distribution and PathologicalChanges
Authors: Yamashita Mariko , Yamamoto Toru
Published: April 2003

We examined the consistency of the so-called aberrant pyramidal tract (APT) in 150 consecutive autopsied human brains using the modified Bielschowsky stain for axons. We were able to identify the APT in all brains except for one with holoprosencephaly. The APT left the pyramidal tract within the crus cerebri and passed in the medial lemniscus of the pons through the upper medulla oblongata. In 13 of the 63 brains with cerebrovascular diseases, wallerian degeneration was found in the APT on the ipsilateral side of the cerebral lesions. Further, the APT showed depletion of small-sized fibers in 2 of the 5 brains with multiple-system atrophy. These findings confirmed that the APT is a normal descending fiber tract and a part of the pyramidal tract.
Immune Cell Distribution in Gut-Associated Lymphoid Tissue and Synthesis of IL-6 in Experimental Porcine Peritonitis
Authors: Ljungdahl M. , Fossum C. , Alm G. , Haglund U.
Published: April 2003

This study aimed to evaluate the possibility to detect early changes in gut-associated lymphoid tissue related to an inflammatory response. Anaesthetised pigs were subjected to faecal peritonitis (n = 9) or to a sham procedure (n = 8). Blood from the vena cava and the superior mesenteric vein was repeatedly sampled, and the levels of interleukin-6 (IL-6) were analysed. Biopsies of the small intestine and mesenteric lymph nodes (MLNs), harvested at 300 min, were incubated with monoclonal antibodies specific for CD2 (T lymphocytes), IgM (B lymphocytes) and CD11a/CD18 (leucocyte adhesion molecule). The number of positive (+) cells was scored. During peritonitis, IL-6 increased significantly. Compared to controls, the number of CD2+ cells decreased, IgM+ cells tended to increase and CD11a/CD18+ cells increased in the mucosa during peritonitis. In MLNs, the number of cells positive for all studied markers increased during peritonitis. We conclude that peritonitis causes an inflammatory response in the gut reflected by changes in the distribution of immune cells in gut-associated lymphoid tissue and release of IL-6 to venous blood.
Factors Determining the Efficiency of Logopaedic Care of Children in Poland
Authors: Jastrzębowska Grażyna
Published: April 2003

The purpose of this article is to establish factors which determine the efficiency of the system of care provided to children with speech disorders attending regular schools and kindergartens. The analysis was made using Poland as an example, which, similar to other countries, has made some achievements in this matter. Although Poland has had an institutionalised care system for children with speech development anomalies for 30 years, the problem of speech disorders is still very difficult to solve. Due to the large scale of the phenomenon among Polish children, this problem can be defined as a social problem in this country. The above-described situation makes it necessary to search for methods of fighting this adverse phenomenon. One of the means of solving this problem is following examples and learning from the experience of countries in which efficient systems of disabled children’s care have already been worked out. By giving examples from other countries the author attempts to establish factors determining the efficiency of logopaedic care.
The Effects of Changes in Speaking Rate on Nasal Airflow and the Perception of Nasality
Authors: Goberman Alexander M. , Selby Julia C. , Gilbert Harvey R.
Published: April 2003

The effects of variation in speaking rate on relative nasal airflow (percent nasal flow) and on the perception of nasality were examined. In addition, the effects of gender and speech rate elicitation techniques (metronome-controlled, self-controlled) were examined. Nineteen normal speakers each produced a stimulus phrase containing nonnasal sounds. Oral and nasal airflows were measured using the Rothenberg aerodynamic system. Results indicated that percent nasal flow and perception of nasality were both greater at slow speaking rates compared to normal and fast rates. Males were perceived as more nasal than females. The metronome-controlled rates were associated with greater nasality than the self-controlled rates. Discussion focuses on physiological correlates to these findings.
Perception of Lateral Misarticulation and Its Physical Correlates
Authors: Akagi Masato , Suzuki Noriko , Hayashi Katsumi , Saito Hiroto , Michi Ken-ichi
Published: April 2003

In order to clarify the relationship between perceptual diagnosis of lateral misarticulation (LM) by sophisticated listeners and the physical correlates of LM, three experiments using sustained speech /∫/ were conducted. Experiment 1 was designed to compare the spectral envelopes of normal speech (NS) /∫/ with those of LM /∫/. Experiment 2 was designed to collect the auditory impressions of sophisticated listeners listening to LM and NS /∫/ with specific spectral envelope bands replaced by LM. These two experiments showed that: (1) the spectral envelopes of LM are flat or decrease along the frequency axis in the frequency band above approximately 4 kHz, and there is a substantial peak at around 3.2 kHz in LM, which varies peculiarly with time; (2) the replacement of the spectral envelope between 2.5 and 4.5 kHz of NS with that of LM resulted in a remarkable increase in auditory impressions of LM. The facts suggest that the spectral envelope characteristic of LM has a peculiar variation at around 3.2 kHz. Additionally, experiment 3 estimated the spectrum of sustained speech /∫/ using vocal tract area functions. The results suggest that typical peaks of LM are related to the length and position of the vocal tract constriction region.
Cathemeral Behavior of Eulemur macaco macaco at Ambato Massif, Madagascar
Authors: Colquhoun Ian C.
Published: April 2003

A 15-month field study of Eulemur macaco macaco socioecology at Ambato Massif revealed year-round cathemeral activity. There were both daily and seasonal rhythms of diurnal behavior. However, as measured by vocalizations and group movements, the relative occurrence of nocturnal activity was not markedly seasonal and apparently followed the phases of the moon. Increased nocturnal activity was noted when the moon was waxing and during the full moon. These nocturnal activity data are preliminary, as they were gathered by indirect methods. Nonetheless, these data strongly suggest that black lemurs do not exhibit a seasonal increase in cathemeral activity in association with the scarcity of fruit resources during the austral winter and a concomitant need to increase consumption of leaves, flowers or nectar.
Nested Patterns of Species Composition and Their Implications for Lemur Biogeography in Madagascar
Authors: Ganzhorn Jörg U.
Published: April 2003

Many communities with a common biogeographic history show a non-random pattern of species composition. When occupying similar habitats, communities with fewer species tend to represent nested subsets of communities with more species. Nestedness can come about by successive extinction of species from communities derived from a common species pool, or when species from the original species pool have different colonization abilities. In the first case extinction depends on site characteristics, but is independent of geographical location. In the second case, communities at sites close to the original species pool have more species in common with the original species pool than do more distant communities. The communities of evergreen rain forest lemur species in eastern Madagascar show a highly nested pattern, but there is no distance effect of species similarity among communities. This finding is consistent with the idea of a common species pool for the whole of eastern Madagascar, with selective extinction during fragmentation of forest during the Pleistocene. In contrast, the communities of dry deciduous forest lemur species in western Madagascar show a strong distance effect of species similarities, but show nested patterns only when the dataset is subdivided into northern and southern community subsets. This indicates a common pool of dry forest species which originated around Toliara and from there spread towards the north and the south.
Field Observations of the Golden-Mantled Tamarin, Saguinus tripartitus, on theRío Curaray, Peruvian Amazonia
Authors: Heymann Eckhard W.
Published: April 2003

During a primatological survey on the Río Curaray in north-eastern Peruvian Amazonia, observations on the ecology and behaviour of the golden-mantled tamarin, Saguinus tripartitus, were made. Two groups consisting of 6 and 9 individuals were observed. The diet of one group that was observed in some detail consisted of fruit, insects (tettigoniid orthopterans) and gums. Patterns of height use were very similar to those observed in saddle-back tamarins, Saguinus fuscicollis. This similarity and the lack of evidence for sympatry with either S. fuscicollis or S. nigricollis lead to the suggestion that S. tripartitus should be reconsidered as a subspecies of S. fuscicollis rather than a species on its own; alternatively, other subspecies of S. fuscicollis should be raised in taxonomic rank.
Molecular Biology of Alzheimer’s Dementia and Its Clinical Relevance to Early Diagnosis and New Therapeutic Strategies
Authors: Wiltfang Jens , Esselmann Hermann , Maler Juan Manuel , Bleich Stefan , Hüther Gerald , Kornhuber Johannes
Published: April 2003

Over the past few years, molecular biological research has considerably deepened our understanding of the pathophysiological basis of Alzheimer’s dementia (AD). Although different genetic origins of the disease have been identified, all of the findings point to a common terminal sequence in familial AD. This consists of an increased production of β-amyloid peptides from β-amyloid precursor protein. For the cases of sporadic AD, which far outweigh the number of cases of familial AD, an impaired catabolism of the β-amyloid peptides may also be pathophysiologically decisive according to the latest findings. Research into the molecular level of AD makes it possible to identify points of attack for rational drug treatment of the disease, while molecular markers of AD are increasingly being used as a part of early and differential neurochemical diagnostics.
Diminished Reserve for Cerebral Vasomotor Response to L-Arginine in the Elderly: Evaluation by Transcranial Doppler Sonography
Authors: Okamoto Masaya , Etani Hideki , Yagita Yoshiki , Kinoshita Naokazu , Nukada Tada-atsu
Published: April 2003

Background: Nitric oxide is pivotal in endothelially dependent vasodilatory regulation. An association of endothelial dysfunction with aging has been documented in the forearm and coronary vascular beds. However, the influence of aging in the human cerebral circulation, where regulation is particularly complex, is incompletely understood. Objective: We systematically administered L-arginine, a precursor of nitric oxide, to evaluate the influence of aging on nitric oxide-mediated cerebral vasomotor regulation. Methods: Among healthy volunteers, 20 older subjects (10 men, 10 women; age: 70.2 ± 2.8 years) and 22 younger subjects (10 men, 12 women; age: 28.8 ± 1.9 years) received intravenous infusions of L-arginine monochloride (500 mg/kg) over 30 min. Hemodynamic parameters were monitored continuously during and after infusion. The cerebral vasomotor response was estimated by transcranial Doppler sonography of the right middle cerebral artery. Results: Infusion of saline as a control brought little change in the mean blood pressure, heart rate or cerebral blood flow velocity in either group. On administration of L-arginine, cerebral blood flow velocity increased and mean blood pressure decreased. After completion of infusion, both parameters rapidly normalized. While reduction of mean blood pressure did not differ between older and younger groups, the cerebral circulation in the older group showed a blunted, smaller, and more easily saturated vasomotor response compared to the younger group, though both groups had similar baseline values. Conclusion: Our results indicate a diminished nitric oxide-mediated cerebral vasomotor response in aging subjects. Additionally, transcranial Doppler sonography can be used to reliably evaluate age-related changes in the physiologic responses of the human cerebral circulation.
Age-Related Alterations in Basal Expression and in vitro, Tumour Necrosis Factor Alpha Mediated, Upregulation of CD11b
Authors: Armstrong M.E. , Alexander H.D. , Ritchie J.L. , McMillan S.A. , Rea I.M.
Published: April 2003

Background: The β2-integrin CD11b (Mac-1) plays a crucial role in the firm attachment of leucocytes to the endothelium during the inflammatory response. Objective: This study aimed to determine whether the increased incidence of infections witnessed in elderly individuals compared to their younger counterparts was associated with deficiencies in basal expression and/or upregulation of CD11b. Methods: Flow cytometry was used to measure CD11b expression, before and after in vitro tumour necrosis factor alpha (TNF-α) stimulation, on neutrophils, monocytes and lymphocytes from healthy volunteers aged less than 36 years and Senieur-approximated 70–85 and over 85 year olds. The TNF-α levels in serum were measured using a commercially available enzyme-linked immunoassay technique. Results: The basal expression of CD11b on monocytes and lymphocytes was highest in the 70–85-year-olds and lowest in the >85-year-olds. Following in vitro stimulation using low (10 IU) and high (100 IU) TNF-α concentrations, subjects >85 years consistently showed significantly lower increases in CD11b expression on each of the three cell types. The maximal increase in CD11b expression was in the 70–85-year age group for neutrophils and monocytes and in <36-year-olds for lymphocytes. Serum TNF-α was significantly higher in the elderly groups. Regression analysis showed a significant association between TNF-α and expression of CD11b on lymphocytes before and after TNF-α stimulation and for neutrophils before stimulation. Conclusions: The results of this study suggest that CD11b expression on leucocytes may not be consistent throughout life. Such age-related changes could compromise the inflammatory response, rendering individuals >85 years old more susceptible to infections. Alternatively, the lower levels of CD11b expression in this group may represent downregulation and protection against excess leucocyte activation within the vascular system and may, therefore, provide a mechanism for successful ageing.
Influence of Muscle Strength and Body Weight and Composition on Regional Bone Mineral Density in Healthy Women Aged 60 Years and Over
Authors: Blain H. , Vuillemin A. , Teissier A. , Hanesse B. , Guillemin F. , Jeandel C.
Published: April 2003

Although weight, lean mass, fat mass and muscular strength are often found to be intercorrelated, the respective role of each parameter in bone mineral density (BMD) remains unknown in older women. The aim of the present study was to investigate the relationship between body weight and composition and quadriceps strength on femoral neck and lumbar spine BMD in healthy postmenopausal women. The relationship between isokinetic quadriceps strength measured by Biodex and BMD measured by dual energy X-ray absorptiometry was studied in 56 women aged 60–81 (70.5 ± 6.2) years in multiple regression models adjusted for age, body composition and menopausal treatment. Weight and age were associated with femoral neck BMD (33 and 10% of variance accounted for, respectively) and lumbar spine BMD (23 and 8% of its variance). When body weight and quadriceps strength were excluded from the model, lean mass and age were associated with femoral neck BMD (29 and 14% of variance explained, respectively) and lumbar spine BMD (28 and 11% of variance explained, respectively). When quadriceps strength was entered into the model, it was strongly associated with femoral neck BMD (30% of variance accounted for), in addition to lean mass (9%) and age (7%), whereas it was not associated with lumbar spine BMD. In conclusion, lean mass explains a great part of the strong association between body weight and femoral neck and lumbar spine BMD. Quadriceps strength explains a great part of the association between lean mass and BMD at the femoral neck site but not at the lumbar spine site. These results suggest a site-specific effect of muscular strength on bone and a potential role of the age-related decline of muscle strength in age-related bone loss in postmenopausal women.
Salivary Concentration of Secretory Leukocyte Protease Inhibitor, an Antimicrobial Protein, Is Decreased with Advanced Age
Authors: Shugars D.C. , Watkins C.A. , Cowen H.J.
Published: April 2003

Background: Secretory leukocyte protease inhibitor (SLPI) exhibits antimicrobial activities that, in addition to other well-characterized proteins such as lysozyme and lactoferrin, is thought to play a critical role in mucosal defenses. Although elderly individuals are particularly susceptible to mucosal infections, salivary production of SLPI has not been assessed in an aged cohort. Objectives: Hypothesizing that oral SLPI concentrations are reduced with advanced age, this cross-sectional study compared SLPI concentrations to concentrations of lysozyme, lactoferrin and total protein in unstimulated salivary secretions of healthy, community-dwelling 79+-year-old and younger adults. Methods: Study participants were 45 non-hospitalized dentate adults aged 79–89 (23 elderly) or 21–51 years (22 non-elderly). Home-based interviews and clinical examinations determined dentate status and confirmed the absence of dentures, oral mucosal disease, anti-infective medication use, irradiation therapy for head and neck cancer and self-perceived xerostomia. Whole unstimulated saliva was collected from all subjects and analyzed for antimicrobial protein concentration by enzyme-linked immunosorbent assay and for total protein content by the bicinchoninic acid method. Bivariate and multivariate (generalized linear modeling) analyses evaluated the relationships between age, gender and salivary protein concentrations. Results: Mean salivary levels of SLPI and lysozyme were lower in elderly compared with non-elderly subjects (p < 0.001), unlike lactoferrin and total protein levels. Similar results were obtained when concentrations of the individual proteins were normalized to the total protein concentration, suggesting that glandular production of SLPI and lysozyme preferentially decreases with aging. Gender differences were detected only for SLPI concentrations; males had lower SLPI levels than females regardless of age (p < 0.01). Generalized linear models confirmed that age (p < 0.001) and gender (p < 0.05) were each associated with the SLPI concentration and together accounted for 50% of the variation in SLPI concentration in this population. Conclusion: These findings indicate that SLPI production is diminished among healthy community-dwelling older adults, particularly elderly males. Further investigation should determine the impact of decreased local SLPI production on the increased risk of oral mucosal disease with advanced age.
Association of Comorbidity with Depressive Symptoms in Community-Dwelling Older Persons
Authors: Lee Yunhwan , Choi Kwisook , Lee Yeon Kyung
Published: April 2003

Background: Depression in later life poses a serious threat to mental health and well-being of older persons burdened with medical illnesses. Comorbid medical conditions independently, as well as through interactions, may influence the degree of depressive symptoms manifested by the elderly. Insight into the role medical comorbidity plays in the manifestation of depression may help to better address both physical and mental health care needs of the depressed elderly. Objective: To examine independent and synergistic effects of comorbid medical conditions in the presentation of depressive symptoms among older adults living in the community. Methods: Data from a national survey of community-dwelling older persons aged 60 years and over (n = 2,058) in Korea were used. The levels of depression were assessed using an eleven-item Center for Epidemiological Studies Depression Scale. Comorbidity was defined as the number of chronic medical conditions and the combination of disease pairs. Sociodemographic characteristics, self-rated health, physical functioning, history of hospital admission in the past year, frequency of contact with friends or neighbors, and emotional support were used as covariates. Results: Overall, persons with a medical condition compared to those without tended to show a higher depressive symptom score. Comorbidity, in terms of the number of medical conditions, tended to show a significant linear association with depression, controlling for confounders. More important, independent effects of medical conditions as well as a tendency to synergy among specific medical conditions were found, with notable gender differences. Conclusion: Given the significant but complex association of comorbid medical conditions with depressive symptoms in aged persons, clinicians should exercise care to address their physical and mental health needs within a common therapeutic context.
Physical and Sporting Activities Improve Vestibular Afferent Usage and Balance in Elderly Human Subjects
Authors: Gauchard Gérome C. , Jeandel Claude , Perrin Philippe P.
Published: April 2003

Background: Ageing is associated with a reduction in balance, in particular through dysfunction of each level of postural control, which results in an increased risk of falling. Conversely, the practice of physical activities has been shown to modulate postural control in elderly people. Objective: This study examined the potential positive effects of two types of regular physical and sporting activities on vestibular information and their relation to posture. Methods: Gaze and postural stabilisation was evaluated by caloric and rotational vestibular tests on 18 healthy subjects over the age of 60 who regularly practised low-energy or bioenergetic physical activities and on 18 controls of a similar age who only walked on a regular basis. These subjects were also submitted to static and dynamic posturographic tests. Results: The control group displayed less balance control, with a lower vestibular sensitivity and a relatively high dependency on vision compared to the group practising low-energy physical activities, which had better postural control with good vestibular sensitivity and less dependency on vision. The postural control and vestibular sensitivity of subjects practising bioenergetic activities was average, and required higher visual afferent contribution. Conclusion: Low-energy exercises, already shown to have the most positive impact on balance control by relying more on proprioception, also appear to develop or maintain a high level of vestibular sensitivity allowing elderly people practising such exercises to reduce the weight of vision.
Predicting Fallers in a Community-Based Sample of People with Parkinson’s Disease
Authors: Ashburn Ann , Stack Emma , Pickering Ruth M. , Ward Christopher D.
Published: April 2003

Background: The risk of people with Parkinson’s disease (PD) falling is greater than that of the general population but to date, disease-specific predictors of falling have not been identified. Objectives: To identify one or more features, which would predict individuals at risk of falling during a 3-month prospective follow-up study. Method: A battery of standardised tests administered in the home and the laboratory with a 3-month follow-up telephone interview. Results: Sixty-three people with PD were recruited from GP practices. Eleven interview variables and six gait laboratory variables were used with subsamples (55 and 44 subjects, respectively) to fit predictive models for identifying future fallers. The number of falls in the previous year was the most important variable, without exception, to be selected as a predictor in various logistic regression models. A history of two or more falls had a sensitivity of 86.4% (95% CI 67.3–96.2%) and a specificity of 85.7% (95% CI 71.2–94.2%) in predicting falling in the next 3 months. Conclusion: Healthcare workers should be asking their patients with PD regularly and carefully about falling, and should consider instigating programmes of fall management for patients with PD who have fallen two or more times in the previous 12 months.
Spasticity: A Rehabilitation Challenge in the Elderly
Authors: Barnes Michael P.
Published: April 2003

There is no doubt that spasticity is a significant cause of disability in the elderly. Regrettably, it is a condition that is often poorly treated and can result in a range of unnecessary complications which can cause further problems for the disabled person and their family. There are now a number of effective treatment options. However, before such options are defined the specific goals of rehabilitation need to be clarified and an appropriate outcome measure chosen in order to determine when such goals are being met. The treatment should be multidisciplinary and input from both the physician and a physiotherapist is essential. Involvement of the elderly person with spasticity, and often their family, is also important in the education process. Simple physiotherapy interventions can be remarkably helpful, including attention to positioning and seating. The role of the physician initially focuses on oral medication. Although we still have older drugs including diazepam, baclofen and dantrolene there are now more modern drugs including tizanidine and, more recently, gabapentin. However, most spasticity is focal in origin and thus requires focal treatment. Although phenol nerve blocks are sometimes helpful the use of botulinum toxin is now to be highly recommended. There is now clear evidence of the efficacy of botulinum toxin, which has been a significant advance in our management of spasticity. More advanced and difficult to treat problems can be alleviated by intrathecal baclofen or sometimes intrathecal phenol or, as a last resort, surgical intervention. The advent of lycra garments for the overall management of more diffuse spasticity is now becoming both fashionable and effective. Conclusion: The management of spasticity in the elderly person is a significant challenge to the rehabilitation team and a combined approach can produce significant benefit for the disabled elderly person.
Coeliac Disease in the Elderly
Authors: Gasbarrini G. , Ciccocioppo R. , De Vitis I. , Corazza G.R.
Published: April 2003

Background: In the last few decades, we have observed either an increased incidence of coeliac disease (CD) or an increased frequency of its diagnosis. However, only scant information is available about the prevalence and clinical features of CD in the elderly. Aim of the Study: To determine the proportion of elderly patients (age ≧65 years) in a large group of consecutive newly-diagnosed cases of adult CD and to analyze the clinical pattern and causes of death. Patients and Methods: 1,353 adult patients with active CD were diagnosed by 10 Italian Gastroenterology Units over a period of 10 years. For each patient, a questionnaire comprising demographic data, signs and symptoms with their duration at the moment of the diagnosis, and associated diseases or complications and the causes of death, was drawn up. Results: A total of 60 patients (4.4%) were over 65 years at diagnosis with a M/F ratio of 1/2.75 which was similar to 1/2.42 in the under-65-year age group. The mean time of delayed diagnosis was 17 ± 19 years in the elderly and 14 ± 13.8 years in the adults. Classical features of malabsorption were the main presenting symptoms and gastrointestinal disorders were very often also present in the geriatric patients. Twelve aged subjects (20%) died during the follow-up period (mean 4.6 years) often due to cachexia (5%) and heart failure (5%), even though complications such as intestinal lymphoma were present in 8.3% of cases and caused death in 3.3% of the elderly. Conclusions: In spite of classical manifestations of CD in the elderly, the diagnosis was made in only 4.4% of subjects aged over 65 years and the delay was 17 years. These observations, together with the shortening of life expectancy of elderly CD patients, emphasize the importance for clinicians to consider CD as a possible diagnosis and the need for further investigations to be carried out in the elderly general population.
Side Effects of Influenza Vaccination in Healthy Older People: A Randomised Single-Blind Placebo-Controlled Trial
Authors: Allsup Stephen James , Gosney Margot , Regan Martyn , Haycox Alan , Fear Simon , Johnstone Fiona C.W.
Published: April 2003

Objectives: To investigate the frequency of side effects following influenza vaccination in healthy participants aged 65–74 years. Materials and Methods: A single-blind randomised placebo-controlled trial was performed in general practices in central Liverpool on 729 healthy individuals (341 females and 388 males) aged 65–74 (median age 68.9) years, of whom 552 received influenza vaccine and 177 received placebo. The main outcome measures were analysed from adverse reactions reported by the subjects on a postal questionnaire 3 days after vaccination. Results: 724 (99.3%) questionnaires were returned. 62 (11.3%) participants who received influenza vaccination complained of local symptoms compared with 9 (5.1%) participants who received placebo (difference 6.2%; 95% CI 1.3 to 10.0%; p = 0.02). 192 (35.1%) individuals who received influenza vaccine complained of one or more systemic side effects compared with 75 (42.4%) who received placebo (difference –7.3%; 95% CI –15.6 to 0.9%; p = 0.10). Conclusion: Healthy people belonging to this age group can be reassured that, when compared with placebo, influenza vaccination causes few, if any, systemic side effects and only a low incidence of local side effects.
Problems in Using Health Survey Questionnaires in Older Patients with Physical Disabilities
Authors: Ball Anne E. , Russell Elizabeth M. , Seymour D. Gwyn , Primrose William R. , Garratt Andrew M.
Published: April 2003

Background: The SF-36 Health Survey questionnaire has been proposed as a generic measure of health outcome. However, poor rates of return and high levels of missing data have been found in elderly subjects and, even with face-to-face interview, reliability and validity may still be disappointing, particularly in cognitively impaired patients. These patients may be the very patients whose quality of life is most affected by their illness and their exclusion will lead to biased evaluation of health status. A possible alternative to total exclusion is the use of a proxy to answer on the patient’s behalf, but few studies of older people have systematically studied patient-proxy agreement. Objective: To compare the agreement between patients, lay and professional proxies when assessing the health status of patients with the SF-36. Methods: The SF-36 was administered by interview to 164 cognitively normal, elderly patients (Mini-mental State Examination 24 or more) referred for physical rehabilitation. The SF-36 was also completed by a patient-designated lay proxy (by post) and a professional proxy. Agreement between proxies and patients was measured by intraclass correlation coefficients (ICCs), and a bias index. Results: Professional proxies were better able to predict the patients’ responses than were the lay proxies. Criterion levels of agreement (ICC 0.4 or over) were attained for four of the eight dimensions of the SF-36 by professional proxies, but for only one dimension by lay proxies. In professional proxies, the magnitude of the bias was absent or slight (<0.2) for six of the eight dimensions of the SF-36 with a small (0.2–0.49) negative bias for the other two. Lay proxies showed a negative bias (i.e. they reported poorer function than did the patients themselves) for seven of the eight dimensions of the SF-36 (small in two and moderate (0.5–0.79) in five). Conclusions: For group comparisons using the SF-36, professional proxies might be considered when patients cannot answer reliably for themselves. However, in the present study, lay proxy performance on a postal questionnaire showed a strong tendency to negative bias. Further research is required to define the limitations and potentials of proxy completion of health status questionnaires.
Understanding Ageing
Authors: Hofer Scott M. , Sliwinski Martin J.
Published: April 2003

Background: Cross-sectional studies of samples varying widely in age have found moderate to high levels of shared age-related variance among measures of cognitive and physiological capabilities, leading researchers to posit common factors or common causal influences for diverse age-related phenomenon. Objective: The influence of population average changes with age on cross-sectional estimates of association has not been widely appreciated in developmental and ageing research. Covariances among age-related variables in cross-sectional studies are highly confounded in regards to inferences about associations among rates of change within individuals since covariances can result from a number of sources including average population age-related differences (fixed age effects) in addition to initial individual differences and individual differences in rates of ageing (random age effects). Analysis of narrow age-cohort samples may provide a superior analytical basis for testing hypotheses regarding associations between rates of change in cross-sectional studies. Conclusions: The use of age-heterogeneous cross-sectional designs for evaluating interdependence of ageing-related processes is discouraged since associations will not necessarily reflect individual-level correlated rates of change. Typical cross-sectional studies do not provide sufficient evidence for the interdependence of ageing-related changes and should not serve as the basis for theories and hypotheses of ageing. Reanalyzing existing cross-sectional studies using a sequential narrow-age cohort approach provides a useful alternative for evaluating associations between ageing-related changes. Longitudinal designs, however, provide a much stronger basis for inference regarding associations between rates of ageing within individuals.
Creatinine Clearance, Cockcroft-Gault Formula and Cystatin C: Estimators of True Glomerular Filtration Rate in the Elderly?
Authors: Burkhardt H. , Bojarsky G. , Gretz N. , Gladisch R.
Published: April 2003

Background: The aim of this study was to assess the accuracy and precision of estimators of true glomerular filtration rate (GFR) (Cockcroft formula, measured creatinine clearance (CCR) and a cystatin-C-based estimation) in elderly patients attending a geriatric department. Additionally, parameters influencing GFR in the elderly were evaluated. Methods: 30 patients aged 57–90 years treated in the Geriatric Department for pulmonary or cerebral diseases were included in the study. Nine patients were diabetic and 16 hypertensive. Exclusion criteria were advanced dementia, acute heart failure and primary renal disease. Inulin clearance (CINU), CCR and estimation by Cockcroft-Gault equation (CG) were performed on the same day. For comparison of the methods an analysis according to Bland and Altman was used, depicting the mean difference between the methods and the limits of agreement of the differences, representing their 95% interval of confidence. Furthermore, the influence of confounding variables on GFR estimation was analyzed by multiple regression. Results: Baseline characteristics showed a median age of 74.5 years and a median body weight of 66.7 kg. Median values for serum creatinine 88.4 µmol/l, 5.74 mmol/l for urea and 1.57 mg/l for cystatin C. CCR (median: 51.6 ml/min) and CG (median: 63.0 ml/min) underestimated CINU (median: 83.3 ml/min). Both methods showed poor precision compared with CINU. The upper limit of agreement of the difference was 101.3 ml/min for CCR and 81.4 ml/min for CG, the lower limit was –33.8 ml/min for CCR and –24.6 ml/min for CG. Among frequently used variables to predict GFR, the reciprocal of serum creatinine and body weight revealed a significant influence but not age or gender. A cystatin-C-based estimation of GFR, derived from regression analysis, did not improve the precision of the estimation of GFR compared to CG. Additionally, the occurrence of diabetes mellitus disclosed a borderline influence on the estimation of GFR. Conclusion: CCR is not only inconvenient and time consuming, but also imprecise and inaccurate in the elderly, mainly due to reduced muscle mass and erroneous urine sampling. CG and a cystatin-C-based estimation are slightly more adequate, but overall there is no sufficiently precise formula for GFR estimation in the elderly.
Implantation versus Infiltration: The Sampson versus the Endometriotic Disease Theory
Authors: Koninckx P.R. , Barlow D. , Kennedy S.
Published: April 2003

It has been assumed that endometriosis is a progressive disease, with growth and development of lesions being inevitable once the disease has started. The implantation and the metaplasia theories describe the mechanism of initiation of endometriotic lesions, but do not explain the different clinical manifestations of endometriosis. To explain the variable expression, growth and development of lesions into severe disease, a new endometriotic disease theory is proposed. This theory suggests that progression of endometriosis to endometriotic disease is considered similar to the onset and progression of a benign tumour. In this theory, the most important factor in the development of endometriotic disease is not the initial implantation/metaplasia, but cellular changes such as mutations. According to this theory, endometriotic disease develops from endometriotic cells that have ‘escaped’ the influence of protective and regulatory factors in the peritoneal fluid.
Molecular Analysis of Clonality in Ovarian Endometrial Cysts
Authors: Yano Tetsu , Jimbo Haruko , Yoshikawa Hiroyuki , Tsutsumi Osamu , Taketani Yuji
Published: April 2003

Ovarian endometrial cysts, one of the typical manifestations of endometriosis, are classified as tumor-like lesions rather than as neoplasms. Clonality analysis provides important information on the histogenesis and progression of neoplastic diseases. It is generally accepted that most neoplasms are monoclonal in origin, while the clonality of endometrial cysts remains uncertain. In our study, the clonality of endometrial cysts was analyzed by means of polymerase chain reaction (PCR) based on restriction fragment length polymorphism of the X chromosome-linked human androgen receptor gene (HUMARA) and on random inactivation of the gene by methylation. We separated 21 fresh epithelial cell samples from 11 endometrial cysts and found that all were monoclonal in the methylation pattern of the human androgen receptor alleles. Moreover, in each of the five cysts where epithelial cells were sampled from multiple areas, the methylation patterns of all samples from a single cyst were identical. These data indicate that endometrial cysts are monoclonal in origin and suggest their neoplastic potential.
The Physiopathology of Endometriosis: Pollution and Dioxin
Authors: Koninckx P.R.
Published: April 2003

Reports in the literature of an increasing incidence of endometriosis in industrialized countries and increasing problems with pollution in these countries leads to speculation about a possible link between one of the most harmful components of pollution, dioxin, and endometriosis. To establish this link, we need to examine three issues more closely: What are the effects of dioxin, what is the true incidence of endometriosis, and what is the nature of the association between endometriosis and dioxin. This report reviews current thinking on these issues.
Endometriosis and Free Radicals
Authors: Ota Hirotaka , Igarashi Shinichi , Hatazawa Junichi , Tanaka Toshinobu
Published: April 2003

Recent studies have shown that synthase for nitric oxide or scavenger enzymes is distributed throughout the endometrium. We have reported that endothelial nitric oxide synthase, originally identified in vascular endothelial cells, is distributed in glandular epithelial cells in the endometrium, peaking in the midsecretory phase. In addition, it is known that superoxide dismutase is distributed throughout the endometrium, varying with the menstrual cycle. Yet it is not clear how these enzymes are committed in the reproductive processes. Endometriosis is often complicated by infertility and miscarriage. Of particular interest is that these enzymes are overexpressed in the disease throughout the menstrual cycle. These findings strongly suggest that excessive amounts of free radicals are produced in endometriosis.
The Potential Role of Environmental Toxins in the Pathophysiology of Endometriosis
Authors: Bruner-Tran Kaylon L. , Rier Sherry E. , Eisenberg Esther , Osteen Kevin G.
Published: April 2003

Environmental contaminants that are known to disrupt steroid action can influence the development of reproductive diseases. Our group has focused on whether 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD or dioxin) can disrupt steroid regulation of endometrial matrix metalloproteinase (MMP) expression. The MMPs regulate extracellular matrix turnover in normal tissues, but the inappropriate expression of these enzymes is associated with numerous disease states that involve invasive processes. We have previously shown that secretion of MMPs by human endometrium is critical for establishment of ectopic lesions in a nude mouse model of experimental endometriosis. In this report, we show that TCDD exposure promotes establishment of experimental endometriosis by interfering with the ability of progesterone to suppress endometrial MMP expression.