Concentrations of plasma methylmalonic acid in 80-year-olds show only weak relation to psychological performance

Most studies of the relation between psychological performance in the elderly and deficiencies of cobalamin and folate have used methods that determine the blood concentrations of these vitamins, which might not reflect the vitamin status in the tissues. Recently, two new markers, plasma homocysteine and methylmalonic acid, have attracted growing interest since they are considered to reflect the status of cobalamins and folates in the tissues. In a previous study, we noted a strong association between five parameters of well-being and lower concentrations of plasma homocysteine. In the present study, we have extended these observations by determination of plasma methylmalonic acid in the same healthy elderly population. In the present study, 18 out of 100 subjects had increased plasma methylmalonic acid and in 7 of these subjects, the concentrations of serum cobalamin, blood folate, plasma homocysteine and serum creatinine were within normal limits. The relation between plasma methylmalonic acid concentrations and concentrations of serum cobalamin and blood folates and five parameters of well-being were investigated. Concentrations of plasma methylmalonic acid were only weakly associated with the concentrations of serum cobalamin and lower scores on the logical reasoning test. The present study clearly shows that the levels of plasma methylmalonic acid show a much lesser association with the parameters of well-being than did plasma homocysteine.

Evaluation of small intestine submucosa and acellular dermis as diaphragmatic prostheses

BACKGROUND/PURPOSE

The repair of large congenital diaphragmatic defects in the neonate continues to be a challenge. Polytetrafluoroethylene (PTFE) is the synthetic material most widely used for reconstruction in instances of partial and complete diaphragmatic agenesis. Recurrent hernia is a frequent complication, because this material does not grow with the infant. This study evaluates two novel materials; small intestine submucosa (SIS; Cook Biotech, Lafayette, IN), and acellular dermis (AlloDerm; Lifecell Corp, The Woodland, TX) for diaphragm reconstruction in growing animals.

METHODS

Sprague-Dawley rats (100 g, n = 87) were anesthetized and underwent laparotomy. The control group (n = 18) underwent a sham laparotomy with a left subcostal incision and closure. The other two groups underwent central excision of the left hemidiaphragm (50% loss) and reconstruction with either a SIS (n = 35) or AlloDerm (n = 19) patch sutured circumferentially with 6-0 prolene. Seventy-two animals survived the operation, and were killed at five separate time intervals (2 weeks, 1, 2, 3, and 4 months). Chest radiographs were performed monthly and before death. Radiographs were reviewed in a blinded fashion by two observers as were the necropsies, and rib deformity was noted if present. Histological examination of the diaphragm patch was performed in each animal.

RESULTS

There was no evidence of rib deformity noted on gross examination at necropsy or on chest radiograph in either experimental group. At necropsy, all patches were intact without hernia, eventration, or contraction. Histology findings initially showed acute and chronic inflammatory changes in both patch materials that lessened at the 2-month time interval. Both prosthetic patches began to thin at 3 months and was most prominent in the SIS rats. At 4 months, both SIS and AlloDerm remained viable without evidence of necrosis. Each patch showed evidence of fibroblastic incorporation and small capillary ingrowth. These changes were more prominent in the AlloDerm group. There was no evidence of skeletal muscle ingrowth.

CONCLUSIONS

These data indicate SIS and AlloDerm may be useful materials for prosthetic repair in instances of partial or total agenesis of the diaphragm. Further investigation in a large animal model over a longer duration is indicated.

Insomnia in an 80-year-old population: relationship to medical, psychological and social factors

In this study, insomnia in 80-year-olds was related to medical, psychological and social factors. The data were based on examinations every year in people aged between 80 and 89 years. Of 333 people living in the city of Lund and born in 1908, 67% participated. Increased severity of insomnia was significantly associated with use of diuretics, other cardiovascular drugs, hypnotics and laxatives, and with nervousness, difficulty relaxing, anorexia, nausea, constipation, backache, feeling cold, sweating, loss of weight, dizziness, depression, general fatigue, exhaustion, angina pectoris, cardiac insufficiency, worsened objective and subjective health, presence of negative T-waves on ECG, anxiety, total life satisfaction, neuroticism, disbelief in a just world, feeling lonely and lower survival rates. Thus insomnia has widespread associations with different aspects of life in 80-year-olds.

Bannayan-Zonana syndrome: a rare autosomal dominant syndrome with multiple lipomas and hemangiomas: a case report and review of literature

BACKGROUND

Bannayan-Zonana syndrome is a rare hamartomatous disorder, characterized by macrocephaly, multiple lipomas, and hemangiomas. Inheritance is by autosomal dominant transmission with few reported sporadic cases. Male predominance is also reported.

METHODS

We describe a patient who presented with multiple subcutaneous lipomas, mild macrocephaly, and an extradural spinal hemangioma. Other affected family members and 24 other previously reported cases are discussed.

RESULTS

Spinal hemangiomas have not been described previously with this syndrome. The patient also had a "malignant bone tumor" removed from his humerus 20 years ago. Two of the patient's siblings also had lymphoma, which is an unusual accompaniment not reported previously. Only the male members in the family showed multiple subcutaneous lipomas.

CONCLUSION

Some patients with Bannayan-Zonana syndrome may have hamartomatous lesions producing cord compression or intracerebral hemorrhage, or they may rarely have other malignant tumors; therefore it is important that neurosurgeons are aware of the entity. The early diagnosis of BZS is also important for genetic counseling.

Metastatic adenocarcinoma arising in a congenital foregut cyst of the esophagus: a case report with review of the literature

Benign tumors and cysts of the esophagus are rare, and malignant transformation of esophageal cysts is even more rare. In this article, we report on the first case to our knowledge of a patient presenting with metastatic adenocarcinoma arising in a congenital foregut cyst of the esophagus. A 37-year-old woman had multiple cysts along the aerodigestive tract and diffuse soft tissue metastases. Endoscopic biopsies of a mediastinal mass revealed an enteric cyst with a spectrum of columnar epithelium ranging from benign through adenomatous to frankly malignant. There was only transient response to radiotherapy and chemotherapy. Only three other cases of carcinoma arising from esophageal duplication foregut cysts have been reported, and none of these were metastatic. Given the rarity of malignant transformation within an esophageal cyst, prophylactic excision of known esophageal cysts is not warranted. However, biopsy of the cyst may be useful to exclude the possibility of malignancy, particularly if the onset of symptoms has been recent.

Impact of autotransfusion after coronary artery bypass grafting on oxygen transport

BACKGROUND

Autotransfusion of shed mediastinal blood after coronary artery bypass grafting (CABG) has been shown to reduce the requirement for allogeneic blood. We have previously demonstrated in non-randomized studies that the oxygen capacity of shed mediastinal blood is similar to the patient's circulating blood and better than stored allogeneic blood. Therefore, we wanted to examine the influence of autotransfusion of shed mediastinal blood on oxygen transport capacity in patients undergoing CABG.

METHODS

A prospective, randomized, controlled study involving 120 patients having elective, uncomplicated CABG was performed. The autotransfusion group received transfusion of shed mediastinal blood for 18 h. Both groups received allogeneic red cells if their hemoglobin concentration decreased below 5 mmol/L. Red blood cell 2,3-diphosphoglycerate (2,3-DPG) was measured preoperatively and at intervals up to the hospital discharged. Hemodynamic measurements as well as blood gas and hemoglobin measurements from samples of arterial and mixed venous blood were used for calculation of oxygen transport capacity.

RESULTS

During the autotransfusion period only 2 patients (4%) in the autotransfusion group required allogeneic blood compared to 11 patients (20%) in the control group. The 2,3-DPG levels in the autotransfusion group were unchanged before and after autotransfusion (4.4 vs. 4.3 mumol/ml erythrocyte). In the control group, 2,3-DPG levels decreased from 4.3 to 3.9 mumol/ml erythrocyte during the same period. There were no differences in the other measured parameters for oxygen transport capacity between the groups.

CONCLUSION

Autotransfusion of shed mediastinal blood conserves the 2,3-DPG level of the red blood cells, while transfusion of stored blood leads to a decrease in 2,3-DPG levels. Autotransfusion had no effect on hemodynamic parameters, oxygen delivery or oxygen extraction.

Weight gain during pregnancy does not influence the spread of spinal analgesia in the term parturient

BACKGROUND

It is still controversial whether the spread of spinal anaesthesia in pregnancy is influenced by particular physique. Investigation was based on a clinical observation that parturients with a pronounced "pregnant" physique, e.g. generalised oedema and heavy abdomen, tended to develop more cephalad sensory blockades than parturients without these physical signs. Using weight gain during pregnancy as a measure for the physique at term, we aimed to determine whether this parameter influences the distribution of analgesia after subarachnoidal injection of plain bupivacaine.

METHODS

Thirty women presenting for elective Caesarean section were studied. All the women received 13.5 mg plain bupivacaine via subarachnoid injection at the L2-3 interspace. Thirty minutes after the injection, while the women were in the supine position with a left lateral tilt on a horizontal operating table, the maximum cephalad extent of sensory analgesia (loss of sensation to sharpness of pinprick) was determined.

RESULTS

Neither weight gain during pregnancy (6-22 kg, range), height (152-185 cm), weight (56-98 kg) nor body-mass index (20.2-31.8 kg/m2) correlated with the cephalad spread of sensory blockade.

CONCLUSION

In parturients, weight gain during pregnancy, height, weight and body-mass index did not influence the extent of sensory analgesia after subarachnoidal administration of plain bupivacaine.

Blood pressure in relation to medical, psychological and social variables in a population of 80-year-olds. Survival during 6 years

OBJECTIVES

To relate elevated blood pressure in 80-year-olds to symptoms, life satisfaction and survival.

DESIGN

Examinations of medical, psychological and social factors every year between 80 and 86 years of age.

SETTING

Primary health care in the city of Lund in southern Sweden.

SUBJECTS

Three-hundred and thirty-three persons living in the city of Lund and born in 1908. Participation rate was 67%.

INTERVENTION

Abnormal findings were further examined and treated.

MAIN OUTCOME MEASURES

Symptoms, blood pressure, laboratory values, psychological factors, cognition, living conditions, and survival.

RESULTS

Hypertension according to the definition used was found in 70%. Women were over-represented (P < 0.05). Amongst persons with alleged hypertension, diuretics (P < 0.001) and 'other cardiovascular drugs' (P < 0.001) were more often used. Analgesics were more often used amongst assessed hypertensives (P < 0.05). Those with assessed hypertension scored better in testing of cognition compared to nonhypertensives (P < 0.05), and less often lived in institutions (P < 0.001). Assessed hypertensives had a better survival than alleged hypertensives during the following 7 years (P < 0.01).

CONCLUSIONS

Eighty-year-olds with assessed hypertension in the consulting room showed fewer symptoms and had a better cognition and survival than alleged hypertensives (those with a history of hypertension).

Characterization and cytokine stimulating activities of heteroglycans from Tremella fuciformis

Three heteroglycans, T1a, T1b, and T1c, have been isolated from the body of Tremella fuciformis Berk. They are composed of mannose (Man), xylose (Xyl), glucose (Glc), fucose (Fuc), and glucuronic acid (GlcA). According to methylation analysis and partial acidic hydrolysis the main chains of T1a, T1b, and T1c consisted of (1-->3)-linked Man, which was branched at the 2, 4, or 6 positions. The branching points were linked with nonreducing terminal GIcA-residues or (1-->6)-linked glucan-chains. Molecular weights of the three heteroglycans are 53,000, 18,000, and 12,000 D respectively, but they undergo self-aggregation in water. T1a-T1c induce human monocytes to produce interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor (TNF) in vitro. Acidic hydrolysate fractions of T1a (T1a-1, 2, 3, 4, 5) with molecular weight from 53,000 to 1,000 D, also induce human monocytes to produce IL-6 as efficient as T1a.

Preoperative evaluation of intubation conditions in patients scheduled for elective surgery

Prediction of a difficult airway is a continuing problem. Several tests have been developed in order to overcome this problem. It has been proposed that using more than one test could increase the degree of predictability. One hundred patients scheduled for general surgery were successfully evaluated using three methods: 1. The size of the tongue in relation to the oral cavity (Mallampati gradation). 2. The thyromental and the mandibular length. 3. The atlanto-occipital angle. Seven patients had a difficult laryngoscopy and were difficult to intubate. It was possible to predict differenties in all seven patients, but it was found that only the Mallampati gradation and the atlanto-occipital angle contributed significantly to predictability. The cost of predicting further difficulties in all patients with a difficult laryngoscopy was a false positive prediction in a further 13 patients who had no problems with laryngoscopy or intubation. By increasing the specificity of the tests the number of false positive classifications could be reduced to 10 patients, but this would have led to the missing of one patient with a difficult laryngoscopy.

Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents

Based on an international consensus conference held in Copenhagen in the autumn of 1994, a set of guidelines for Good Clinical Research Practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents are presented. The guidelines are intended to be a help for people working in this research field, and it is hoped that the guidelines will assist researchers, editors, and drug companies to enhance the quality of their pharmacodynamic studies of neuromuscular blocking agents.

Laboratory values, symptoms and survival in an 80-year-old population

Medical, psychological and sociological factors were related to laboratory values in an 80-year-old population encompassing 211 persons. 21% of the men and 17% of the women had elevated ESR. 36% had elevated blood glucose (7% had diabetes). 13% of the men and 7% of the women had anaemia. Persons with anaemia generally had a lower quality of life compared with non-anaemic persons. Low haemoglobin, elevated ESR and low serum iron were all associated with impaired subjective and objective health. There were no significant correlations between the laboratory data and psychological and social parameters. The survival over 5 years was significantly decreased for those with anaemia, elevated ESR, high white blood count, high blood glucose, low serum iron or deviating serum potassium.

Acute meningitis of unknown aetiology: analysis of 219 cases admitted to hospital between 1977 and 1990

Clinical and biochemical parameters in 219 patients with meningitis of unknown aetiology were analyzed according to their initial CSF leucocyte count. The male/female ratio was 1.1 and the median age 30 years,(males = 22 years/females = 42 years). Pre-admission antibiotic, which may inhibit bacterial growth, was given to 28% patients. On admission symptoms of meningitis were predominant: 96% had fever, 91% neck rigidity and 19% a severely affected mental state. In addition, 10% had a petechial rash. A bacterial aetiology was likely, as 91% had a predominance of polymorphonuclear leucocytes in the CSF and in 50% it was frankly purulent. The CSF leucocyte count correlated positively with age, the period of fever and the length of hospitalization, but did not relate to the 10.1% in-patient mortality rate. Mortality was related to advancing age, but not to the antibiotic regimen chosen. Patients admitted directly from their homes had the least complicated disease course and all survived. A low CSF leucocyte count, mainly found in young patients so admitted, could indicate either a non-bacterial self-limiting aetiology or diagnosis at an early stage of the disease. We found, however, that bacterial meningitis cannot be excluded on the basis of the CSF leucocyte count in combination with any clinical and biochemical parameters. Rapid hospital admission, regardless of age, is of major importance for prognosis. Improvement of non-cultural diagnostics tests and adjunctive therapy regimens are essential.

Liver disease and serum hexosaminidase levels. Studies in a human hepatoma cell-line (Hep G2 cells)

In various forms of liver disease, increased levels of the lysosomal enzyme beta-hexosaminidase (Hex) occur in serum. This may be caused by disturbances of the hepatocytic function, and we therefore studied the intracellular and extracellular isoenzyme pattern of Hex in a human hepatoma cell-line (Hep G2), using an immunoassay method, which separates Hex A and Hex B isoforms. This cell-line synthesizes and secretes Hex. The cumulative release of extracellular activity was about 3-10% of the intracellular activity. B-isoforms comprised one-third of intracellular activity but only 20% of extracellular activity. The proportion of extracellular B-isoforms increased with time, presumably due to instability of A-isoforms at 37 degrees C. Cycloheximide inhibited the release of Hex activity, whereas NH4Cl increased the extracellular fraction of Hex, even at a concentration of 1 mmol/l. We speculate that the increased concentration of NH4+ in patients with liver disease interferes with the distribution pathway of the lysosomal enzymes. This might be one reason for the increased serum Hex activity found in patients with liver disease.

[Cancer morbidity among alcoholics]

Data on the association between alcohol abuse and cancer morbidity are scarce in large cohorts of non-hospitalized alcoholic men an women. Of 18,368 alcohol abusers who entered an out-patient clinic in Copenhagen between 1954-1987, 18,307 were followed. Their cancer incidence was compared to that of the total Danish population. The overall morbidity of cancer was significantly increased among alcohol abusers. The men developed 1441 cancer cases (RR = 1.6), and the women 182 cases (RR = 1.5). Significantly increased incidences were found for cancer of the tongue, mouth, pharynx, oesophagus, liver, larynx, lung, pleura, and secondary cancer. The women had a significantly increased risk of cervical cancer (RR = 2.0). The men developed prostatic cancer significantly more frequently than expected (RR = 1.4). The relative risks of cancer of the stomach, pancreas, kidney and endocrine system were only slightly increased. The risk of breast cancer in women was not significantly increased (RR = 1.3).