Assay of intracellular thymidylate synthetase activity and inhibition by 5-fluoro-2'-deoxyuridine in lymphocytes. Thymidylate synthetase catalyses the formation of thymidine monophosphate from deoxyuridine monophosphate. Purified thymidylate synthetase can be assayed radiochemically using labelled deoxyuridine monophosphate as substrate, but cells are impervious to deoxyuridine monophosphate and so intracellular thymidylate synthetase activity cannot be assayed in this way. In this paper we describe the assay of intracellular thymidylate synthetase activity in intact cells using labelled 2'-deoxyuridine. The assay showed linear kinetics with respect to time, concentration of 2'-deoxyuridine, and cell concentration. 5-fluoro-2'-deoxyuridine inhibited intracellular thymidylate synthetase activity measured with this assay by 50% at 5 nM. Cell growth was inhibited by 50% at 6 nM 5-fluoro-2'-deoxyuridine. The assay was specific for thymidylate synthetase and enabled measurement of thymidylate synthetase activity in situ in intact cells.


Establishment of a multi-dose study of chondroitin sulfate iron colloid for evaluation of the reticuloendothelial system function. The assay system of chondroitin sulfate iron colloid (CSFe) was established to evaluate the reticuloendothelial system (RES) function in individual rabbits. In the multi-dose study of CSFe, CSFe was repeatedly administered to each individual rabbit with increasing doses (0.6, 1.2, 2.4, 6.0 mg/kg) at set intervals. Blood samples were serially collected after injection of CSFe and the concentration of CSFe in serum was directly measured as an iron concentration by modifying the previously described assay method [1] to minimize the sample volume. The clearance rate of CSFe at each injected dose was computed by the least-squares method and the double-reciprocal plotting of the doses against the phagocytic velocities by the Lineweaver-Burk method was obtained in each rabbit. The maximum phagocytic velocity (Vmax) and the CSFe concentration producing 1/2 Vmax (Kp) obtained in ten rabbits were 0.129 +/- 0.025 mg/kg per min and 0.417 +/- 0.121 mg/kg (mean +/- S.D.), respectively. The results obtained from this multi-dose study were comparable to our previous results obtained from the mean values of five groups given different doses [1]. The clearance rates of CSFe (0.6, 1.2, 6 mg/kg) decreased after the co-injection of 80 mg/kg of carbon colloid. The calculated Vmax and Kp in 29 rabbits were 0.125 mg/kg per min and 1.167 mg/kg. The Kp was apparently greater than that of the control (Vmax = 0.128 mg/kg per min, Kp = 0.421 mg/kg). Carbon colloid (80 mg/kg) was injected to six rabbits after the completion of the first multi-dose study of CSFe and then the second multi-dose study of CSFe was repeated after 24 h. No differences were found in Vmax and Kp between the two studies as were in the control group (10 rabbits) where saline was injected instead of carbon colloid. These results indicated that carbon colloid (80 mg/kg) gives a competitive and reversible inhibition on the RES. This multi-dose study of CSFe may be applicable for a bed-side analysis of the RES function in a patient.


Development of an antibody against a 170-kDa fragment of fibroin isolated from cocoon fibres of Bombyx mori. A simple method for the isolation of denatured fragments of the fibroin protein from cocoon fibres by alkali solubilization is discussed. This 170-kDa antigen has been purified and used to raise the polyclonal antibody in rabbit. The specificity of this antibody to the purified cocoon protein has suggested strong immunoreactivity up to a titre of 1:5000 dilution of the antibody. Further, dot-blot analysis with the tissue extracts from silk glands of different larval stages (3rd to 5th) reveals that this antibody reacts showing a stage-specific increase in the intensity of the colour, correlating well with the in-vivo expression of the silk protein. This study suggests the availability of a specific polyclonal antibody that detects the native fibroin with no crossreactivity with other tissue proteins.


A new micromethod for mechano-chemical research. A new micromethod to study activity of enzymes in crystalline and amorphous solid samples subjected to tension is described. Both static (up to 200%) and dynamic (with an amplitude up to 50% and frequency of 10(-3)-50 Hz) deformation may be applied to the sample during the activity measurement. Strain-induced changes in activity of thin (3-10 microns) needle-like strips (0.2-0.5 microns long), cut out of the microtome sections of cross-linked crystals of pancreatic carboxypeptidase A is measured in a droplet of substrate solution (with volume of 10(-6)-10(-9) l) with a pH-microelectrode technique.


Characterization of immobiline membranes for application in a multicompartment electrolyzer for protein purification. The efficient use of preparative protein purification in a multicompartment electrolyzer with Immobiline membranes depends on the knowledge of membrane characteristics. For that purpose, an experimental investigation of the effects of ionic charges on the membrane characteristics has been carried out through the measurements of membrane swelling and conductance. We also investigated the effects on the electrolyzer behaviour of operating parameters such as the Immobiline concentration and the presence of ion-exchange membranes. Data show that polyacrylamide gel degree of swelling is strongly dependent upon the pH and the ionic strength of the bathing solution as well as on the type and molarity of charges incorporated in the gel. The conductance of supported Immobiline gels in contact with uni-univalent chloride solutions has been measured by means of a mercury cell. The membrane conductance is also influenced by the ionic strength of the equilibrium solution and the presence of weak ionizable groups in the gel matrix. This study has demonstrated the close link between electrochemical and electromechanical properties of Immobiline membranes.


Decreased Coomassie brilliant blue colour yield with glycated proteins. Collagen, myosin and albumin were incubated for 7 days at 20 degrees C with fructose, ribose or glyceraldehyde. For thus-formed glycated proteins, quantities were determined by the Conway microdiffusion technique and by the colorimetric method based on Coomassie brilliant blue G-250 colour yield. It was found that when albumin was glycated with increasing amounts of glyceraldehyde, the colour yield was decreased by 7-33%. In collagen, myosin and albumin incubated with 0.5 mol/l fructose, 0.5 mol/l ribose or 0.1 mol/l glyceraldehyde, protein concentration was not changed, as proved by the Conway microdiffusion technique; the Coomassie brilliant blue G-250 colour yield was up to 50% lower, depending on the protein used, and was decreased much less when proteins were incubated with less sugar.


Effect of chemical sympathectomy on scintigraphic gastric and small bowel transit in the rat. Our aims were to measure gastric and small bowel transit of radiolabeled chow or liquids in rats and to assess the effect of pharmacologically induced chronic sympathectomy of at least 5 weeks duration. Three series of experiments were performed. In series I, four rats in each group underwent i.p. chloral hydrate anesthesia, tracheostomy with intubation and mechanical ventilation: they received by gavage 1.0 g rat chow dissolved in 1.5 ml saline labeled with 1.0 mCi 99mTc-DTPA In series II, four rats in each group were anesthetized with only i.p. chloral hydrate and received 1.5 ml labeled saline. Rats were placed on a gamma camera for dynamic acquisition of 1-min images for 7 h in series I, and 4 h in series II. Activity was quantitated in stomach and cecum; gastric emptying was analyzed by the power exponential model. In series III, four rats in each group were studied for 1 h on gamma camera and sacrificed after 5 h. At the end of each study, the stomach, small bowel, cecum and colon were removed and radioactivity counted in each organ in a dose calibrator. Quantitation of radioactivity by gamma camera was highly accurate: labeled chow in the stomach at 7 h was identical by external camera and counting of the excised organ (linear regression slope = 1.01, r = 0.97, P less than 0.0001). Similar precision was observed with labeled liquids (slope = 0.93, r = 0.93, P = 0.001). Chow emptied slower than liquid in both groups (P = 0.048). Ileocecal movement of isotope occurred by bolus transfers.(ABSTRACT TRUNCATED AT 250 WORDS)


Structure of autonomic neuromuscular junctions in the sinus venosus of the toad. The structure of cholinergic and adrenergic neuromuscular junctions in the sinus venosus of the toad, Bufo marinus, was determined by electron microscopy. From random sections of sinus venosus tissue it appeared that there were variable separations between cholinergic or adrenergic varicosities and the nearest sinus venosus muscle cell. However, when the structure of complete cholinergic and adrenergic varicosities was determined by examining serial electron micrographs, virtually all varicosities that lost their covering of Schwann cell were found to form an area of close apposition with an adjacent muscle cell. At the region of close apposition, the neuromuscular cleft was filled with a single layer of basal lamina to give a neuromuscular separation of about 70 nm. Synaptic vesicles within a varicosity were usually found to be concentrated towards the region of close apposition. These observations are discussed in relationship to the idea that when transmission occurs at these neuromuscular junctions the transmitters act on discrete pools of specialized subsynaptic receptors.


Effect of L-threo-3,4-dihydroxyphenylserine on muscle sympathetic nerve activity in humans. To clarify the effect of L-threo-3,4-dihydroxyphenylserine (L-threo-DOPS), a precursor of norepinephrine (NE), the effect of this drug on microneurographically recorded muscle sympathetic nerve activity (MSA) from the tibial nerve was analyzed in ten healthy male volunteers. A single dose of 600 mg of L-threo-DOPS was orally administered and the effect of this norepinephrine precursor on MSA at resting and at upright standing positions, as well as the MSA responsiveness to head-up tilting was examined by comparing the data obtained after administration of the drug with those obtained under control conditions. The plasma NE levels were determined in two subjects. The results were as follows: (1) resting MSA increased significantly 80 min after administration of L-threo-DOPS and was accompanied by an increase in plasma NE levels; (2) standing MSA when treated with the drug was not significantly different from values obtained under control conditions; and (3) MSA responsiveness to orthostasis was reduced after L-threo-DOPS. We conclude from the activation of MSA by L-threo-DOPS that this drug raised blood pressure not only through an increase in metabolized plasma NE levels, but also through the enhancement of MSA by activation of descending noradrenergic or adrenergic pathways proximal to the recording site of the sympathetic discharge.


Differential effects of V2 vasopressin agonist and antagonists on blood pressure regulation in normotensive (WKY) and spontaneously hypertensive (SHR) rats. The effects of arginine vasopressin analogs with V2 agonistic and antagonistic properties on blood pressure (BP) and heart rate (HR) were compared in conscious, spontaneously hypertensive (SHR) and normotensive (WKY) rats under resting conditions and after administration of phenylephrine (Phe) and sodium nitroprusside (SN). In WKY rats, resting BP and HR were not significantly affected during intravenous (i.v.) infusion of dVDAVP, (V2 agonist; 200 pg/kg/min), d(CH2)5 (D-Ile2,Abu4]AVP (V2 antagonist 1; weak V1 antagonist; V2/V1 ratio = 29; 0.6 microgram/kg/min), d(CH2)5[D-Ile2,Ile4,AlaNH2]AVP (V2 antagonist 2; very weak V1 antagonist; V2/V1 ratio = 83; 0.6 microgram/kg/min) and combined infusion of V2 agonist and V2 antagonist 2. Under resting conditions BP and HR were not affected in WKY by any of the treatments. In SHR rats BP and HR were significantly decreased by V2 antagonist 2 infused alone or in combination with V2 agonist. In WKY but not in SHR V2 agonist without and with prior V2 receptors blockade significantly augmented bradycardia associated with a maximum increase of the systolic blood pressure after Phe administration. Significant differences were found between SHR and WKY in SN-induced changes of HR and BP after administration of V2 agonist and antagonists. The results suggest that circulating vasopressin may modify the baroreflex by interaction with receptors which are stimulated by V2 agonist but are different from the classical V2 receptors. The study supports evidence for differential effects of vasopressin analogs on blood pressure and blood pressure-heart rate relations in WKY and SHR.


[Surgical treatment of strabismus by sagittal cutting of the oblique muscles. Apropos of 449 cases]. The theoretical proposals and the therapeutic approach described at the beginning of the sixties by Gobin concerning the treatment of incomitant strabismus have had such positive results as to convince many surgeons to adopt this methodology. The principal merit of Gobin's technique lies in evaluation of all aspects of the strabismus (horizontal, vertical and oblique) searching for the obstacles to ocular movements which cause alteration of binocular vision and removing them. According to the above criteria, we have operated 449 cases of incomitant strabismus due to sagittalization of the oblique muscles. The validity of this technique has been demonstrated by the results obtained in a single operation (a success rate of over 50%). With a second operation the success rate was increased to 70% (orthophoria, heterophoria and esthetic angle < 7 degrees).


[Use of perfluorocarbon solutions in the surgical treatment of posterior luxation of the lens]. Posterior lens dislocations represent 20 to 40% of all lens dislocations. It can occur after trauma. Visual prognosis can be good, but most often there are complications such as glaucoma, retinal detachment and uveitis. A few years ago, surgery was difficult, and surgery was delayed until the development of specific complications. A new technique, using perfluorocarbon liquids (PFCL), should be recommended because it is simple, and constantly effective. After vitrectomy, perfluorodecalin is injected into the vitreous cavity. As PFCL have a density twice the density of water, it allows the lens to float on the surface of the PFCL, behind the iris. Lens extraction can be associated with trabeculectomy, and anterior chamber lens implantation. We present a prospective study of 6 cases operated according to this technique. Postoperative results were good: visual acuity was preserved and ocular tension was controlled in cases of preoperative hypertonia. We believe this technique can be recommended after posterior lens dislocation, to prevent complications and to preserve visual acuity.


[Changes in the fundus in subacute sclerosing panencephalitis. Apropos of 23 cases]. Subacute sclerosing panencephalitis (SSPE) is a fatal slow encephalitis. It is related to a chronic infection of the central nervous system by a defective measles virus. Among 41 patients with SSPE, 23 had ocular involvement. The ophthalmologic involvement preceded the onset of neurological signs in 4 cases, they were detected at first presentation in 9 cases, and they occurred in the course of the disease in 10 cases. The ocular involvement was bilateral in 19 cases. Various ophthalmologic features were reported: retinitis (16 eyes), macular pigment disturbances (4 eyes), optical neuritis (33 eyes), visual agnosia (1 patient). The macular lesions were typical of the disease, but at the acute stage they were liable to be confused with toxoplasmosis. This complication of measles should disappear with the systematic vaccination of 12 month old children.


[Intraocular absorption of cyclosporin A eyedrops]. A study was carried out on ocular and systemic absorption after topical application of 2% cyclosporin A in patients requiring corneal transplants, determining by polarized light immunofluorescence the levels of this drug in the cornea, aqueous humor and blood. Between 30 and 85 minutes after the last application, considerable levels of cyclosporin A were found in the explanted cornea (236 +/- 42 ng/mL). Relatively lower levels were found in the aqueous humor although there were significant differences between the patients who received a total topical dosage of 5 mg (16.92 +/- 6.86 ng/mL) and those who received 10 mg (25.06 +/- 9.13 ng/mL) over the same period of time. No analytically detectable levels were found in the plasma. We consider that topically administered cyclosporin A can reach immunosuppressive levels of activity in some ocular compartments thus eliminating the potential systemic effects resulting from its utilization by general administration.


[Persistent hyperplastic primary vitreous. Middle-term results of vitrectomy]. In this study, the authors present a homogeneous series of seven children suffering from persistent hyperplastic primary vitreous, in its complete anterior and posterior form. These children were operated by pars plana lensectomy and vitrectomy. The surgical operation was beneficial in every case: not only were there no complications, but the operation also prevented progression towards neovascular glaucoma, vitreous hemorrhages and phtisis bulbi. In addition, one of the benefits of this technique was esthetic, with the disappearance of leucocoria, the occasional correction of strabismus and the reduction in microphthalmos. Visual recovery can be surprisingly good, in the absence of any associated retinal malformation.


[Orbito-palpebral prosthesis retained by intraosseous implants]. The use of intraosseous implants, whose tolerance is continually improving, constitutes an important progress in the field of prosthetic rehabilitation. In particular, titanium implants largely resolve the problem of retention of craniofacial prostheses. Our experience, based on that of Swedish authors concerning the extra-oral use of intraosseous implants, was sufficiently convincing to adopt this effective technique in our patients candidates for prosthetic rehabilitation. The case of a patient rehabilitated by means of an orbito-palpebral prosthesis is presented after a brief biomechanical review and presentation of the technique. Our results, although preliminary, are very encouraging in terms of the technical aspects as well as patient comfort. A further study could reinforce our decision.


[Giant peripheral tear of the retinal pigmented epithelium]. The authors present a case of gigantic tear of the retinal pigmented epithelium. This tear was situated in the middle periphery and seems to have appeared spontaneously together with a carotid-cavernous fistula. The functional outcome was favorable. The authors deal with the various possible patho-physiological mechanisms.


[Eye controlled microscope used in ophthalmic microsurgery]. This article presents a system of oculomotor control of the microscope used in ophthalmic microsurgery. An eye movement sensor has been integrated within the microscope lens. The information provided by this sensor is used to control the position of the microscope with no alteration of the surgeon's visual functions and no interference with his visual sensori-motor reflexes. Results have been obtained from laboratory experimentations as well as from a series of anterior and posterior segment surgical procedures. They demonstrate the high precision and sensitivity of the gaze control which can be used to compensate for the reduction of the field of vision resulting from the optical magnification of the microscope.


[Granuloma of the conjunctiva caused by synthetic fibers]. A five year old girl with pseudo-tumoral lesion of the inferior right fornix underwent surgical excision. Histology of the lesion showed a granulomatous giant cell inflammation surrounding foreign material, probably related to synthetic fabric fibers.


[Is A29, B12 vasculitis caused by the Q fever agent? (Coxiella burnetii)]. The authors describe the first two cases, to their knowledge, of retinal vasculitis, associated with Q fever. The first case was a chronic infection induced by Coxiella burnetii associated with HLA group A29 and B12; in the second case, the phenotype was B12. The authors tried to determine whether this agent could be the "Birdshot chorioretinopathy" promoting factor. Several epidemiologic findings tend to prove that Q fever is not the only cause. On the other hand, its similarity with rickettsia, the fact that it is found in patients with vasculitis, suggest that it could be one of the initial causal factors.


[Monobloc PMMA lenses. Anteroposterior displacement of the implant as a function of the insertion diameter]. Data concerning the biomechanical properties of IOL are rare. A systematic study of these properties was performed in the "laboratoire de Mécanique des Structures" at the "Ecole Centrale de Nantes". The results of the anteroposterior displacement of the optical part of eleven posterior chamber lenses (all PMMA) which were subjected to a diameter reduction, are reported. The deplacement of the implants was very slight and the position of the posterior side was relatively anterior whatever the diameter of insertion. The clinical implications, especially concerning the posterior capsule, are discussed.


[Long-term results of successful surgical treatment of retinal detachment by vitrectomy and silicone oil injection. Effect of removal of the tamponade on further complications]. We present, with a minimal follow up of six months, the results of 118 silicone oil removals following successful treatment of retinal detachment by pars plana vitrectomy and silicone oil injection. A recurrent retinal detachment occurred in 8.5% of cases, 13% of the 61 phakic eyes at the time of silicone oil removal maintained a clear lens, 29.6% of the eyes had a raised intraocular pressure and 6.8% had a keratopathy. The visual acuity improved in 72.8% of eyes after silicone oil removal. The main reasons for a late decrease in visual acuity were recurrence of the detachment, hypertonia, chronic hypotonia and keratopathy. All the eyes with late complications after silicone oil removal had a clinically significant droplet dispersion in the anterior chamber. Only complete and early silicone oil removal seems to decrease the complication rate.


[Posterior luxation of lens or implant: surgical treatment using a perfluorocarbon solution. Technique and results of 13 cases]. We used perfluorocarbon liquids in the management of 6 cases of posterior dislocation of the lens and 7 cases of (sub-) luxation of a posterior chamber intraocular lens (IOL). The perfluorocarbon liquid was injected into the vitreous cavity after complete vitrectomy, to bring back the lens or IOL to the posterior chamber where it can be easily removed. The main characteristics of perfluorocarbon liquids used in this indication are their high specific gravity and their good surface tension. Because of these two qualities, when injected in a vitrectomized eye, the perfluorocarbon liquid forms a bubble, filling the vitreous cavity from the posterior pole to the ora serrata with the dislocated lens or IOL floating on its surface. We found this technique to be helpful and quite atraumatic in this difficult surgical situation. Complications included regressive corneal edema in 6 cases and retinal dialysis with localized detachment in 3 cases.


[Ocular prognosis in Behçet's disease].

[Ocular prognosis in Behçet's disease]. The ocular prognosis of Behçet's disease was assessed in 31 French native patients with ocular involvement. The mean follow-up time was 6 years. Ophthalmologic manifestations revealed the disease in 61% of patients, and it was the first symptom in 29%. Two groups of patients could be identified: the minor forms (23%) which remained stable with colchicine alone and the severe forms (77%) which required steroid (32%) and/or immunosuppressive (45%) therapy. In the severe forms, 32 eyes were unchanged, 4 eyes showed improvement, and 12 eyes showed deterioration in visual acuity. Positivity of HLA B5, sex and complete form of the disease were not predictive factors of ocular involvement, or of its seriousness. At 6 years, 16% of the eyes (versus 14% at the beginning) had a visual acuity less than 1/10, and 71% (versus 74% at the beginning) had a visual acuity greater than 8/10. A close collaboration between ophthalmologists and internists allows a good visual prognosis in Behçet's disease.


[Cicatricial ectropion and ichthyosis. Apropos of 4 cases]. Ichthyosis are dystrophic inheritance skin disorders with inconstant palpebral complications like cicatricial ectropion and lagophthalmos due to large skin retractions. The authors report two cases of cicatricial ectropion in two adults. For one of the two cases, it is the first description to our knowledge of cicatricial ectropion associated with ichthyosis vulgaris sex-linked. The authors, after a short description of physiopathology and of classification of the different types of ichthyosis describe the surgical treatment with skin grafts, with good results in the first post operative period only in two adults. The two newborns had good results with medical treatment only.


[Large orbito-palpebral cavernous hemangioma]. Cavernous hemangiomas are benign vascular orbital lesions that exert a slowly progressive mass effect. They usually occur in adults. The authors report an unusual case of a large orbito-palpebral cavernous hemangioma with peculiar history and symptoms. The main clinical and radiological characteristics of this tumor are recalled together with the basis of surgical management.


[Corneal cyst].

[Corneal cyst]. A 76-year old woman developed an intracorneal cyst following uncomplicated cataract surgery. Progressive enlargement led to partial visual loss. Following drainage of the cyst, cytopathologic examination showed epithelial cells. The cyst subsequently reformed and caused acute pupillary block. Repeat drainage and cryotherapy were performed. Vision was limited by corneal edema, and penetrating keratoplasty was performed.


Enlargement of the entire posterior aspect of the calcaneus: treatment with the Keck and Kelly calcaneal osteotomy. Painful enlargement of the entire posterior aspect of the calcaneus can be difficult to effectively treat and must be differentiated from a classical Haglund's deformity. Clinical, radiographic, and surgical treatments of this deformity will be discussed. An illustrative case presentation is also included.


First cuneiform closing abductory osteotomy for reduction of metatarsus primus adductus. The closing subtraction osteotomy of the first cuneiform effectively reduces pronounced obliquity of the first metatarsal cuneiform joint and predictably reduces the intermetatarsal angle in patients with metatarsus primus adductus. This osteotomy is combined with other procedures in surgical realignment of the first ray. Cases best suited for this procedure must be selected carefully. The procedure involves resecting the existing bone block from the opposing surfaces of the first and second metatarsal bases and from the distal one half of the opposing surfaces of the first and second cuneiforms. A triangular-shaped wedge of bone is then resected from the midbody of the first cuneiform while retaining a medial hinge. Closure of the first cuneiform osteotomy should require only minimal pressure. Two threaded Steinman pins transfix the osteotomy site. The vascular cancellous bone of the first cuneiform assures adequate healing of the osteotomy site.


A new method of repair for rupture of the Achilles tendon. Rupture of the Achilles tendon requires prompt and appropriate treatment to prevent prolonged or permanent disability. Although the literature abounds with evidence supporting both conservative and surgical treatment, more recent studies report lower rerupture and complication rates with surgical repair. The development of ligament anchoring devices has led to new methods of repair for ligament and tendon injuries. A modification of the Lindholm technique that utilizes these devices is presented.


A calcaneal fracture from a fall or a fall from a calcaneal fracture? A case of a calcaneal avulsion fracture from a relatively minor traumatic incident is presented. The mechanism of calcaneal avulsion fractures is discussed. Special attention is given to the possibility of a pathologic fracture. The literature is reviewed and treatment is discussed.


Forces on the first metatarsophalangeal joint: a pilot study. The following is a pilot study designed to examine the forces in and around the first metatarsophalangeal joint during the contact phase of the normal gait cycle. The architecture of this study was designed to be simple, effective, and repeatable with minimal complications. This study used a force plate to examine ground reaction forces with the simultaneous use of a video tape recorder to provide overlapping images of the angular displacement of the proximal phalanx on the first metatarsophalangeal joint coinciding with these ground reaction forces. Peak ground reaction force was found to be 1.16 x body weight while the proximal phalanx was found to be maximally dorsiflexed just 0.09 seconds after the peak ground reaction force. The mean range of motion during this process was found to be 31.54 degrees.


A modification of the Ellis Jones procedure for chronic peroneal subluxation. The authors present a modification of the classic Ellis Jones procedure. The modification primarily involves the technique used for tenodesis of the transferred slip of Achilles tendon to the fibula. Advantages and disadvantages are discussed, as well as the results of 31 cases.


Septic shock syndrome in the surgical wound care patient. The occurrence of septic shock in lower extremity surgery is rare. Its early identification and treatment are vital to its outcome. The authors present a case history of septic shock occurring in the surgical wound care patient, discuss the pathophysiology of septic shock, and then consider diagnosis along with treatment options.


Austin bunionectomy: postoperative MRI evaluation for avascular necrosis. The authors used magnetic resonance imaging (MRI) to evaluate the formation rate of avascular necrosis following performance of 20 modified Austin bunionectomies. Five modified McBride bunionectomies without first metatarsal osteotomy were also performed as an MRI control. Results showed an avascular necrosis formation rate of 50%. The majority of the avascular necrosis areas were found dorsally within the cancellous bone substance of the first metatarsal head. These lesions, in all cases, did not cause any patient disability or result in any decline in the degree of patient satisfaction. The MRI positive avascular necrosis evaluations do suggest potential problem areas with the surgical technique that may be eliminated through further modification of the classic Austin bunionectomy procedure.


Invasive melanoma of the hallux.

Invasive melanoma of the hallux. The authors present a classic case of superficial spreading melanoma. Superficial spreading melanoma is the most commonly acquired cutaneous malignant melanoma. Its true etiology is unknown. Superficial spreading melanoma may remain in the epidermis with peripheral extension (radial growth phase) for as long as 5 years before invading deeper tissue layers. Definitive diagnosis is established through biopsy. Treatment, following biopsy, involves wide radical excision, and possibly lymphadenectomy and combination chemotherapy depending on the extent of the pathology.


Fifth metatarsal distal oblique wedge osteotomy utilizing cortical screw fixation. A retrospective study of 26 tailor bunionectomies is presented. The use of an apical axis guide, reciprocal planing, and strict application of Association for Osteosynthesis principles offers ease of application, increased stability, and greater healing predictability than other techniques. Potential complications such as angular displacement, shortening, nonunion, and transfer lesions are minimized.


The cytological and biochemical implications of periungual fibroma. Periungual fibromas may be acquired lesions or they may be associated with tuberous sclerosis or von Recklinghausen's Disease. Such tumors are comparatively rare benign dermatological entities. Periungual fibromas associated with the posterior nail fold have a potential for inducing deforming nail deformity. Pain resulting from the growth is due to concentration of pressures which may be placed on the nail matrix and contiguous soft tissue structures. This is further complicated by compression developed within the toe box of the shoe. The preferred treatment in symptomatic cases is that of complete surgical excision of the entire lesion. The present study presents such a case, together with histopathological features of this type of growth, with special emphasis on the subcellular features of the neoplasm.


Modulation of pituitary gonadotropins and prolactin secretion by testosterone in vitro. Investigations were undertaken to study the differential modulation of LH, FSH and PRL secretion by testosterone (T) using whole pituitary (PI) or pituitary-hypothalamus coincubates (PHC) as in vitro constructs. PI and PHC from intact and castrated rats were incubated with or without T thrice, for 24 h each, (24 h x 3, total incubation period 72 h). The spent media was replenished every 24 h. At the end of 72 h, a few of the pituitary glands were challenged with 10 nM LHRH for 4 h. The spent media and pituitary glands were analyzed for LH, FSH and PRL using specific RIAs. Incubation of PI or PHC from intact rats with T stimulated the release of LH and FSH but inhibited the release of PRL. T had no effect on the intrapituitary contents of LH but inhibited intrapituitary contents of FSH and PRL, as compared to controls incubated without T. Castration increased intrapituitary contents of LH and FSH with concomitant decrease in PRL levels. Incubation of PI or PHC from castrated rats with T inhibited intrapituitary contents of LH to intact pituitary levels, while PRL levels were further reduced instead of being ameliorated. It is concluded that PI or PHC can be used as convenient in vitro models to monitor the effect of castration or of T modulation of pituitary and hypothalamus functions. T does not affect the synthesis of LH at the gonadotroph level but facilitates the regulation of intracellular LH and FSH levels. It is postulated that T inhibits the synthesis of FSH/PRL at the gonadotroph/lactotroph levels.


Acquired fibrokeratoma of the heel.

Acquired fibrokeratoma of the heel. Acquired fibrokeratomas traditionally have been classified by both appearance and anatomical location. They are benign, solitary lesions that characteristically involve the digits of the hands and feet. The authors present a case with unusual involvement of the plantar surface of the heel.


A modification of the Regnauld procedure for hallux limitus. Surgical correction of hallux limitus can be challenging to the foot surgeon. The procedures available to date are numerous. Satisfactory results require proper candidate selection, and other procedures must be weighted carefully. The Regnauld procedure has become an accepted technique in this extensive surgical armamentarium. This manuscript describes a means of fixation that eliminates many of the complications associated with the original nonfixed technique, and allows for early range of motion to be initiated.


Pituitary reserve after repeated administrations of releasing hormones in young and in elderly men: reproducibility on different days. Combined testing of the pituitary gland by administration of GHRH, CRH, GnRH and TRH has been proposed for clinical studies, although some reports indicate that individual endocrine responses can be different when releasing hormones are used alone or in combination. Aims of this study were to evaluate: 1) the reproducibility of the combined test on different days; 2) the endocrine responses to the combined test applied twice at 3h and at 5h interval; 3) differences of endocrine responses in young and in elderly men. Six healthy young men (aged 25 to 35 yr) and 6 healthy elderly men (aged 65 to 75 yr) were evaluated: elderly men had lower testosterone, free T3, and somatomedin-c levels than young men, while 17 beta-estradiol and inhibin were not significantly different, all values being within normal laboratory limits. The 12 men were tested on day 1 with iv GHRH (50 micrograms) CRH (50 micrograms), GnRH (100 micrograms) and TRH (200 micrograms) at 08:00h and again at 11:00h; on day 8, the same men were tested at 08:00h and again at 13:00h. At 08:00h, the endocrine responses were similar on day 1 and on day 8. The second GH (young and elderly men) and PRL (only young men) response was blunted on day 1, when the interval between two consecutive stimuli was 3h, but not on day 8, when the interval was 5h. Elderly men differed from young men only for GH and for PRL release on day 1 at 08:00h.(ABSTRACT TRUNCATED AT 250 WORDS)


Use of granulosa-luteal cell culture to evaluate low and high clinical responses to menotropin stimulation. The cause of a poor response to human menopausal gonadotropin (hMG) remains unexplained. To determine whether aromatase activity of cultured granulosa cells obtained from relatively low estradiol (E2) responders (serum E2 < 1000 pg/ml) to hMG therapy differed from that of good responders (E2 > or = 1000 pg/ml), we prospectively compared serum E2 on the day of human chorionic gonadotropin administration to in vitro aromatase activity following a 72-h culture. Granulosa cells were obtained from seven women undergoing hMG therapy and oocyte aspiration. Follicle stimulating hormone (FSH) was added to one-half of the cultures. Serum E2 was determined by radioimmunoassay, and aromatase activity was determined indirectly by measuring tritiated water formed by aromatization of 1-beta [3H] androstenedione to estrogen in 1 h. In this study, luteinized granulosa cells from patients with a relatively low serum E2 produced less estrogen in cultures when compared to cells from higher responders (p < 0.01). Aromatase activity was not significantly increased by FSH in the relatively high responders, whereas FSH stimulated a significant increase in aromatase activity in cells from lower responders (p < 0.001). Our results indicate that the clinical response to hMG is at least partly due to the "quality" of granulosa cell aromatase activity. A clinically relevant "block" to FSH action may be present in vivo in low responders which can be reversed in culture by addition of FSH.


Chronic ankle instability and pain: a case report of a teenager with open epiphysis. The author discusses the treatment of chronic ankle instability in a young child of 14 years of age. A procedure is described that avoids drilling of the fibula and disruption of the epiphyseal plate. An autogenous graft procedure is described.


Phalangeal periosteal (juxtacortical)chondroma of the foot. The author discusses a benign cartilaginous tumor involving the tubular bones, more frequently in the hand than the foot. Its rare occurrence in the second toe of an adult male is illustrated. Pain and swelling required excisional biopsy, whose diagnosis was aided by radiographic findings of calcification and cortical erosion.


Changes in lymphoid organs of Ames dwarf mice after treatment with growth hormone, prolactin or ectopic pituitary transplants. This study was performed to obtain more insight into the roles of PRL and GH in the control of immune functions in hereditary dwarf mice characterized by severe immunodeficiency. Adult female Ames dwarf mice (df/df) were injected daily for 10 days with ovine PRL (oPRL), bovine GH (bGH), oPRL+bGH or were implanted with a normal pituitary under the kidney capsule for 5 days. Only the treatment with bGH resulted in significant increases in the gain of body weight, and in absolute and relative thymus and spleen weights. Treatment with oPRL alone did not affect body weight gain or thymus and spleen weights. Treatment with oPRL+bGH produced a significant increase in the gain of body weight and in absolute and relative spleen weight but these effects were smaller than those measured in dwarf mice treated with bGH alone. Only bGH therapy resulted in extensive recovery of the absolute number of lymphocytes in the thymus and spleen of dwarf mice, with the values in treated dwarf mice not significantly different from those found in normal non-dwarf females. However, when these values were corrected for body weight, both the splenic and the thymic indices exceeded the values found in normal mice. The absolute numbers of lymphocytes in the spleen were also increased by oPRL+bGH treatment, but did not reach the values found in normal mice; however, the splenic index exceeded the values found in normal animals. Surprisingly, the absolute and relative numbers of lymphocytes found in the thymus of dwarf mice under oPRL+bGH therapy were indistinguishable from those found in oPRL or vehicle treated dwarf mice.(ABSTRACT TRUNCATED AT 250 WORDS)


Rigid internal fixation of the Austin/Chevron osteotomy with Herbert screw fixation: a retrospective study. One of the adaptations of the Herbert bone screw (Zimmer Corp., Warsaw, Indiana) in podiatric surgery has been in the fixation of the Austin type osteotomy of the first metatarsal, to obtain rigid internal fixation. Technical difficulties in performing the procedure and complications have resulted in the development of several modifications of the original technique to better facilitate application of the Herbert screw. A brief review of the literature including history of distal metaphyseal osteotomies, and the uses of the Herbert screw is included. The purpose of this manuscript is to present utilization of the Herbert bone screw and modified jig in a modified Austin osteotomy, and to produce rigid internal fixation without the disadvantages of other internal fixation techniques.


Alterations in the concentrations and binding properties of sex steroid binding protein and corticosteroid-binding globulin in HIV+patients. The abnormal concentrations of steroid hormones and free fatty acids in the plasma of HIV-infected subjects are associated with qualitative and quantitative alterations in two of the major steroid hormones carrier proteins, sex steroid-binding protein (SBP) and corticosteroid-binding globulin (CBG). The properties of SBP and CBG in the sera of two age-matched groups of 67 men healthy blood donors (controls) and 64 HIV+subjects: 11 CDC group II and III (ASY), 6 CDC group IVA and 47 groups IV C1+D (AIDS) were analyzed. The HIV+patients had SBP concentrations 39-51% above those of controls. The sera of AIDS patients had higher SBP association constants (Ka) for testosterone than did those of the II, III and IVA groups and controls. In contrast, the CBG concentrations in all the HIV+subjects were similar to those of the controls. However, the binding properties of HIV+CBG were abnormal: the Ka's for cortisol and 17 alpha hydroxyprogesterone binding were 50% below normal, while the number of binding sites was significantly higher. Such changes in these carrier proteins could result from conformational transitions; they may cause abnormal transfer of hormonal information and/or steroid hormones metabolism, thus modifying the impact of steroids on the immune response in HIV+subjects.


Diencephalic idiopathic gliosis: an unusual hypothalamic syndrome of dermopathy, diarrhea and growth arrest. This case report of a 16-year-old girl describes the association of chronic diarrhea and lower limb dermopathy with an unusual and widespread gliosis within hypothalamic and other diencephalic structures. This syndrome to our knowledge has not been previously reported. Hypothalamic disease was suggested during life by examination findings of sustained hypothermia, altered sleep-wake cycles and abnormal cortisol diurnal rhythms. Profound growth arrest from the age of 8 yr (growth velocity < 1.4cm/yr) despite normal levels of growth hormone and response to physiological stimuli were additional unusual features. Autopsy after sudden death at 16 yr showed extensive gliosis in hypothalamic and adjacent diencephalic structures with proportionately little neuronal loss--suggesting an unidentified stimulus to glial proliferation. In the absence of evidence of other organ dysfunction it is suggested that dermopathy and chronic diarrhea in this case may have an autonomic basis. The impaired tissue response to growth hormone could be due to chronic hypothermia or involvement of some other (unidentified) hypothalamic factor regulating growth velocity.


Classics in conventional radiography of the foot. The authors display a variety of conditions that can be recognized using standard pedal radiographs. Letter markings on the enclosed x-rays denote the particular areas of interest. Brief descriptions of the pathologic conditions are also provided.


DNA repair and Alzheimer's disease.

DNA repair and Alzheimer's disease. The accumulation of nonrepaired or misrepaired DNA lesions, induced by exogenous and/or endogenous DNA-damaging agents, has been postulated to be one of the major and fundamental causes of aging. The accumulation of DNA damage might lead to changes in the expression of genes important for cell survival and, as such, could be a relevant risk factor in the etiology of various age-related diseases, including neurodegenerative diseases. This review deals specifically with Alzheimer's disease (AD) and the proposed role of defective DNA repair in the etiology of this disease. The evidence that a genetic defect in some aspect of base excision repair is present in cells from AD patients is discussed. Based on the available data, it seems justified to conclude that in at least the familiar form of the disease such a DNA repair defect is present in fibroblast and lymphoid cells. The absence of sufficiently efficient DNA repair mechanisms, involved in the removal of small base damages in the brain, could result in the accumulation of misrepaired or nonrepaired DNA damage and might ultimately lead to the neuronal degeneration as observed in AD patients. In this respect, the existence of inherently imperfect DNA repair processes in longer-lived species, such as mammals, might be regarded as a trade-off between reproductive success and cellular maintenance and repair, which would lead to a high level of DNA damage and mutation at old age.


Effect of age on potassium- and tyramine-induced release of norepinephrine from cardiac synaptosomes in male F344 rats. Potassium (K+)-induced norepinephrine (NE) release was examined in preparations of cardiac synaptosomes and sliced atria from 6-, 24-, and 26-mo-old male F344 rats. Cardiac synaptosomes were prepared from rat hearts by collagenase digestion followed by homogenization in 0.32 M sucrose and centrifugation. The synaptosome preparations and the sliced atria were labeled with 3H-NE and then placed in a superfusion system. K(+)-induced net fractional release of NE from synaptosomes prepared from 24- and 26-mo-old rats (4.3% and 3.0%, respectively) was significantly reduced when compared to NE release from synaptosomes from 6-mo-old rats (5.2%). K(+)-induced NE release from sliced atria from 24-mo-old rats (4.7%) was also significantly reduced when compared to NE release from atria from 6-mo-old rats (6.3%). Perfusion of cardiac synaptosomes with buffer prepared without calcium (CA++free, < 5 microM) reduced K(+)-induced release by 50% in all age groups studied. Perfusion with tyramine induced identical rates of NE release from cardiac synaptosomes prepared from 6- and 24-mo-old rats. These results confirm that depolarization-induced NE release from cardiac sympathetic nerves is reduced in the old male F344 rat.


Adipocytes of old rats produce a decreased amount of differentiation factor for preadipocytes derived from adipose tissue islets. Adipose tissue of young rats (3.5 mo) contains cell formations ("islets") that, in culture, give rise to a variety of preadipocytes, or islet-derived cells (IDCs), that undergo rapid morphologic differentiation into adipocytes. Such adipose conversion depends on a differentiation-promoting factor produced by the mature adipocytes also present in the cultures. Here we report that cultured IDCs from epididymal fat of senescent rats (20 +/- 3 mo) show decreased adipose conversion compared to IDCs from 3.5 mo rats at 3 days of culture (14.2% vs 29.9%; p < .001). Both the number of co-cultured adipocytes and increased fragility with age were excluded as having a substantial role in explaining the decreased conversion. In order to determine whether the decrease differentiation of the IDCs of the old rats was intrinsic or due to reduced production of the differentiation factor by the old adipocytes, cross-over cultures of IDCs from young and old rats were grown in the presence of young or old adipocytes. When IDCs of old rats were cultured in the presence of young adipocytes, a significant twofold increase in differentiation was seen compared to old IDCs grown with old adipocytes (22.7% vs 10.3%; p < .001). This response was comparable to that of young IDCs grown with young adipocytes. Thus, old IDCs retain their ability to undergo extensive morphologic differentiation when appropriately stimulated. Reduced production of the differentiation-promoting factor by old adipocytes rather than the ability of IDCs to differentiate appears to be responsible for the decreased adipose conversion of IDCs seen in cultures of adipose tissue from senescent rats.


Dietary restriction alters characteristics of glucose fuel use. A longitudinal study of plasma glucose and insulin concentrations in ad libitum fed and dietary restricted male F344 rats was carried out. The life span diurnal pattern of plasma glucose concentration was such that through most of the day dietary restricted rats have significantly lower plasma glucose levels than ad libitum fed rats. Throughout the life span, dietary restricted rats maintain mean 24-hour plasma glucose concentrations about 15% below those of ad libitum fed rats. Plasma insulin levels are maintained in dietary restricted rats at about 50% of the levels in ad libitum fed rats. Although plasma glucose and insulin levels are lower, dietary restricted rats use glucose fuel at the same rate per unit of metabolic mass per day as rats fed ad libitum. While these findings are consistent with the glycation hypothesis of aging and with our hypothesis that dietary restriction retards the aging processes by altering the characteristics of fuel use, they do not establish the validity of either. It is possible that this effect of dietary restriction on carbohydrate metabolism plays no role in its antiaging action. Further studies are required to define the role of these altered characteristics of carbohydrate metabolism in the aging processes.


Octogenarian subjects have low postprandial levels of chylomicron remnants: a possible explanation for protection against atherosclerosis. Postprandial lipoprotein metabolism may play an important role in the development of atherosclerosis. It is widely believed that in healthy octogenarians, the atherogenic process occurs very slowly. In the present study, postprandial lipoprotein metabolism was examined in 14 octogenarian subjects (mean age, 84 +/- 4.2 years) and 19 younger controls (mean age, 50 +/- 4.8 years) using the vitamin A-fat loading test, in which intestinally derived lipoproteins are specifically labeled with retinyl palmitate (RP). Results indicated that mean peak chylomicron remnant RP levels and the areas below the chylomicron remnant RP curve were significantly lower in the octogenarian group than in the controls (625 +/- 329 vs 1321 +/- 688 micrograms/L and 3740 +/- 1078 vs 6162 +/- 1063 micrograms/L.h, respectively; p < .0001). No differences were found between the two groups in chylomicron RP levels or in lipolytic activity. The study suggests that octogenarians do not exhibit the decrease in chylomicron lipolysis that usually accompanies aging. In addition, these subjects have significantly lower levels of chylomicron remnants in the circulation. Since accumulation of these particles has been implicated in the development of atherogenesis, our findings may indicate a major mechanism of atherosclerosis prevention in healthy octogenarians.


Effect of aging on circadian rhythm of atrial natriuretic peptide, plasma renin activity, and plasma aldosterone. Atrial natriuretic peptide (ANP) shows a nychtohemeral fluctuation and an age-related trend. The aim of this study was to explore the circadian rhythm of ANP as a function of age. Circadian rhythms of plasma renin activity (PRA), aldosterone (PA), and cortisol (PC) were explored as well. Twenty clinically healthy subjects, 10 young (20-25 yrs) and 10 elderly (65-75 yrs), were investigated, while recumbent, after synchronization to light-dark regimen and meal timing. Blood samples for RIA tests were collected six times during the 24-hr span. The chronobiologic analysis in young subjects demonstrated a significant circadian rhythm for all the investigated variables with an acrophase-timing located at 16.48 for ANP, 4.44 for PRA, 5.32 for PA, and 7.12 for PC. In elderly subjects we documented an important increase of 24-hr mean plasma levels but not a statistically significant circadian rhythm for ANP, and a decrease in mean value of PRA which maintained, however, a significant periodic 24-hr oscillation in parallel with PA and PC. The results in young subjects reinforce the concept that ANP plays physiologically an inhibitory role on the phasic secretion of renin. The lack of the circadian rhythm for ANP along with the divergent changes in ANP and PRA 24-hr mean concentration of elderly subjects both suggest that ANP exerts with advancing age only a counterregulatory role on the tonic rather than the phasic release of renin.


Functional status and clinical findings in patients with Alzheimer's disease. We analyzed the association of clinical findings with impaired functional status, i.e., activities of daily living (ADLs), in a sample of 240 patients diagnosed with Alzheimer's disease by NINCDS/ADRDA or DSM-III-R criteria. Logistic regression models were used to determine independent predictors of both the number of ADL impairments and number of ADL impairments characterized as moderate to severe. Two psychiatric problems, behavioral disorders and apathy, as well as a history of hypertension were significantly associated with ADL impairment independent of age, sex, race, and cognitive impairment. Behavioral disorders and apathy were also significantly associated with moderate to severe ADL impairment, but hypertension was not significant at this level.


Incidence of depression in long-term care settings. A one-year longitudinal study examined incidence and persistence of depression among nursing home and congregate apartment residents. Of 868 persons interviewed at Time 1, 15.7% displayed research-diagnosed possible major depression, and 16.5% displayed minor depressive symptoms. A follow-up interview a year later (T2; n = 448) yielded an incidence rate for possible major depression of 6.6% among persons with only minor or no depression in the previous year. For T1 nondepressives (i.e., excluding minor depressives), the incidence of possible major depression was 5.6%, and of minor depression, 6.3%. More than 40% of T1 possible major depressives showed no remission of symptoms a year later. In contrast, more than half of T1 minor depressives showed no depression at T2; however, another 16.2% appeared at follow-up to suffer possible major depression. Change in depression was associated with cognitive status, functional disability, and physical health. In general, persistence of depression was associated with greater decline, although patterns differed somewhat for the three functional indicators. Clinical and research implications of findings are discussed.


Equations for predicting stature in white and black elderly individuals. In an anthropometric nutritional assessment, elderly individuals are frequently unable to assume the positions needed for many measurements. This is especially true for stature, which is affected by mobility and skeletal deformities, and as a result measurements may be unreliable and inaccurate. An alternative is to use a surrogate value of stature. We developed predictive equations using data from elderly subjects in Cycle I of the National Health Examination Survey (NHES). The developed equations were cross-validated using two separate independent and more contemporary samples of elderly White men and women. The possible predictor variables were knee height and buttocks-knee length in the men and knee height and age in the women. For both the men and the women, the majority of the variance in stature was accounted for by knee height. Selected equation models were cross-validated, and a single equation was recommended for each elderly group that included knee height rather than buttocks-knee length as predictor variables. This selection was based upon the performance of the equations, and also upon the practical ease of collecting the possible predictor variables. Included with the recommended equations are the RMSEs and the standard error for predicting stature for an individual (SEI). The successful application of the recommended equations with two recent sets of elderly persons indicates the current utility of the recommended equations in White elderly Americans.


Knee extensor and knee flexor strength: cross-sectional area ratios in young and elderly men. The relationships between isometric and isokinetic-concentric knee extensor and knee flexor strength, and quadriceps and hamstring cross-sectional area (CSA) were determined in young (n = 13, M = 24.5y) and elderly (n = 12, M = 70.7y) men. Quadriceps and hamstring CSA was determined by computed tomography. Knee extensor and flexor strength at 0 degree/s and 120 degree/s was determined on a Kin-Com isokinetic dynamometer. Compared to the young men, elderly men had significantly smaller quadriceps muscles and were weaker (22-32%) in knee flexion and knee extension at both angular velocities. Strength:CSA ratios were similar at 0 degree/s, but elderly men had decreased ratios for both extensors and flexors at 120 degree/s. Correlations of knee extensor and flexor strength with muscle CSA were significant at both velocities in elderly men, but not at either velocity for the knee flexors in young men. The decrease in isometric strength in elderly men can be accounted for by their decrease in muscle CSA, but their decrease in isokinetic-concentric strength was greater than their loss of CSA. Further study is required to determine the reason for this nonproportional loss of isokinetic-concentric strength.


Attenuation of the cutaneous vasoconstrictor response to cold in elderly men. This study tested the hypothesis that the cutaneous vasoconstrictor response to cold is reduced in elderly individuals. We measured laser Doppler flux (LDF) in the fingertip and blood cell velocity (CBV), via videodensitometry, in individual capillaries of the finger nailfold both before and during submersion of the contralateral arm in a 15 degrees C water bath. Subjects were 10 young (M = 25 years) and 10 old (M = 71 years) male adults. During the first minute of cooling, both the young (Y) and old (O) groups experienced a significant (p < .004) decrease in LDF. Over the subsequent 4 minutes of cold stress, LDF remained significantly depressed in the Y group, whereas LDF returned to values not significantly different from pre-cooling control in the O subjects. During the cold stress, CBV significantly decreased in the Y (p < .03) subjects; however, the degree of change was much less than that of LDF (49% decrease in LDF versus 14% decrease for CBV). In contrast to the Y subjects, the O group showed no significant change in CBV during cooling (p > .28). These results indicate that indirect cooling elicits a reflex decrease in cutaneous bloodflow, which is more pronounced in the deep vessels than in the superficial capillaries, and that these effects are attenuated with advancing age.


Changes in grief and mental health of bereaved spouses of older suicides. Comparisons are made of the impact of a suicide death on the surviving spouse (55 years and older) with that of a natural death on spouse survivors and a married nonbereaved control group over a bereavement period of 2 1/2 years after death. Regardless of mode of death, the loss of a loved one is a difficult psychological trauma, accompanied by depression, confusion, and pervasive feelings of emptiness. Few differences in the impact of the deaths in the early months of bereavement were reported, but changes appeared over the course of the 2 1/2-year measurement period. Compared with natural death survivors, the process of bereavement was found to be more difficult for the survivors of a suicide death, whose severe depressive feelings do not seem to lessen significantly and whose feelings of mental health do not seem to improve until after the first year. Women, in general, report greater feelings than men of anxiety, tension, and apprehension, especially within the first 6 months. By the end of the observation period, most of the differences between the two bereaved groups have disappeared, and both report functioning adequately despite continuing feelings of sadness and loss.


Pain, activity restriction, and symptoms of depression among community-residing elderly adults. Relations among physical illness, functional disability, pain, and symptoms of depression were investigated in a sample of community-residing elderly outpatients. As expected, physical illness, functional disability, and pain were correlated with depressive symptomatology. It was further hypothesized that functional disability (but not physical illness per se) would attenuate the relation between depressed affect and pain. The data supported these predictions by showing that functional disability (but not physical illness) accounted for differences in reported pain between nondepressed subjects and those at risk for developing clinical depression. Additional analyses revealed that functional disability mediated relations between pain and depressed affect and also between illness and depressed affect. These results indicate that both pain and illness are important contributors to functional disability, which in turn contributes to symptoms of depression. Secondary analyses revealed that restriction of certain activities associated with physical mobility and independence were strong individual factors in attenuating the relation between pain and depressed affect. An important implication of this research is that neither pain nor activity restriction should be treated in isolation. Maximal effects are likely to be achieved when both are targeted simultaneously.


Determinants of change in perceived health in a longitudinal study of older adults. To determine the factors that are predictive of a negative decline in perceived health in a longitudinal study of 251 men and women aged 62 and older, we developed a "synthetic" cohort of individuals who experienced a decline in perceived health between two time points and a control cohort of those who did not. The longitudinal design of the study made it possible to evaluate the effects of "baseline" predictors, gathered prior to the time interval during which the reported change in perceived health occurred, in addition to measures assessed at the two time points between which the change in health was reported. Hierarchical logistic regression models were used to examine the effect of demographic, psychosocial, and illness measures on change in perceived health. These analyses revealed that increases in new illnesses, increased physician visits, and worsening of preexisting conditions (in subjects who had higher feelings of self-efficacy) were all associated with a decline in perceived health, after controlling for the effects of baseline illnesses and medication use. After accounting for these effects of changes in objective illness indicators, we found that changed psychosocial factors also predicted a decline in perceived health. Lower life satisfaction and higher depression at baseline were predictive of a later decline in perceived health. In addition, data collected at the third consecutive time point were evaluated to assess determinants of a sustained vs transient decline in perceived health. A sustained decline in perceived health was associated with increased depression and decreased self-efficacy.


Self-recognition in Alzheimer's disease: a mirror and video study. Twenty-nine subjects with Senile Dementia of the Alzheimer Type (SDAT) were tested for self-recognition when confronted with their reflection in a mirror and with a noncontingent video image. All subjects at stage 5 (moderately severe cognitive decline) on the Global Deterioration Scale (GDS) showed self-recognition in the mirror condition, whereas 25% of GDS stage 6 subjects (severe cognitive decline) did not self-recognize. Only seven subjects showed signs of self-recognition on video (six at GDS 5, one at GDS 6). The results confirm two hypotheses: the first, based on studies with infants, is that contingency cues in the mirror condition facilitate self-recognition; the second is that SDAT patients may show "regression" of at least some cognitive functions.


A comparative analysis of functional status among Spanish- and English-speaking patients with dementia. The assessment of functional capacity is regarded as an important part of a comprehensive diagnostic work-up for dementia. However, there is a paucity of data regarding comparative functional performance among different ethnic/cultural groups. In this study, we compared Spanish- and English-speaking dementia patients and normal controls on a comprehensive functional assessment battery administered within the clinical setting. Despite equivalent levels of cognitive impairment, Spanish-speaking dementia patients evidenced more difficulties on certain functional tasks relative to their English-speaking counterparts. On the other hand, Spanish- and English-speaking controls did not differ with regards to their functional performance. Results suggest that the extent of deterioration in specific functional subskills may be related to the degree to which they have been overlearned and practiced. Further, they indicate the potential utility of direct functional assessment in both Spanish- and English-speaking populations.


Event-related potential correlates of repetition priming and stimulus classification in young, middle-aged, and older adults. Electrophysiological and behavioral measures were concurrently recorded from young, middle-aged, and elderly subjects during two classification tasks that required different levels of processing. In both tasks, a portion of stimuli repeated after lags of 2, 8, and 32 intervening items following their first presentation, although these repetitions were incidental to the primary task. All three age groups showed similar patterns of behavioral and event-related potential (ERP) responses associated with stimulus classification and item repetition. ERPs to repeated words were characterized by greater positive amplitude relative to words at first presentation. Similarly, ERPs elicited by items in a primed category were more positive compared with unprimed items. Reaction times were faster to both repeated and primed items. Behavioral and ERP effects were more marked when subjects were required to discriminate items based on meaning rather than on orthography. This study supports previous behavioral evidence suggesting that processes associated with repetition priming and stimulus classification are preserved with age, and demonstrates that ERPs are responsive to repetition throughout the life cycle. Implications for the cognitive processes underlying repetition effects are also discussed.


Effects of aging and schedules of knowledge of results on motor learning. Little research has been conducted on aging and the learning of motor skills. In this study, we examined the effects of different schedules of knowledge of results (KR) on the acquisition and retention of a movement timing task by young adults (20-23 years) and older adults (60-82 years). The results indicated that there were differences between young and older adults in the accuracy and consistency of motor performance when KR was provided. Accuracy effects persisted during a retention interval when KR was no longer provided, although there were no differences in variability. There were no interactions of age with any of the KR-related variables. These findings suggest that the ability to process KR, and the effects of KR on motor learning, are similar in young and older adults. These findings are discussed in terms of age-related issues in movement control and learning processes.


Antecedents and dimensions of religious involvement among older black adults. This study proposed and tested a measurement model of religiosity among a sample of older (55 years of age and above) Black Americans. This model incorporates three correlated dimensions of religious involvement, termed organizational, nonorganizational, and subjective religiosity. Findings indicate that the proposed model provides a good fit to the data, is preferable to other alternative models, and exhibits convergent validity with respect to exogenous or antecedent variables (age, gender, marital status, income, education, urbanicity, and region) known to predict religious involvement. In addition, these antecedents exhibit stronger effects on subjective religiosity than on the two more behavioral dimensions of religiosity. Interpretation of these status-group differences in religiosity focuses on socialization experiences and social environment factors which may promote a religious world-view.


Acculturation and psychological distress in three groups of elderly Hispanics. The goal of this study was to evaluate the relationship between acculturation and psychological distress in three groups of older adults who have immigrated from Mexico, Cuba, and Puerto Rico. Financial strain and social isolation are specified as intervening mechanisms that are thought to link acculturation with well-being in late life. Data from a recent nationwide survey of older Hispanics suggest that levels of psychological distress tend to vary across Hispanic groups and that these differences may be attributed in part to the complex interplay between educational attainment, language acculturation, financial strain, and social isolation.


Family structure and changes in living arrangements among elderly nonmarried parents. We used Longitudinal Study of Aging data to investigate change between 1984 and 1986 in living arrangements of older nonmarried parents, focusing on transitions from living alone and living with children to living alone, with children, with others, and institutionalization. Predictors reflect opportunities for coresidence (number and gender of children), resources, needs, and (indirect measures of) attitudes. We find that those with more children are more likely to change from living alone to living with a child. However, number of children does not affect the odds of moving from living with a child to other arrangements (including institutionalization). Gender of children does not affect tendencies to begin coresidence, although there is slight evidence of more movement out of coresidence for those with sons. Findings are interpreted in terms of the influence of adult children's and parents' needs in determining coresidence.


New cohorts of urban elders: are they in trouble? Recent social and economic trends suggest that the health and welfare of elderly persons living in urban areas may have deteriorated during the past two decades. Two representative samples of noninstitutionalized urban persons aged 65 and over were interviewed, one in 1975 (n = 1598) and the other in 1987 (n = 1491). Cohorts of "young-old" (ages 65-76), "old-old" (ages 77-88), and "oldest-old" (ages 89-100) urban residents were compared at the two time points by multivariate analysis. Over the 12 years studied, the proportion of Blacks and poor persons rose, while the educational level improved. The young-old cohort of 1987, in particular, reported more chronic illness, more psychological distress, more need for help with activities of daily living, more visits to physicians, and more need for additional medical care. We conclude that, between 1975 and 1987, a new cohort of urban residents who were more impaired, disabled, and disadvantaged than their predecessors entered the young-old age group.


Perceived health status and mortality among older men and women. This article separately examines the relationship of perceived health status and mortality for the 1,599 men and 2,904 women self-respondents in the Longitudinal Study on Aging. Using hierarchical logistic regression, the zero-order relationships are decomposed by the serial introduction of demographic, socioeconomic, health status, and psychosocial factors. For men, only those in poor health are significantly more likely to die than those in excellent health (adjusted odds ratio = 1.754), all other things being equal. For women, those in fair or poor health are more likely to die than those in excellent health (adjusted odds ratios = 1.870 and 2.181, respectively), all other things being equal.


Refusal rates in a longitudinal study of older people: implications for field methods. Use of a carefully designed refusal conversion protocol at first follow-up in a longitudinal study of a representative sample of over 4,000 older people was investigated. Respondents who refused initially did not differ from respondents by age or gender but were more functionally independent, citing disinterest most frequently as the reason for refusal. The protocol was successful in convincing 43 percent of these initial refusals to continue participation, but less successful with proxy respondents (27% converted). Most of the refusals that were converted were done by telephone at minimal cost. Results show that it is possible, given appropriate field methods, to retain the very old and disabled in longitudinal studies.


Breast cancer screening among older racial/ethnic minorities and whites: barriers to early detection. Screening mammography for early detection of breast cancer has been shown to be an effective method for reducing mortality in older women. Based on the results from the 1987-88 National Health Interview Survey, older minority women have low prevalence rates of screening mammography. Among women aged 75 and older, 83.5% of Black women, 93.2% of Hispanic women, and 75.0% of White women have never had a mammogram. On the average, about 12% of minority women over the age of 65 have had a screening mammogram within the preceding year, compared with about 15% of White women. Among women 75 + years of age, Black and Hispanic women had markedly lower rates of clinical breast examination in the last year (23.4% and 20.5% respectively) as compared to White women (35.2%). The most common reason for not having a mammogram among Black women 65 years of age and older was that the doctor did not recommend a mammogram. For Hispanic and White women in this age group, the most common reason was that a mammogram was not needed or not necessary. Aggressive and creative breast cancer screening activities for minority aged 65 and older are clearly indicated.


Physician-related barriers to breast cancer screening in older women. Despite evidence that annual mammographic screening in women 50 years and older reduces mortality, surveys of physicians and patients have repeatedly demonstrated that annual screening mammography is not performed. The fundamental question addressed in this chapter is: If the assumption is made that the scientific evidence supports the use of mammography, what, then, are physician-related barriers to mammographic screening of elderly women? Using a model that classifies barriers to implementing prevention protocols into three categories (predisposing, enabling, and reinforcing factors), literature is reviewed to help identify reasons for low mammographic screening rates, especially in elderly women. This article concludes with a discussion of strategies that may help overcome barriers to mammographic screening in elderly women.


Breast cancer screening in older women: the family practice perspective. This article reviews screening for breast cancer in older women from the perspective of the primary care physician. Although breast cancer is a leading cause of cancer in women, the diagnosis of breast cancer in an asymptomatic woman is an uncommon occurrence for the individual physician. Physician compliance with breast cancer screening recommendations is less than optimum: physicians report higher compliance in survey studies than is demonstrated by performance audits. The low yield of screening, cost concerns, concerns about the reliability of radiology reports, concerns about patient compliance, lack of time, and forgetfulness are reasons cited for poor provider compliance with screening recommendations. In general there is no reason not to recommend mammography for older women unless individual factors including biologic age, life expectancy, comorbidities, or patient preference appear to make screening not worthwhile. The decision to stop recommending mammography for an older woman should be made in conjunction with the patient.


Breast cancer screening in older women: the geriatrician/internist perspective. There are many issues of concern to internists and geriatricians as they face the prospect of implementing breast cancer screening programs for elderly women. Population heterogeneity and variations in comorbidity require individualization in order to maximize benefit. Decision making is complicated by family interactions, especially for patients with altered cognition. The time it takes to perform exams and discuss possibilities in a busy office practice may be inhibitory. Internists will want to see more definitive data on efficacy, specifically in women > age 70, but patients in this age cohort may actually rely on physicians' recommendations to a greater extent than younger cohorts.


Breast cancer screening in older women: the consumer perspective. Fear of cancer and weak support from physicians make it difficult to encourage women to have regular mammograms. An effective campaign of broad mammography screening should be aimed at both health professionals and women. Essential to this screening is a public policy that establishes public and private insurance coverage. Barriers, including high cost, must be eliminated. Effective organization can succeed in reaching more older women for screening. Rationing breast cancer screening, at a time when the incidence of breast cancer is increasing, violates fundamental beliefs in equality and justice. Proposals to limit or to expand screening require a defensible and supportable rationale. Health professionals should not decide for patients whether they should have a mammogram and what treatment is best. The physician should counsel and assist the patient or the surrogate to decide on an appropriate plan of care.


Decision making and the principles of screening for breast cancer. This position paper raises issues central to the screening process and how it relates to breast cancer in the elderly. These comments reflect neither a formal model developed specifically for breast cancer screening nor detailed data about this disease. Such information is available elsewhere in these Forum proceedings. Rather, this discussion develops the general principles of screening as they impact on breast cancer in elderly women.


The biology of breast cancer in older women. The incidence of breast cancer among women older than 65 years of age is 1.7 times higher than the rate for women 45 to 64 years of age, and 10 times higher than for women younger than 45. In addition, the relative survival from breast cancer is decreased among elderly women. Although elderly women more frequently present with advanced breast cancer, the incidence of other poor prognostic factors generally associated with early disease recurrence and short survival is not increased among the elderly compared to younger women. Most breast tumors from elderly patients contain estrogen receptors and progesterone receptors and would be expected to respond to hormonal therapies, and most tumors have low proliferative rates which would be indicative of slow-growing, indolent tumors. Several studies have documented that elderly women often do not receive complete workups for definitive staging of their breast cancer, and that even after adjustment for comorbid conditions, elderly patients are less likely to receive optimal standard therapy for their disease.


Comorbidity and functional status in older women with breast cancer: implications for screening, treatment, and prognosis. This is a review of research on the effects of comorbidity and functional status on breast cancer diagnosis, treatment, and prognosis in older women. The objective is to summarize results from recent studies and recommend directions for future research (a) to develop more precise guidelines for breast cancer screening, and (b) to identify and eliminate barriers preventing the attainment of those guidelines. Research is needed to determine more clearly how comorbidity and functioning affect screening practices and stage of disease at diagnosis. There is evidence that comorbidity explains, in part, why older women receive less invasive therapy. It is unknown, however, whether these treatment decisions improve quality or duration of survival. Although it is evident that comorbidity and disability adversely affect survival, research is needed to examine the etiology, course, and effects of specific combinations of conditions. Final recommendations include using the Established Populations for Epidemiologic Studies of the Elderly (EPESE) and the Surveillance, Epidemiology, and End Results (SEER) programs to address a number of these questions.


Demographics (1950-1987) of breast cancer in birth cohorts of older women. The effects of screening on breast cancer mortality, incidence, and prevalence were investigated using a general forecasting and simulation model. First, a biologically motivated model of disease incidence and mortality was fit to the breast cancer mortality experience of 15 U.S. White female birth cohorts followed for a 38-year period. The model assumed that breast cancer was the result of two different diseases. The first, or "premenopausal" disease, tends to have strong associations with the family history of disease and to be histologically more aggressive. The second, "postmenopausal" disease, occurs at more advanced ages, is apparently less strongly linked to family history, and is less aggressive with different histological characteristics (e.g., positive estrogen receptor status). Those results were used to forecast the effects of screening on the stage at diagnosis to simulate a screening program which reduced late-stage diagnoses by 50%. This produced large reductions in breast cancer mortality--an impact larger for disease associated with late age of onset.


Mammography for older women: who uses, who benefits? In order to juxtapose the health, social, and behavioral factors associated with use of screening mammography with short-term mortality among elderly women, we analyzed the NHIS Cancer Epidemiology Supplemental Survey and the Longitudinal Study of Aging. After controlling for sociodemographic factors, having a usual source of care of and knowledge of screening guidelines, we found that a woman's health status is unrelated to having had a screening mammogram. Analyses of the LSOA, however, revealed that health factors were strongly related to 4-year mortality, particularly among women 75 and over. As it is unlikely that the subpopulation of older women who are at high risk of death within 4 years will benefit from a program of universal screening, outreach program messages and physician education programs should probably be designed to proactively recruit those most likely to benefit.


Economic considerations in breast cancer screening of older women. The incidence of breast cancer increases with age, tending to result in more favorable cost-effectiveness outcomes with more advanced age of the screened population. On the other hand, the decreased remaining life expectancy of older women can be expected to reduce the cost effectiveness of screening. To assess these competing factors, the cost effectiveness of a long-term breast cancer screening program was evaluated using a computerized simulation model. The cost per life year saved decreased when the 65-69 year age group was added to a program screening women aged 50-64. For older age groups, however, cost effectiveness became relatively less favorable. The cost per life year saved of screening the 80-84 year age group was 55% higher than for the 65-69 group.


Screening mammography in women over age 65. Routine screening by mammography and physical examination can detect breast cancers earlier at all ages. In women over age 65 the sensitivity of mammography is increased, and the positive predictive value for mammography is higher than in younger women. There are no direct data that can be used to determine at what age screening is no longer of value. This question must be evaluated on an individual basis and should take into account the quality of life and competing causes of death. The medical benefit from screening for a given individual should be considered separately from society's cost/benefit goal to reduce health care expenditures, because the two are likely to produce contradictory recommendations.


Physical examination of the breasts in screening for breast cancer. No currently available evidence from breast cancer screening studies provides strong justification for the implementation of screening in elderly females. Because it is an absence of evidence rather than negative evidence which pertains, it is concluded that if screening is introduced it should include both mammography and clinical examination of the breasts because the two complement one another. As well, stringent quality control procedures are required for both modalities. It is possible that clinical examination of the breasts performed by a nurse-examiner will enhance compliance with screening schedules.


The efficacy of breast self-examination. Literature related to the efficacy and to the definition and measurement of breast self-examination (BSE) is reviewed with particular attention to its relevance for women over 65. Overall, data on the efficacy of BSE suggest that it has a small but measurable impact on earlier detection of breast cancer as measured by clinical stage and tumor size and sometimes by pathological stage. The largest differences are between some BSE and no BSE. An analysis of BSE suggests that instructions could be simplified for older women in order to increase the reliability and acceptability of the examination. A research agenda is proposed which includes (a) testing BSE instructions tailored for older women, (b) studying the intervening steps between BSE and cancer diagnosis, (c) testing methods to increase acceptance by older women, and (d) investigating the relationship between BSE and earlier detection of breast cancer in older women.


Breast self-examination in women 65 and older. Studies of breast self-examination (BSE) in older women have revealed deficiencies in both frequency and proficiency of practice. Current data from an ongoing study indicate that practice is sufficiently poor as to make the detection of lumps difficult. Interventions to increase frequency and proficiency, however, have been encouraging. Several studies are reporting significant improvement in practice following specific strategies. Barriers such as forgetting and embarrassment need to be addressed when attempting to increase frequency and proficiency. The efficiency of BSE cannot be adequately addressed until women are trained at a proficient level.


Efficacy of screening for breast cancer in older women. The effect of screening on mortality from breast cancer has been evaluated in four intervention (experimental) studies with random assignment, one intervention study with nonrandom assignment, three case-control studies, and one follow-up study. Each of these studies showed a beneficial effect of screening among women who were at least 45, 50, or 55 years old at entry, but there is almost no information available on the value of screening women more than 74 years old. The data are not helpful in choosing a screening interval within the range 12-33 months, or in deciding whether to screen by mammography and palpation combined or by mammography alone. Additional issues in screening very old women are the delay before the effect of screening appears, the high mortality from causes other than breast cancer, and the effect of previous screening.


Older women's participation in breast screening. The incidence of breast cancer increases with age, but women's participation in breast screening decreases with age. National and regional surveys indicate a number of barriers. Women over age 65 are more likely to say they have never heard of mammograms, that they did not know they needed them, and that their doctors did not recommend them. In a study conducted at Fox Chase Cancer Center, in Philadelphia, participation in an HMO-sponsored breast screening program appeared to reverse the usual age-related decrease in mammography. If mammography utilization is to increase in women over age 65, physicians must offer unambiguous referrals to older women. In addition, health education interventions are needed to improve knowledge and beliefs of older women and their physicians. And, finally, strategies also are needed to enhance access. With the advent of Medicare coverage, payment will be less of a barrier. But other barriers remain.


A qualitative study about breast cancer screening in older women: Implications for research. Focus groups were used to explore a range of issues concerning breast cancer screening in elderly women and to contribute to defining a research agenda. Two groups consisted of women aged 65-75 and 75 and older, and one group consisted of primary care physicians. Predominant topic areas were women's awareness of breast cancer and screening information, attitudes and perceived barriers to screening (including those related to women themselves, to the health care system, and to physicians), issues related to relationships within the medical community, and opinions about and priorities for change.


Culture, environment, and restraints: a conceptual model for research and practice. 1. Despite its importance to the care of the elderly, little research has focused on the effects of the environment on health and well-being. 2. It is hypothesized that environmental factors, including cultural attitudes and beliefs of nursing home staff, contribute to restraint of nursing home residents. 3. Nurses can be instrumental in creating a nursing home culture that values a restraint-free environment.


Reducing physical restraints: developing an educational program. 1. Philosophical premises for an educational program aimed at restraint reduction include beliefs about quality of care, commitment to understanding the meaning of behavior, and desire to shift practice from control of behavior to individualized approaches to care. 2. If change is to occur, an educational program aimed at restraint reduction must recognize the potential contributions of all staff members, use an interactive teaching style, and promote discussion and problem solving. 3. Results of testing a Restraint Education Program suggested that altering staff beliefs and increasing knowledge produced a change in restraint practices, at least in the short term.


A century of progress: today's strategies for responding to wandering behavior. 1. In an effort to protect wanderers, nurses have overused physical restraints. Such practices have been reinforced by the potential for lawsuits charging negligence when wandering results in negative outcomes. 2. Wandering is movement changing over time and, thus, is a nonlinear ultradian rhythm, with locomoting and nonlocomoting phases. As a rhythm, an individual's wandering pattern is stable over a 1-week period. 3. Because most travel is direct, most ambulation, even for known wanderers, may not be wandering at all. Among inefficient travel patterns, lapping was the most frequently observed. 4. Behavior modification, grids, camouflage, and other environmental interventions are preferable to chemical or physical restraint in attempting to reduce unwanted or unsupervised exits by wanderers. These methods are not fail-proof, however, and do not replace careful supervision of wanderers by personnel.


Goal-directed care: caring for aggressive nursing home residents with dementia. 1. Aggressive behavior in elders with dementia occurs most often during personal care. It is often a response to invasion of private space and may be prevented or reduced by interpersonal approaches that reflect a set of individualized goals for the resident. 2. Five resident goals for preventing or reducing aggressive behavior are to feel safe, to feel physically comfortable, to experience a sense of control, to experience optimal stress, and to experience pleasure. 3. These goals provide a framework for humane care that respects the personhood of the individual and minimizes the need for psychotropic medications and physical restraints.


Falls in the nursing home: preventable or inevitable? 1. Falls in the elderly are frequent occurrences and are usually a result of the complex interaction of environmental, physiological, and pathological variables. Fall-related injuries happen much less frequently. 2. Physical restraints have not been found effective in preventing falls and may be associated with increased risk of fall-related injury. 3. Because of the complex nature of falls in the elderly, fall prevention programs must emphasize the critical assessment of each resident's risks for falling with targeted interventions.


Correlates of self-care among the independent elderly: self-concept affects well-being. There was a significant positive correlation between self-care and self-concept, suggesting that psychosocial interventions that enhance an older person's self-concept may be expected to improve self-care and, conversely, that participation in self-care activities may be expected to strengthen self-concept. Although functional health status was not significantly correlated with self-care, it was related to self-concept, suggesting either that functional health has a role in maintaining self-concept among older persons or that self-concept positively contributes to functional health status. Self-concept and self-care can be enhanced in older persons by communicating respect and demonstrating caring behaviors, reinforcing health-promoting behaviors, encouraging activities of daily living that contribute to independence, and by avoiding a focus on self-care deficits.


An exploratory study: assessing the meaning in life among older adult clients. Meaning in life has been intimately linked to health, but it has not been explored in an elderly population. The factors that elderly people perceive as being meaningful must be identified, as well as the extent to which they experience fulfillment of meaning in their lives. The majority of study participants indicated that relationships give meaning to their lives; however, nurses must individually assess clients regarding what is most meaningful to them. Clients without meaning or low levels of meaning need to be identified. As nurses become more aware of what is meaningful to older people, they can plan and carry out interventions based on interaction to support or improve areas meaningful to the older person.


Skin problems: epidemiology of pressure ulcers in a skilled care facility. The majority of nursing home residents have conditions that place them at risk for the development of pressure ulcers. Reported pressure ulcer prevalence rates range from 16% to 35%. Pressure ulcers are multifactorial in origin and necessitate ongoing vigilance by the entire health-care team. Associated risk factors include impairments of circulation, sensation, physical condition, nutrition, mobility, and activity. Stage I pressure ulcers frequently go unrecognized, yet their recognition is essential to prevent further damage. Comprehensive initial assessments of the skin and risk factors of pressure ulcer development at admission will allow for easier reassessment and comparison.


Diagnostic dilemma: cognitive impairment in the elderly. Cognitive impairment is a significant health problem for the elderly and is associated with severe negative consequences: higher morbidity and mortality and a diminished capacity to care for self. The accurate diagnosis of acute confusion, dementia, and depression depends on the routine, systematic, and comprehensive assessment of cognition, best achieved through the use of a mental status questionnaire and a behavioral rating scale. Nonspecific clinical features, atypical and variable presentations of symptomatology, and the frequent coexistence of acute confusion, dementia, and depression make an accurate diagnosis of the specific form of cognitive impairment difficult. The primary cognition disorder in acute confusion is that of attention, memory with dementia, and mood with depression.