Age-related changes in mean CT attenuation values of brain tissue were analyzed by an objective, automated technique. Study participants included 64 healthy men ranging in age from 31 to 87 years. Five CT slices from each individual were evaluated: the last ventricular slice and the next four supraventricular slices. Regression analyses indicated that specific regions in the brain change with age. A schematic reconstruction of these regions suggests that several brain regions are selectively altered with age. On the medial aspect of the cerebral hemisphere there was bilaterally symmetrical atrophy of the cingulate gyrus and sulcus, the adjacent interhemispheric frontal gyri, the parietooccipital sulcus, and the marginal branch of the cingulate sulcus. On the convexity of the cerebral hemispheres there was asymmetrical widening of the central and postcentral sulcus on the left, and the intraparietal sulcus on the right.

Adult↗

PubMedDate not supplied

Neuropsychological and neurophysiological changes in healthy adult humans across the age range.

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Adult↗

PubMedDate not supplied

Use of preincisional ketorolac in hernia patients: intravenous versus surgical site.

BACKGROUND AND OBJECTIVES: This study was designed to determine whether administration of ketorolac directly in the surgical site results in enhanced analgesia. METHODS: A randomized double-blind study was undertaken at a university-affiliated tertiary care hospital. Thirty outpatients undergoing unilateral inguinal hernia repair by one of two surgeons under local anesthesia with sedation were evaluated. Patients were invited to participate in this investigation at the time of the preoperative surgical visit. Patients who had a contraindication to the use of ketorolac or who refused repair under local anesthesia with sedation were excluded. Patients received ketorolac 60 mg either via the parenteral route or directly in the surgical site (mixed with the local anesthetic). The outcome measures included visual analog pain scores, measured at two different times in the hospital, pain scores at rest and with movement 24 hours after surgery, time to first analgesic, and total analgesic requirement. RESULTS: The study revealed lower 24 hour movement-associated pain scores (P < .02), increased time to first analgesic (P < .03), and decreased oral analgesic consumption (P < .0002) in the surgical site group. CONCLUSIONS: Ketorolac provides enhanced patient comfort when it is administered in the surgical site in patients undergoing inguinal hernia repair. It is recommended that clinicians add ketorolac to the local anesthetic solution in such patients.

Adult↗

PubMedDate not supplied

Use of clonidine in hernia patients: intramuscular versus surgical site.

BACKGROUND AND OBJECTIVES: This study was designed to determine if administration of clonidine in hernia patients enhances analgesia. It was also designed to determine whether administration directly in the surgical site further improves the analgesia. METHODS: A randomized, double-blinded study was undertaken at a tertiary care hospital. Forty-five outpatients undergoing unilateral inguinal hernia repair by one of two surgeons (D.P. or M.A.) under local anesthesia with monitored anesthesia care were evaluated. Patients were invited to participate in this investigation at the time of the preoperative surgical visit. Patients who had a contraindication to the use of clonidine or who refused repair under local anesthesia with sedation were excluded. Patients were randomized to one of three groups: (a) clonidine 0.5 microg/kg intramuscularly and saline in the surgical site (mixed with the local anesthetic); (b) clonidine 0.5 microg/kg in the surgical site and saline intramuscularly; or (c) saline in both the surgical site and intramuscularly. The outcome measures included visual analog pain scores twice in the hospital, pain scores at rest and with movement 24 hours postoperatively, the time to first analgesic, and total analgesic requirement. RESULTS: The pain scores were lower in both clonidine groups at 2 hours postoperatively than in the control group (P < .03). No difference was observed with respect to the time to first analgesic, 24-hour analgesic use, or 24-hour pain scores among the groups. CONCLUSIONS: When clonidine is administered to patients undergoing hernia repair, the 2-hour pain scores are lowered. No difference was exhibited when clonidine was administered intramuscularly or directly into the hernia site.

Analgesics↗

PubMedDate not supplied

Social networks and service utilisation in patients with severe mental illness.

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Humans↗

PubMedDate not supplied

Comparison of D0870 and fluconazole in the treatment of murine cryptococcal meningitis.

Cryptococcal meningitis is a common infection in patients with AIDS. Using a murine cryptococcosis model, we compared treatment with a new triazole, D0870, and fluconazole. Groups of ICR (Institute for Cancer Research) mice were infected intracerebrally with eight different isolates of Cryptococcus neoformans variety neoformans with different in vitro susceptibilities to fluconazole. For survival studies mice were challenged with two to four times LD(50) or six to nine times LD(50). Treatment was given for 10 days. Mice were observed through to day 30. To assess the effect of treatment on fungal tissue burden, mice received a three to five times LD(50) inoculum and treatment for 10 days. They were sacrificed on day 12 and serial dilutions of brain homogenates were cultured. Fluconazole prolonged survival primarily in isolates which were susceptible in vitro. D0870 prolonged survival in all isolates except one, which was also resistant in vitro to D0870 and fluconazole. Both drugs reduced colony counts of all isolates. D0870 warrants further development for use in cryptococcosis, and appears effective for isolates relatively resistant to fluconazole. There is a relative correlation of in vivo and in vitro susceptibility to D0870 as well as fluconazole.

Animals↗