The accuracy of pre-mortem diagnosis was investigated in 100 patients (age range 65-97 years) undergoing autopsy. Post-mortem rate was 22%. In 32% of cases there were discrepancies between ante- and post-mortem diagnosis; in 14% these may have affected therapy or outcome. We conclude that autopsy remains a useful tool in clinical quality control, and should be part of a quality assurance plan in all geriatric units.

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PubMedDate not supplied

The accuracy of information on current drug therapy in geriatric out-patients' records.

We have undertaken a survey to investigate the accuracy of the information about current drug therapy contained in the case notes of geriatric out-patients. One hundred patients (age range 68-92 years, mean age 72, 58F/42M) attending the geriatric out-patient department and taking three or more drugs were included in this study. The final version of drug treatment (established after seeing the drugs that were brought by the patients at their clinic visit) differed from the one based on the case notes review in 72 (72%) of the cases and the one produced after taking a drug history at an earlier clinic visit in 56 (56%) of the cases. In 54 (54%) of the cases the discrepancies resulted from patients taking one or more additional drugs. 16 (16%) were taking a different dosage of some drugs. There were some major errors or omissions in the treatment regimen in 20 (20%) of cases. The elderly out-patients are being placed at risk of toxicity by unnecessary and excessive prescribing and inadequate supervision of their treatment.

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PubMedDate not supplied

Electron microscopic effects of thallium poisoning on the rat hypothalamus and hippocampus: biochemica changes in the cerebrum.

Rats were given thallous acetate (5 mg elemental thallium/kg body weight) IP daily for 7 days and prepared for electron microscopy (perfusion-fixation) and for biochemical study. Increased incidence of Golgi zones and electron-dense bodies were observed in the anterior hypothalamus and hippocampus. Sequestrated axons were seen in the hypothalamus. Depletion of succinic dehydrogenase and guanine deaminase occurred in the cerebrum.

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PubMedDate not supplied

Ventricular surface of rabbit hippocampus: a scanning electron microscope study.

Portions of the ependyma were obtained from the hippocampus of adult rabbits and processed for scanning electron microscopy. The major part of the ependymal surface was covered with a dense layer of cilia, some of these cilia showed bulbous preterminal enlargements. Irregularly arranged pits of variable diameter were also seen. Pes hippocampi showed fewer cilia and deeper furrows than did the remainder of the hippocampus.

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PubMedDate not supplied

Stroke prevention in atrial fibrillation: physicians' attitudes to anticoagulation in older people.

The increased prevalence of atrial fibrillation (AF) in older people contributes to an increased risk of stroke. Although clear guidelines exist, there is considerable variation in physicians' approaches to the selection of patients appropriate for warfarin treatment as stroke prevention. We compared attitudes to the anticoagulation of elderly patients with AF, in a postal study of geriatricians and specialist physicians (general physicians with specialist interests in Cardiology, Gastroenterology, Diabetes and Endocrinology, Nephrology and Neurology). A structured questionnaire was mailed to all 108 consultant physicians and geriatricians in South East Wales. This explored their attitude to their patients' age and comorbidity when considering the benefits and risks of warfarin prophylaxis for AF. About 25/30 geriatricians (83%) and 43/78 specialist physicians (55%) responded; an overall response rate of 63%. About 94% of the respondents agreed that patients aged over 75 with atrial fibrillation were at a greater risk of stroke than younger patients. About 68% considered warfarin related bleeds more likely in this age group, despite which most thought that the benefits of warfarin outweighed the risks. In people aged above 75, only 13/25 (52%) geriatricians and 17/43 (40%) specialist physicians viewed lone AF (AF with no underlying risk factor) as an indication for anticoagulation. When considering the use of warfarin, geriatricians' appeared more likely to be influenced by coexisting problems such as disability, falls, cerebrovascular disease and limited life expectancy. Only a history of falls (96% geriatricians vs. 86% specialist physicians) and cerebrovascular disease (79% geriatricians vs. 51% specialist physicians) had a significant influence on prescribing practice (P<0.05, chi(2) test). There appears to be widespread uncertainty about the indications for warfarin as stroke prophylaxis, and ageist attitudes or a lack of conviction of benefit appear to be disadvantaging older people. Patients aged below 65 with lone AF who are at the lowest risk of embolic events are often considered for treatment, whilst the use of warfarin in 75-year-olds with lone AF who are at a moderately high risk of embolic events remains disappointing.

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