One hundred eleven mildly to moderately insomniac patients participated in a double-blind, placebo-controlled study to establish the efficacy of diphenhydramine as an over-the-counter (OTC) sleep aid. A two-week crossover design was employed in which all patients received both diphenhydramine and placebo for one week each. The daily diphenhydramine dose was 50 mg at bedtime. Results obtained indicate that diphenhydramine improved various sleep parameters, including sleep latency, to a significantly higher degree than did placebo. In addition, patients on diphenhydramine reported feeling more restful the following morning and patients preferred the diphenhydramine drug to placebo despite experiencing more side effects. This study thus supports the use of 50 mg diphenhydramine as an OTC sleep aid in the treatment of temporary mild to moderate insomnia.

Adult↗

PubMedDate not supplied

Intraoral air pressure of alaryngeal speakers during a no-air insufflation maneuver.

Intraoral air pressure was recorded during the production of the consonant cognate pairs /p/-/b, /t/-/d, and /s/-/z/ by eight esophageal speakers. These consonants were combined with the vowel /a/ to form CV, VCV, and VC syllables and produced under two experimental conditions: after the insufflation of air and without air insufflation. The purpose was to determine if the voiced-voiceless pressure difference associated with the production of cognate pairs would occur in the absence of an insufflated air flow source. The results revealed that peak intraoral air pressure magnitudes were significantly greater following the insufflation of air than without it. Moreover, the voiceless consonants were generally produced with greater peak air pressures than the voiced consonants under both experimental conditions, although not all contrasts were significantly different. Finally, peak air pressure magnitudes were significantly more variable in the air insufflation condition. The finding that the esophageal speakers exhibited a pressure difference relative to voicing in the absence of an insufflated air flow source provides support to the concept that intraoral air pressure may be an important variable in regulating and controlling consonant production.

Aged↗

PubMedDate not supplied

Age-related decrease in vulnerability to excitatory amino acids in the nucleus basalis.

The present study investigated the effects of nucleus basalis magnocellularis (NBM) lesions in young (3 months), adult (9 months), and aged (24 months) rats by injections of either NMDA or AMPA upon performance of a delayed alternation task on a T maze. During phase 1 of testing, the interchoice interval (ICI) was 5 s and each rat was given 10 trials per day during phase 2, the ICI was 30 s across 10 trials per day; during phase 3, the ICI was 5 s across 20 trials per day. Analyses of variance revealed (a) a significant effect of age during phase 1 (i.e., 24-month-old rats performed worse than 3-month-old rats); (b) a significant effect of age and lesion in phase 2 (i.e., the lesions impaired choice accuracy equally in all age groups when the ICIs were 30 s); (c) a significant effect of age and lesions, and a significant interaction in phase 3 (i.e., young rats were more impaired by the lesions than were aged rats.

Age Factors↗

PubMedDate not supplied

Effects of nonparticipation in trauma center system on emergency department utilization.

The University of Illinois Hospital (UIH) serves an inner-city urban population in one of the highest crime rate districts in Chicago. On May 20, 1986, the city's Level I Trauma ordinance took effect with the University of Illinois Hospital declining to participate. To measure the impact of the ordinance on a nonparticipating hospital, we undertook a retrospective analysis of our trauma patient utilization statistics. Consecutive monthly patient census data of 71 months was compiled with emphasis on patient presenting complaints and related subspecialty evaluation. We observed significant decreases of patients presenting with head injuries, fractures, and animal bites as well as with major trauma, minor trauma, and general surgery hospital admission. The final disposition of the patients arriving by ambulance was consistent with the observed decrease in major traumatic conditions and in minor traumatic conditions. However, the mean number of patient presentations per day (ppd) admitted to regular medical or surgical beds decreased from 2.70 ppd to 2.30 ppd while the mean number of ppd sent home increased from 2.64 ppd to 3.49 ppd. These data suggest that loss of trauma center status designation has a profound effect on utilization of emergency departments not participating in the trauma system. Nonparticipation appears to be associated with a significant decrease in utilization rates for major and minor trauma patients and a significant increase in the number of patients discharged who had arrived by the Chicago Fire Department Paramedic System (CFD). This effect on the emergency department extends to utilization of inpatient services.

Chicago↗

PubMedDate not supplied

Vascular determinants of univentricular support.

The dynamic coupling between cardiac pump performance and vascular arterial-venous capacitive and resistive properties was examined analytically and experimentally to determine the feasibility of maintaining systemic and pulmonary circulation, devoid of the right heart. Analysis of the cardiovascular system (excluding neurohumoral factors), used a mathematical representation of the major determinants involved in cardiac output and demonstrated that change in pump flow output has reciprocal effects on the venous and arterial pressures. Independent of the pump's performance characteristics, cardiac output reserve was restricted, reaching a critical plateau (50% of normal) because of the rapidly depleting pulmonary venous pressure, concurrent with the translocation of the venous stressed volume to the arterial side of the circulation. Animal experiments aided by computer modeling confirmed that near normal flow can be sustained by actively mobilizing or augmenting blood volume, or by reducing selectively the unstressed volume and venous pooling. A single blood pump, in a form of a mechanical substitute, or the biologic left heart acting alone, can support the entire circulation. The right heart is not essential for normal pulmonary circulation, but serves to maintain low systemic venous pressure and a relatively high left heart flow reserve state. Peripheral vascular parameters, i.e., stressed volume and venous capacitance, serve a vital role in preserving the mechanical self regulation of cardiac output.

Animals↗

PubMedDate not supplied

Cardiac surgery in nonagenarians.

OBJECTIVES AND BACKGROUND: The purpose of this study was to document our initial experience with patients 90 years of age and older and to determine whether cardiac surgery is justified in this age group. Cardiac surgery in octogenarians has proven to be a successful and worthwhile procedure. A small group of nonagenarians with severe coronary artery disease (CAD) and aortic valve disease refractory to medical therapy have been considered for surgery. METHODS: Fourteen patients aged 90 or more underwent cardiac surgery for symptomatic CAD or aortic valvular disease refractory to medical therapy. Eight patients underwent isolated coronary artery bypass grafting (CABG) and six patients underwent aortic valve replacement (AVR). All patients were in NYHA Class IV preoperatively. RESULTS: Hospital mortality occurred in one patient (7%). Hospital morbidity occurred in 10 patients (71%) and included 7 cardiac, 5 neurological, 1 gastrointestinal, 1 infectious, and 1 pulmonary event. All survivors left the hospital symptomatically improved. The mean length of stay was 26 days. Four CABG patients went on to die at a mean of 2 years and 2 months, and 3 remain alive at a mean of 2 years and 4 months. Three AVR patients expired at a mean of 3 years and 4 months, and 3 remain alive at 4 years and 1 month. CONCLUSIONS: Cardiac surgery in carefully selected nonagenarians is justified and can be performed with acceptable results.

Aged↗