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PubMed1986

Ethical and legal aspects of dementia.

Medical ethical dilemmas regarding life-sustaining treatment in elderly and demented patients are becoming increasingly commonplace and complex. In dealing with these situations, health care providers must ensure that a patient's rights are balanced against society's needs. To help medical professionals understand these issues, the authors describe the distinction between substantive standards and procedural guidelines as well as the interrelationship between the two. It is only when careful procedural steps are followed after thoughtful consideration is given to the substantive issues that termination of treatment decisions will be made in the best possible context.

Aged↗
PubMed1984

Brief and appendix for amicus curiae: the American Geriatrics Society.

In February 1984, the following "friend of the court" (amicus curiae) brief was submitted to the New Jersey Supreme Court by the American Geriatrics Society to assist in the Court's deliberation in the case known as In re Claire C. Conroy. The Board of Directors of the AGS had decided to undertake this endeaver because the reasoning adopted by the Appellate Division in this case would, if affirmed by the Supreme Court, greatly diminish the capacity of physicians to serve their patients, especially their older patients. The brief was prepared by AGS member Joanne Lynn, MD, and was critiqued, revised, and finally approved by all of the members of the Executive Committee of the Board of Directors. A New Jersey attorney, Mr. Charles Deubel, III, filed the brief and the necessary associated papers on behalf of the AGS and without charge. Expenditures by the AGS in this endeavor totalled less than $300. The Editors of the Journal and the Board of Directors of the AGS would welcome comments from the membership and other concerned persons concerning the content of the brief and the process of developing and submitting it.

Aged↗
PubMed1990

Verapamil inhibits phosphatidic acid formation and modifies phosphoinositide metabolism in stimulated platelets.

Rabbit platelet-rich plasma was incubated with [32P]orthophosphate, after which the platelets were washed, further incubated in the absence or presence of verapamil and subsequently stimulated with PAF-acether or thrombin. In the absence of verapamil, a rapid increase in radioactivity in phosphatidic acid was observed in platelets stimulated with PAF-acether or thrombin. This was inhibited by verapamil over the concentration range 10(-7) to 10(-4) M, at which concentration the rise in phosphatidic acid was completely abolished. In unstimulated platelets, 10(-4) M verapamil induced an increase in radioactivity in polyphosphoinositides but not significantly in phosphatidylinositol. When these verapamil-treated platelets were stimulated with PAF-acether or thrombin, there was a rapid, sustained loss of the additional radioactivity induced in the polyphosphoinositides by verapamil. Polyphosphoinositide radioactivity remained unchanged in platelets stimulated in the absence of verapamil. Verapamil may stimulate formation of a separate pool of polyphosphoinositide which is susceptible to agonist-induced phospholipase C, and failure to re-synthesize this polyphosphoinositide could result from inhibition of phosphatidic acid synthesis.

Animals↗
PubMed2001

Re-creating ancient hominid virtual endocasts by CT-scanning.

Probably the first radiographic study of human fossils, that by D. Gorganovic-Kramberger on Neandertal remains from Krapina, Croatia, was published in 1906, only 11 years after Röntgen announced the discovery of X-rays. Many subsequent studies on fossil hominids used regular clinical diagnostic radiological apparatus, as depicted in Atlas of Radiographs of Early Man by M.F. Skinner and G.H. Sperber (1982). Some specimens such as crania filled with heavily calcified matrix proved intractable. Ordinary radiographs of such specimens usually failed to reveal endocranial structure, as fossilized bone and calcified endocast were approximately equally radio-opaque. Thus, neither endocranial volume nor structural details were detectable. The only invasive method that could have been employed involved mechanical removal of the solid matrix, but this entailed hazards to the cranial vault and the destruction of the natural endocranial cast. In 1983--1984, G.C. Conroy and M. Vannier utilized recent advances in high-resolution computed tomography to produce non-invasive, intracranial capacity measurements of matrix-filled fossil skulls. They tried the method on two fossil mammal skulls filled with hard sandstone matrix (1984, Science 26:456-458), and then successfully applied it to a South African, matrix-filled cranium of the ancient hominid (hominin) species, Australopithecus africanus from Makapansgat (Conroy et al. 1990, Science 247:838-841). Details of the morphology of the endocranial surface of the braincase were revealed, including the pattern of venous sinus drainage in the posterior cranial fossa. A group based in St. Louis, Vienna, Paris, Rome, and Johannesburg has taken such studies further. Beautiful "virtual endocasts" have been produced on a large male specimen of A. africanus from Sterkfontein, South Africa, and the endocranial capacity has been determined (1998). The methods make it possible to re-create "virtual endocasts" of ancient hominids.

Cephalometry↗
PubMed1989

Childhood farm accidents: a continuing cause for concern.

Farms in Ireland remain a dangerous environment for children despite increasing publicity about farming hazards based on international research. A one year prospective study on farm accidents was carried out in four Irish accident and emergency departments. During this time, four deaths and 62 cases of injury aged 15 years and under were seen. Half the cases required admission to hospital; tractor accidents were common and serious. Most injuries occurred to the extremities but 13 (21 per cent) had multiple injuries. Forty-three (69 per cent) of the children required outpatient follow-up and twenty-seven of these (63 per cent) had more than one outpatient re-visit. The Irish farming community is still unappreciative of the risks to their children on the farm, and urgent attention needs to be directed towards educational and legislative measures to improve the safety profile of Irish farms.

Accident Prevention↗
PubMedDate not supplied

CSF monoamines, age and impulsivity in wild grivet monkeys (Cercopithecus aethiops aethiops).

Brain monoaminergic activity has been associated with behaviors, such as impulsive risk-taking, that tend to peak during adolescence in humans and nonhuman primates. This study was designed to assess natural variation in monoamine neurotransmitter metabolism in relation to age and behavioral impulsivity in grivet monkeys (Cercopithecus aethiops aethiops) living in their native habitat and subject to natural ecological pressures. Cisternal cerebrospinal fluid, collected from 22 animals living in the Awash National Park, Ethiopia, was assayed for the major metabolites of serotonin (5-hydroxyindoleacetic acid, 5-HIAA), dopamine (homovanillic acid, HVA) and norepinephrine (3-methoxy-4-hydroxyphenylglycol, MHPG). Concentrations of HVA declined significantly from one year of age to older adulthood. Further, a significant curvilinear relationship was identified between age and the 5-HIAA/HVA ratio, with the trough coinciding with the period of adolescence. Finally, behavioral impulsivity, as measured by re-entering baited traps a second time after the animal had already been captured and sampled for CSF, was related to lower levels of MHPG. The results suggest that normal variation in central monoaminergic activity may have functional consequences in wild populations.

Aging↗
PubMed1986

The relation of social class to risk factors, rehabilitation, compliance and mortality in survivors of acute coronary heart disease.

We studied 299 consecutive male 28-day survivors of unstable angina or myocardial infarction aged under 60 years to examine the relationship between social class and initial risk factors, change in risk-factors at one year follow-up, return to work, and 3-year mortality. There was a significant correlation between smoking on admission and social class, with 80% of lower and 31% of upper classes being current smokers. Daily cigarette consumption among smokers was significantly higher in lower-class patients. Lower-class patients also had a significantly higher weekly alcohol intake. Although the proportion of hypertensives did not vary with social class, mean in-hospital blood pressure was higher in lower-class patients. Social class bore no relationship to amount of leisure exercise, serum cholesterol or degree of overweight. There was a 90% 1-year return to work overall, and while there was no relationship between social class and eventual re-employment, lower-class patients took significantly longer to return to work. There were highly significant associations between social class and successful smoking cessation, increase in leisure exercise and weight reduction over the first year after discharge. There was no significant association between social class and 3-year mortality.

Angina, Unstable↗
PubMed2004

Continuing care--should geriatricians re-engage?

Continuing care settings cater for some of the most disabled individuals. Their care can often present major ethical dilemmas; teams involved in such care require a broad range of skills. We illustrate this with a challenging case history and discuss specific dilemmas, including investigation and treatment in the absence of specific consent and advance directives. We suggest that continuing care should be recognised as a valuable component of training in geriatric medicine.

Advance Directives↗
PubMed2000

Effect of plasma homocysteine concentration on early and late events in patients with acute coronary syndromes.

BACKGROUND: Although a raised plasma homocysteine is a risk factor for vascular disease, it is not known whether it is associated with an adverse cardiac outcome in patients admitted with acute coronary syndromes. We evaluated the relationship between plasma homocysteine and short-term (28 days) and long-term (median 2.5 years) prognosis in acute coronary syndromes. METHODS AND RESULTS: We evaluated the relationship of quintiles of homocysteine to fatal and nonfatal coronary disease early (28 days) and late (29 days to a median of 2. 5 years) after admission to a single unit of patients with unstable angina (n=204) and myocardial infarction (n=236). The end points studied were cardiac death (n=67) and/or myocardial (re)infarction (n=30). Cox regression and logistic regression were used to estimate the relationship of homocysteine to coronary events. The event rate within the first 28 days (22 cardiac deaths and 5 nonfatal infarctions) was not related to the admission homocysteine level. In the 203 unstable angina and 214 myocardial infarction survivors, an apparent threshold effect was seen on long-term follow-up, with a significant step-up in the frequency of events between the lowest 3 quintiles (14 cardiac deaths and 11 nonfatal infarctions) and the upper 2 quintiles (31 fatal and 12 nonfatal events). Patients in the upper 2 quintiles (>12.2 micromol/L) had a 2.6-fold increase in the risk of a cardiac event (95% CI, 1.5 to 4.3, P<0.001). CONCLUSIONS: Elevated total homocysteine levels on admission strongly predict late cardiac events in acute coronary syndromes.

Acute Disease↗