Drug-induced dystonia in young and elderly patients

This retrospective study examined the common notion that neuroleptic-induced dystonia is less frequent in elderly patients. The hospital records of 45 young patients and 45 elderly patients were reviewed. Thirty-one percent of the young patients developed dystonia, compared to 2% of the elderly patients. This significant difference did not appear to be the result of types of neuroleptics used, dose, or concomitant administration of anticholinergic drugs.     

Brain changes in geriatric depression

The clinical and neurobiological literature of geriatric depression which focuses on the relationship between depression and dementia is reviewed. The hypothesis that depression of late life and dementia are linked by a spectrum of underlying ageing-associated brain changes is presented, and the implications for future research are discussed.     

Platelet MAO activity in primary degenerative dementia

Platelet MAO activity was studied in 24 patients with primary degenerative dementia and 20 normal elderly controls. Demented patients had significantly higher platelet MAO activity than did controls. The increase was greater than that reported to occur in normal aging.     

Geriatric depression

Depression in later life can present unique clinical and therapeutic challenges. Phenomenology is often atypical and the concurrence of physical illness can confound both diagnosis and treatment. A review of current knowledge about epidemiology, pathogenesis, clinical features, and therapeutic issues is presented.     

The Conformity of an Anatomically Shaped Endotracheal Tube to the Shape of the Airway

The conformity of a pre-shaped endotracheal tube to the shape of the airway during endotracheal intubation was studied from lateral radiographs in patients lying supine on the operating table, with the neck in the normal, extended and flexed positions. A computer programme calculated the anterior contour of the pre-shaped tube and the posterior contour of the airway as mean values of the original contours on the radiographs. The mean configuration of the airway in intubated individuals with a pre-shaped endotracheal tube was then presented in a standard coordinate system. The results were compared with the shape of the airway in non-intubated patients and in patients intubated with a standard endotracheal tube.     

Simultaneous endometrioid ovarian and uterine carcinoma diagnosed after an in vitro fertilization procedure--case report and review of the literature

BACKGROUND: The presence of simultaneous carcinomas involving both the ovary and uterus is relatively uncommon, while the possible link between fertility drugs and carcinogenesis still remains controversial. CASE: The case of a 40-year-old patient with simultaneous aggressive endometrioid carcinoma of the ovary and uterus a few months after the sixth attempt of in vitro fertilization is presented. The patient had de novo lung disease at surgery and diffuse metastatic spread to adjacent bone, subcutaneous tissue and the central nervous system (CNS) soon after a spectacular response to the primary paclitaxel/carboplatinum chemotherapy and while on maintenance and second-line chemotherapy, respectively. CONCLUSION: The fulminating course of our patient might in part be attributed to the existence of advanced disease at presentation. Definite conclusions about the possible association with the previously performed assisted reproduction cannot be drawn but close clinical surveillance of such patients before, during and after infertility treatment is strongly warranted.     

Diagnosis of rejection in renal allograft biopsies using the presence of activated and proliferating cells

Forty cyclosporine-treated renal allograft biopsies were stained with anti-Tac, a monoclonal antibody (MoAb) against interleukin 2 receptor (CD25), anti-transferrin receptor MoAb, and Ki67 MoAb (a proliferating cell marker), using a method of gold enhancement of the diaminobenzidine reaction product, in order to study the utility of these markers to differentiate rejection from other causes of graft dysfunction. Biopsies were selected on the basis of availability of sufficient frozen material and optical microscopy diagnosis, and only biopsies that showed acute cellular rejection and biopsies that did not show any sign of rejection (cyclosporine toxicity or a stable graft) were studied. In addition biopsies were stained with a panel of monoclonal antibodies reacting with CD45, CD3, CD4, CD8, EBM11 (a monocyte-macrophage marker), HLA-DR, DP, and DQ, using the usual indirect immunoperoxidase method. The clinical diagnosis (rejection versus no rejection) was made in ignorance of the biopsy findings. In 17 of 18 (94%) episodes of rejection, anti-Tac and anti-transferrin receptor-positive cells, and in 15 of 18 rejection episodes (83%), proliferating cells, were found in the interstitium. Anti-Tac-positive cells were never found in the 11 biopsies diagnosed as no rejection, and only in two a few anti-transferrin receptor-positive cells were present. The proportion of activated and proliferating cells in rejection episodes, expressed as the percentage of CD45-positive cells were: anti-Tac MoAb 4.1 +/- 2.9%, anti-transferrin receptor MoAb 6.9 +/- 3.9%, and Ki-67 MoAb 6.3 +/- 4.8%. There was a positive correlation between the total number of infiltrating cells and the number of cells stained with anti-Tac (r = 0.75, P less than 0.005), anti-transferrin receptor MoAb (r = 0.84, P less than 0.0001), and Ki-67 (r = 0.50, P less than 0.05). The episodes of rejection that took place when cyclosporine levels were high had fewer 1L-2R-bearing cells in the interstitium than those that took place when cyclosporine levels were low (r = 0.47, P less than 0.05). We conclude that during rejection the presence of activated and proliferating cells is a consistent finding, and that these markers could be useful in differentiating between rejection and other causes of graft dysfunction as well as in grading the severity of rejection.     

Autonomic antecedents to variant angina exacerbation after beta-blockade withdrawal

We describe a patient with nonsignificant coronary artery disease who experienced variant angina after beta -blockade withdrawal. Standard therapy with nifedipine and nitrates aimed at suppressing symptoms and typical transient ST-segment elevations was superseded by the reinstitution of metoprolol. The autonomic alternations before and after readministration of metoprolol were analyzed by time and spectral indices of heart rate variability (HRV). Metoprolol reduced the HRV and reversed the low-frequency/high-frequency power ratio toward a more physiological autonomic balance. We conclude that the reinstitution of beta -blocker acted protectively by preventing surges of sympathetic activity on an underlying basis of parasympathetic predominance.