Longitudinal association of initiation/perseveration and severity of geriatric depression.

OBJECTIVE: Many older adults with major depression (MDD) present with impairment in initiation and perseveration (IP) tests. However, it remains unclear how these abnormalities change during the course of depression. METHODS: The authors studied the longitudinal covariation of depression severity and IP functioning in 157 depressed older adults with MDD. Patients with and without baseline IP impairment were studied on three occasions over 1 year. RESULTS: Depression severity was associated with concurrent IP scores; however, despite IP improvement, those with impaired baseline IP functioning did not reach the level of their non-impaired counterparts. CONCLUSION: The persistence of IP abnormalities suggests that these patients require careful treatment planning and follow-up, given that earlier studies noted an association of abnormal IP with disability and poor outcomes of depression treatment.     

The pathogenetic significance of C5b-9 in IgA nephropathy

Renal biopsies from 20 patients with IgAN were retrospectivelystudied using monoclonal antibodies against T cells, monocytes/macrophages(MM), HLA-DR-related antigen and the C5b-9 neoantigen. GlomerularC5b-9 deposits were mainly found in the mesangial areas andshowed an association with IgA (P<0.005) and C3 deposits(P<0.001). Interstitial T cells and MM were highly correlatedwith the interstitial DR+ve cells (P<0.001 and P<0.0005respectively). Tubular C5b-9 deposition was observed on thetubular basement membranes and related to the numbers of interstitialT cells (P<0.005), MM (P<0.005) and DR+ve cells (P<0.01)as well as to the tubular DR expression (P <0.025). The severityof tubular atrophy and interstitial fibrosis showed a positivecorrelation with the interstitial T cells, MM and DR+ve cells,as well as with the intensity of tubular C5b-9 deposition (P<0.05and P<0.05 respectively). Plasma creatinine on presentationwas correlated with the numbers of interstitial T cells (P<0.05),MM (P<0.01), interstitial DR+ve cells (P<0.005), and tubularC5b-9 deposits (P<0.005). No correlation between glomerularT cells, MM, and C5b-9 deposits with plasma creatinine was seen.During follow-up, renal function deteriorated in those patientswith the more extensive tubular C5b-9 deposits In conclusion, glomerular C5b-9 deposition seems to be secondaryto the IgA and C3 deposition. In contrast, tubular C5b-9 isrelated to the numbers of interstitial T cells and MM. Activatedinterstitial mononuclear cells may lead to the tubular depositionof C5b-9, which eventually might contribute to the developmentof tubulointerstitial lesions (TIL) and renal function impairment     

Plasma 10-hydroxynortriptyline and ECG changes in elderly depressed patients

Among 18 elderly depressed patients given ECGs before and during nortriptyline treatment, plasma E-10-hydroxynortriptyline and the sum of E-10-hydroxynortriptyline and nortriptyline distinguished the group with conduction/repolarization effects. Plasma nortriptyline, age, drug dose, and baseline cardiovascular status did not.     

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.     

Mucus Transport and Surface Damage After Endotracheal Intubation and Tracheostomy. An Experimental Study in Pigs

The effects on mucus transport of different grades of tracheal injury produced experimentally by an intubation tube were studied in 26 pigs. Two of them were not intubated and served as controls, while the rest were anaesthetized and either intubated or tracheostomized, or both, and ventilated for approximately 4.5 h. They were then killed and the trachea and larynx were immediately removed and placed in a specially designed chamber at 3 7^oG and 85 % relative humidity. Cardio-green dye was deposited caudally in the trachea as a mucus marker. The mucus transport was observed macroscopically and the ultrastructure of the tracheal wall at the region of mucus arrest was studied by light microscopy and scanning and transmission electron microscopy. In non-intubated pigs the mucus was transported to the posterior larynx. The ciliated epithelium was usually intact along the pathway where cardio-green-stained mucus had travelled. In pigs which had been intubated and/or tracheostomized, mucus transport stopped completely at different levels of the trachea. The damage to the ciliated epithelium varied; in some animals there was almost none at all and in others there was a patchy loss of a large proportion of the cilia, or complete lack of cilia. Lesions which also included epithelial cells were often seen. Tracheal injury due either to a cuffed endotracheal tube or to a tracheostomy tube, with destruction of epithelium and cilia, causes a barrier to mucus transport, leading to arrest and accumulation of mucus further down in the airway. We were unable, however, to demonstrate a direct correlation between grade of damage and tendency to mucus arrest.     

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.