Mortality and causes of death in idiopathic Parkinson's disease: results from the Aberdeen whole population study

Two hundred and forty-nine patients with Parkinson's disease previously examined by Mutch et al 1,2 were followed up three and a half years after the original study. Cognitive impairment, age, some postural signs and symptoms of Parkinson's disease and high scores on the Hoehn and Yahr scale predicted premature death. Patients were more likely to die from respiratory infections than controls. Respiratory diseases as cause of death recorded on the death certificate were not related to kyphosis, posture scores or Hoehn and Yahr scores before death. The hypothesis is advanced that death of respiratory causes might be associated with signs of general autonomic dysregulation.     

A comparison of endoesophageal tubes. Improved results with the Atkinson tube

We reviewed our use of endoesophageal tubes for the palliation of patients with carcinoma of the esophagus from 1973 through 1986. Celestin tubes were implanted by means of laparotomy and traction. Proctor-Livingston tubes were implanted by pulsion with frequent laparotomy for staging. All Atkinson tubes were placed by means of the pulsion method without simultaneous laparotomy in any case. Patients with an Atkinson tube had fewer complications, including aspiration, sepsis, reflux, and pneumonia. Mean hospital stay was shortened to 4 days when the Atkinson tube was used, and hospital death rate was 6% versus 42% when either the Celestin or Proctor-Livingston tube was used. Mean long-term survival (108 days) was significantly lengthened when Atkinson tubes were used. A comparison of all patients receiving tubes revealed a less frequent prevalence of reflux when the distal end of the tube was positioned above the gastroesophageal junction. Laparotomy resulted in significantly more episodes of aspiration, sepsis, reflux, and pneumonia. Laparotomy was also associated with a 41% hospital death rate versus 17% when laparotomy was not performed. Hospital days were shortened to 7 versus 16 days when laparotomy was not performed. The Atkinson tube provided improved palliation and decreased morbidity and mortality in our hands. These benefits were probably the results of ease of insertion without the use of a laparotomy and the ability in most cases to position the distal end of the tube above the gastroesophageal junction.     

Mechanisms of Acetaldehyde-Mediated Growth Inhibition: Delayed Cell Cycle Progression and Induction of Apoptosis

Chronic ethanol exposure has been associated with pleiotropic effects on cellular function in vivo and in vitro, including inhibition of growth. To date, it has been difficult to dissociate the primary effects of ethanol from the effects of ethanol metabolism, generation of acetaldehyde, and reducing equivalents. We have previously described the development of a Chinese hamster ovary cell line, A-10, which expresses a transfected murine-liver alcohol dehydrogenase. Cultures of these cells accumulate acetaldehyde due to the low level of aldehyde dehydrogenase. One noticeable effect of chronic acetaldehyde exposure, but not ethanol exposure, is the inhibition of cell growth. This study focuses on the mechanisms that underlie this growth inhibition. Our studies with the A-10 cell on the rates of [³H]thymidine incorporation and flow cytometry of asynchronous cultures indicated that acetaldehyde did not lead to arrest of the cell cycle in the G₁ phase as has been found in other models of ethanol exposure. Rather, we observed a generalized delay in cell cycle progression. However, the slower cell cycle did not account exclusively for the slower rates of cell accumulation. Chronic exposure to acetaldehyde also increased the rate of cell death. The increased rate of cell death was both cumulative and dose-dependent. The dead cells accumulated in the medium and were apoptotic. Apoptosis was confirmed using morphological criteria and quantitation of DNA fragmentation. These data lend additional support to the idea that chronic acetaldehyde exposure can affect the mechanisms that regulate cell division and the apoptotic program.     

Craniocervical bone pneumatisation

We report a case of extensive craniocervical bone pneumatisation presenting after minor trauma. The patient had neurological signs and initial radiographs showed multiple lucencies in the skull base and the atlas vertebra. CT established the true nature of this rare condition.     

Cognitive performance in UK sample of presymptomatic people carrying the gene for Huntington''s disease.

This paper presents an investigation of cognitive ability in 30 subjects at risk for Huntington's disease. Those shown to be at high or low risk for this disease are compared on a wide range of neuropsychological measures. Results indicate only one significant difference between the two groups; those who carry the gene show a higher level of performance on the Corsi Supraspan task. It is suggested, however, that minimal deficits are apparent in the at risk gene carrying group but that current measures of assessment are not sensitive enough to identify them.     

Linguistic entrapment: medico-nursing biographies as fictions

This paper argues that in their trainings health professionals are encouraged to use language naively as if it were a transparent medium of scientific communication We contend that language use, particularly in the field of mental health care, should be studied in terms of its social functions and attention should be paid to the inevitably constructive nature of language in patients'records, in order that a'fictional distance'opens up between patients and their records Recent developments in literary theory and narrative analysis can be deployed as theoretical frameworks to understand this process, and we suggest that more attention to the use of language should be included in the educational programmes for health care professionals to counteract the risk of'linguistic entrapment'or'incarceration'