Carers, ethics and dementia: a survey and review of the literature.

BACKGROUND: Much has been written on ethical issues in dementia, but usually from the point of view of the various professionals involved. Whilst there has been an increasing amount of interest in the psychosocial problems that face the carers of people with dementia, the ethical nature of some of these problems has largely been ignored. OBJECTIVE: To review the literature on ethical issues in dementia from the perspective of the main, non-professional carers of people with dementia. METHOD: A systematic literature search using Medline, Clinpsych and CINAHL databases between 1982 and 2000. A pilot study of carers. RESULTS: The lay perspective provides both a wide variety of issues and unique approaches. Although in the literature quantitative research answers some questions, it is qualitative research that deepens our understanding of the issues from the perspective of carers. CONCLUSION: It is particularly qualitative research that brings out the ethical issues for carers, which tend to be more varied than the ethical issues raised in the professional literature. Awareness of such issues could inform and shape the support given to carers.     

Morphologic and immunohistochemical observations in granulomatous glomerulonephritis.

Eight renal biopsies of Wegener's granulomatosis and other vasculitic syndromes with periglomerular granulomatous reactions (granulomatous glomerulonephritis) are studied. Controls consist of 57 biopsies of crescentic and focal necrotizing glomerulonephritis (of various diseases, excluding systemic lupus erythematosus). Both groups have in common the morphologic alterations of inflammatory tuft necrosis, fibrin exudation into the urinary space, crescent formation, and breaks of Bowman's capsule. In the study group, the unique feature of glomeruli with surrounding granulomatous reactions was the presence, within the urinary space, of an exudate of fibrin mixed with immune reactants (immunoglobulins and usually complement) in association with gaps of Bowman's capsule. This contrasts with an exudate of fibrin alone in glomeruli of the control group and other glomeruli of the study group. The study group also had a significantly greater incidence of immune deposits in Bowman's capsule (P less than 0.001). Giant cells may result from the interaction of macrophages of the granuloma with Bowman's capsule that is permeated with immune reactants.     

Renal protection by antihypertensive therapy

The attainment of adequate renal protection requires strict blood pressure control and a diminution of proteinuria or microalbuminuria to values as near from normalcy as possible. It has been considered that by getting the first, the second could be attained at the same price. Recent data have confirmed that renal protection in hypertensive patients, diabetics or not, requires combination therapy that has to include an angiotensin converting enzyme inhibitor or an angiotensin receptor blocker. A calcium channel blocker can be added to this without renal compromise. A diuretic will also be needed in most cases. Proteinuria will diminish with this combination in particular if up-titration of the drug blocking the effects of angiotensin II is performed. The control of other associated risk factors is also required, in particular smoking and lipids.     

The effect of increased sodium in the drinking water on right ventricular hypertrophy, right ventricular failure and ascites in broiler chickens

One hundred commercial male broiler chickens were grown to 27 days in four floor pens on a commercial diet containing 0.14% sodium (Na+). From day 6 each pen received different levels of sodium chloride (NaCl) in the drinking water; 0.0%, 0.15% (0.06% Na+), 0.3% (0.12% Na+) and 0.6% (0.24% Na+). Eight chicks from each group were killed at 13, 20 and 27 days and examined for right ventricular hypertrophy (RVH) and right ventricular failure (RVF). By day 27 as little as 0.06% added Na+ caused two cases of RVH and one case of RVF with ascites, typical of the ascites caused by RVF in commercial broilers. RVH, RVF and ascites developed earlier in broilers on higher levels of Na+.     

The variation in isometric tension with sarcomere length in vertebrate muscle fibres

1. The variation of isometric tetanus tension with sarcomere length in single fibres from frog striated muscle has been re-investigated with special precautions to ensure uniformity of sarcomere length within the part of the fibre being studied.2. In most respects the results of Ramsey & Street (1940) were confirmed, but (a) the peak of the curve was found to consist of a plateau between sarcomere lengths of 2.05 and 2.2 mu, (b) the decline of tension above this plateau is steeper than found by Ramsey & Street, and (c) the decline of tension below the plateau becomes suddenly steeper at a sarcomere length of about 1.67 mu.3. Many features of this length-tension relation are simply explained on the sliding-filament theory.4. It is concluded that, in the plateau and at greater lengths, the tension on each thin filament is made up of equal contributions from each bridge which it overlaps on adjacent thick filaments.5. Internal resistance to shortening is negligible in this range but becomes progressively more important with shortening below the plateau.