Pyridoxal-5′-phosphate and pyridoxal biokinetics in aging Wistar rats

Biokinetic parameters of plasma pyridoxal-5′-phosphate (PLP) and pyridoxal (PL) disposition were studied in male Wistar rats aged 8 and 27 months kept from weaning on a purified diet containing 250 g casein and 6 mg pyridoxine·HCl per kg. Baseline plasma PLP concentration was lower in the older animals (514 ± 56 nmol/L for young and 317 ± 124 nmol/L for old animals), whereas baseline plasma PL concentration did not differ between age group (average 235 nmol/L for both young and old animals). We hypothesized lower baseline plasma PLP in the older animals was caused by an increased PLP elimination rate, a decreased PLP synthesis rate, or a combination of these processes. Observations from earlier in vitro experiments suggest age-related changes occur in vitamin B-6 metabolizing enzyme activities. In the in vivo experiments described here no age-related difference in plasma PLP elimination rate nor in plasma PLP synthesis rate was observed to explain the observed decrease in plasma PLP concentration with age.     

The inside-out Bankart procedure

Bankart capsulorraphy for recurrent shoulder instability produces predictable results. Time-consuming, technically demanding details of the procedure, however, discourage its use. A simplified technique and new instrumentation solving these limitations was used in 69 procedures, all performed by the same surgeon. Seventy-eight percent of these procedures were reviewed independently at a minimum of 2 years followup: 77% were asymptomatic, 12% had minimal symptoms, and 11% had residual problems. Instability recurred in six patients and was associated with a significant traumatic event in five. Thus, the inside-out Bankart modifications were effective.     

Patient education and the physician-patient relationship

Noncompliance is a major problem that patient education aims at resolving. The emphasis in patient education upon didactic strategies, educational content, and materials distracts from perhaps the most important factor in the success of patient education, that is, the quality of the physician-patient relationship. In the context of the physician-patient relationship many of the patient's psychological needs, wishes, and fears will be revealed, and these factors have bearing upon compliance and the ability to make use of patient education. When the physician develops a psychotherapeutic attitude characterized by empathic attunement to the patient and his or her underlying psychological reasons for resistance to medical advice, the likelihood of accepting patient education increases.     

Changes in laboratory values and their relationship with time after rupture of an abdominal aortic aneurysm

Purpose  Many laboratory values are abnormal after surgery for a ruptured abdominal aortic aneurysm (RAAA). However, these changes have not been comprehensively evaluated. We analyzed the changes in routine laboratory values and how these changes related to outcome in a consecutive series of RAAA patients. Methods  All patients who underwent surgery for an RAAA between January 1990 and June 2003 at our hospital were included in this study. We analyzed laboratory data acquired during the first week for all patients and at discharge for survivors. We categorized 29 different measurements into six categories based on the related pathological process, including hematology and coagulation, metabolism, systemic inflammation, renal function, liver function, and electrolytes. Results  A total of 290 patients underwent RAAA surgery, with a hospital mortality of 34%. Hemorrhage was the most common cause of early death, whereas multiple-organ failure (MOF) was the most common cause of death several days after surgery. Most laboratory values deviated from normal at multiple time points and they differed significantly between survivors and nonsurvivors. Conclusions  Both survivors and nonsurvivors of RAAA surgery displayed characteristic time-dependent laboratory abnormalities. Awareness of these responses may help us predict patients prone to complications.     

Autonomic dysfunction in patients with progressive supranuclear palsy

The most important features that characterize and differentiate progressive supranuclear palsy (PSP) from other parkinsonian syndromes are postural instability, supranuclear gaze palsy, pseudobulbar palsy, and cognitive disturbances. Although it has been reported that significant autonomic dysfunction is an exclusionary feature for PSP diagnosis, we could demonstrate in this study using semiquantitative clinical interview and cardiovascular testing that both PSP and idiopathic Parkinson's disease (PD) patients can present with significant autonomic dysfunction. The parasympathetic cardiovascular system seems to be involved to a similar extent in PD and PSP patients, whereas sympathetic cardiovascular dysfunction is more frequent and severe in PD patients, but can also be found in PSP patients. Our findings have a profound implication on the diagnosis and treatment of PSP patients. © 2008 Movement Disorder Society