Coronary heart disease and depression in the elderly--a population- based study

BACKGROUND: Growing interest is nowadays focused on the quality of life of elderly people who survive with chronic diseases. Coronary heart disease (CHD) is one of the most common diseases among the elderly and may have an unfavourable impact on the patient's emotional well-being. OBJECTIVES: We aimed to describe the prevalence of depression and the occurrence of depressive symptoms among elderly CHD patients, with a special emphasis on the relations between depression and the severity of CHD, and to find out the possible association between CHD and depression. METHODS: The study was carried out at the health centre of the municipality of Lieto, in south-west Finland. The study population consisted of 488 community-dwelling men and 708 women, over 64 years old, from among whom the participants with CHD (89 men and 73 women) were selected, and for whom 178 male and 146 female sex- and age- matched controls (free of CHD) were drawn from the population. CHD patients were selected on the basis of the presence of angina pectoris or a past myocardial infarction. Depressive symptoms were measured with the Zung Self-rating Depression Scale. Depression was described in relation to the severity of dyspnoea and chest pain among patients. The associations between depression and age, health, health behaviour, drugs, functional ability and social, psychosocial and environmental factors were analysed by logistic regression analyses. RESULTS: The prevalence of depression was 29% among male patients and 20% among female patients. Depression was significantly more common among male CHD patients than among male controls (P = 0.011). Among women, depression was not associated with CHD. Earlier, depression had gone undiagnosed among many CHD patients and controls, especially male patients. Among male CHD patients, depression was associated with more severe dyspnoea, but no similar association was found among female CHD patients. Among men the occurrence of CHD, physical disability, widowhood or divorce, and among women previous clinical depression, physical disability and the use of angiotensin-converting enzyme (ACE) inhibitors, were associated with depression. CONCLUSION: Depression is common among patients with CHD. It seems that CHD is not an independent factor in the aetiology of depression among the elderly. The association of CHD with depression among men is explained by the acute or chronic psychic stress caused by CHD. It may be that the more complicated the patient's CHD, the more probable is the presence of depression.      

The inter‐rater reliability between nurse‐assessors clinically assessing infection of chronic wounds using the WUWHS criteria

The aim of this study was to determine the inter‐rater reliability between one expert‐nurse and four clinical‐nurses who were asked to clinically assess infection of chronic wounds by using the World Union of Wound Healing Societies (WUWHS) criteria. A quasi‐experimental design was used to collect the data. In comparison to phase 1 in which ‘open questions’ were asked, in phase 2 a pre‐printed form (checklist) was introduced. In both phases, 55 chronic wounds were clinically assessed. For each WUWHS criterion the inter‐rater reliability of signs and symptoms was expressed by Cohens Kappa (κ). A substantial agreement (κ ≥ 0·6) was considered as adequate. In both phases pocketing (p < 0·02), and erythema (p < 0·004) scored statistically significant results. Phase 2 showed higher inter‐rater agreements compared with phase 1 (three substantial agreements (easily bleeding/friable granulation tissue, delayed healing, increasing exudate), an almost perfect‐ and a perfect agreement for malodour and pain, respectively. According to the results it can be concluded that the clinical assessment of infection of chronic wounds may be better supported by a pre‐printed form than making use of an ‘open questions’ form. To provide this with a higher level of evidence, there is need for more well conducted studies.     

高效液相色谱法测定消痰咳片的含量

目的：采用反相色谱法同时测定消痰咳片中两种主要成分甲氧苄啶和磺胺体的含量。方法：以乙腈：0.1%H3PO4(15:85)为流动相，检测波长254nm，HPLC法测定含量。结果：试验表明，甲氧苄啶和磺胺林在0.8-8ug范围内呈良好的线性关系，回归方程分别为Y＝－1127.1＋110.2x(r=0.9994),Y=-1852.3 256.2x(r=0.9996),相对标准偏差分别为2.1%和0.8%。结论：该方法简便、准确、可靠。     

5种注射剂的细菌内毒素检查法初步考察

目的：考察５种注射剂盐酸林可霉素注射液，盐酸精氨酸注射液，注射用玻璃酸酶，肝素钠注射液和顺铂注射液的细菌内毒素检查法可行性。方法：中国药典细菌内毒素检查法。结果；除ｄ外，其余原液及稀释液均于有干扰作用。结论：ｄ的原液及ａ的２０倍以上稀释液可用灵敏度为０．５ＥＵ／ｍｌ的鲎试剂作细菌内毒素检查，而ｂ，ｃ和ｅ尚需进一步探讨。     

磁性明胶微球体内分布实验研究

对磁性明胶微球进行了同位素标记。用γ-闪烁照相技术观察了磁性明胶微球在兔体内的分布。结果表明:靶部位的放射活性加磁场是未加磁场的15倍,而且施加磁场时间长和磁场强度大有利于磁性明胶微球定位于靶区。文中也介绍了自行设计的外加磁场装置。     

Chronic daily headache with migrainous features due to papilledema-negative idiopathic intracranial hypertension

Patients with the syndrome of chronic daily headache often report migrainous symptoms and consequently are diagnosed as having a primary headache syndrome. We report two cases of idiopathic intracranial hypertension causing chronic daily headache with migrainous features in the absence of associated papilledema.     

A randomized prospective comparison of oral versus intraperitoneal ofloxacin as the primary treatment of CAPD peritonitis

Summary: Oral ofloxacin has been successfully used in our centres for the primary treatment of peritonitis complicating continous ambulatory peritoneal dialysis (CAPD). In view of the progressive rise in the resistance rate to ofloxacin among peritoneal bacterial isolates, a study was conducted to determine if oral ofloxacin remains a viable first line treatment for CAPD peritonitis in our centres and if the result can be improved by changing from an oral to an intraperitoneal (i.p.) route. In patients on three 2 L daily CAPD exchanges, ofloxacin given at the i.p. dosage of 200 mg loading followed by 25 mg/L of peritoneal dialysate achieved overnight trough peritoneal levels which are at least four times the minimal 90% inhibitory concentration (MIC90) of most bacterial pathogens without significant accumulation in the systemic circulation. This i.p. dosage was therefore chosen for the clinical study and the result was compared to that using ofloxacin given in the oral dosage of 400 mg loading followed by 300 mg once daily as maintenance. of all the recruited episodes, 35 were eligible for analysis. the overall primary cure rate including primary failures and relapses was 55.6% (10/18) in the oral treatment group and 70.6% (12/17) in the i.p. treatment group. the corresponding figures for gram positive bacterial (g +) infections were 36.4% and 50%, for gram negative bacterial (g -) infections were 66.7 and 80% and for culture negative infections were 75 and 80%. In culture positive cases, all treatment failures were due to resistant infections which were observed in 42.3% of all bacterial isolates, 47.1% of g + isolates and 33.3% of g - isolates. Due to the high background level of bacterial resistance among our CAPD population, ofloxacin monotherapy given either by the oral or the i.p. route can no longer be recommended for the primary treatment of CAPD peritonitis.     

A study of prophylactic use of 15-methyl prostalglandin F2alpha in the active management of third stage of labour

To compare active management of third stage of labour with 15-methyl prostaglandin F2alpha (PGF2alpha) and conventional management with methylergometrine as prophylaxis for postpartum hemorrhage, a randomised comparative study was carried out at Calcutta National Medical College and Hospital, Kolkata on 100 women. They were randomly allotted to one of the two groups. Group A included 50 women who received 15-methyl PGF2alpha (125 microg) intramusculary at the time of delivery of the anterior shoulder and group B included 50 women who underwent conventional management of the third stage of labour where methylergometrine 0.2 mg was given after delivery of placenta. Main outcome measured were duration of third stage, amount of bleeding and side-effects. The present study showed that there were significent reduction of the duration of third stage as well as reduction of amount of bleeding particularly when 125 microg of 15-methyl PGF2alpha was given intramuscularly at the time of delivery of the anterior shoulder in comparison to coventional method of management of third stage of labour with methylergometrine. Placental expulsion occurred within 4 minutes in group A and 16.5 minutes in group B. The amount of bleeding following delivery was 95.6 ml in average in group A and 249.6 ml in average in group B. 15-methyl PGF2alpha (125 microg) is certainly effective in prevention of postpartum haemorrhage particularly in developing country like India where this complication contributes a major factor for maternal mortality.     

原代培养鼠胚脊髓运动神经元活力状态与肌萎灵注射液的干预作用

目的:从细胞水平,观察扶元起萎,养荣生肌的中药制剂肌萎灵注射液对原代培养鼠胚脊髓运动神经元的保护作用。方法:实验于2004-03/2005-03在解放军第三军医大学完成。实验分组:清洁级SD雌性孕鼠,孕期10～14d。应用密度梯度离心法分离鼠胚脊髓运动神经元进行原代培养,运动神经元培养72h后,按培养板及孔分为4.5μg/L肌萎灵组(肌萎灵注射液,含生药0.9g/mL)、9μg/L肌萎灵组、45μg/L肌萎灵组、力如太组(力如太R利鲁唑片,应用时经0.9%NaCl-0.01NHCl溶解)和对照组。实验处理:各组分别加入用新鲜培养基稀释为0.5%(终浓度4.5μg/L)、1%(终浓度9μg/L)、5%(终浓度45μg/L)的肌萎灵注射液,力如太组加入利鲁唑(终浓度10μmo/L),对照组加入等量新鲜培养基。实验评估:①共同培养3d用四甲基偶氮唑盐法观察其对细胞活力的影响,以吸光度表示。②采用NF-200免疫组织化学染色并进行图像分析,测定神经突起主干长度。结果:①培养的运动神经元活力状态比较:4.5,9,45μg/L肌萎灵组培养运动神经元活力显著增强,与对照组相比,差异有显著性意义(0.317±0.054,0.396±0.087,0.329±0.097,0.230±0.130,P<0.05)。力如太组细胞生长与对照组相比无显著差异(0.266±0.141,0.230±0.130,P>0.05)。②脊髓运动神经元突起生长情况结果:4.5μg/L肌萎灵组和9μg/L肌萎灵组可促进其生长,与对照组相比,差异有显著性意义[(315.96±32.32),(373.46±80.24),(159.71±48.95)μm,P<0.05]。结论:肌萎灵注射液可增强运动神经元活力,促进脊髓运动神经元突起的生长。