Comparison of functional outcome following acute care in young, middle-aged and elderly patients with traumatic brain injury

Primary objective: To compare functional physical and cognitive outcome of patients in three age groups with mild, moderate and severe traumatic brain injury (TBI) at discharge from acute care.

Research design: Retrospective database review.

Methods and procedures: Scores on the Extended Glasgow Outcome Scale (GOSE) and on the FIM™ instrument,1 discharge destination and length-of-stay (LOS) were gathered and compared for 2327 patients with TBI admitted to a level 1 trauma hospital from 1997-2003 divided into three age groups; 971 patients between 18-39 years, 672 between 40-59 years and 684 aged 60-99 years.

Main outcomes and results: Relative to younger adults with similar TBI severity, elderly patients showed worse outcome on the GOSE and FIM™ instrument (physical and cognitive ratings) and longer LOS. No difference was observed between the young and middle-aged groups except for cognitive FIM™ ratings and LOS for severe TBI. A higher percentage of elderly patients went to in-patient rehabilitation, to long-term care facilities or died compared to young and middle-aged patients. A higher number of young and middle-aged patients were discharged home.

Conclusions: Further development of services in early rehabilitation as well as post-rehabilitation geared to the specific needs of the elderly patient with TBI is required as the population ages.     

Effects of garlic oil on postmenopausal osteoporosis using ovariectomized rats: comparison with the effects of lovastatin and 17beta-estradiol

The purpose of this study was to examine the antiosteoporosis effects of garlic oil in an ovariectomized (Ovx) rat model of osteoporosis and to compare its efficacy with lovastatin (a synthetic hypocholesterolemic drug) and 17beta-estradiol (a potent antiosteoporotic agent). Animals were divided into five groups: sham-operated control, ovariectomized, ovariectomized supplemented with lovastatin, ovariectomized supplemented with garlic oil and ovariectomized supplemented with 17beta-estradiol. In our study, the development of a high rate of bone turnover and osteoporosis in the ovariectomized animals were confirmed by significant alterations of serum alkaline phosphatase activity, serum tartrate-resistant acid phosphatase activity, urinary excretion of calcium, phosphate, hydroxyproline and urinary calcium to creatinine ratio, when compared with the sham-operated control group. Supplementation of these animals with either garlic oil or lovastatin or 17beta-estradiol, in addition to their hypocholesterolemic effect, could counterbalance all these changes. The results revealed that all three compounds significantly protected the hypogonadal bone loss as reflected by higher bone densities and higher bone mineral contents than the ovariectomized group of animals. The results emphasize that, like 17beta-estradiol, the hypocholesterolemic compounds garlic oil and lovastatin are also effective in suppressing bone loss owing to estrogen deficiency and their efficacy in the order of lower to higher is garlic < lovastatin < 17beta-estradiol.     

Role of oil extract of garlic (Allium sativum Linn.) on intestinal transference of calcium and its possible correlation with preservation of skeletal health in an ovariectomized rat model of osteoporosis

The present study was undertaken to examine the effects of an oil extract of garlic on the in vivo intestinal transference of calcium, and also to verify its role in maintaining the bone mineral content and bone tensile strength in an ovariectomized rat model of osteoporosis. The results suggest that, in this experimental model, oil extract of garlic promotes intestinal transference of calcium by modulating the activities of both intestinal alkaline phosphatase and Ca(2+) activated ATPase. Also the observed low bone mineral content and low bone tensile strength in these rats were significantly restored by garlic oil supplementation. Further, garlic oil supplementation was able to revive partially the bilateral ovariectomy-induced decrease in the serum estrogen titer. The serum parathyroid hormone level, however, was found unaltered in these rats. The garlic oil supplemented partial recovery in serum estrogen titer in bilaterally ovariectomized rat was found to be persistently associated with enhanced calcium transference and better preservation of bone mineral content. The results of this study propose that the phytoestrogenic efficacy of an oil extract of garlic prevents ovarian hormone deficiency induced bone mineral loss possibly by promoting intestinal transference of calcium through the partial revival of the serum estrogen titer.     

Placental vessel morphometry in growth retardation and increased resistance of the umbilical artery Doppler flow

OBJECTIVES: To study the tertiary-stem villi vessel lumen and wall thickness of placenta in pregnancy complicated with placental insufficiency and intrauterine growth retardation (IUGR), its correlation with the umbilical artery Doppler flow study, and compare with normal and non-IUGR pregnancies. METHODS: Placentas from 45 deliveries (between 28 and 38 weeks) were collected for morphometric study of the tertiary-stem villi vessels. Each pregnancy had clinical suspicion of IUGR and was confirmed by serial ultrasound biometry, HC/AC ratio, and had abnormal umbilical artery Doppler velocimetry (RI). Each placenta was weighed after trimming of the membrane and the cord. Sections of the placenta (4 micron) were stained with hematoxylin and eosin and periodic acid-Schiff reagents. Tertiary-stem villi vessels were identified under a microscope (x40) and morphometric study was performed. Inner and outer circumferences (2.pi.r) were measured, radii (r) were calculated, and vessel wall thickness was determined (outer r - inner r). These findings were compared with the findings from 78 placentas from normal pregnancies (between 28-40 weeks) and 27 placentas from pregnancies with medical complications without IUGR (non-IUGR) and with normal Doppler velocimetry (between 33 and 38 weeks). RESULTS: Weight of placentas were significantly (P < 0.005) lower in IUGR than the normal and non-IUGR groups. The vessel wall thickness was significantly (P < 0.0001) increased in IUGR group (mean 21.17 +/- 3.16 micron [SD]) compared to normal and non-IUGR groups (mean 13.19 +/- 1.66 micron). With advancing gestational age, the thicknesses of vessel walls in all groups were significantly (P < 0.001) decreased. There was significant (P < 0.001) decrease in lumen circumference in the IUGR group (mean 173 +/- 31 micron) compared to normal and non-IUGR groups (mean 69 +/- 23 micron). Significant (P < 0.001) correlation was observed between the thickness of a vessel wall and the increase in Doppler RI. CONCLUSIONS: Pregnancies with growth retardation are associated with smaller placentas, increase in the thickness of tertiary-stem villi vessel wall, and decrease in lumen circumference. These changes are associated with an increase in the resistance index of the umbilical artery Doppler flow velocimetry.     

Conservative medical management of advanced cervical ectopic pregnancies

Cervical ectopic pregnancy is the rarest form of ectopic gestation. Viable cervical ectopic pregnancies of 10 weeks' gestation or more are even rarer. It is unclear whether these advanced cervical ectopic gestations should be managed primarily by surgical evacuation or by more conservative medical management with chemotherapeutic agents. Cases of medical treatment of viable cervical ectopic gestations reported in the literature are reviewed. An additional case of a 10.6 weeks of gestation, viable cervical ectopic pregnancy treated with methotrexate, intrafetal potassium chloride, and intramuscular methotrexate is added to the previously reported literature. Advanced cervical ectopic pregnancies with fetal cardiac activity at 10 or more weeks' gestation may be successfully managed with chemotherapeutic agents. Ultrasound-guided intrafetal injection of feticidal agents may be preferable to maternal systemic chemotherapy alone.     

Prognostic effect of epithelial cell adhesion molecule overexpression in untreated node-negative breast cancer

PURPOSE: Epithelial cell adhesion molecule (Ep-CAM) recently received increased attention not only as a prognostic factor in breast cancer but also as a potential target for immunotherapy. We examined Ep-CAM expression in 402 consecutive node-negative breast cancer patients with long-term follow-up not treated in the adjuvant setting. EXPERIMENTAL DESIGN: Ep-CAM expression was evaluated by immunostaining. Its prognostic effect was estimated relative to overexpression/amplification of HER-2, histologic grade, tumor size, age, and hormone receptor expression. RESULTS: Ep-CAM status was positive in 106 (26.4%) patients. In multivariate analysis, Ep-CAM status was associated with disease-free survival independent of age, pT stage, histologic grade, estrogen receptor (ER), progesterone receptor (PR), as well as HER2 status (P = 0.028; hazard ratio, 1.60; 95% confidence interval, 1.05-2.44). Recently, so-called triple-negative (HER-2, ER, and PR) breast cancer has received increased attention. We noticed a similar association of Ep-CAM with disease-free survival in the triple-negative group as for the entire cohort. CONCLUSION: In this study of untreated breast cancer patients, Ep-CAM overexpression was associated with poor survival in the entire cohort and in the subgroup of triple-negative breast cancer. This suggests that Ep-CAM may be a well-suited target for specific therapies particularly in HER-2-, ER-, and PR-negative tumors.     

Repair of O6-methylguanine in DNA by demethylation is lacking in Mer- human tumor cell strains

The ability of extracts of human tumor cells to demethylateO6-methylguanine (O⁶-MeG) in DNA was assayed using the syntheticDNA polymer poly(dC,dG,m⁶dG). Cell strains proficient in repairof O⁶-MeG in vivo (Mer+ phenotype) contained a methyltransferaseactivity while repair deficient cells (Mer^– phenotype)had little or no activity. Mixing extracts of different Mer^–strains did not result in the appearance of the activity. Extractsof Mer^– cells did not inhibit the activity in extractsof Mer⁺ cells. Both Mer⁺ and Mer^– strains contained methylnitrosourea-damage-specificendonudease activity. The data suggest that the Mer⁺ strainsare deficient in methyltransferase and that this is the fundamentalreason for their hypersensitivity to the cytotoxic effects ofDNA alkyla-tion. The activity was partially purified from aMer⁺ colon carcinoma cell strain. Its kinetics parallel therepair of O⁶-MeG in DNA in vivo and suggest that the activityis inactivated during repair of DNA.