Results of resuscitation in injured elderly patients

This study assessed the results of intensive care in elderly trauma patients and quantified the different factors involved in the final outcome. It included 116 patients, aged 65 years or more, and covered a two year period. The following parameters were obtained for each patient: age, severity of trauma (ISS and SAPS), head injury (GCS), prehospital health status (ESA), survival after three months and quality of survival. Three months after trauma, overall mortality was 45.7%. Survivors were 72.8 +/- 4.9 year old, while those that died were 75.3 +/- 7.5 year old (p = 0.01). Mean ISS was 19.7 +/- 8 and mean SAPS was 9.4 +/- 3.2. The risk of death was 3.6 (1.6 to 8.1) times greater if ISS was over 15. The same risk was 4.7 (2.1 to 11.1) times greater if SAPS was over 9. GCS was 8.8 +/- 4.4 in dead patients and 12.5 +/- 2.4 in survivors (p = 0.001). The risk of death was 10.4 (4.2 to 26.2) times greater if GCS was under 8. The final prognosis could be assessed with the following exponential model: Survival = 1/(1 + exp - (8.7 - 0.07 X age - 0.07 X ISS - 2.9 X GCS*), where GCS is equal to 0 if the real GCS was under 8, and equal to 1 otherwise. The ESA did not affect mortality. Three months after trauma, the degree of independence was the same as before in 87% of survivors. It was concluded that age and the severity of trauma were the most important factors in determining prognosis in geriatric trauma patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

MANAGEMENT OF TRACHEOMALACIA IN ASSOCAITION WITH CONGENITAL TRACHEO-OESOPHAGEAL FISTULA

Tracheomalacia is commonly associated with oesophageal atresiaand tracheo-oesophageal fistula. Severe cases may present withlife threatening cyanotic and apnoeic attacks following surgicalrepair of the oesophageal atresia. The anaesthetic, and surgicalmanagement (by tracheopexy), of such a case are described.     

Failure of genetically selected miniature swine to model NIDDM

Ten young adult miniature swine from a line reported to be genetically selected for glucose intolerance and eight normal controls were obtained from Colorado State University. They were consecutively exposed to 4 mo of a high-fiber, low-fat standard swine diet; 4 mo of a high-sucrose, high-fat, low-fiber diabetogenic diet; and 4 mo of excess diabetogenic diet for obesification. Results of oral glucose tolerance and intravenous insulin tolerance tests conducted at the end of each regimen were compared. Hyperglycemia was not observed in any animals after any manipulation. Insulin sensitivity was also not influenced by diet. We conclude that F7 low-K miniature swine from this colony fail to model human non-insulin-dependent diabetes.     

Left ventricle in Noonan's syndrome. Electro-vecto-echo and angiocardiographic aspects

The electrocardiographic features of Noonan's syndrome have been known for several years, but the discordance between these electrical findings and the underlying haemodynamic disorders remains unexplained. In an attempt to elucidate the genesis of electrical abnormalities, we present here a retrospective study of 14 children with Noonan's disease, aged from a few days to 16 years and evaluated by electrocardiography, vectography, one- or two-dimensional echocardiography, angiography and His bundle electrophysiology. The electrocardiographic abnormalities observed concerned ventricular depolarization and intracardiac electric conduction with, notably, a QRS axis directed towards the right upper part of the electric field and a first degree infra-hisian atrioventricular block (His bundle potentials). Vectography showed in some cases an image of inferior pseudo-necrosis due to the absence of initial inferior forces; this image is highly characteristic. In other cases the QRS loop showed an image of left segmental block which is unusual in this type or cardiac pathology (pulmonary stenosis with or without atrial septal defect of the ostium secundum type).     

3-(Methylnitrosamino)propionitrile: occurrence in saliva of betel quid chewers, carcinogenicity, and DNA methylation in F344 rats

3-(Methylnitrosamino)propionitrile (MNPN), a potent carcinogen in F344 rats, was detected for the first time in the saliva of betel quid chewers at levels ranging from 0.5 to 11.4 micrograms/liter. The tumorigenic properties of MNPN and its potential to methylate DNA in F344 rats were evaluated. Groups of 21 male and 21 female rats were given 60 s.c. injections over a 20-week period (total doses 0.055 and 0.23 mmol per rat). The experiment was terminated after 106 weeks. MNPN at the higher dose induced 18 (86%) malignant tumors of the nasal cavity in male and 15 (71%) in female rats. The lower dose induced nine (43%) liver tumors. Groups of four or five male F344 rats were treated with a single s.c. or i.v. injection of MNPN (0.4 mmol/kg). MNPN was also administered to rats by swabbing the oral cavity (2.21 mmol/kg). The levels of 7-methylguanine and O6-methylguanine, formed 0.5-36 h after treatment, were measured in the liver, nasal mucosa, esophagus, and oral issues. The highest levels of methylated guanines were detected in the nasal cavity independent of the route of administration. The results of this study demonstrate that MNPN is present in the saliva of betel quid chewers and is a potent carcinogen in F344 rats.     

Diagnoses of the relatives of schizotypal outpatients

Relatives of 22 schizotypal probands were evaluated for lifetime psychiatric diagnoses. Forty-four (N = 44) of the 97 available relatives were interviewed directly using the Diagnostic Interview Schedule. The rates of psychiatric diagnoses were compared with those of sixty-six (N = 66) of 140 relatives of 30 depressed patients. Family history of mental illness was ascertained by the informant method on the remainder of relatives of both proband groups. The rate of depression found in the relatives of schizotypal patients was 52% in those directly interviewed and 25.7% when informants' reports on unavailable relatives are pooled with direct interview data. These rates were not significantly higher than those found for the relatives of depressed probands (34.8% by direct interview and 21% including reports from informants). The high rates of depression in the relatives of schizotypal probands may indicate that schizotypal personality is associated with affective disorder and not only with schizophrenia. However, the high rates may be due to the presence of depressive character traits in relatives, which inflate the rates of dysthymic disorder and other chronic depressive disorders in the relatives of borderline patients.