Abnormal behavior of elderly people residing in institutions of medical and social welfare systems

Abstract We investigated factors correlated with abnormal behavior in the elderly residing in a special nursing home (group A) and a psychiatric hospital (group B) using the dementia behavior disturbance scale, the mini mental state examination, the Japanese version of the Philadelphia Geriatric Center morale scale, and the ADL assessment scale. The cognitive function of group B was decreased compared with that of group A, but most activities of daily living (ADL) in the latter group were disrupted compared with those in the former. Only a few categories of ADL correlated with abnormal behavior in group A, whereas cognitive function, quality of life, and most categories of ADL correlated with abnormal behavior in group B. These results suggest that factors correlated with abnormal behavior in the elderly differ within institutions of medical and social welfare systems.     

急性颅脑损伤患者脑脊液中兴奋性和抑制性氨基酸含量改变及其临床意义

采用氨基酸自动分析仪检测了１８例急性颅脑损伤患者脑脊液中谷氨酸、天门冬氨酸、牛磺酸、甘氨酸、丙氨酸、γ－氨基丁酸、脯氨酸含量的动态变化。结果发现，伤情越重、预后越差的患者，脑脊液中牛磺酸、γ－氨基丁酸、丙氨酸含量伤后早期升高越明显，恢复至正常的时间也越长；其中２例早期死于急性弥漫性脑肿胀、脑水肿的患者，伤后当天脑脊液中牛磺酸含量分别为９２．６和５１．５μｍｏｌ／Ｌ，是对照值的９．６倍和５．４倍，γ－氨基丁酸含量分别为１１９．８和２４６．２μｍｏｌ／Ｌ，是对照值的２．７倍和５．５倍。表明伤后脑脊液中牛磺酸、γ－氨基丁酸和丙氨酸含量的动态变化可初步反映颅脑损伤的严重程度及颅脑损伤患者的脑功能恢复状况，并可能与急性脑水肿、脑肿胀的病理生理过程有关。     

克林霉素在老年患者呼吸道感染中的应用

目的:探讨克林霉素在老年呼吸道感染中的应用价值.方法:38例老年呼吸道感染惠者随机分为治疗组(克林霉素)和对照组(青霉素 丁胺卡那霉素),观察临床疗效.结果:治疗组在退热时间和治疗时间上均短于对照组,差异具有显著性意义,而副反应少而轻微.结论:克林霉素治疗老年呼吸道感染安全有效.     

功能性矫治器在正畸矫治中运用的伦理思考

功能性矫治器是正畸临床中常用的一种矫治器，作者从口腔正畸学理论基础出发，探讨了功能性矫治器在正畸矫治作用中存在的伦理道德问题，主要有（1）不能正确的诊断、制定周密的矫治计划。（2）操作不规范、不细致、缺乏敬业精神。（3）态度简单，粗曝，缺乏与患者良好的交流。并提出解决方法（1）刻苦学习专业知识，不断提高诊疗水平及个人修养。（2）建立高度的道德责任感，以严谨的作风，规范的操作为病人服务。（3）尊重、善待青少年，建立良好的医患关系。     

肺部疾病中痰巨噬细胞对结核菌素试验反应的临床研究

目的:测定肺结核、肺肿瘤及非特异性炎症患者注射结核菌素前后痰巨噬细胞的不同数量变化,由此提供一种新的鉴别诊断方法。方法:皮内注射结核菌素、收集注射前、后痰液,测定痰巨噬细胞在不同时间的数量变化。结果:肺结核病人在结核菌素试验后痰巨噬细胞明显增加,肺部肿瘤及非特异性炎症则无显著性变化。结论:肺部患者测定结核菌素前后痰巨噬细胞变化,可作为菌阴肺结核与肺部肿瘤及非特异性炎症鉴别诊断依据之一。     

老年肝外胆管梗阻85例治疗分析

目的：探讨老年性肝外胆管梗阻的治疗。方法：85例老年胆管梗阻中良性疾病引起的梗阻为59例，主要是由于胆管结石嵌顿MIRRIZI‘S综合征；恶性肿瘤引起的梗阻为26例，主要为壶腹部周围癌，肝门区肿瘤等。手术分别采取胆囊切除术、胆总管切开取石＋T管引流术、胰十二指肠切除术、腹部探查＋内外引流术以及ERCP下行置管内支撑术后引流和ENBD等。结果：良性疾病引起的梗阻中仅1例术后死于ARDS，恶性肿瘤 引起的梗阻者中有11例术后死于肝肾综合征、ARDS和DIC等。结论；手术仍是老年肝外胆管梗阻的首选方法。老年患者合并其它脏器病变，病情较重者如先行胆管引流，能有效降低病死率及延长生命。     

Serum digoxin and beta-methyldigoxin in elderly patients on hospital admission: correlation with home compliance and clinical variables

Summary Serum digoxin and beta-methyldigoxin (BMD) were measured in 165 elderly patients (age >60 years) admitted to hospital, of whom 109 had been treated at home with digoxin and 56 with BMD.The mean BMD level was significantly lower than that of digoxin (1.1 vs. 1.4 ng/ml). Creatinine clearance and daily dose were the variables most strongly associated with digoxin level, and the prescribed dose and serum albumin were the best predictors of the BMD concentration. Compliance was assessed by a compliance index (CI), namely the ratio of the measured glycoside concentration, corrected for creatinine clearance, over the expected steady-state dose, calculated from a hospitalized reference group. Compliant individuals in both treatment groups, i.e. those with a CI > the median value, were characterized by a lower daily dose and dosage frequency.Toxicity, whether clinical or electrocardiographic, was present in 9% of the patients and was associated only with a significantly higher mean serum level of the drug.     

婴幼儿患者手术的护理要点

目的进一步认识婴幼儿患者实施外科手术的危险性及规范手术配合程序的重要性,提高配合质量,提出手术配合要点。方法回顾近几年168例婴幼儿患者外科手术护理配合,同时结合自己的临床实际经验和手术配合中的体会,提炼出婴幼儿患者手术的护理配合要点。结果婴幼儿患者手术的配合要做好术前评估,掌握患者心肺主要脏器的功能情况,做好充分准备,手术室感染控制,术中的各项检测,监测输液量、速度及体温维持情况。结论掌握婴幼儿患者手术的护理配合要点,可提高手术配合质量和手术成功率。     

Biological characteristics of newly diagnosed poor prognosis acute myelogenous leukemia

A pilot study was conducted of the biological characteristics of the leukemia cells of newly diagnosed patients with poor prognosis acute myelogenous leukemia (AML). This study included measurements of the pretherapy proliferative rate of the leukemia cells in vivo, assessment of differentiation in vivo during remission induction therapy, and the level of expression of the fms, myc, and IL1β genes in pretherapy leukemia cells. Short cell cycle times were characteristic of the best prognostic category and were associated with a rapid reduction in marrow leukemia cells in cytosine arabinoside (araC)-sensitive patients. Expression of c-fms was associated with rapid reduction in marrow leukemia cells during araC therapy and with a successful treatment outcome. Expression of the IL1β gene was associated with short remissions. These studies suggest that when compared to newly diagnosed standard prognosis AML, the leukemia of poor prognosis patients is more likely to exhibit long cell cycle times, low levels of fms expression, and is less likely to be associated with myeloid differentiation during remission induction therapy. © 1993 Wiley-Liss, Inc.     

The effect of age on the pharmacokinetics of the opioid antagonist nalmefene

1 The disposition of nalmefene was evaluated in young and elderly normal healthy volunteers. Subjects received either a single 1  mg ( n =18 young; n =11 elderly) or 2  mg ( n =8 young; n =15 elderly) intravenous bolus dose of nalmefene.
2 Following the administration of nalmefene, the initial plasma concentrations were significantly higher in elderly vs young subjects. The higher concentrations were the result of the 30 to 40% smaller central compartment apparent volume of distribution that was observed in the elderly subjects as compared with the young volunteers (2.8±1.1 vs 3.9±1.1  l  kg⁻¹ for 1  mg dose). The elderly volunteers also had a significantly shorter distributional half-life ( t1/2λ1 ) than young volunteers (0.7±0.7 vs 1.3±0.8  h for 1  mg dose). No significant differences between groups were observed for the elimination half-life, clearance or steady-state apparent volume of distribution.
3 Although transiently higher nalmefene plasma concentrations were observed in the elderly immediately following drug administration, there was no association between this observation and adverse events. We conclude that no dosage alteration is warranted in elderly patients.