Screening, Detection and Management of Depression in Elderly Primary Care Attenders. II: II: Detection and Fitness for Treatment: a Case Record Study

Case note data were obtained for 186 elderly primary care attenderswho also completed the 15 item Geriatric Depression Scale (GDS15).The presence or absence in the case notes of a current or pastdiagnosis of depression, of current treatment of depression,and of a number of clinical features of depression were noted.Case notes were also rated for the presence or absence of contraindicationsto the use of tricyclic antidepressants (TCAs) and to serotonin-specificreuptake inhibitors (SSRIs). Whereas 65 (35%) patients wererated as ‘cases’ of depression on the GDS15, only28 (15%) had a current case note diagnosis of depression and37 (20%) had one or more current symptoms of depression recordedin the case notes. Patients rated by their GP as having oneor more current symptoms of depression scored higher on theGDS15 (P < 0.05) and were more likely to be categorized asa GDS case (P = 0.05). There was no significant relationshipbetween GDS caseness and a current case note diagnosis of depression.Seventy-three patients (39%) had a past history of depressionand 53 (28.5%) patients had previously been treated with antidepressants.The former was significantly associated with GDS caseness (P< 0.05). Twenty-four patients (13%) were currently on antidepressants,19 of them receiving adequate doses (equivalent to at least75 mg of amitriptyline). Current antidepressant treatment wasnot associated with GDS ‘caseness’. A significantlyhigher proportion of patients (both in the sample as a wholeand in the subgroup of GDS15 depression ‘cases’)had a medical condition or were taking a drug that mitigatedagainst the use of TCAs than was the case for SSRIs.     

Triiodothyronine (T3) and Cardiovascular Therapeutics: A Review

Hypothyroidism is associated with an abnormal hemodynamic state characterized by decreased heart rate, stroke volume, output, and contractility, and increased systemic vascular resistance. Since cardiopulmonary bypass (CPB) and surgical stress can induce profound decreases in triiodothyronine (T3) levels, the hemodynamic consequences of "stress-induced" hypothyroidism and T3 repletion are of increasing clinical interest. Available data generally support the likelihood of a beneficial effect associated with T3 replacement in brain-dead organ donors and in cases of low cardiac output following CPB. Although hypotheses have been advanced to account for these salutary effects, the mechanism by which T3 may augment hemodynamic performance has not been precisely defined, particularly in the acute setting. Although additional research is needed to clarify these and other issues, preliminary findings with T3 replacement indicate that such investigation is warranted.     

Lymphocyte Production and Life-span in the Bone Marrow of the Guinea Pig

Guinea pigs were given 14 daily injections of ³H-thymidine to label a proportion of cells with a slow rate of turnoverin addition to rapidly proliferating cells.In the bone marrow the only unlabeledcells were some reticular, endothelial, andplasma cells, damaged cells, and 14.1%of small lymphocytes. Six weeks afterdiscontinuation of ³H-thymidine 7% ofthe marrow lymphocytes remained labeled. In guinea pigs injected every 4 hrwith ³H-thymidine for 4 days to label allcells entering DNA synthesis, 14.4% ofsmall lymphocytes remained unlabeledalong with some reticular, endothelial,phagocytic, monocytoid, damaged, andplasma cells. The pattern of appearanceof labeled lymphocytes was consistentwith the kinetics of transitional cells thatfunction as their precursors. Thus, in thebone marrow of the guinea pig the majority of lymphocytes have a short lifespan and a rapid turnover, whereas about14% turn over more slowly and 7% havea life-span exceeding 4 wk. In this respect the kinetics of marrow lymphocyteproduction differs from that of the rat.

Submitted on March 11, 1971 Revised on April 9, 1971 Accepted on April 14, 1971     

Studies on Lymphocytes. II. The Production of Lymphocytosis by Intravenous Heparin in Calves

1. Intravenous commercial heparin produces a lymphocytosis in the calf.The effect is not due to the preservative commonly present in heparin.

2. The lymphocytosis is mediated to a great extent by an increased inputof lymphocytes into the blood via the thoracic duct.

3. The necessity of considering, plus controlling the heparin effect onblood lymphocyte levels and on the output of thoracic duct lymphocytes inall studies on lymphocyte production, migration and behavior, is discussedand emphasized.

Submitted on March 29, 1962 Accepted on June 25, 1962     

Enhanced fibrinolytic activity during cardiopulmonary bypass in open-heart surgery in man is caused by extrinsic (tissue-type) plasminogen activator

The nature of the enhanced blood fibrinolytic activity which is known to occur during cardiopulmonary bypass is not understood. We show here that the cause is an increase in extrinsic (tissue-type) plasminogen activator. In six patients, the nature of the enhanced blood fibrinolytic activity that evolved during cardiopulmonary bypass was characterized by differential inhibition using the fibrin plate method and was shown to be C1-inactivator-resistant (extrinsic-activator activity). The C1-inactivator-resistant-activator activity was completely quenched by an antibody against extrinsic (tissue-type) plasminogen activator but not by antiurokinase, proving that the activity was due to the presence of extrinsic (tissue-type) plasminogen activator. The concentration of extrinsic (tissue-type) plasminogen activator increased during cardiopulmonary bypass and disappeared rapidly thereafter. Fibrinogen, plasminogen and alpha 2-antiplasmin were not consumed during cardiopulmonary bypass, while no increase or occasionally a moderate one in fibrinogen degradation products occurred. This is in accord with the property of extrinsic (tissue-type) plasminogen activator which activates plasminogen predominantly at sites where fibrin is present and not in the free circulation.     

Pressure‐Guided Cryoballoon Isolation of the Pulmonary Veins for the Treatment of Paroxysmal Atrial Fibrillation

Pressure‐Guided Cryoballoon Pulmonary Vein Isolation. Background: Pulmonary vein (PV) isolation using a balloon‐mounted cryoablation system is a new technology for the percutaneous treatment of atrial fibrillation (AF). Complete PV occlusion during balloon ablation has been shown to predict successful electrical isolation. The aim of this study was to correlate mechanical PV occlusion with changes in a pressure curve recorded at the distal tip of the cryoballoon catheter. Methods and Results: We analyzed 51 PVs in 12 patients (61 ± 6 years old) with paroxysmal AF. At first, PV occlusion via the cryoballoon was documented by changes in the pressure curve. Once the PV is occluded, the pressure curve registered in the vein converts from a left atrial pressure curve to a pulmonary artery pressure curve: the PV wedge curve. Occlusion was then confirmed by transesophageal echocardiography (TEE). Following 2 cryoablation applications, electrical PV isolation was assessed with a circumferential mapping catheter. Under the exclusive guidance of changes in the pressure curve at the tip of the cryoballoon, mechanical occlusion confirmed by TEE was achieved in 47 of 51 PVs (92%). Three PVs required further TEE guidance to achieve occlusion. All 50 occluded veins were electrically isolated after cryoablation. One right inferior vein, which could not be occluded with the balloon, displayed conduction post cryoablation and was isolated by focal ablation. Conclusions: Occlusion and electrical isolation of PVs during cryoballoon ablation can be predicted by the appearance of a PV wedge curve at the tip of the catheter. This new straightforward parameter may facilitate the procedure. (J Cardiovasc Electrophysiol, Vol. 21, pp. 120‐125, February 2010)     

Studies on Lymphocytes. I. Lymphopenia Produced by Prolonged Extracorporeal Irradiation of Circulating Blood

1. A method for extracorporeal irradiation of the circulating blood hasbeen developed.

2. Extracorporeal irradiation of the blood will produce a lymphopeniapromptly which persists for weeks.

3. Heparin in high doses in the calf produces a lymphocytosis and neutrophilic leukocytosis.

Submitted on March 8, 1962 Accepted on April 11, 1962     

Age differences in responses to facial trauma

This study examines age differences in causes, characteristics, and outcomes of facial trauma seen in a major trauma hospital. A retrospective analysis was undertaken of 615 cases of facial trauma that had occurred during a 5-year period. The greatest proportion of patients were aged 20 to 29; those older than age 60 represented just 6.8% of the total cases. Gender differences were not observed in the oldest age groups. The oldest patients (older than 70 years) were more likely to have had pedestrian accidents and less likely to have been assaulted than other age groups. Older patients had more multiple injuries but fewer treatment procedures than other age groups. Significant differences were found in death rates; the older patients were more likely to die as a result of their injuries. Implications for patient management based on age and treatment needs are discussed.