Arnold J. Rosin

Sitting Equilibrium 2 Weeks after a Stroke Can Predict the Walking Ability after 6 Months

The prediction of mobility soon after a stroke should allow proper selection for rehabilitation and suggest the long-term prognosis of gait ability. Stable gait is related to midline body orientation and equilibrium mechanisms. We proposed that the sitting balance during the 1st, 2nd, or 3rd weeks after a hemiplegia could be a prognostic indicator for gait at 6 and 12 months. Sitting equilibrium measured in hospital was correlated with gait at the time of discharge and after 6 and 12 months, assessed by standing up, walking, and climbing stairs. The power in the affected limbs in hospital was also correlated with gait at those times. In the 134 patients followed up at 6 months, the correlation of equilibrium with gait at 6 months was r = 0.675 (p < 0.0001), and that of arm power with gait was r = 0.551 (p < 0.0001). Correlations with gait at 12 months were smaller and less meaningful. Assessment of sitting balance, even before the patient can stand, forms an important part of early management of the stroke patient.

Nonclassical organ involvement in temporal arteritis

Revue de la litterature. Description clinicobiologique et anatomo-pathologique. Criteres au diagnostic de maladie de HORTON. Description des atteintes: pericardiques et myocardiques, du tractus respiratoire, renales, du systeme nerveux central, auditives, du tractus genital feminin, du foie, de la thyroide

Thiazide-Induced Hyponatremia and Vasopressin Release

Excerpt To the Editor:We read with interest the report of Friedman and colleagues (1) on thiazide-induced hyponatremia. Although they ascribe the pathogenesis of thiazide-induced hyponatremia to ex...

The physical and behavioural complex of dementia.

An inquiry was made into the physical and behavioural problems presented by patients admitted to hospital because of dementia. 81 patients were studied over a period of 3 years, and a comparison was made between the 38 with idiopathic (Alzheimers) dementia, and the others, most of whom suffered from focal cerebral arteriosclerosis or Parkinsons disease with dementia. The average age was between 70 and 80 years, and the hospital stay averaged 18-28 months. Nursing difficulties ranged from immobility of the patients on the one hand to wandering on the other, especially in the Alzheimers group. Behaviour disturbances, shouting, incontinence and degenerate habits were found in a high proportion and the incidence of fractures reached 15%. Vascular incidents as complications or causes of death were relatively uncommon; in those who died, the cause was usually infection. The mainstays of treatment were tranquillising drugs, used only when necessary, and in minimal quantities, simple occupational activity, and an awareness by the staff of the high morbidity to which these patients were prone.

Subtle ethical dilemmas in geriatric management and clinical research

Routine management of geriatric problems often raises ethical problems, particularly regarding autonomy of the old person. The carers or children may be unaware of the sensitivity of role reversal in dealing with the financial affairs; the need for a residential carer may compromise the old person’s privacy. Attending a day centre confers much benefit, but one must understand the old person’s resistance to change in the proposal of a new daily regimen. Similarly his or her autonomy must be the priority in planning for admittance to an old age home, and not the assumption that the family knows best. A common dilemma is the assessment of an old person’s competency in decision making, either about management of his affairs, or regarding consent to treatment, or participation in research. Because cognitive capacity is not always identical with competency, meaningful tools have recently been developed in which the emphasis is on the specific situation to be investigated.

Factors Influencing Admission or Nonadmission of the Aged to the Hospital

A prospective study was carried out to determine which social, functional, or medical factors influenced the decision to admit or not to admit aged people to a general hospital in Israel. The study also focused on characteristics of patients admitted to the geriatric ward of the medical division as distinct from those sent to the internal medicine ward. Two hundred patients over the age of 65 were examined during ten consecutive intake days for the internal medicine ward over a period of five weeks. One hundred and sixty‐seven were interviewed in the emergency departments, and the others after transfer from other departments by prearranged consultation. Thirty‐five per cent were not admitted, 28 per cent were admitted to internal medicine, and 26 per cent were admitted to the geriatric department. Social factors played little part in the selecting process, the dominant need being acuteness and severity of illness. However, patients in the geriatric ward were found to be functionally much more disabled in regard to mobility, mental state, and incontinence. This was also reflected in a longer average stay of 15 days compared with nine in internal medicine, a higher mortality (19 per cent as against 7 per cent) and a higher degree of disability on discharge from hospital.

Treatment of Dyskinetic and Choreatic Movement Disorders in Adults

Involuntary movements due to chorea or facial dyskinesia were successfully treated in 13 out of 16 patients with antidopaminergic drugs of the phenothiazine, butyrophenone or reserpine type. In 3 of the 4 chorea patients, the movements were significantly suppressed, but with development of parkinsonian rigidity in 1 of them. 11 patients had buccal-lingual-masticatory movements, mainly from degenerative brain disease, and often associated with mild rigidity. Significant suppression of the dyskinesia occurred in 9 without unduly exacerbating the parkinsonism. The dose of drug could often be reduced over the following few months or years, and sometimes movements did not recur after withdrawal of the drug. Present views on choreatic and dyskinetic syndromes attribute them to dopaminergic dominance in the striatum, or to the development of supersensitivity of dopamine receptors brought about by partial blockage by neuroleptic drugs or neuronal damage. There is also evidence that imbalance may occur between two types of dopamine receptors – excitatory and inhibitory, as well as between the dopaminergic and the cholinergic transmitter systems. The actions of dopamine-depleting and dopamine-receptor-blocking drugs can be explained by a resetting of the balance of the dopaminergic transmitters. It is suggested that treatment of choreatic syndromes should be carefully monitored, and that drugs should be reduced in dosage whenever possible. Combinations of dopamine-depleting and dopamine-receptor-blocking drugs may be effective, and the potential of central cholinergic activating drugs as useful treatment for dyskinetic disorders is also discussed.

Fungal serology in the elderly

90 geriatric patients without any clinical signs of systemic fungal infection had their sera tested for the presence of candida and aspergillus precipitins and cryptococcal antigens. None of the patients had positive aspergillus or cryptococcal serology. 13% of patients were found to have candida precipitins, but these cases were not significantly correlated with candida colonisation, length of hospitalisation, prior antibiotic therapy, steroid therapy or diabetes. Allowing for 13% false positives, serological testing might be helpful in identifying systemic candidiasis. It is probably highly specific for parenchymal involvement by aspergillus or cryptococcus.