[Combined vision and hearing impairment: in an estimated 30,000-35,000 people aged 55 years or over in The Netherlands]. / Gecombineerde visus- en gehoorbeperking: naar schatting bij 30,000-35,000 55-plussers in Nederland.

OBJECTIVE: To determine the number of older people with acquired dual sensory impairment (DSI) in The Netherlands. DESIGN: Combination of studies in the general population and in relevant subpopulations. METHOD: Eight databases derived from recent studies on older persons with vision and hearing data on Dutch subjects aged 55 years or over were selected for further analysis. The measurement methods included self-reports, clinical measurements and observations. The prevalences of DSI were calculated for the general population, the non-institutionalised population, and subgroups such as older people in nursing homes and homes for the elderly. The calculated prevalences were extrapolated to the overall Dutch population. RESULTS: For the non-institutionalised population of 55 years and older, the prevalences of acquired DSI in two different data sets were 0.4% (95% CI: 0.2-0.6) and 0.6% (95% CI: 0.3-0.8), respectively. Among the inhabitants of homes for the elderly these percentages were 5.4% (95% CI: 0.9-9.9) and 5.5% (95% CI: 3.8-7.2), and in nursing homes they were 12.7% (95% CI: 9.7-15.7) and 16.7% (95% CI: 14.6-18.8). Acquired DSI was most common in persons 85 years of age and older. It was estimated that the number of people aged 55 years and over with acquired DSI in The Netherlands is 30,000 to 35,000. CONCLUSION: DSI is particularly a problem of the oldest old. An integrated approach to the visual and hearing problems of these subjects is essential.

Less invasive determination of cardiac output from the arterial pressure by aortic diameter-calibrated pulse contour.

BACKGROUND: Cardiac output by modelflow pulse contour method can be monitored quantitatively and continuously only after an initial calibration, to adapt the model to an individual patient. The modelflow method computes beat-to-beat cardiac output (COmf) from the radial artery pressure, by simulating a three-element model of aortic impedance with post-mortem data from human aortas. METHODS: In our improved version of modelflow (COmfc) we adapted this model to a real time measure of the aortic cross-sectional area (CSA) of the descending aorta just above the diaphragm, measured by a new transoesophageal echo device (HemoSonic 100). COmf and COmfc were compared with thermodilution cardiac output (COtd) in 24 patients in the intensive care unit. Each thermodilution value was the mean of four measurements equally spread over the ventilatory cycle. RESULTS: Least squares regression of COtd vs COmf gave y=1.09x[95% confidence interval (CI) 0.96-1.22], R2=0.15, and of COtd vs COmfc resulted in y=1.02x(95% CI 0.96-1.08), R2=0.69. The limits of agreement of the un-calibrated COmf were -3.53 to 2.79, bias=0.37 litre min(-1) and of the diameter-calibrated method COmfc, -1.48 to 1.32, bias=-0.08 litre min(-1). The coefficient of variation for the difference between methods decreased from 28 (un-calibrated) to 12% after diameter-calibration. CONCLUSIONS: After diameter-calibration, the improved modelflow pulse contour method reliably estimates cardiac output without the need of a calibration with thermodilution, leading to a less invasive cardiac output monitoring method.

Development of spontaneous leg movements in infants with and without periventricular leukomalacia.

The main question asked in the present study was whether support could be found for the notion that supraspinal influences on the generation of spontaneous kicking movements become increasingly apparent in the first half-year after birth. In comparing groups of infants with and without damage in tracts connected with the cortex surrounding the central sulcus, such support would consist of the finding that similar patterns of spontaneous kicking are observed early in development, whereas differences between groups should occur with increasing age. Using 3-D registrations, the spontaneous kicking movements of 19 infants with differing degrees of periventricular, lobar, and subcortical leukomalacia based on white matter (WM) abnormalities on ultrasound were compared to those of 10 healthy control infants at 6, 12, 18, and 26 weeks of corrected age. Magnetic resonance imaging recordings were used to identify the location and severity of the brain lesions. Infants with extensive lesions in the periventricular and lobar WM with or without diffuse lesions in the subcortical WM showed a decreased variability on some spatial and temporal parameters of kicks. More importantly, these infants showed a different developmental course for intralimb couplings when compared to the other infants; they were unable to dissociate tight intralimb couplings at 18 and 26 weeks. As all of these infants had substantial damage of the corticospinal tracts, these findings suggest that these tracts are involved in the regulation of intralimb joint dissociations between 4 and 6 months of age. However, caution is needed as areas outside those in which the corticospinal tracts are located could be damaged as well and most of the infants with moderate to severe lesions in the corticospinal tract had additional psychomotor problems. For interlimb couplings and most of the spatial and temporal parameters of kicks, no differences were found between groups. This strengthens the claim that inter- and intralimb couplings are organized in fundamentally different ways.

Spontaneous kicking behavior in infants: age-related effects of unilateral weighting.

The age-related effects of unilateral weighting on spontaneously generated kicks in 18 healthy, full-term infants were investigated. The main question was whether infants during the first half-year after birth reveal changes in how they adjust to unilateral weighting. At 6 weeks, infants reduced the frequency of the weighted leg and increased that of the unweighted leg whereas at 12 weeks the frequency of kicking increased in both legs. At both ages, unilateral weighting also resulted in differences on a number of kinematic parameters. By 18 and 26 weeks, such frequency and kinematic effects were no longer present. With regard to interlimb couplings, a clear pattern of bilateral coordination was only present at 26 weeks; these results suggest that the effects of unilateral weighting are not directly related to the tightness of interlimb couplings. The implications of these age-related differences for understanding developmental changes in the control of leg movements are discussed. It is suggested that the infants' improved ability to act in a task-specific manner as well as nonlinear changes in the musculo-skeletal system and fine-tuning processes at a neural level might be factors of importance.

Intention and the omission bias: omissions perceived as nondecisions.

People often evaluate a decision to commit an action more negatively than a decision to omit an action, given that both decisions have the same negative consequence. This phenomenon is called the omission bias. In the present experiments, subjects were not asked to justify their judgments in view of doubts about whether the processes underlying decision making are open to introspection. Instead, they were asked to rate an agent's immorality-or the anger evoked by the employer of the agent-as well as the agent's intention, causality, and responsibility for either a commission or an omission version of several scenarios. The results of the three experiments suggest that the basis of the omission bias is a difference in perceived causality, making the outcome of an omission appear less intended than the outcome of a commission. This reduction in perceived intention for outcomes of omissions might make the evaluation of someone's behavior less negative.

Callosal size in children with learning disabilities.

The corpus callosum (CC), the main structure subserving hemispheric collaboration, that is necessary for efficient cognitive functioning, undergoes developmental processes such as axonal retraction and myelination. Callosal growth therefore is vulnerable for adverse events such as perinatal asphyxia, but there are also genetic and epigenetic factors that determine form and thickness. MRI scans of 110 children, either with specific learning disabilities (LD), i.e. dysphasia/dyslexia, or with several degrees of general LD, showed callosa that were highly variable in size. The callosal size corrected for brain size did not vary significantly according to the severity of the LD, although it tended to be smaller in severe LD, i.e. mental retardation. Callosal size varied however, due to the likely presence of genetic influences or of adverse perinatal events. Children with familial dysphasia/dyslexia, had a thicker CC, possibly reflecting a poorly understood neurodevelopmental mechanism that inhibits the establishment of cerebral dominance. LD children (all subgroups together) with perinatal adverse events had a smaller CC than the familial cases, suggesting CC damage. Despite a multitude of developmental factors influencing the final size, this study suggests that total callosal size, supposedly linked to interhemispheric function, may contribute to the pathophysiological mechanisms that give rise to LD.

Intravenous fenoldopam infusion in severe heart failure.

Fenoldopam, a selective DA1-receptor agonist, infused intravenously for 24 hours (0.6 +/- 0.3 microgram/kg/min, range 0.1-1.5) in 25 patients with NYHA functional class III or IV heart failure, produced a prompt and sustained hemodynamic response. Cardiac index rose from an average preinfusion baseline value of 1.8 to 2.6/l min. Stroke volume index increased from 19 to 26 ml/m2 and stroke work index increased from 18 to 25 g M/m2. These changes were accompanied by a reduction in systemic vascular resistance from an average of 2400 to 1500 dynes sec/cm5. There was no change in the heart rate or right atrial pressure. There was a transient reduction in the left ventricular filling pressure from 25 to 20 mmHg. Urinary sodium excretion did not change significantly. Transient asymptomatic thrombocytopenia developed in four patients. The drug was well tolerated by all patients. These results suggest that continuous intravenous infusion of fenoldopam is safe and produces favorable hemodynamic responses in severe heart failure. However, unlike its effects in patients with hypertension, it failed to produce sustained natriuresis in these patients.

[The relationship between creatinine clearance and glomerular filtration rate in the critically ill patient]. / Die verband tussen kreatinienopruiming en glomerulêre filtrasiespoed in die kritiek siek pasiënt.

A study was undertaken to show that the determination of glomerular filtration rate with radio-labelled sodium chromate ethylenediaminetetra-acetic acid is a repeatable, easily performed and accurate examination in the critically ill patient. Differences in glomerular filtration rate were relatively small, with a phase difference of between -10,59 and 5,34. Creatinine clearance showed a greater variation over a corresponding period, with a difference of between -27,50 and -4,10. The study indicated that this method of determining glomerular filtration rate can be very useful in an intensive care unit, because it seems to be more accurate and easier to perform. Information is obtained more quickly than when the glomerular filtration rate is determined by means of creatinine clearance.

An electronic apparatus for early detection of changes in red cell content of blood during anaesthesia. A preliminary report.

An electronic apparatus was developed for anaesthetists to use to detect changes in red cell concentration during surgery. The mechanism is based on the relationship between the red cell content and the electrical conductivity of blood. In a pilot study of 170 blood samples, a correlation coefficient of 0.9806 was obtained between haematocrit and the instrument readings. To evaluate the instrument's performance in practice, and factors that might influence its readings, a series of 10 cases of aortic surgery were investigated. It is concluded that, although changes in electrolyte concentration, pH and temperature do affect the instrument's readings, these are insignificant compared with those of red cell content, and that the device can be used to indicate a drop in red cell concentration.

Ingestion of codeine and salicylic acid causing convulsions and coma. A case report.

A 3-year-old White child was admitted to the critical care unit in a coma after a generalized convulsion. Codeine and salicylic acid were present in his plasma. The possible aetiology and management are discussed.

Severe staphylococcal infection with pneumonia treated by plasmapheresis and plasma exchange. A preliminary report.

Three cases of extremely severe staphylococcal infection are reported. All 3 patients were treated by plasmapheresis and fresh plasma or fresh-frozen plasma replacement, and all made a steady recovery. In all 3 cases blood culture for Staphylococcus aureus was positive, 1 patient had osteitis, and 1 signs of spinal cord compression by an infectious process (an abscess). It is thought that the above mentioned procedures may offer a useful additional line of therapy for desperately ill patients with staphylococcus infections.