Comparison of health and functional ability between noninstitutionalized and least dependent institutionalized elderly in Finland.

Finland's active deinstitutionalization policy aims to reduce the number of elderly people in long-term residential care and to keep noninstitutionalized elderly people living at home as long as possible. As a contribution to the issue of the appropriateness of long-term institutional care, we compared the health and functional ability of elderly people living at home or in residential care to assess the theoretical possibility of discharging the least dependent elderly from residential homes. Findings from two separate data sets collected in 1992 were compared; one (n = 475) was obtained by computer-assisted telephone interview (elderly at home) and the other (n = 459) by postal survey (elderly in residential care). The direct method was used in age and gender standardization, and logistic regression analysis was applied. Elderly people living at home were found to be in better health and with better functional ability than those in residential care. However, a proportion of home-dwellers needing some help with Activities of Daily Living (ADLs) assessed their health as being even worse than those in care, and approximated that of institutionalized elderly judged by the personnel to be able to manage with home-based care. Compared with home-dwellers, those assessed as able to manage in-home care were mostly single and had less education and more restrictions in their Instrumental ADLs and medication. Our results indicate that one third of those assessed as able to manage in-home care could possibly be discharged if adequate servicers and housing were available.

The relationship between serum lipoprotein levels and marbling of muscle tissue in beef cattle.

The relationship between serum lipoprotein levels and the grades of marbling in muscle tissue was analyzed by gel filtration of lipoprotein fraction obtained from sera of 80 Japanese black beef cattle in the final stage of fattening. It was found that the increase in the Beef Marbling Standard number was positively correlated with the concentration of low-density lipoprotein cholesterol (r = 0.79) and negatively with that of high-density lipoprotein cholesterol (r = -0.47).

[Prognostic factors of renal cell carcinoma: a multivariate analysis].

In a series of 104 patients with renal cell carcinoma, a variety of clinical and histological factors were analyzed to establish their value as prognostic factors. In a univariate analysis (log-rank test), the presence or absence of symptoms, tumor size, pT, N, M, pV categories, TNM stage, Robson stage, nuclear grade and cell type were significantly associated with cause-specific survival, while age, sex and tumor side were not. In a multivariate analysis using Cox's proportional hazard model of 73 informative cases, only N (0 vs. 1-3) and M (0 vs. 1) categories of stage and nuclear grade (1-2 vs. 3) proved to be independent prognostic markers.

[A case of nonseminomatous germ cell tumor: usefulness of alphafetoprotein subfraction].

Alfa-fetoprotein (AFP) is an indispensable examination in the management of non-seminomatous germ cell tumor. However, many liver diseases also frequently show the elevation of AFP. Therefore, it is essential to discriminate between yolk sac-derived component and liver-derived one. A 32-year-old male who had suffered from chronic hepatitis, visited our clinic in December, 1991. He complained of left scrotal atrophy and dull pain. Surgical specimen was histologically diagnosed as embryonal carcinoma with syncytiotrophoblastic giant cell. The levels of tumor markers, such as AFP, beta-human chorionic gonadotropin (beta-HCG), were estimated. Both of them were elevated, and radiographical studies demonstrated metastatic lesions of bilateral lung field and retroperitoneal lymph nodes (RPLN). After three courses of cisplatin based chemotherapy, lung and RPLN metastases diminished and serum beta-HCG had normalized. However, the serum AFP persisted to show an abnormally high concentration. The subfraction profile with lens culinaris hemagglutinin (LCA) was estimated. The one after the first course was compared with the one after third course. The latter one showed complete diminution of peak 2. This implied the diminishment of yolk sac element.

[The perineal implantation of a bladder tumor through urethro-vasal reflux].

Perineal implantation of urinary bladder cancer in a 57-year-old male is reported. The patient had been suffering from incomplete paraplegia and neurogenic bladder for these 29 years because of accidental injury of lumbar spinal cord with episodes of bladder stones two times and right epididymitis three times, and presented urinary leakage from a perineal fistula. The fistula orifice was surrounded by a hard mass lesion. Bilateral swelling of inguinal lymph nodes was present. Fistulogram and voiding cysto-urethrography revealed reflux from posterior urethra to the fistula through right vas and epididymis. Histological diagnosis of resected perineal mass and biopsied left inguinal lymph node was transitional cell carcinoma with predominant metaplasia of squamous cell carcinoma. Tissues obtained by TUR-biopsy of a mass lesion at bladder wall was also histologically diagnosed transitional cell carcinoma with metaplasia of squamous cell carcinoma. The present case indicates implantation of a bladder tumor to perineum by urethero-vasal reflux and metastases to inguinal lymphnodes from the perineal lesion.

[BEP (bleomycin, etoposide, cisplatinum) chemotherapy as an induction therapy of advanced extragonadal germ cell tumor].

Five patients with advanced extragonadal germ cell tumor (EGGCT) were treated with cisplatinum + vinblastine + bleomycin (BVP) or cisplatinum + etoposide + bleomycin (BEP) chemotherapy as an induction therapy. All patients had high levels of tumor markers and multiple distant metastasis in poor nutritious conditions. Two patients given BVP therapy died 6 and 9 months after the chemotherapy. By contrast, three patients given BEP therapy achieved complete remission and were surviving longer than one year without any evidences of disease. Granulocytopenic fever was seen soon after the first course of BEP therapy. Prophylactic granulocyte-colony stimulating factor (G-CSF) treatment, enabled two of them to receive full dose chemotherapy without any fever attacks. In conclusion, BEP chemotherapy is effective to EGGCT as well as far advanced testicular tumors and G-CSF treatment is useful for achievement of induction chemotherapy to advanced germ cell tumors.

[Relation of tumor number to clinical course of superficial papillary bladder tumors].

Clinical courses of 293 patients with superficial papillary bladder tumors were analysed on the basis of tumor number at the first presentation. The follow-up period ranged from 6 to 266 months with a median of 59 months. 171 patients (58%) had a single tumor, while 122 (42%) had multiple tumors. Those older than 60 years occupied 68% in the latter group and 51% in the former (p less than 0.01). High grade tumors were more frequent in the latter than the former (p less than 0.05). The five-year recurrence rate was 68% for the latter and 39% for the former single tumor group (p less than 0.01). Malignant progression was observed in 3.6% of patients with a single tumor and 13.4% of those with multiple tumors (p less than 0.01). The results would offer a theoretical background to the finding of a poor ten-year actuarial survival rate of 54% for multiple tumor group compared with 76% for the single tumor group (p less than 0.05). However, the rate of primary cancer death was similar in both groups.

[Magnetic resonance imaging for the evaluation of prostate cancer metastatic to bone].

The response of bone metastatic lesions to endocrine therapy was assessed by repeated magnetic resonance imaging (MRI) and an isotope bone scan after an average period of 7.0 months (2-10 months) in 12 patients with prostate cancer. MRI used both T1-weighted spin echo technique and short TI IR (STIR) sequence. Of 7 patients with hormone-dependent cancer, the bone metastatic lesions resolved or became vague in all patients on STIR image, while in only 4 and 3 on T1-weighted image and bone scan, respectively. Of 5 patients with hormone-refractory cancer, the lesions progressed on both MRI and bone scan in all patients except one who had initially had diffusely metastatic lesions of systemic bone. The results indicate that STIR image of MRI is helpful for the therapeutic evaluation of bone lesions.

A study on prevention of hospital infection control caused by tooth preparation dust in the dental clinic. Part 1. Preventive measures against environmental pollution in the dental clinic caused by microbial particles.

Tooth preparation dust, an indispensable part of dental treatment, contains bacteria and viruses. In order to examine environmental pollution in the dental clinic during tooth preparation, we monitored microorganism spread by counting colony forming units (CFU) with the "Andersen Microbe Sampler." This test was conducted in a "Clean Booth." Mitis-salivarius medium was used to count the oral-streptococcus species. The ability of the "Extra-Oral Vacuum Aspirator (EOVA)" to effectively eliminate contamination was also tested, and the EOVA was found to reduce the spread of oral-streptococci, significantly. The EOVA was therefore viewed as an effective method for reducing air pollution in the dental clinic, and should be used when treating patients with certain infectious diseases.

The effectiveness of the "Clean-Area-System" for infection control in the dental clinic.

The use of effective infection control procedures and universal precautions in dental clinics, prevents cross contamination that could extend to dental health care workers and patients. The present study was initiated to investigate airborne environmental contamination in the dental clinic by viable cell count of oral streptococci grown on Mitis-Salivarius and blood agar plates. The reduction of the contamination by the "Clean-Area-System" was evaluated. "Andersen-Microbe-Sampler-Apparatus" and "Laser-Particle-Counter-System" were used for sampling and counting the bacterial cells and airborne dust, respectively. Numbers of viable cells counted as total colony forming units (CFUs) in the dental clinic were found to be significantly higher than those in the waiting room and the research laboratory. We found that the "Clean-Area-System" significantly reduced the CFUs grown on blood agar plates (p < 0.05), and that using the "Clean-Area-System" combined with the "Extra-Oral-Vacuum-Aspirator" is desirable in dental procedures such as cavity preparation. The "Extra-Oral-Vacuum-Aspirator" reduced airborne environmental contamination during tooth cutting and ultrasonic scaling procedures. In non-grinding procedures, this system proved to be very useful for infection control in the operative area. The authors concluded that the combined use of "Clean-Area-System" (dust collection ablation) and "Extra-Oral-Vacuum-Aspirator" (absorb dust ablation) was effective to reduce airborne environmental contamination in the dental clinic. We also fully confirmed that oral streptococci were an adequate indicator in the assessment for infection control in dental institutions.

Health-related quality of life among the least dependent institutional elderly compared with the non-institutional elderly population.

The purpose of this study was to investigate health-related quality of life (HRQOL) and functional ability among the least dependent elderly in residential care, and to compare them with information on the general population. A stratified systematic sample (n = 1,587) was drawn from a one-day census of patients in all public residential homes in Finland on December 2, 1991. Sixty-nine per cent of residents in 1992 were able to participate (n = 1,097) and 86% of them returned the questionnaire (n = 948), of which n = 795 were acceptable, the response rate being 72%. A postal survey was used for data collection. The personnel of residential homes were allowed to help residents complete the questionnaire, and 90% of respondents received such help. HRQOL was measured by the Nottingham Health Profile (NHP) and functional ability by a 14-item questionnaire. Finnish studies among the general population were used for comparisons. According to the NHP, the HRQOL appeared lower in institutional care and this was associated with the dependency level. Similarly, for most ADL items the general population had less restrictions than the least dependent residential care patients. In general, women expressed more difficulties in physical mobility and lack of energy than men. The longest stay elderly expressed better HRQOL. In multivariate models adjusted for age and gender those with poor vision had worse HRQOL in almost every dimension of NHP. Difficulties in speech were connected with emotional reactions and social isolation. Chronic illness limiting normal daily life predicted more problems in energy, pain, physical mobility, and emotional reactions. The married or widowed experienced less social isolation than single elderly. Higher education was related to better HRQOL in all NHP dimensions. Poorer perceived health was associated with lack of energy, pain, and emotional reactions. We conclude from these results that there are only a few clients in residential care whose HRQOL or functional ability compare with the non-institutionalized population.