Is there such thing as "reversible dementia" (RD)?

RD is an extremely important problem for the practice of geriatricians. Rationale for this review had come from our question: could we increase and improve the cognitive function of our patients by treating some of "internal medicine" diseases at our hospital. Our clinical experience is telling us that it might be so. We administered the mini mental state examination (MMSE) test on 77 patients to check, if there is a relation between mental state and physical health. Patients were treated with appropriate cardiological, pulmonological and other needed therapies. Results indicate that recovering from the main disease increases the MMSE scores. This leads to the conclusion that successful treatment of patients can be followed and also confirmed by the results of the MMSE test. We have also observed that damaged physical health can inflict cognitive functions, no matter how old a person is.

Prognostic significance of the dobutamine echocardiography test in idiopathic dilated cardiomyopathy.

Dobutamine stress echo provides potentially useful information on idiopathic dilated cardiomyopathy (IDC). From February 1, 1997, to October 1, 1999, 186 patients (131 men and 55 women, mean age 56 +/- 12 years) with IDC, ejection fraction <35%, and angiographically normal coronary arteries were studied by high-dose (up to 40 micro/kg/min) dobutamine echo in 6 centers, all quality controlled for stress echo reading. In all patients, wall motion score index (WMSI) (from 1 = normal to 4 = dyskinetic in a 16- segment model of the left ventricle) was evaluated by echo at baseline and peak dobutamine. One hundred eighty-four patients were followed up (mean 15 +/- 13 months) and only cardiac death was considered as an end point. There were 29 cardiac deaths. Significant parameters for survival prediction at univariate analysis are: DeltaWMSI (chi-square 20.1; p <0.0000), New York Heart Association (NYHA) class (chi-square 17.57; p <0.0000), rest ejection fraction (chi-square 10.41; p = 0.0013), angiotensin-converting enzyme inhibitors (chi-square 8.23; p = 0.0041), and hypertension (chi-square 8.08, p = 0.0045). In the multivariate stepwise analysis only DeltaWMSI and NYHA were independent predictors of outcome (DeltaWMSI = hazard ratio 0.02, p < 0.0000; NYHA class = hazard ratio 3.83, p < 0.0000). Kaplan-Meier survival estimates showed a better outcome for patients with a large inotropic response (DeltaWMSI > or =0.44, a cutoff identified by receiver-operating characteristic curves analysis) than for those with a small or no myocardial inotropic response to dobutamine (93.6% vs 69.4%, p = 0.00033). Thus, in patients with IDC, an extensive contractile reserve identified by high-dose dobutamine stress echocardiography is associated with a better survival.

Preinfarction angina prevents left ventricular remodeling in patients treated with thrombolysis for myocardial infarction.

BACKGROUND: It has been shown that preinfarction angina may have beneficial effects on infarct size and mortality. However, there are no studies that have serially assessed the impact of preinfarction angina on left ventricular (LV) function in a large series of patients. HYPOTHESIS: The study was undertaken to determine whether preinfarction angina (within 7 days before infarction) influences LV remodeling. METHODS: In all, 119 consecutive patients with acute myocardial infarction were serially evaluated by 2-dimensional echocardiography (on Days 1, 2, 3, and 7; at 3 and 6 weeks; and at 3, 6, and 12 months following infarction). Left ventricular volumes were determined using Simpson's biplane formula and normalized for body surface area. Wall motion score index and sphericity index were calculated for each study. Coronary angiography was performed before discharge. RESULTS: Preinfarction angina was detected in 39 of 119 patients. Initial echocardiographic and clinical data as well as the incidence of patent infarct-related artery and collaterals were similar for patients with and without preinfarction angina. In the subset of thrombolysed patients, patients with preinfarction angina showed decrease of LV end-diastolic and end-systolic volumes during the follow-up period (p = 0.033 and p = 0.001, respectively), and improvement of wall motion score index (p < 0.001) and ejection fraction occurred (p = 0.001), without changing of LV shape (p > 0.05); in addition, patients with preinfarction angina had smaller LV volumes and higher ejection fraction than did those without angina, from 3 weeks onward. These favorable effects were not detected in patients not treated with thrombolysis. CONCLUSIONS: These data indicate that preinfarction angina has an inhibiting effect on long-term LV remodeling in patients who underwent thrombolysis for first acute myocardial infarction. It appears that preinfarction angina has no impact on infarct size and early postinfarction LV function.

The comparison of aluminium effects and its uptake by Escherichia coli in different media.

The investigation of the toxic effects and the uptake of aluminium by Escherichia coli in growth medium (GM) and in physiological solution (PS) have been studied. The toxicity was quantitatively determined according to the decrease of the colony forming units (CFU) in the physiological solution, that is its growth inhibition in the growth medium, vs. the aluminium concentration and incubation time, at pH 5.2, 6.2 and 7.2. The uptake of aluminium was investigated by determining the intracellular aluminium in dry weights (DW), by graphite fumace atomic absorption spectrophotometry, considering that aluminium adsorbed to the cell surface was removed by washing with EDTA solution. The results show that toxicity and accumulation increase with the increase of the aluminium concentration and incubation time. However, the linearity of these functions was lost at higher values, which indicate dependence on time and concentration saturation. The effect of pH was specific, and correlated with the form of aluminium in solution. The increase in toxicity as the pH decreases, suggests that the Al(H2O)6(3+) ion is the major toxic form, among the remaining present ones aluminium in aqueous media. The results also show that the aluminium in a concentration range from 0.10 to 10.0 mg/l toxic to E. coli in PS, was significantly less toxic for bacteria in the GM, mainly because of living conditions and the accessibility of free Al.

The disinfection of water by microalloyed aluminium-based composite.

In the submitted paper the water disinfection capacity of the microalloyed aluminium based composite (MABC) was studied. MABC is material in the form of steel wire, plated with microalloyed aluminium. The effects of the composite are based on the very negative stationary potential of microalloyed aluminium, and its spontaneous dissolution in water with generation of AI(III) ions, and reduction of water with the generation of H2 and OH ions. As a final product of these reactions, a voluminous Al(OH)3 precipitate is formed. Having in mind its great efficacy in purification of different waters from many chemical pollutants we made the following hypothesis: reduction characteristics of the MABC surface, presence of Al(III) and OH ions, and coprecipitation on Al(OH)3, can be also toxic and destructive for bacteria in water. The experiments were carried out with the water model solutions (WMS) based on adapted natural surface water (NSW), inoculated with the Escherichia coli. All treatments were performed in the original semi-flow system (SFS), in which convection increases efficacy. The results show that approximately every 10 min the number of viable bacteria was reduced for about one log10 count, with the complete disinfected water phase as the outcome of the treatment. At the end of the treatment, the Al(OH)3 precipitate still contained a low amount of coprecipitated viable bacteria, which died within a relatively short period.

Development of bony acetabulum in newborns with developmental hip dysplasia.

Trend in the development of bony acetabulum in newborns with developmental hip dysplasia was examined during the first year of life. The study comprised 120 newborns with developmental hip dysplasia. The degree of dysplasia was determined by measuring the acetabular angle (AC) on X-rays of the hips in the anteroposterior projection. The experimental trend curve was most adequate for both the whole group and each subject. The coefficient of trend was assessed by specially designed iterative method. The exhibited trend form allows the extrapolation and prognosis of treatment outcome already after 3-5 measurements of the AC angle. The applied iterative method for the determination of the coefficient of exponential trend iterated rather quickly. The chosen form of the trend curve proved to be adequate for manifestations in which a constant value is expected after a longer period of time. The exponential curve represents a mathematical model of the acetabular development dynamics, with allometric exponents and coefficients of the equation being numerical parameters that define developmental changes. As the AC angle reaches the constant value with the closure of triradiate cartilage, this parameter is an objective measure of the development of bony acetabulum. When assessing the acetabular growth in developmental dysplasia it is necessary to bear in mind that duration, specific position and quantity of newly formed and remodelled bone are determined genetically, and that external factors have a significant influence on the definitive formation.

Echosonogrametric diagnosis of developmental dysplasia of the hip.

In view of adding to ultrasonographic scanning of the neonatal hip through various projections and in order to improve the measurement and quantification base of the normal and dysplastic neonatal hip, the research was conducted on anatomic hip preparation of full-term still-born baby. The research on a clinical sample covered 600 ultrasonically examined normal and dysplastic hips. Ultrasonographic serial scanning was performed on various planes using linear transducer with 5 and 7.5 MHz and with or without a water pillow. On the clinical sample of the particular group various projections were applied and results compared with projections obtained on anatomic preparation. Concluded was that with several projections frontal sonographic projections tomographic examination of the hip joint could be performed. Better insight of the position of the femoral head at rest in neutral and flexed positions, the relative stability of the hip with motion and stress and the depth and configuration of the bony and cartilaginous portions of the acetabulum could be obtained if, besides frontal sections, cross sections of the hip were used. Sufficient measurement data echosonogrametric parameters were indispensable for an adequate definition of all hip joint structures.

The role of pelvic MRI in assesment of combined surgical and infliximab treatment for perianal Crohn's disease.

AIM: To evaluate the role of pelvic MRI in diagnosis and assesment of combined surgical and infliximab treatment of perianal Crohn's disease (PACD). METHOD: 24 patients with signs of PACD were prospectively evaluated. They were previously treated with azathyoprin for a period of 6 months to 7 years and antibiotics and than started on Infliximab 5 mg/kg (IFX) at 0, 2 and 6 weeks induction protocol. Luminal CD activity was assesed by colonoscopy. Perianal Disease Activity Index (PDAI) was calculated to evaluate perianal fistulae activity. Surgical examination under anesthesia (EUA) was performed and non-cutting seton placed where appropriate. Pelvic MRI was performed in each patient before Infliximab treatment, and in half of the patients after IFX. MRI criteria were used to asses activity and remission of PACD. RESULTS: 14/24 (58.5%) patients had ileocolitis, 10/24 (41.5%) colitis, and in 22/24 (91.7%) rectum was affected. Median disease duration was 5.5 +/- 2.5 years. MRI revealed simple fistula in 4/24 (16.7%) and complex fistula in 20/24 (83.3%) patients. Abscess was present in 19/24 (79%) patients. Enterocutaneous and recto-vaginal fistula was found in 2 (8.3%) and 3 (12.5%) patients, respectively. Median PDAI before and 8 weeks after IFX treatment was 8.3 +/- 2.08 and 3.5 +/- 1.03, respectively (p = 0.00064). Incomplete response (reduction fistulae drainage by 50%) was found in 10/24 (42%) patients, complete response (no drainage) in 11/24 (46%) patients, while in 3/24 (12.5%) new fistula opened. Control pelvic MRI was performed in 13/24 (54%) patients. Of those, 9/13 (69%) had complete remission according to MRI criteria. Seton was removed after second IFX dose in 15/24 (62.5%) patients and placed again in 2/24 (8%) patients 4 months after completion of IFX treatment. CONCLUSION: In patients with PACD, pelvic MRI before and after IFX treatment is an important diagnostic tool to asses fistula tract localisation, reveal abscess, planning adequate treatment approach and assess the effect of treatment. Surgical decision to remove seton was in accordance with MRI criteria for remission in PACD.

Long-term outcome after admission for acute severe ulcerative colitis in Oxford: the 1992-1993 cohort.

BACKGROUND: To determine the long-term outcome of patients admitted with acute severe colitis (ASC) who avoided colectomy on the index admission, a retrospective cohort study was performed. METHODS: Patients admitted for intensive treatment of ASC in 1992-1993 previously described for a predictive index of short-term outcome in severe ulcerative colitis (UC) were followed for a median 122 months (range 3-144). Complete responders (CR) to intensive therapy had <3 nonbloody stools/day on day 7 of the index admission; incomplete responders (IR) were all others who avoided colectomy on that admission. Main outcome measures were colectomy-free survival, time to colectomy, and duration of steroid-free remission. RESULTS: In all, 6/19 CR (32%) came to colectomy compared to 10/13 IR (P = 0.016; relative risk 3.33, 95% confidence interval [CI] 1.12-9.9). The median +/- interquartile range time to colectomy was 28 +/- 47 months (range 6-99) for CR who came to colectomy versus 7.5 +/- 32 (3-72) months for IR (P = 0.118). Among the IR, 7/13 came to colectomy within 12 months, and all within 6 years from the index admission. The longest period of steroid-free remission was 42 +/- 48 (0-120) months for CR, but 9 +/- 20 (1-35) months for IR (P = 0.011). CONCLUSIONS: One week after admission with ASC in the prebiologic era, IRs had a 50% chance of colectomy within a year and 70% within 5 years, despite cyclosporin and azathioprine where appropriate. The maximum duration of remission in CRs was almost 5 times longer than IRs. It is unknown whether biologics change the long-term outcome.

A quantitative morphometric study of rectal mucosa in adult and aged healthy subjects.

Rectal mucosa is relatively susceptible to pathological processes and frequently it is affected by various diseases. However, there is a notable lack of quantitative data regarding normal rectal mucosa, which would provide a reference for histoquantitative studies of the pathologically changed tissue. Therefore, we obtained the tissue from 27 healthy patients subjected to diagnostic rectoscopy during active screening for asymptomatic cancer of the large intestine, in which no disease was found. Using computer-aided morphometric analysis, we studied all structural elements of the rectal mucosa. The patients were divided into four groups according to the age and sex: adult males, elderly males, adult females and elderly females. The patients under 60 years of age were grouped as adult and those older than 60 years as aged subjects. A decreased height of surface epithelium was registered in both elderly male and female groups. This finding, however, was significant only when adult and elderly male groups were compared. The tendency towards reduction of the mucosal height was also registered comparing male adult and elderly groups. The number of crypts per 0.1 mm2 of tissue increased with aging in both males and females, whereby the crypts were always more numerous in males than in females. The increase in number of crypts in male subjects was accompanied by a decrease in their diameter and perimeter. The changes associated with ageing were discrete and affected only the male subjects.

Short early filling deceleration time on day 1 after acute myocardial infarction is associated with short and long term left ventricular remodelling.

OBJECTIVE: To assess the relations between early filling deceleration time, left ventricular remodelling, and cardiac mortality in an unselected group of postinfarction patients. DESIGN AND PATIENTS: Prospective evaluation of 131 consecutive patients with first acute myocardial infarction. Echocardiography was performed on day 1, day 2, day 3, day 7, at three and six weeks, and at three, six, and 12 months after infarction. According to deceleration time on day 1, patients were divided into groups with short (< 150 ms) and normal deceleration time (>/= 150 ms). SETTING: Tertiary care centre. RESULTS: Patients with a short deceleration time had higher end systolic and end diastolic volume indices and a higher wall motion score index, but a lower ejection fraction, in the year after infarction. These patients also showed a significant increase in end diastolic (p < 0.001) and end systolic volume indices (p = 0.007) during the follow up period, while ejection fraction and wall motion score index remained unchanged. In the group with normal deceleration time, end diastolic volume index increased (p < 0.001) but end systolic volume index did not change; in addition, the ejection fraction increased (p = 0.002) and the wall motion score index decreased (p < 0.001). One year and five year survival analysis showed greater cardiac mortality in patients with a short deceleration time (p = 0.04 and p = 0.02, respectively). In a Cox model, which included initial ejection fraction, infarct location, and infarct size, deceleration time on day 1 was the only significant predictor of five year mortality. CONCLUSIONS: A short deceleration time on day 1 after acute myocardial infarction can identify patients who are likely to undergo left ventricular remodelling in the following year. These patients have a higher one year and five year cardiac mortality.

[The effect of gender on vasomotor function of the vascular endothelium and cardiovascular remodelling during aging]. / Uticaj pola na vazomotornu funkciju endotela krvnih sudova i kardiovaskularno remodelovanje tokom starenja.

INTRODUCTION: Aging is correlated with decreased endothelial vasomotor influence, increased carotid intima-media thickness and stiffness, increased left ventricular mass index and increased blood pressure [1-3]. However, these changes are not expressed in the same way in both genders [4, 5]. It seems that females are more protected from cardiovascular changes during aging compared to males [1, 6]. AIM OF THE STUDY: The aim of the study was to evaluate the influence of gender on brachial vasomotor responses (reactive hyperemia test) as well as the correlation with vascular and cardiac remodelling in healthy volunteers of different ages. MATERIAL AND METHODS: The study was carried out on healthy subjects (n = 66; 37 males, 29 females) of different ages (20-82 years) with no history of cardiovascular diseases and diabetes mellitus. All subjects were normotensive, non-smokers with normal blood lipid and glucose values, were not taking any medication at the time of investigation and were asked to refrain from eating and drinking alcohol, coffee or tea 12 hours before the examination. Subjects were divided in two groups (male and female) and 5 age-related groups according to appropriate decade (20-29, 30-39, 40-49, 50-59, and above 60 years). All subjects underwent regular cardiologic examination, ECG recording and cardiac ultrasound in order to exclude valvular diseases, decreased myocardial contractility and ejection fraction. During the study blood pressure and ECG were recorded continuously. Carotid artery intima-media thickness and brachial artery diastolic internal diameter (mm) and blood flow (ml/min) values were measured continuously using high-resolution ultrasound. Brachial artery parameters were measured in baseline condition, during ischaemia and reactive hyperemia (endothelium-dependent relaxation) and after nitroglycerin administration (endothelium independent relaxation, 2 x 400 micrograms, sublingual) [7, 8]. Brachial ischaemia was induced by inflation of a pneumatic tourniquet placed at the forearm to a pressure of 300 mmHg followed by deflation after 3 min. We analyzed changes in peripheral arteries (changes in brachial artery diastolic diameter and flow during 90 sec after cuff deflation), structural changes of carotid artery, functional and structural changes of the left ventricle (19-11). We used cardiac ultrasound (Hewlett Packard Sonos 2500) with a 2.0-2.5 MHz imaging transducer and a 7.0-MHz linear array transducer for vascular measurements. Demographic and clinical characteristics of subjects are presented in Table 1. All results are expressed as mean and S.E.M. Data analysis was done by linear regression analyses, multivariate test (LSD procedure) and Student's T-test. P values less than 0.05 were considered to be significant. RESULTS: Relative changes in brachial artery diastolic diameter in reactive hyperemia in comparison to aging (with gender distribution) are shown in Graphs 1 and 2. Our study showed decrease in brachial vasodilator response to reactive hyperemia during aging (male p < 0.05, female p < 0.001). Data analysis showed a significant difference between age-related groups above 40 years and groups below 30 years of age (p < 0.001). The analysis of carotid intima-media thickness showed increased values during aging in both genders but without statistical significance (Graph 2). Analysis of relationship between carotid intima-media thickness and aging (by gender) showed a good correlation of these parameters expressed by the following formula: intima-media thickness (cm) = 0.0009 x years of age + 0.0139. ANOVA test for age-related groups showed significant correlation (p < 0.01) between all age-related groups except 30-40 vs. 40-50 year group. Student's T-test showed no significant correlation between genders. The relationship between the left ventricular mass index (LVMI) and aging (with gender distribution) is shown in Graphs 3 and 4. The left ventricular mass index was increased during aging