Anorexia of aging in long term care: is dronabinol an effective appetite stimulant?--a pilot study.

INTRODUCTION: Anorexia and subsequent weight loss increase the risk of death in long term care (LTC) residents. In patients who fail to respond to nutritional intervention, orexigenic drugs are sometimes prescribed. There is limited data regarding the safety and efficacy of these drugs in older adults. OBJECTIVE: To examine the effect of a 12-week course of dronabinol on LTC residents with anorexia and significant weight loss. DESIGN, SETTING, PARTICIPANTS: Retrospective observational study on residents in five LTC facilities in a major metropolitan area. RESULTS: Twenty-eight subjects (22F, 6M) were involved in the study. Mean age 79.5 +/- 19.8 years (range 46-98 y). Mean body weight, serum albumin and serum prealbumin at baseline were 105.7 +/- 24.7 lbs, 3.39 +/- 0.47 g/dl and 22.15 +/- 7.92 mg/dl respectively. 15 subjects (53.5%) gained weight on dronabinol, of which 10 (67%) gained more than 5 lbs and 6(40%) gained more than 10 lbs. Five (33%) subjects gained less than 5 lbs. Residents who lost weight on dronabinol were younger than those who gained weight (70.9 +/- 5.62 y and 90.8 +/- 7.84 y respectively; p = 0.007) Overall, the mean weight gain on dronabinol was 3 +/- 8.01 lbs (p=0.2). Eleven subjects lost weight (mean loss 3 +/- 2.6 lbs). Of the subjects who lost weight 7 (64%) died compared with 4 (26%) in the subgroup who gained weight. CONCLUSIONS: Dronabinol therapy was well tolerated. Overall, there was a trend toward weight gain in LTC residents treated with 12 weeks of dronabinol. Failure to respond to dronabinol may indicate increased risk of death.

Treating malnutrition with megestrol acetate: literature review and review of our experience.

Megestrol acetate is a semi-synthetic progestational steroid that was originally used as a therapeutic modality for metastatic breast and endometrial cancers. What was originally considered to be it's most frequent side effect, an increase in appetite and in body weight, has gradually become an established treatment of malnutrition in patients with the acquired immuno-deficiency syndrome or with non-hormone responsive cancers. The use of megestrol acetate in treating malnutrition in older persons, in patients on dialysis and in a number of other situations is currently under investigation. The authors review the evidence available to support the use of megestrol acetate in treating malnutrition in these selected groups, and the problems associated with administering megestrol acetate; they also report on their own experience with megestrol acetate in the geriatric population.

Health issues unique to the aging man.

Several health conditions specifically involve men, including impotence (erectile dysfunction), androgen deficiency syndrome, benign prostatic hypertrophy, prostate cancer, baldness, and gynecomastia. This article reviews the major features of these syndromes and highlights the specific nursing issues involved.

Tinea capitis caused by Trichophyton rubrum.

Tinea capitis is seldom caused by Trichophyton rubrum. A case is reported in a young British child and the literature reviewed.

Rotational dynamics of luteinizing hormone receptors on bovine and ovine luteal cell plasma membranes.

To determine whether LH receptor rotational diffusion is similar in closely related species, we compared the rotational correlation times of LH receptors on bovine CL membranes with those of LH receptors on sheep small luteal cells and luteal cell plasma membranes using time-resolved phosphorescence anisotropy techniques. After binding of erythrosin isothiocyanate (ErITC)-derived bovine LH (bLH), ErITC-ovine LH (oLH), or ErITC-hCG, there was no difference in the initial and final anisotropy at 4 degrees C, 15 degrees C, 25 degrees C, and 37 degrees C, indicating that the bLH receptor was rotationally immobile on the time scale of our experiments. On these same membrane preparations, the epidermal growth factor (EGF) receptor occupied by ErITC-murine EGF exhibited temperature-dependent rotational correlation times of 80 +/- 5 microseconds, 111 +/- 7 microseconds, 254 +/- 4 microseconds, and > 1000 microseconds at 4 degrees C, 15 degrees C, 25 degrees C, and 37 degrees C, respectively. Slower rotational times for EGF receptor observed at higher temperatures suggested the occurrence of temperature-dependent receptor aggregation. Like the bLH receptor, the oLH receptor on intact cells and on CL plasma membranes was rotationally immobile on the time scale of our experiments when occupied by ErITC-hCG. However, the oLH-occupied receptors on small luteal cells and on luteal cell membranes had comparable rotational correlation times at 37 degrees C. These results suggest that bLH receptors are present in large, rotationally immobile structures, whereas the receptor-containing structure formed on ovine luteal cells depends on whether that receptor is occupied by hCG or oLH. Also, despite the similarities between reproductive function in these species, the LH-occupied receptor appears to be organized differently in the plasma membranes of these hormone-responsive luteal cells.