Cholinesterase inhibitors slow decline in executive functions, rather than memory, in Alzheimer's disease: a 1-year observational study in the Sunnybrook dementia cohort.

To determine if there are differential treatment effects of second-generation cholinesterase inhibitors over one year, 130 patients (untreated=65, treated=65) meeting NINCDS-ADRDA criteria for mild or moderate probable AD underwent standardized cognitive testing at baseline and 12 months later at a university memory clinic. Patients were followed either prior to or after the availability of treatment and were matched on education and baseline Mini Mental State Examination (MMSE). A detailed medical history evaluation was conducted. In this well matched longitudinal observational cohort study, there were no differences in the prevalence of comorbid illnesses, concomitant medication use or vascular risk factors except for a greater number of treated patients with a previous history of smoking. Separate repeated measures MANCOVAs on the MMSE, Mattis Dementia Rating Scale (DRS), and its 5 subscores (attention, initiation/perseveration, conceptualization, construction and memory) (Bonferroni corrected), after covarying for the effects of smoking, and SSRI use, showed less decline over one year in the treated group in overall cognition and in all subscores of the DRS except for memory (effect sizes 0.5-0.7). Less decline was also seen in the treated group in function and in instrumental and basic activities of daily living as measured with the Disability Assessment for Dementia Scale (DAD) (effect sizes 0.4-0.8). Executive, language and visuospatial functions, rather than memory, appeared to be more amenable to stabilization over one year by cholinesterase inhibitors in AD.

Autologous thin thiersch's grafts in vitiligo: experience of 8000 cases, 50000 grafts (1959-98) with modified technique in 198 cases in the year 1997-98.

The present study, spread over past four decades of experience gathered after operating 8000 stable vitiligo patients, reaffirms the value of thin Thiersch's grafts in treating this disfiguring disease. Under experienced hands, the success rate can be over 95%. However, selection of the patient, quality of the graft and the state of the donor and recipient sites can affect the final outcome.

Etiopathogenesis of vitiligo : Are we dealing with an environmental disorder ?

The increasing incidence of vitiligo in this part of the world (4.25%), prompted us to study 5000 fresh vitiligo patients. Several triggering factors were elicitable. Malnutrition and intake of junk food were very common in childhood vitiligo. Intercurrent infections as well as intake of antibotics were also significant, immediately preceding the development of depigmented patches in younger age group. Genetic predisposition was uncommon. Autoimmune disorders were infrequent and usually accompanied late onset vitiligo. For management, vitiligo was classified into VI (active), V2 (quiescent) and V3 (improving) stages. The therapy administered varied in each stage. As a common denominator, all out efforts were made to eliminate possible trigger factors in individual cases throughout the period of treatment, and building the general health to prevent recurrence in future. The study strongly points out that vitiligo is a multifactorial disorder. It can be effectively managed after each patient is individually assessed. Elimination of possible triggering factors may form the mainstay of vitiligo therapy along with controlled pharmacological intervention. The improvement of general resistance of body may bring spontaneous repigmentation.

Results of tricuspid valve replacement for nonrheumatic and noninfective disease.

Because of the rarity of isolated, nonrheumatic, noninfective tricuspid valvular disease, the long-term results of treatment by tricuspid valve replacement are uncertain. From June 1967 to April 1986, we implanted 23 biological or mechanical tricuspid valve prostheses in 20 patients for nonrheumatic, noninfective endocarditis. All cases were followed from 1 to 20 years after the procedure, for a total of 215.08 patient-years. There were 2 hospital deaths and 3 late deaths. Actuarial analysis indicated a mortality rate of 1.39% + 1.6% per year. Late morbidity included 3 episodes of prosthetic thrombosis in 2 patients, arrhythmias in 5 patients, and recurrent spontaneous abortions in 1 patient. New York Heart Association Functional Class improved in all survivors. We conclude that tricuspid valve replacement, especially when a bioprosthesis is used, can be performed with a low operative risk and good long-term results in patients who have nonrheumatic, noninfective, valvular disease.

Post infarction ventricular septal defect. Review of 41 surgical cases.

Forty-one patients with ventricular septal rupture after myocardial infarction were operated over about a 4-year period. The "early" group included 17 patients operated upon within the first 24 hours and 13 of them died. A total of 29 patients were operated within the first week and 21 died. The other 12 were operated after the first week since the diagnosis was made and 11 (92%) survived. The most relevant risk factors were: cardiogenic shock, hypertension and diabetes. The initial management was based on digitalis, diuretics, inotropes (dopamine, dobutamine) and the intra-aortic balloon pump. There was no significant difference in mortality between those patients with associated procedures and those without them, except in those cases of coronary grafts with infartectomy, whose mortality was higher. Early surgical repair of ventricular septal rupture implies a very high mortality (72%), which is even worse when the operation is performed within the first 24 hours (76%).

Isolated coarctation of the aorta: surgical treatment and late results. Eighteen years' experience.

From March 1967 to February 1985, ninety one patients aged from eleven months to 53 years underwent surgical treatment of isolated coarctation of the aorta. On reviewing the long term results it was found that persistence of hypertension was related to the age when the operation was performed. Dividing the patients into three age groups; group I: 0-5 years, group II: 6-15 years and group III: over 15 years, it was found that there was no late hypertension in group I while hypertension persisted in 11% in group II and 25% in group III. Fifty per cent of the patients with persistent hypertension were above the age of 20 years at the time of operation. The need for graft replacement was related to age of the patients and to the anatomy of the coarctation being used more frequently in older patients and in those where the coarctation was at the junction of the arch and the descending aorta or proximal to that site. Because of this relationship to the anatomy, the coarctations were classified into 4 types. The surgical procedures performed were: resection with end to end anastomosis, resection with replacement by a tube graft, patch and bypass grafts, in descending order of frequency. Eighty six patients have been followed up (mean 10 years). There was no hospital or late mortality (one patient committed suicide one year after operation) and none of the patients suffered from spinal cord injury. There were three recurrent coarctations in patients who had primary reconstruction under one year of age.(ABSTRACT TRUNCATED AT 250 WORDS)

Terapia antiplaquetaria despues de cirugia coronaria / Antiplatelet therapy after coronary surgery

El tratamiento post-operatorio con drogas antiplaquetarias ha demostrado ser benefico para prevenir la obstruccion de injertos venosos utlizados en cirugia coronaria. Este estudio analiza 2 grupos de pacientes, uno (212) si terapia antiplaquetaria y el otro (205) con antiplaquetarios. Se encontro una diferencia importante en la recurrencia clinica de la angina post-operatoria. Se discute la fisiopatologia en la oclusion post-operatoria temprana y tardia de los injertos y el efecto de los medicamentos antiplaquetarios en la prevencion de ese fenomeno

Niveles de hemoglobina y cirugia coronaria: II. Relacion entre concentracion de hemoglobina y angina recurrente despues de cirugia coronaria / Hemoglobin levels and coronary surgery: II. Relationship between hemoglobin concentration and reccurrent angina after coronary surgery

Con el objeto de probar la relacion existente entre bajas concentraciones de hemoglobina y menor riesgo de trombosis despues de cirugia coronaria, y en esta forma menor incidencia de angina recurrente, hemos tomado en cuenta los niveles de hemoglobina en 212 pacientes sometidos a cirugia de injerto aorto-coronario (bypass). La incidencia de angina recurrente encontrada en enfermos con niveles altos de hemoglobina (alrededor de 13-14 g%) fue significativamente mayor en comparacion con aquellos que tuvieron concentraciones relativamente bajas (alrededor de 11 g%), con una significancia estadistica de p<0,001.

Surgical treatment of isolated coarctation of the aorta: 18 years' experience.

From March 1967 to February 1985 91 patients aged from 11 months to 53 years underwent surgical treatment of isolated coarctation of the aorta. The surgical procedures in descending order of frequency, were: resection with end to end anastomosis, resection with replacement by a tube graft, patch aortoplasty, and bypass graft. Resection with end to end anastomosis was achieved mainly in younger patients. The number of patients needing other procedures increased with advancing age. Eighty six patients have been followed up (mean 10 years). There were no hospital or late deaths and none of the patients suffered from spinal cord injury. There were three recurrences of the coarctation, all in patients who had had primary reconstruction below the age of one year. The patients were divided into three groups by age: group 1, 0-5 years; group 2, 6-15 years; and group 3, over 15 years. It was found that there was no late hypertension in group 1 while hypertension persisted in 7% of group 2 and in 28% of group 3. Fifty per cent of the patients with persistent hypertension were above the age of 20 years at the time of operation and had resection with replacement by a tube graft. It is recommended that elective surgery for coarctation of the aorta should be performed at the age of 3-5 years to avoid both recurrence of stenosis and persistent hypertension.

A simple, inexpensive method of unilateral sternal retraction.

A method of unilateral sternal retraction for the dissection of internal mammary artery is described. The procedure is safe, simple, and inexpensive.

Sonography in complicated hepatic amoebic abscess.

Ultrasound examination was conducted on 150 patients with hepatic amoebic abscesses. Twenty of 150 patients were found to have various complications such as direct thoracic involvement, peritoneal rupture, subphrenic collection, obstructive jaundice and ascites. Ultrasound examination of the liver is not only useful in demonstrating the abscess cavity but it also depicts the complications extremely well.

Foley catheter in cardiac surgery.

Three cases of massive hemorrhage during open heart surgery are reported. They were successfully treated using a Foley catheter.

Mediastinoscope: another use.

We describe a technique for the retrieval of left atrial pressure monitoring catheters using a mediastinoscope. The procedure is simple, safe and it can be accomplished quickly without re-opening the sternum.

The preparation of saphenous veins for coronary artery bypass grafts.

Coronary grafting is the commonest operation nowadays performed in the Western world. Its success depends on the quality of the vein harvested; this task should be the duty of the most skilled surgeon of the team. This article lays down a rational quick efficient and successful technique so that the coordinated simultaneous procedures necessary in the early phase of a coronary graft operation result in an excellent vein in good time for its implantation in the heart.