An internal medicine perspective review of risk factors for assessing and progression of primary open angle glaucoma.

Aim of this review was to resume risk factors for the assess and progression of primary open-angle glaucoma (POAG), particularly considering systemic risk factors that can be associated with glaucomatous damage. If intraocular pressure is the main risk factor, we must consider carefully familiarity, age, gender and possible associations with diabetes, hypertension, vascular autoregulation disorders, hypo- and hyperthyroidism, hypo- and hyperadrenalism, sleep apnea syndrome, corticosteroids therapies and other suspected factors cited in literature. Glaucoma's etiology remains unknown, its physiopathology is poorly understood and its diagnosis is often difficult. It is the leading cause of irreversible blindness worldwide and it is the real "silent thief of sight" because the loss of vision often occurs gradually over a long period of time, and symptoms only occur when the disease is quite advanced. Cost-effectiveness analyses for POAG screening are weighted by the degree of uncertainty that glaucoma screening can be effective and reliable achieved. Addressing patients to an ophthalmologic investigation on the basis of the identified risk factors is a fundamental preventing measure.

Accumulation of polyamines and their weak association with lower body temperature in elderly convalescent patients.

Because spermine and spermidine have caused hypothermia in rodent experiments, we tested the hypothesis that these polyamines accumulate in some elderly convalescent patients and that this accumulation could predispose to lower body temperature. Fourteen healthy young, seven healthy older, and 47 convalescent elderly subjects had serum spermine and spermidine concentrations measured by high-pressure liquid chromatography. The mean +/- SD spermine values were 18 +/- 10, 24 +/- 15, and 40 +/- 54 ng/ml, respectively. The values for spermidine were 28 +/- 10, 38 +/- 29, and 76 +/- 46 ng/ml, respectively. The differences between the young and convalescent elderly were statistically significant for both compounds. Rectal temperatures were measured in 39 elderly convalescent subjects with a thermometer designed for accuracy at low temperatures. These subjects were stratified into a warm and cool half based on a median rectal temperature of 37 degrees C. There was an association between having high spermine levels and being in the cool half of the elderly convalescent group (P less than 0.05). We conclude that some elderly convalescent patients have high levels of spermidine and spermine and that these high spermine levels may be associated with lower body temperature.

Antidepressant therapy after stroke. A double-blind trial.

Twenty-seven inpatients participating in a stroke rehabilitation program were randomized to receive either placebo or trazodone hydrochloride (Desyrel) beginning a mean (+/- SEM) of 44 +/- 4 days after stroke. The target dosage was 200 mg/d. Patients with either a clinical diagnosis of depression or abnormal Zung depression scores showed a consistent trend toward greater improvement in Barthel activities of daily living (ADL) scores with trazodone than with placebo. An abnormal dexamethasone suppression test result was associated with significant improvement in the Barthel ADL scores of patients receiving trazodone (38 +/- 6 vs 20 +/- 6 for placebo). Patients with stroke and evidence of depression are therefore likely to benefit from treatment with trazodone.

The dexamethasone suppression test. An indicator of depression in stroke but not a predictor of rehabilitation outcome.

The dexamethasone suppression test (DST) result was found to be abnormal in 49% of patients who were an average of seven weeks post stroke. The DST response correlated with depressive symptoms as measured by both the Zung and modified Hamilton Depression scales. The specificity of the DST for clinically diagnosed depression reached 87% for the 8 AM cortisol determination, with a corresponding sensitivity of 47%. It was not related to the patient's final level of self-care function as measured by the Barthel score, need for nursing home placement following discharge, or duration of rehabilitation needed to achieve maximum benefit. Abnormal responses were more prevalent in cerebral hemisphere than in brain-stem or cerebellar strokes. The more extensive the stroke the more likely the possibility of an abnormal DST response. The DST response is stable, with test-retest replicability being 84% at two weeks and 74% at seven weeks.

Energetics of isometric exercise in man.

In isometric contractions of the plantar flexors (5-40% of maximal tension, Tmax), VO2 is linearly related to the force exerted, averaging 2 ml/min-kg of tension. At tension levels above 5% Tmax the lactic acid contribution to the overall energy demand is constant at about 20%. Therefore, up to at least 40% Tmax,-muscle blood flow is not totally occluded, though it is impaired even at low force levels. Below 5% Tmax no lactic acid (LA) accumulates in blood. The energy required for the development of the tension is linearly related to the force exerted up to 33% Tmax, thereafter increasing disproportionately. In the transition from rest to static contractions of the plantar and forearm flexors (30 and 40% Tmax, respectively) VO2 increases initially to 200% of the controls, leveling off later at 150%. During recovery, VO2 increases up to 200% of the initial resting level, due to the payment of a large O2 debt, decreasing then with a t 1/2 of about 30 s. The glycolytic component is relatively more important in isometric contractions of the forearm than of the plantar flexors. No LA accumulates in static contractions of the plantar flexors of 5-10 s duration interrupted by equal pauses.