PREDICTORS OF SUDDEN CARDIOVASCULAR DEATH IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CONNECTIVE TISSUE DYSPLASIA.

Connective tissue dysplasia (CTD) occurs in 70% of the patients with obstructive bronchial pathology. It promotes the development of electrical instability of myocardium and life-threatening arrhythmias. We studied electrocardiographic markers of myocardial instability in patients with chronic obstructive bronchial pathology and CTD markers. Such patients were shown to more frequently have ventricular and supraventricular arrhythmias, decreased circadian heart rate index and enhanced heart rhythm variability. Other findings included high frequency of such predictors of sudden cardiovascular death as prolonged and enhanced dispersion. of QT intervals, T-wave microalternation, late atrial and ventricular potentials. The arrhythmic activity and the occurrence of predictors of sudden cardiovascular death increased in the patients aged above 60 vears with obstructive bronchial Pathology and CTD.

[Main factors of remodeling of vascular wall].

With a purpose of identifying and ranking factors influencing remodeling of vascular wall in 168 practically healthy subjects (71 men, 97 women) aged 30-60 years we conducted a study of risk factors of cardiovascular disease, and infectious, immunological, inflammatory and metabolic parameters. Using artificial neural network we found that process of remodeling of vascular wall was most significantly impacted by: cytomegalovirus and hlamydia neumoniae infections, decreased number of T-lymphocytes, development of latent vascular microinflammation, and diastolic blood pressure above 80 mm Hg.

Urinary free cortisol excretion in elderly persons with minor and major depression.

Several studies have found that cortisol hypersecretion may occur in severely depressed patients, characterized by melancholic features. On the other hand, illness chronicity seems to be related to low, rather than high, cortisol levels. This study aims to trace factors associated with 24-h urinary free cortisol levels in a sample of 23 elderly persons with major or minor depression and 21 non-depressed control subjects. Depressive episodes were subdivided according to severity and chronicity (i.e. length and recurrence). None of the depressed persons showed unusually high 24-h cortisol levels, and cortisol excretion was not elevated as compared with that in the control group, regardless of subtype of depression. The results suggest, however, that hyposecretion of cortisol may be a feature of chronic depressive episodes, especially in males.

[Drug utilization by the elderly with depressive symptoms]. / Medicijngebruik door ouderen met depressieve klachten.

OBJECTIVE: Obtain a picture of non-psychiatric medication use and depressogenic medication use by elderly people suffering from depression. DESIGN: Cross-sectional, self-reported by respondents. METHOD: Information about medication usage and the presence of chronic diseases was obtained from 183 depressive respondents and 96 control respondents. The respondents were aged 55 years or over. They were recruited between April 1996 and May 1998 in the provinces Groningen, Drenthe and Friesland, the Netherlands. Recruitment was via Regional Institutes for Outpatient Mental Health Care (RIAGGs), a psychiatric outpatient clinic, general practitioners participating in the 'Groningen longitudinal ageing study' (GLAS), a survey under the elderly within the general population, and screening with the 'Geriatric depression scale' (score > or = 6) in the GLAS main file. RESULTS: Respondents with subsyndromal depression recruited via screening were prescribed more depressogenic medication (mean: 3.26 drugs per patient, of which 45.6% depressogenic) than the control group (respective figures: 1.78; 26.1%) and the depressive groups recruited via general practitioners (2.77; 31.8%) or those recruited via RIAGGs/psychiatric outpatient clinic (2.60; 38.3%).

Depression in later life: three etiologically different subgroups.

BACKGROUND: Various studies support the notion that early onset depression and late onset depression have different etiological pathways. Late onset depression has been found to be a heterogeneous group. This study attempts to divide the late onset group in two subgroups with different aetiology and find evidence for the vascular depression hypothesis. METHODS: Subjects were 132 depressed elderly persons from the general population, general practitioners and mental health care outpatient clinics. Sixty-four had early-onset depression (< 60), 69 had late-onset depression (> or = 60). The latter group was divided into subjects with (n = 15) and without (n = 15) severe life stress. The groups were compared with respect to a variety of variables including vascular risk factors RESULTS: Early-onset depression was associated with neuroticism and parental history. Subjects with late-onset depression and no severe life stress had higher vascular risk factors than whose depression was preceded by a severe stressor did. CONCLUSIONS: Our findings suggest that late life depression can be divided into subgroups with different etiological pathways: (1) early-onset with longstanding psychobiological vulnerability; (2) late-onset as reaction to severe life stress; and (3) late-onset with vascular risk factors.

Increase of NK-T cells in aged depressed patients not treated with antidepressive drugs.

BACKGROUND: A change in number and/or activity of natural killer cells has repeatedly been reported in depressive illness. Much less attention has yet been given to the subgroup of natural killer cells that are positive for the T-cell marker CD3 (NK-T cells). These cells possibly have important immunoregulatory properties. METHODS: We compared number and percentage of NK-T cells (defined as CD3(+) and CD16(+) and/or CD56(+) by two-color flow cytometry) in the peripheral blood of control subjects and two groups of elderly depressive subjects using or not using antidepressive drugs. RESULTS: The number and percentage of NK-T cells were strongly elevated in elderly depressive subjects not using antidepressive drugs, as compared with control subjects and elderly depressive subjects using antidepressive drugs. CONCLUSIONS: Depressive illness in a geriatric population is associated with a substantial increase of NK-T cells. This increase was absent in a depressive group using antidepressive drugs.

Correlates of symptomatic, minor and major depression in the elderly.

BACKGROUND: Associations between different types of depression with clinical characteristics and putative vulnerability factors from several domains (health, disability, personality, familial psychopathology) were studied in a sample of elderly subjects, in order to find arguments that support or discard the notion of discontinuity in correlates of depression. METHODS: Subjects were 183 depressed elderly persons from the general population, general practitioners and mental health care outpatient clinics, and a random elderly control group (n=74). Depression was subdivided into symptomatic (n=45), DSM-IV minor (n=73), and DSM-IV major (n=65) depression. The groups were compared with respect to a variety of variables from different domains. RESULTS: Most variables showed a marked difference between the control group and the depressive groups, and smaller or no differences between depressive subtypes. LIMITATIONS: The data were collected cross-sectionally. CONCLUSIONS: With a few notable exceptions, all subtypes of depression were significantly different from the control group, while differences between depressive subtypes were generally smaller. Depressive subtypes showed no discontinuum with respect to the associated variables. Similar associations in different subtypes of depression may indicate common vulnerability factors.

Effect of seating position and restraint use on injuries to children in motor vehicle crashes.

OBJECTIVE: To determine the effect of restraint use and seating position on injuries to children in motor vehicle crashes, with stratification by area of impact. METHODS: Children <15 years old involved in serious automobile crashes in Utah from 1992 through 1996 were identified from statewide motor vehicle crash records. Serious crashes are defined as those resulting in occupant injuries with broken bones or significant bleeding or property damage exceeding $750. Probabilistic methods were used to link these records with hospital records. Analysis used logistic regression controlling for age, restraint use, occupant seating position, and type of crash. RESULTS: We studied 5751 children and found 53% were rear seat passengers. More than 40% were unrestrained. Sitting in the rear seat offered a significant protective effect (adjusted odds ratio: 1.7; 95% confidence interval: 1.6-2.0), and restraint use enhanced this effect (adjusted odds ratio: 2.7; 95% confidence interval: 2.4-3.1). Mean hospital charges were significantly greater for front seat passengers. CONCLUSIONS: Rear seat position during a motor vehicle crash provides a significant protective effect, restraint use furthers this effect, and usage rates of restraint devices are low. The rear seat protective effect is in addition to and independent of the protection offered from restraints.

Severe ventilatory compromise due to gastric distention during pediatric cardiopulmonary resuscitation.

We describe a child in cardiac arrest with severe ventilatory compromise due to gastric distention. During cardiopulmonary resuscitation (CPR), positive pressure ventilation may lead to gastric insufflation because of decreased pulmonary compliance and decreased lower esophageal sphincter tone. Essentially, gas delivered will follow the path of least resistance, which may be to the stomach. In our patient, gastric distention precluded effective ventilation and gastric decompression relieved ventilatory compromise. The values and pitfalls of clinical evaluation and capnography are presented.

Assisted ventilation does not improve outcome in a porcine model of single-rescuer bystander cardiopulmonary resuscitation.

BACKGROUND: Mouth-to-mouth rescue breathing is a barrier to the performance of bystander cardiopulmonary resuscitation (CPR). We evaluated the need for assisted ventilation during simulated single-rescuer bystander CPR in a swine model of prehospital cardiac arrest. METHODS AND RESULTS: Five minutes after ventricular fibrillation, swine were randomly assigned to 8 minutes of hand-bag-valve ventilation with 17% oxygen and 4% carbon dioxide plus chest compressions (CC + V), chest compressions only (CC), or no CPR (control group). Standard advanced life support was then provided. Animals successfully resuscitated received 1 hour of intensive care support and were observed for 24 hours. All 10 CC animals, 9 of the 10 CC + V animals, and 4 of the 6 control animals attained return of spontaneous circulation. Five of the 10 CC animals, 6 of the 10 CC + V animals, and none of the 6 control animals survived for 24 hours (CC versus controls, P = .058; CC + V versus controls, P < .03). All 24-hour survivors were normal or nearly normal neurologically. CONCLUSIONS: In this model of prehospital single-rescuer bystander CPR, successful initial resuscitation, 24-hour survival, and neurological outcome were similar after chest compressions only or chest compressions plus assisted ventilation. Both techniques tended to improve outcome compared with no bystander CPR.