Community survey of home nebulizer technique by elderly people.

To determine the prevalence and nature of difficulties elderly subjects experience using home nebulizers we have studied all patients in the Leeds Health District aged 70 years and older loaned a nebulizer from the hospital for at least 6 months. Of 42 subjects with a nebulizer, 40 (95%) agreed to assessment. They had a mean age of 79 years (range 70-84 years) and mean duration of nebulizer use of 38 months (range 6-120 months). Twenty subjects had one or more problems with 14/40 (35%) rated as moderate or severe; difficulties with cleaning 16/40 (40%) and filling 7/40 (18%) were the most frequent; 13/40 (33%) were sometimes or always dependent on their carers to administer their nebulizers. Elderly subjects often experience practical difficulties, or require help from a carer, when using a home nebulizer.

Evidence against a putative role for glucagon as a physiological splanchnic vasodilator in man.

1. Previous studies have suggested that glucagon in supraphysiological doses may mediate postprandial and hypoglycaemia-induced splanchnic vasodilatation in man and experimental animals. There are no reported studies investigating the role of glucagon in doses producing circulating concentrations within the physiological range. 2. Two separate studies were performed. In study 1, superior mesenteric artery blood flow was measured by Doppler ultrasound in six normal subjects during either saline or glucagon infusion at 1, 3 and 6 ng min-1kg-1, which resulted in circulating glucagon levels within the physiological range. Mean superior mesenteric artery blood flow fell during the 3 and 6 ng min-1kg-1 glucagon infusions (3 ng min-1kg-1: -31.8%, range -20 to -56% of baseline; 6 ng min-1kg-1: -20.7%, range -8 to -53% of baseline; P < 0.05). 3. In study 2, superior mesenteric artery blood flow was measured during hypoglycaemia induced by an insulin infusion in 12 normal subjects. In six of these subjects the effect of suppression of glucagon release during hypoglycaemia was assessed by pretreatment with the somatostatin analogue octreotide (0.8 microgram/kg subcutaneously) given 30 min before the insulin infusion. 4. The nadir in blood glucose concentration at the hypoglycaemic reaction was similar in both groups and glucose recovery was complete by 60 min after the hypoglycaemic reaction. Plasma catecholamine concentrations rose in both groups after the hypoglycaemic reaction. 5. Superior mesenteric artery blood flow rose at the hypoglycaemic reaction in both groups despite suppression of glucagon release with octreotide.(ABSTRACT TRUNCATED AT 250 WORDS)

Splanchnic blood flow in man: evidence for mediation via a beta-adrenergic mechanism.

1. Superior mesenteric artery blood flow was examined by Doppler ultrasound in six male subjects aged 19-23 years during the infusion of saline (control), 10 and 40 ng of adrenaline min-1kg-1 for 30 min, or propranolol and 10 ng of adrenaline min-1kg-1 for 30 min, on four separate occasions. 2. Adrenaline infusion resulted in significant peak mean (SEM) rises in circulating adrenaline concentrations during the infusion period only [control, 0.20 (0.05) nmol/l; 10 ng of adrenaline min-1kg-1, 1.37 (0.29) nmol/l; 40 ng of adrenaline min-1kg-1, 3.73 (0.40) nmol/l; 10 ng of adrenaline min-1kg-1 and propranolol, 1.48 (0.16) nmol/l, P < 0.001 versus control]. These values are within the physiological range. 3. Superior mesenteric artery blood flow rose in a dose-dependent manner during the adrenaline infusions alone, but not during the infusion of adrenaline and propranolol [mean (95% confidence interval) area under the curve: control, -4.2 (-11 to +2.7)%; 10 ng of adrenaline min-1kg-1, +4 (-1 to 11.9)%; 40 ng of adrenaline min-1kg-1, +34 (+6.5 to +61.5)%; 10 ng of adrenaline min-1kg-1 and propranolol, -8.4 (-23 to +6)%]. 4. Superior mesenteric artery resistance fell during the adrenaline infusions alone and rose during the combined adrenaline and propranolol infusion [mean (SEM) area under the curve: control, 6.4 (2.7)%; 10 ng of adrenaline min-1kg-1, -2.9 (2.5)%; 40 ng of adrenaline min-1kg-1, -15 (1.4)%; 10ng of adrenaline min-1kg-1 and propranolol, 16.9 (10)%]. 5. These data suggest that splanchnic vasodilatation is mediated via a beta-adrenergic mechanism.

Dysphagia in the elderly: what does it mean to the endoscopist?

The role of fibreoptic endoscopy in the investigation of dysphagia in an elderly population was investigated. Three hundred and sixty-five subjects were studied. Two hundred and sixty subjects had abnormalities with extra oesophageal disease accounting for symptoms in a substantial minority. Endoscopy was safe, offered the advantage of immediate therapy and was well tolerated. Sub-group analysis showed it to be preferable to radiological investigation in diagnosing both benign and malignant mucosal lesions.

Trends in primary care in the United Kingdom.

Trends in primary care in the United Kingdom were studied using the diagnostic information available at Intercontinental Medical Statistics Ltd (IMS) for 1969-80. Total consultation rates overall showed an increase until 1978 when they started to decline. Diseases of the respiratory system showed a decline for first consultations. Diseases of the musculoskeletal and connective tissue and diseases of the nervous system and sense organs showed an increase. Diseases of the respiratory system, circulatory system, and mental disorders accounted for 15.4%, 11.2%, and 9.6% respectively of the total consultations in 1980. Neuroses and personality disorders accounted for the highest consultation rates in general practice. This study identifies areas for further research in general practice and the potential of this data base, if expanded, for the continuous monitoring of morbidity in primary care.