Apolipoprotein E and B polymorphisms--longevity factors assessed in nonagenarians.

To test if the prevalence of genetic risk factors for coronary heart disease (CHD) is low in individuals who have reached an extremely old age, the allele frequencies of apolipoprotein E (apo E) and B (apo B) polymorphisms and plasma lipoprotein(a) levels were investigated in nonagenarians and in younger control groups. The frequency of the epsilon 4 allele of apo E was significantly lower in the nonagenarians than in the middle-aged and young adults (P < 0.05). Also, the frequency of EcoRI allele R- of apo B was low in the nonagenarians, whereas the allele frequency for the XbaI polymorphism of apo B and plasma lipoprotein(a) concentrations did not differ between the nonagenarians and the younger groups. These findings strongly suggest that the presence of these potential genetic risk factors for CHD, namely the epsilon 4 allele of apo E and the R- allele of apo B, decreases the probability of an individual reaching an extremely old age.

Safety and efficacy of a bulk laxative containing senna versus lactulose in the treatment of chronic constipation in geriatric patients.

Thirty geriatric long-stay patients aged 65-94 years (mean 81.8) participated in the trial the aim of which was to examine bulk laxative plus senna (Agiolax) in the treatment of chronic constipation using lactulose (Levolac) as a reference medicine. Bulk laxative plus senna (daily doses 14.8 g) produced more frequent (p < 0.05) bowel habits (4.5 vs. 2.2-1.9/week) than lactulose (daily doses 20.1 g). Both laxatives proved to be safe to use. Our study indicated bulk laxative plus senna to be more efficient in treating constipation in geriatric long-stay patients.

Diarrhea and fecal impaction in elderly long-stay patients.

A retrospective screening of one year's duration was carried out on 245 permanently hospitalized geriatric patients to study the frequency and cases of periods of at least three days' diarrhea. Such periods were suffered by 65/245 patients and 32% had recurrencies. Fecal impaction was the most common cause of diarrhea (in 55%). Diarrhea was induced by laxatives in 20%. Gastrointestinal infections caused 5% of the diarrhea cases. Immobility and fecal incontinence were strongly associated with fecal impaction in cases of diarrhea. Urinary tract infections treated with antibiotics in the patients with fecal impaction and diarrhea almost were twice as frequent as in patients with other causes of diarrhea or patients with no diarrhea. This retrospective investigation emphasizes the importance of the recognition and proper treatment of constipation, especially in bedridden or chairbound elderly persons with fecal incontinence and diarrhea.

Comparison of the effects of magnesium hydroxide and a bulk laxative on lipids, carbohydrates, vitamins A and E, and minerals in geriatric hospital patients in the treatment of constipation.

In a crossover study the effects of magnesium hydroxide on serum lipids, carbohydrates, vitamins A and E, uric acid and whole blood minerals were compared with those of a bulk laxative containing plantago rind and sorbitol in 64 constipated, elderly long-stay patients, 55 of whom were receiving diuretics. Hypomagnesaemia occurred in 11 (17%) patients after bulk laxative and in two (2%) patients after magnesium hydroxide treatment. There was a slight reduction in low values of high-density lipoprotein cholesterol and high values of triglycerides after magnesium hydroxide treatment. There were no significant differences in plasma lipids, whole blood minerals or vitamins A and E using either laxative. Negative correlations were found between the increase in serum concentrations of magnesium and glycosylated haemoglobin A1 (P less than 0.02) and the serum level of uric acid (P less than 0.01). These results suggest that the long-term effects of magnesium hydroxide and bulk laxative on the absorption of nutrients may not be significantly different. Magnesium hydroxide, however, may have beneficial effects on lipid disorders, impaired glucose tolerance and hyperuricaemia in magnesium deficiency due to diuretics and thus may be a favourable laxative for use in bedridden geriatric patients receiving diuretics.

Constipation in elderly long-stay patients: its treatment by magnesium hydroxide and bulk-laxative.

Sixty-four geriatric long-stay patients aged 65 years or older participated in the trial. All were using laxatives prior to the study. For the study laxatives the mean dose of magnesium hydroxide was 25 ml daily and for bulk-laxative 8.7 g daily. Magnesium hydroxide caused a more frequent bowel habit (13.2 vs. 10.4/4 weeks, p less than 0.001) than bulk-laxative and additional laxative bisacodyl was not needed as often as with bulk-laxative (2.3 vs. 3.3/4 weeks, p less than 0.01). Also the stool consistency was more normal during the magnesium hydroxide treatment. In two patients serum magnesium was over 1.25 mmol/l after the magnesium hydroxide treatment but there were no clinical signs of hypermagnaesemia. Our study indicated magnesium hydroxide to be more efficient than bulk-laxative in treating constipation in elderly long-stay patients.

The carry-over effect on the bowel habit in elderly long-term patients of long-term bulk-forming products containing stimulant laxative.

This study was undertaken to investigate the possible carry-over effect on elderly long-term patients of bulk-forming products containing stimulant type laxatives. Thirty-six patients received magnesium hydroxide daily for a mean period of 10 months prior to the study, and 23 patients received bulk laxatives containing cassiae senna daily for a mean period of 13 months prior to the study. The pre-study laxatives were randomly changed either to magnesium hydroxide or to bulk laxatives. In the patient group receiving a bulk-forming product containing stimulant type laxative long-term prior to the study, the need for additional stimulant laxatives during the pure bulk laxative (3.0 vs. 3.8/4 weeks, NS) or magnesium hydroxide treatment (2.6 vs. 2.7/4 weeks, NS) was not more frequent and the frequency of defaecation was not lower than in the patients (during bulk laxative 11.2 vs. 9.3/4 weeks, NS and during magnesium hydroxide 12.0 vs. 13.7/4 weeks, NS) who received long-term magnesium hydroxide treatment prior to the study. Thus, our data indicated no carry-over effect after the use of bulk-forming laxatives containing senna for 13 months in elderly long-term patients.

Effect of prolonged treatment with acetylsalicylic acid and dipyridamole on platelet thromboxane A2 production in atherosclerotic subjects.

We evaluated the effect of four weeks treatment with 90 mg and 1500 mg of acetylsalicylic acid (ASA), 990 mg of ASA together with 225 mg of dipyridamole and 225 mg of dipyridamole daily on the production of thromboxane A2 (TxA2) by platelets of atherosclerotic subjects. All doses of ASA studied inhibited 99% or more of TxA2 production from the third day to the end of the treatment, whereas dipyridamole did not have any effect. After the treatment, TxA2 production recovered in two weeks. Our results argue against the clinical relevance of the recent suggestions that salicylate accumulating during prolonged treatment with ASA could reduce the effect of the parent drug on the synthesis of TxA2 by platelets. Our data also dispute the inhibition of TxA2 synthesis as an antithrombotic mechanism of dipyridamole.