Interventional stroke therapies in the elderly: are we helping?

BACKGROUND AND PURPOSE: It is unclear whether endovascular therapies for the treatment of AIS are being offered or are safe in older adults. The use and safety of endovascular interventions in patients older than 75 years of age were assessed. MATERIALS AND METHODS: A retrospective review of patients with AIS 75 years or older (n = 37/1064) was compared with a younger cohort (n = 70/1190) by using an established data base. Admission and discharge NIHSS scores, rates of endovascular treatment, SICH, in-hospital mortality, and the mBI were assessed. RESULTS: Rates of endovascular treatments were significantly lower in older patients (5.9% in the younger-than-75-year versus 3.5% in the older-than-75-year cohort, P = .007). Stroke severity as measured by the NIHSS score was equivalent in the 2 age groups. The mBI at 12 months was worse in the older patients (mild or no disability in 52% of the younger-than-75-year and 22% in the 75-year-or-older cohort, P = .006). Older patients had higher rates of SICH (9% in younger-than-75-year versus 24% in the 75-year-or-older group, P = .04) and in-hospital mortality (26% in younger-than-75-year versus 46% in the 75-year-or-older group, P = .05). CONCLUSIONS: Patients older than 75 years of age were less likely to receive endovascular treatments. Older patients had higher rates of SICH, disability, and mortality. Prospective randomized trials are needed to determine the criteria for selecting patients most likely to benefit from acute endovascular therapies.

Celiac disease: parental knowledge and attitudes of dietary compliance.

Parents of 43 children with celiac disease, 28% of whom were classified as noncompliant, were interviewed. The knowledge, attitudes, and dietary behavior of parents of compliant patients were compared with those of noncompliant patients. Parents of compliant patients are better educated and from a higher social class. Although objective knowledge of the disease is similar in both groups, parents of compliant patients consider themselves adequately informed about the disease and are better able to choose gluten-free items from a menu. Parents of compliant patients are less worried about health in general but are more concerned with possible adverse effects celiac disease might have on the future of their children. Parents of both groups are not significantly different with regard to their understanding of the diet, the tendency to use medical care, and the perception of barriers to compliance or social support. It was concluded that to increase dietary compliance in celiac patients, parents should be guided mainly by the following three purposes: (1) enhancing their subjective evaluation of their own knowledge of celiac disease; (2) improving their practical ability to handle a menu; (3) increasing their anxiety regarding possible long-term adverse effects.

Postirradiation cell division in 5-fluorouracil-pre-treated Escherichia coli.

The correlation between 5-fluorouracil-induced resistance to ultraviolet (UV) light and the ability of bacterial cells to repair irradiation damage was investigated in various strains of Escherichia coli. Preincubation with 5-fluorouracil did not influence the dark-repair mechanism. It affected, however, the UV light-induced damage of cell division in filament-forming strains. It is suggested that the delay in postirradiation macromolecular synthesis of 5-fluorouracil-pretreated bacteria plays a decisive role in the recovery process leading to cross cell wall-forming ability in the damaged strains.