Effect of dialysate temperature on hemodynamic stability among hemodialysis patients.

Cooling the dialysate below 36.5 degrees C is an important factor that contributes to hemodynamic stability in patients during hemodialysis (HD). In this study, the effect of dialysate temperature on hemodynamic stability, patients' perception of dialysis discomfort and post dialysis fatigue were assessed in a group of patients on HD.

Baroreflex sensitivity varies during the rat estrous cycle: role of gonadal steroids.

Baroreflex sensitivity (BRS) increases in women during the luteal phase of the menstrual cycle, when gonadal hormones are elevated, but whether a similar cycle-dependent variation in BRS occurs in rats is unknown. In addition, whether cyclic BRS changes depend on gonadal steroids has not been previously investigated. To test these hypotheses, BRS was determined in cycling female rats using two approaches: 1) baroreflex control of renal sympathetic nerve activity (RSNA) in anesthetized rats; 2) cardiovagal spontaneous BRS (sBRS) in conscious rats instrumented for continuous telemetric measurements of mean arterial pressure (MAP) and heart rate (HR).

Nutritional and inflammatory status of hemodialysis patients in relation to their body mass index.

Objective: The study tested whether obese hemodialysis (HD) patients have a better nutritional and inflammatory state than those with overweight or normal body mass index (BMI).

Design: This was a single-center, cross-sectional study.

Setting And Patients: Ninety-six stable HD patients from a local HD unit were divided into 3 groups according to BMI (normal, overweight, and obese).

The influence of maintenance quality of hemodialysis machines on hemodialysis efficiency.

Several studies suggest that there is a correlation between dose of dialysis and machine maintenance. However, in spite of the current practice, there are conflicting reports regarding the relationship between dose of dialysis or patient outcome, and machine maintenance. In order to evaluate the impact of hemodialysis machine maintenance on dialysis adequacy Kt/V and session performance, data were processed on 134 patients on 3-times-per-week dialysis regimens by dividing the patients into four groups and also dividing the hemodialysis machines into four groups according to their year of installation.

Biofeedback systems and adaptive control hemodialysis treatment.

On-line monitoring devices to control functions such as volume, body temperature, and ultrafiltration, were considered more toys than real tools for routine clinical application. However, bio-feedback blood volume controlled hemodialysis (HD) is now possible in routine dialysis, allowing the delivery of a more physiologically acceptable treatment. This system has proved to reduce the incidence of intra-HD hypotension episodes significantly.

Evaluation of the adult with suspected immunodeficiency.

Several primary immunodeficiencies may have their initial presentation in adulthood. Although recurrent infections are the hallmark of an underlying immunodeficiency, they need not be the presenting manifestation. This review highlights aspects of infections, as well as noninfectious diseases, that should prompt a high index of suspicion for an underlying immune disorder.

Vitreous injections of pegaptanib sodium triggering allergic reactions.

Purpose: To report two cases of systemic allergic response associated with vitreous administration of pegaptanib sodium.

Design: Observational case report.

Methods: Two patients were treated for systemic allergic reactions associated with the administration of pegaptanib sodium.

Association between dialysis dose improvement and nutritional status among hemodialysis patients.

Background: Several studies suggest an association between improved survival and better nutritional status. It has been suggested that there is a correlation between dose of dialysis and nutritional status. However, in spite of the current practice, there are conflicting reports regarding the relationship between dose of dialysis or malnutrition, and biochemical outcome.

Agreement between instruments for rating treatment decisional capacity.

Objective: The objective of this study was to measure agreement between three treatment decisional capacity assessment instruments in mild to moderate dementia.

Method: Subjects (N=79) were recruited from the community. Rating agreement was evaluated with kappa statistics.

Three methods of assessing values for advance care planning: comparing persons with and without dementia.

Advance care planning ideally includes communication about values between patients, family members, and care providers. This study examined the utility of health care values assessment tools for older adults with and without dementia. Adults aged 60 and older, with and without dementia, completed three values assessment tools-open-ended, forced-choice, and rating scale questions-and named a preferred surrogate decision maker.

Cognitive performance predicts treatment decisional abilities in mild to moderate dementia.

Objective: To examine the contribution of neuropsychological test performance to treatment decision-making capacity in community volunteers with mild to moderate dementia.

Methods: The authors recruited volunteers (44 men, 44 women) with mild to moderate dementia from the community. Subjects completed a battery of 11 neuropsychological tests that assessed auditory and visual attention, logical memory, language, and executive function.

Neuropsychological predictors of decision-making capacity over 9 months in mild-to-moderate dementia.

Background: Older adults with dementia may have diminished capacity to make medical treatment decisions.

Objective: To examine rates and neuropsychological predictors of treatment decision making, or consent capacity, among older adults with dementia over 9 months.

Design: Consent capacity was assessed initially and 9 months later in subjects with and without dementia using a longitudinal repeated measures design.

Race and vascular depression risk in community-dwelling older adults.

Objective: Authors examined racial differences in cerebrovascular risk factors (CVRFs) and overall depressive symptomatology.

Methods: The authors applied a correlational design using a depression inventory, the Center for Epidemiological Studies Depression scale (CES-D) and self-report CVRF data from black and white community-dwelling elderly subjects (N=362).

Results: Black subjects were more likely than whites to screen positive for depression, but there were no race differences in CVRFs.

The vascular depression hypothesis: the influence of age on the relationship between cerebrovascular risk factors and depressive symptoms in community dwelling elders.

The current study examined the moderating effect of age on the relationship between cerebrovascular risk factors (CVRF's) and depressive symptoms. Consistent with the broader vascular depression model, it was hypothesized that CVRF's would demonstrate a stronger link to depressive symptoms in the older age groups than among the younger age groups. Data from 2916 adults from the Resources, Stress, and Older Persons Panel Study were utilized.

Hopes and Cautions for Instrument-Based Evaluation of Consent Capacity: Results of a Construct Validity Study of Three Instruments.

Does instrument based evaluation of consent capacity increase the precision and validity of competency assessment or does ostensible precision provide a false sense of confidence without in fact improving validity? In this paper we critically examine the evidence for construct validity of three instruments for measuring four functional abilities important in consent capacity: understanding, appreciation, reasoning, and expressing a choice. Instrument based assessment of these abilities is compared through investigation of a multi-trait multi-method matrix in 88 older adults with mild to moderate dementia. Results find variable support for validity.

Capacity to consent to treatment: empirical comparison of three instruments in older adults with and without dementia.

Purpose: The purpose of this study was to compare adults with and without dementia on capacities to consent to treatment as assessed by three instruments.

Design And Methods: Eighty-eight older adults with mild to moderate dementia were compared with 88 matched controls on four indices of legal competency to consent to medical treatment as assessed with three capacity instruments.

Results: Mean performance of adults with dementia on a legal standard of understanding treatment information was impaired relative to controls on all instruments, and it was also impaired for an appreciation standard on one instrument and a reasoning standard on two instruments.

Metastatic liposarcoma of the thyroid gland.

Metastatic liposarcoma of the thyroid gland is exceptionally rare. A case of pleomorphic liposarcoma, which manifested as a soft tissue lump in the neck, is described in a 30-year-old woman. Fine needle aspiration cytology permitted prompt diagnosis.

The impact of participatory ergonomics on working conditions, quality, and productivity.

A participatory ergonomics model was designed for improving working conditions, quality, and productivity in a medium-sized manufacturing enterprise by making use of a Supportive Expert Team (SET). In order to implement the model, a team-based structure consisting of a Steering Committee (SC) and 2 Action Groups (AGs) was designed and a 5-phase methodology followed. To validate the model, a similar factory was selected as control.

Prognostic significance of nonfatal myocardial reinfarction in survivors of a first infarction.

Background: Patients who develop a reinfarction are at increased risk for subsequent reinfarctions and death. However, follow-up studies in these patients are rare.

Objective: The purpose of this study was to examine the risk of mortality after a first myocardial reinfarction and to determine the independent contribution of nonfatal reinfarction to the risk of subsequent mortality.

Garlic induces a shift in cytokine pattern in Leishmania major-infected BALB/c mice.

The regulation of T helper (Th)1- and Th2-type cytokine patterns is important in the final outcome of leishmaniasis in human and murine models. We examined the efficacy of garlic therapy or a combination of garlic and an antimonial drug (glucantime) in promoting healing and regulation of Th1/Th2 cytokine patterns in highly susceptible BALB/c mice infected with Leishmania major. Separate groups of infected mice received 20 mg/kg/day garlic, 60 mg/kg/day glucantime or a combination of the two, from day 30 after infection for 2 weeks.

Long-term changes in the response of conductance and resistance coronary vessels to endothelium-dependent and independent vasodilators. A double-blind placebo-controlled study of the effect of a 6-month treatment with cilazapril.

Background: The aim of this study was to assess the effect of a 6-month treatment with the inhibitor of the angiotensin-converting enzyme cilazapril on the response of conductance and resistance vessels to endothelium-dependent and independent vasodilators, in a randomized placebo-controlled parallel group single center study.

Methods: Quantitative angiographic and Doppler flow time-averaged peak velocity measurements were performed in an artery with < 30% diameter stenosis after sequential selective intracoronary injection of papaverine (7 mg), acetylcholine (0.036, 0.

Human rabies in Lebanon: lessons for control.

Human rabies is known to be endemic in countries bordering Lebanon, but its prevalence in Lebanon has not been studied before. All eight cases of human rabies reported to the Lebanese Ministry of Public Health between 1991 and 1999 were reviewed, as well as three other cases admitted to the American University of Beirut Medical Center. A total of 1102 cases of animal bites to humans, the majority of which were dog bites, were reported to the Ministry of Public Health between 1991 and 1996.

Clinical and angiographic outcome of elective stent implantation in small coronary vessels: an analysis of the BENESTENT trial.

We examined the influence of vessel size using an intention-to-treat approach in 259 patients who underwent stent implantation and in 257 patients who underwent balloon angioplasty alone in the BENESTENT trial. In the stented population, smaller vessel size was associated with a higher stent:vessel ratio, a greater relative gain and a greater subsequent loss index, and a higher risk of adverse cardiac events. In the balloon angioplasty population small vessel size conveyed an increased requirement for revascularization but did not increase the risk of procedural failure or myocardial infarction during follow-up.