Terminal Lucidity in a Pediatric Oncology Clinic.

The sporadic occurrence of unusually enhanced mental clarity before death has been documented over time and cultures, and reported in patients with and without neurodegenerative diseases, psychiatric disorders, and other neurocognitive deficits, as well as those with nonterminal and terminal conditions. Using a purposive sampling method via existing professional networks, clinical presentations of terminal lucidity in pediatric populations, as witnessed by pediatric oncologists and medical personnel, were solicited. We document clinical presentations suggestive of terminal lucidity in children, which were compiled by their attending physician at two large tertiary pediatric hospitals.

Loneliness and sleep in the American Indian Blackfeet community.

Background: Sleep is largely understudied in American Indians (AIs), even though sleep is implicated in the chronic diseases which disproportionately affect AI communities.

Objective: To investigate relationships between daily self-reported loneliness and sleep as measured with actigraphy.

Methods: In a sample of 98 Blackfeet adults living on the Blackfeet reservation in Montana, we used Ecological Momentary Assessment and actigraphy over a week-long period to investigate relationships between loneliness and sleep.

Mphi1 and Mphi2 can be re-polarized by Th2 or Th1 cytokines, respectively, and respond to exogenous danger signals.

Macrophages (Mphi) represent a dynamic cell population that develops and operates within a changing microenvironment. In parallel to Th1/Th2 cells, primary Mphi may undergo classical (Mphi1) or alternative (Mphi2) activation. Here, we investigated whether Mphi1/Mphi2 may be re-polarized by a secondary stimulation by Th1 or Th2 cytokines or by exogenous danger signals.

Age-dependence of lipid parameters in the general population and vegetarians.

Age-dependent changes of lipid metabolism may arise both as a result of mechanisms of biological ageing and factors influencing age-dependent changes. To study possible influences of nutrition and life-style of vegetarians on age-dependence of lipid parameters, subjects of general population were compared with vegetarians. In the frame of population-based lipid screening projects in the city of Leipzig/Germany (Lipid Study Leipzig, LSL) 10 550 subjects (3,816 men and 6,734 women, age 18-99 years) of general population were compared with 417 vegetarians (vegans, lacto-vegetarians, lacto-ovo-vegetarians, 148 men and 269 women, age 18-93 years).

[Importance of left ventricular function for active early ambulation following acute myocardial infarct].

On the 4th postmyocardial infarction day a risk group determination among n = 80 patients was undergone on the base of LDH-isoenzyme-monitoring. The active early mobilization was carried out following corresponding risk groups: less risk (38%) until the 14th, middle risk (23%) until the 21st and high risk (38%) until the 28th postmyocardial infarction day or longer. The average period of hospitalization was 21.

[The surgical risk in patients with cardiac diseases].

The increase in the number of patients with heart and circulatory diseases during selective surgical operations in the past decades is due to both the epidemiologic situation and the increase in the number of old and very old people. To ensure optimum perioperative care of these patients, the anaesthetist must know the degree of illness of each individual and the functioning state of the haemodynamic system. In this paper we show factors which increase the perioperative risk of cardiac complications.

[Modified bedside diagnosis in patients at risk for aortocoronary venous bypass surgery].

Early detection of perioperative complications during cardiosurgical operations is of differential diagnostic and differential therapeutic importance. Various risk groups of aortocoronary venous bypass operations have been analysed under different aspects: age, (not significant), implemented bypass rate (aneurysm resection 1.75/p less than 0.

[Experiences from general practice: use of acetylsalicylic acid and anticoagulants in patients following acute myocardial infarct].

An effective therapy with coumarin derivatives within the secondary prevention after acute myocardial infarction makes great demands on the dispensary care. The risk of serious complications is relatively high. The risk of therapy with acetyl salicylic acid (ASS) in low dosage is significantly smaller.

[Drug therapy under physical conditioning and during phase III rehabilitation in patients following acute myocardial infarct].

In the framework of the secondary prevention after acute myocardial infarction the interaction between physical conditioning (pK) and medicamentous therapy was analysed and a retrospective evaluation of the therapy was performed during the rehabilitation phase III. During the physical conditioning (n = 110) in 31% of the patients changes of the medicamentous therapy rendered themselves necessary (15% increase of the dose, 16% reduction of the dose and withdrawal of a medicament, respectively). In the rehabilitation phase III (n = 277) 72% of the patients were given nitrates, 68% calcium antagonists and 55% beta-receptor blocking agents (43% double, 29% triple combinations) and 15% digitoxin.

[Perioperative complications in at-risk patients undergoing heart valve surgery].

The success of operations of the replacement of heart valves is disturbed by perioperative complications and early lethality. A valuation of the perioperative risk individually of patients with operations of the replacement of heart valves according to defined subgroups is controlled by the perioperative course. In order to achieve the registration of patients with perioperative lesion of the myocardium and/or low output syndrome, the bedside performance of a marker protein monitoring consisting of enzymes/isoenzymes (CK, CK-MB, ALAT) and the muscle protein myoglobin, respectively, is necessary.

[Drug therapy following heart valve prosthesis].

Patients with prostheses of the cardiac valve are, related to the total population, only a small part. But their number permanently increases. Alone in our clinic since 1973 3,250 patients have been provided with artificial cardiac valves.

[Therapy of perioperative myocardial damage in aortocoronary venous bypass surgery].

The perioperative lesion of the myocardium in heart-lung machine operation can on principle not be prevented despite complex measures of the protection of the myocardium and the individual monitoring of the patients, this particularly by including patients with high risk of ischaemia of the myocardium (instable angina pectoris, stenosis of the trunc and greatly restricted left-ventricular function, respectively) in former years. In a proved perioperative lesion of the myocardium the limitation of the myocardial lesion stands in the centre of intensive-medical measures with vasodilators and positive inotropic substances.

[Thrombolytic therapy in acute myocardial infarct. 2. Clinical studies with thrombolytic therapy].

The highly dosed short-term therapy of thrombolysis with intravenous streptokinase at the beginning of therapy less than or equal to 6 angina pectoris time has with a high probability as a consequence the early recanalisation of a coronary thrombosis. A reduction of the lethality is significant, however, furthermore also patients with longer angina pectoris time have advantages. The combination of the intravenous streptokinase therapy with the immediate medication of acetyl salicylic acid (ASA) is a decisive factor for the decrease of the reocclusion and the reinfarction rate, respectively, and thus for the limitation of the lethality.

[Localization and type of acute myocardial infarct in relation to myocardial infarct size--patients with acute re-infarct].

A differentiated estimation of the acute re-infarction is individually necessary for the estimation of risk and prognosis. Thereby the methodical approach is of particular importance, since the further restriction of the remaining function of the myocardium in re-infarction is of fundamental significance. A monitoring for the establishment of CKmax as well as the measuring of the ejection fraction globally (EFg) allow a semiquantitative determination of the size of the myocardial infarction.

[Thrombolytic therapy in acute myocardial infarct. 1. Markers for evaluating effectiveness and thrombolytic substances].

By means of serial investigations of coronary angiographies and acute dissections in the acute myocardial infarction (AMI) in the vast majority of the patients fresh thrombi could be made evident as cause of the vascular occlusion. By lysins produced within the body parts of the thrombi can be lyzed (spontaneous lysis up to 20%). However, thrombolytically effective substances considerably increase the recanalization in the first hours after the beginning of the symptomatology.

[Site and type of acute myocardial infarct in relation to myocardial infarct size--dynamics of global ejection fraction in acute myocardial infarct].

By the ejection fraction global (EFg) statements concerning the remaining function of the myocardium in acute myocardial infarction and thus individually concerning the prognosis (classification of risk groups) become possible. For the valuation of the dynamics of the EFg in a period up to 6 months after an acute myocardial infarction the EFg was multifariously controlled. Only patients with first myocardial infarction in localization on the anterior wall and Q-wave showed a significant dynamics of the EFg between the measurements acute and third week as well as acute and 6th month (absolutely 5.

[The significance of thrombolytic therapy in acute myocardial infarct in advanced age].

The thromboticgenesis and the close time dependence of the development of the acute myocardial infarction (AMI) are decisive findings of the dynamic development in the past ten years. Therapy started in time including the elimination of the thrombotic coronary occlusion as soon as possible leads to the reperfusion of the vessel affected by the infarction and thus to the limitation of the size of the myocardial infarction. Because of the temporally limited tolerance of ischaemia of the myocardium, an efficient thrombolytic therapy (TT) with an objectifiable improvement of the left-ventricular function (ejection fraction global-EFg) is possible up to the 4th ApS hour.

[The significance of the performance-lactate quotient in patients following acute myocardial infarct in a preliminary stress test].

According to the risk group classification on the basis of an isoenzyme monitoring n = 67 patients (of them 12 females) with acute myocardial infarction were temporarily differentiated: slight risk (n = 26) on the 14th day, medium risk (n = 16) on the 21st day and high risk (n = 25) greater than or equal to 28. By means of orientating tolerance test and measurement of the lactate concentrations examinations were performed on the day post infarction. All patients with slight risk achieved the physical performance of 375 Watt/min in slight lactate concentrations (less than 4 mmol/l).

[Creatine kinase risk groups in acute myocardial infarct].

The individual valuation of risks in patients with acute myocardial infarction on the basis of a monitoring of the creatine kinase (CK) is made evident as relevant to practice for the basic medical care. Thereby a classification of risk groups on the basis of CKmax (less than or equal to 23; greater than 23 less than or equal to 40; greater than 40 less than or equal to 60; greater than 60 mumol/l.s) is controlled.

[Submaximal stress test and lactate dynamics following acute myocardial infarct in elderly patients].

Eighty patients were physically conditioned after definite myocardial infarction (WHO definition). The percentage of patients older than 60 years was 28%. Physical conditioning as part of the non-drug therapy of acute myocardial infarction is of great importance also to older patients.

[Physical conditioning following acute myocardial infarct in the elderly].

In a prospective study n = 80 patients after acute myocardial infarction, upper age limit 75 years, were conditioned by a 6-week outpatient training programme. 78% of the patients older than 60 years could be conditioned successfully. In particular patients at high risk went through a low level exercise training.

[An orienting stress test following acute myocardial infarct in the elderly].

In a prospective study of 150 patients with definite myocardial infarction (WHO) risk group assignment in the acute phase was done based on lactate dehydrogenase isoenzyme monitoring. 28% of the patients were older than 60 years. The informative functional exercise test was performed by the end of the hospital phase according to three risk groups at different times.

[Prognostic indices and advanced age in acute myocardial infarct].

The extent of the acute damage to the myocardium essentially determines the prognosis for patients after acute myocardial infarction. The definition of the risk in the early hospital phase by a semiquantitative evaluation of the infarction size is of great important to the layout of active early mobilisation and is done by iso-enzyme monitoring of lactate dehydrogenase. Beginning, intensity, and duration of the mobilisation programme are fixed individually according to risk groups under consideration of previous myocardial damages and of age.