First delirium episode in Parkinson's disease and parkinsonism: incidence, predictors, and outcomes.

To define the incidence, predictors and prognosis of the first hospital delirium episode in Parkinson's disease (PD) and atypical parkinsonism (AP), we identified the first hospital episode of delirium after diagnosis in the Parkinsonism Incidence in North-East Scotland (PINE) study, a prospective community-based incidence cohort of parkinsonism, using chart-based criteria to define delirium. Of 296 patients (189=PD, 107=AP [dementia with Lewy bodies, progressive supranuclear palsy, multiple system atrophy, vascular parkinsonism]), 152 developed delirium (PD = 98, AP = 54). Incidence of first hospital delirium episode per 100 person years was 8.

Interpreting ancient food practices: stable isotope and molecular analyses of visible and absorbed residues from a year-long cooking experiment.

Chemical analyses of carbonized and absorbed organic residues from archaeological ceramic cooking vessels can provide a unique window into the culinary cultures of ancient people, resource use, and environmental effects by identifying ingredients used in ancient meals. However, it remains uncertain whether recovered organic residues represent only the final foodstuffs prepared or are the accumulation of various cooking events within the same vessel. To assess this, we cooked seven mixtures of C and C foodstuffs in unglazed pots once per week for one year, then changed recipes between pots for the final cooking events.

Using stylized agent-based models for population-environment research: A case study from the Galápagos Islands.

Agent Based Models (ABMs) are powerful tools for population-environment research but are subject to trade-offs between model complexity and abstraction. This study strikes a compromise between abstract and highly specified ABMs by designing a spatially explicit, stylized ABM and using it to explore policy scenarios in a setting that is facing substantial conservation and development challenges. Specifically, we present an ABM that reflects key Land Use / Land Cover (LULC) dynamics and livelihood decisions on Isabela Island in the Galápagos Archipelago of Ecuador.

Late lumbar hemorrhage after open repair of abdominal aortic aneurysm: computed tomographic appearance resembling type II endoleak.

Development of endoleak after conventional open repair of abdominal aortic aneurysm is less well documented compared with endovascular stenting. We present a case report of a 65-year-old man who had sudden onset of back pain with central abdominal tenderness 34 days after successful open repair of an abdominal aortic aneurysm. Urgent laparotomy revealed the presence of a noninfective intrasac hemorrhage, due to recanalization of the lumbar arteries.

Pelviureteric junction disruption as a complication of chemical lumbar sympathectomy.

Chemical lumbar sympathectomy is a commonly performed procedure in vascular surgery and pain management. This case report discusses the management of a patient who suffered pelviureteric junction disruption following phenol injection for ischaemic leg pain despite radiological evidence of correct placement. The authors suspect this is an underreported complication, which could be relevant in obtaining informed consent.

Closing the loop: the role of audit in reducing groin complications associated with coronary angiography.

Background: Local vascular complications of coronary angiography present a significant but often ignored clinical problem. This audit was performed because of a perception that the number of false aneurysms requiring surgical repair was increasing.

Standard: An acceptable incidence of false aneurysm was derived from series in which ultrasound examinations were only performed if a false aneurysm was suspected (0.

Vascular surgeon's experience with intraoperative angioplasty.

Background: Intraoperative balloon angioplasty as an adjunct to vascular reconstruction is controversial and radiologists suggest that it may be less effective than preoperative or postoperative percutaneous transluminal angioplasty. The aim of the present study was to explore the role of intraoperative balloon angioplasty as performed by a vascular surgeon.

Methods: The notes and angiograms of 63 patients on whom 67 intraoperative angioplasty/stenting procedures were performed were retrieved using a computerized prospective audit system.

Carotid endarterectomy; local or general anaesthesia?

Objectives: to review the evidence for theoretical and clinical benefits of local or general anaesthesia for carotid endarterectomy.

Methods: literature review.

Results: animal studies suggest cerebral protection by a variety of general anaesthetic agents but clinical evidence is lacking.

Does hypothermia prevent cerebral ischaemia during cardiopulmonary bypass?

It is believed that moderate hypothermia (25-32 degrees C) during cardiopulmonary bypass provides cerebral protection by reducing the cerebral metabolic rate (CMRO2). Nevertheless episodes of ischaemia do occur and thus it has been suggested that cerebral oxygenation should be monitored by jugular venous oximetry. However, this technique is cumbersome and invasive.

Cerebral haemodynamics and embolization during carotid angioplasty in high-risk patients.

Background: Patients with symptomatic internal carotid artery (ICA) stenosis greater than 70 per cent in association with a contralateral ICA occlusion may have an increased risk of stroke following carotid endarterectomy. Such patients might benefit from the theoretically shorter ischaemic time offered by carotid angioplasty and stenting.

Methods: Nine patients who underwent carotid angioplasty and stenting were monitored using near-infrared spectroscopy, continuous jugular venous oximetry and transcranial Doppler ultrasonography to detect both haemodynamic ischaemia and embolic events.

The differing effects of regional and general anaesthesia on cerebral metabolism during carotid endarterectomy.

Objectives: To examine the effects of either regional (RA) or general (GA) anaesthesia upon parameters of cerebral metabolism (near infrared spectroscopy, continuous jugular venous oximetry) during carotid endarterectomy.

Design: Prospective, non-randomised, observational study.

Materials: Sixty-five consecutive patients (33 RA; 32 GA) undergoing carotid endarterectomy.

Massive haemothorax secondary to angiosarcoma.

A patient who presented with recurrent haemoptyses was found to have an angiosarcoma of the adrenal gland which disseminated throughout the pleural space.