[Rehabilitation of multiple morbidity patients in the clinic and day clinic].
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Aged↗
Biomedical subjects
K Hager
Publications and source records attributed to K Hager.
Virtual image grasping in patients with Alzheimer-type dementia.
Patients with various neuropsychiatric disorders who confused virtual images with real objects have recently been described. When asked to take objects from an investigator's hand while looking in a mirror, these patients reached directly into the mirror for the object's image. To investigate whether the phenomenon occurs in patients with Alzheimer's disease, we studied 127 cases, of whom 67 were suspected of having Alzheimer-type dementia (DAT). The phenomenon in question was not observed in either of two control groups, but whereas 38 (57%) of the DAT patients responded correctly, 17 (25%) of them grasped at the mirror image. Characteristically, none of the eight patients who grasped into the mirror and underwent single photon emission computed tomography analysis showed symmetric activity. We also analyzed the behaviour and verbal utterances of the DAT patients in front of the mirror.
Aged↗
Alpha-lipoic acid as a new treatment option for Alzheimer [corrected] type dementia.
Oxidative stress and energy depletion are characteristic biochemical hallmarks of Alzheimer's disease (AD), thus antioxidants with positive effects on glucose metabolism such as thioctic (alpha-lipoic) acid should exert positive effects in these patients. Therefore, 600 mg alpha-lipoic acid was given daily to nine patients with AD and related dementias (receiving a standard treatment with acetylcholinesterase inhibitors) in an open study over an observation period of, on avarage, 337+/-80 days. The treatment led to a stabilization of cognitive functions in the study group, demonstrated by constant scores in two neuropsychological tests (mini-mental state examination: MMSE and AD assessment scale, cognitive subscale: ADAScog). Despite the fact that this study was small and not randomized, this is the first indication that treatment with alpha-lipoic acid might be a successful 'neuroprotective' therapy option for AD and related dementias.
Journal Article↗
Large-scale analysis of the yeast genome by transposon tagging and gene disruption.
Economical methods by which gene function may be analysed on a genomic scale are relatively scarce. To fill this need, we have developed a transposon-tagging strategy for the genome-wide analysis of disruption phenotypes, gene expression and protein localization, and have applied this method to the large-scale analysis of gene function in the budding yeast Saccharomyces cerevisiae. Here we present the largest collection of defined yeast mutants ever generated within a single genetic background--a collection of over 11,000 strains, each carrying a transposon inserted within a region of the genome expressed during vegetative growth and/or sporulation. These insertions affect nearly 2,000 annotated genes, representing about one-third of the 6,200 predicted genes in the yeast genome. We have used this collection to determine disruption phenotypes for nearly 8,000 strains using 20 different growth conditions; the resulting data sets were clustered to identify groups of functionally related genes. We have also identified over 300 previously non-annotated open reading frames and analysed by indirect immunofluorescence over 1,300 transposon-tagged proteins. In total, our study encompasses over 260,000 data points, constituting the largest functional analysis of the yeast genome ever undertaken.
Algorithms↗
[Stroke rehabilitation can be successful even in old age].
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Aged↗
[Paying attention to atypical signs of illness in the elderly].
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Activities of Daily Living↗
[Stages in coping after stroke].
People who suffer a stroke most often experience a major crisis in their lives. This leads to psychological problems which are likely to influence the patient's life satisfaction, long-term rehabilitation outcome, and quality of life as much as the physical consequences caused by the stroke, The patient's ability to accept the new reality created by a disability as a part of their future life is therefore essential. This necessitates an individual coping strategy in the center of which is a mourning process, which unfolds in the same way as other experiences of vital threat, e.g. confrontation with one's own dying. Different stages of mourning that can also be found in stroke patients are nonacceptance of the facts, erupting emotions, parting with the former and finding of a new self as well as new perspectives for one's future. Whether a coping process is successful does not depend on the type of the defense mechanisms or stages, but essentially on their persistence. It is the task of the therapeutical team to support this process by applying a basic therapeutic behavior, stage-consistent interventions and a positive feedback. A failed process of coping may be one of the causes of the high prevalence of psychological disorders like depression and anxiety disorders in patients having suffered a stroke.
Adaptation, Psychological↗
[Clostridium difficile toxin-associated diarrhea in geriatrics].
In the course of 1 year, Clostridium difficile-associated diarrhea, which may lead to pseudomembranous colitis and therefore may be very harmful in frail elderly people, was diagnosed in six patients of a geriatric clinic. The disease is associated with antibiotic therapy, due to an overgrowth of the intestinal flora with Clostridium difficile. Symptoms varied from a state of asymptomatic carriage or benign diarrhea to acute stages of the disease with severe diarrhea, abdominal pain, fever and acute phase response. Diagnosis of Clostridium difficile associated diarrhea was established when, in addition to typical clinical symptoms, a toxin-positive stool specimen was found. Oral vancomycin was effective in all cases, leading to a stop in the diarrhea and an amelioration of systemic inflammatory parameters. According to recent results, in order to prevent the induction of vancomycin-resistance and in view of higher treatment costs, metronidazole is considered as the drug of choice in mildly and moderately ill patients.
Aged↗
[Long-term outcome of hip-operated geriatric patients].
A follow-up of patients with hip fractures discharged from a geriatric rehabilitation unit was conducted by means of a questionnaire sent to the former patients, in case of non-compliance calling to ask for participation in the study and completion of the questionnaire. 234 patients were examined, 8 of whom died during rehabilitation. From 91.8% (n = 206) discharged after rehabilitation information about their fate was obtained, from 98.7% (n = 223) if they were still alive. On discharge, mean age was 81 (+/- 9) years, time of follow up was 2.7 years after discharge. 34.5% had died, 36% of them within the first six months. Of those surviving, 93% still lived in the living conditions they had been discharged to. Comparing the activities of daily living of the survivors as assessed with a modified Barthel index (max. 110 points), at discharge by the occupational therapists, at follow up by the patients themselves, only a slight decrease was seen (95.5 +/- 19.2 points at discharge; 88.5 +/- 24.0 points at follow up; p < 0.01).
Activities of Daily Living↗
[Geriatrics on the internet].
National and international data networks for data transfer and communication are playing an increasingly important role in science and medicine. These networks already exist on a regional, national and international scale. The biggest international network, the Internet, offers more than 300 sites referring to "aging", which lead to a great number of other related pages. The access to the Internet and some examples of the information on aging available are presented here. This is to give the reader an impression of the present state of this worldwide data network, which may be useful for his professional use. At this stage, the author has the impression that conventional media such as journals, books and especially personal contacts are still sufficient to satisfy the need for professional information, and opinion that may well have to be reconsidered soon. In view of the future, however, it seems useful for medical societies to be represented on the Internet as soon as possible.
Aged↗
[Age dependence of interleukin 6 and acute phase proteins].
In 59 healthy subjects of different age groups with no signs of inflammatory processes, the basal II-6 levels were measured. The II-6 concentrations were significantly higher in the oldest group (66-90 years) than in the two other age groups (24-40, 41-65 years). A positive correlation was found between age and II-6 concentration (r = 0.470). Otherwise, a statistically detectable relationship was found merely with alpha-2-macroglobulin and with total and LDL cholesterol.
Acute-Phase Proteins↗
Kinetics and specificity of the renal Na+/myo-inositol cotransporter expressed in Xenopus oocytes.
The two-microelectrode voltage clamp technique was used to examine the kinetics and substrate specificity of the cloned renal Na+/myo-inositol cotransporter (SMIT) expressed in Xenopus oocytes. The steady-state myo-inositol-induced current was measured as a function of the applied membrane potential (Vm), the external myo-inositol concentration and the external Na+ concentration, yielding the kinetic parameters: KMI0.5, KNa0.5, and the Hill coefficient n. At 100 mM NaCl, KMI0.5 was about 50 microM and was independent of Vm. At 0.5 mM myo-inositol, KNa0.5 ranged from 76 mM at Vm = -50 mV to 40 mM at Vm = -150 mV. n was voltage independent with a value of 1.9 +/- 0.2, suggesting that two Na+ ions are transported per molecule of myo-inositol. Phlorizin was an inhibitor with a voltage-dependent apparent KI of 64 microM at Vm = -50 mV and 130 microM at Vm = -150 mV. To examine sugar specificity, sugar-induced steady-state currents (at Vm = -150 mV) were recorded for a series of sugars, each at an external concentration of 50 mM. The substrate selectivity series was myo-inositol, scylloinositol > L-fucose > L-xylose > L-glucose, D-glucose, alpha-methyl-D-glucopyranoside > D-galactose, D-fucose, 3-O-methyl-D-glucose, 2-deoxy-D-glucose > D-xylose. For comparison, oocytes were injected with cRNA for the rabbit intestinal Na+/glucose cotransporter (SGLT1) and sugar-induced steady-state currents (at Vm = -150 mV) were measured. For oocytes expressing SGLT1, the sugar selectivity was: D-glucose, alpha-methyl-D-glucopyranoside, D-galactose, D-fucose, 3-O-methyl-D-glucose > D-xylose, L-xylose, 2-deoxy-D-glucose > myo-inositol, L-glucose, L-fucose. The ability of SMIT to transport glucose and SGLT1 to transport myo-inositol was independently confirmed by monitoring the Na(+)-dependent uptake of 3H-D-glucose and 3H-myo-inositol, respectively. In common with SGLT1, SMIT gave a relaxation current in the presence of 100 mM Na+ that was abolished by phlorizin (0.5 mM). This transient current decayed with a voltage-sensitive time constant between 10 and 14 msec. The presteady-state current is apparently due to the reorientation of the cotransporter protein in the membrane in response to a change in Vm. The kinetics of SMIT is accounted for by an ordered six-state nonrapid equilibrium model.
Animals↗
Fibrin degeneration product concentrations (D-dimers) in the course of ageing.
D-dimers, cross-linked fibrin split products, have been found to be an indicator of thromboembolic disease and may predict, as fibrinogen or other factors of hemostasis, a higher risk of cerebro- and cardiovascular diseases. D-dimers rose with advancing age in healthy elderly subjects and reached values well above the upper limit of the normal test values. The increase is considered to be the result of several causes, i.e. higher fibrinogen concentrations in the elderly, a slower urinary excretion, more frequent fibrin generation, (occult) diseases, risk factors, inflammatory reactions and degenerative vascular damage. In the elderly, moderately elevated D-dimers are therefore an unspecific finding. The specificity of the D-dimer test for diagnosing thromboembolic diseases can be expected to be lower than in young subjects.
Adolescent↗
[Hypertensive blood pressure in elderly patients in emergency care].
1143 records have been analysed in order to evaluate specific age-dependent problems of arterial hypertension in outpatients, asking for emergency treatment. 33 percent of these patients and half of those with hypertension were older than 70 years. In this age-group one out of three was hypertensive. Regardless of age, only about 50 percent were actually treated, with nitrates and nifedipine being the drugs of first choice. For elderly, nitrates and furosemide, probably due to other underlying diseases, as well as urapidil i.v., were preferred. For antihypertensive therapy in a broader sense also sedatives were used. These data underline the importance of considering and treating elevated blood pressure in the course of emergency treatments. The high proportion of elderly outpatients stresses the important role geriatric medicine plays for emergency physicians.
Adolescent↗
Fibrinogen and aging.
Plasma fibrinogen concentration is becoming widely accepted as a risk factor for cardio- and cerebrovascular disease. In order to evaluate its age-dependency, plasma fibrinogen and several other blood components were determined in 156 persons (23-96 years). In 116 participants, living on their own and rating themselves as healthy, fibrinogen increased by 26 mg/dL and decade. After exclusion of persons with pathological laboratory findings and risk factors, fibrinogen still rose by 25 mg/dL per decade, thereby reaching concentrations above 320 mg/dL in 81% of those older than 65 years. In prospective studies, these values were found to be associated with an augmented cardio- and cerebrovascular risk. In this investigation, the age-dependent rise of fibrinogen was more pronounced than that of blood glucose or cholesterol. Increasing fibrinogen may reflect a multitude of processes, such as (occult) acute phase reactions, risk factors, subclinical degeneration of vascular endothelium, or a more frequent activation of coagulation and fibrinolysis, with interleukin 6 (IL-6) as a possible mediator.
Adult↗
[Case report of extra-intestinal manifestation of salmonella infection].
The case history of a 75 year old man is demonstrated, who developed an abscess in the scar after B-II-resection 30 years ago. In this abscess S. typhi murium was detected. Diabetes mellitus was an additional risk factor. A review of the literature is given concerning extraintestinal manifestations of salmonellosis with emphasis to the predisposing conditions.
Abdominal Abscess↗
[Are there prognostic parameters for predicting the success of regional chemotherapy in nonresectable liver metastases of colorectal cancer?].
When compared with systemic therapy, hepatic arterial chemotherapy significantly increases the response rate for hepatic metastases from colorectal carcinomas. However, only 2 studies showed a significant prolongation of survival. In our study on 54 patients tumor related characteristics and the response to regional chemotherapy were correlated to the success of the treatment. In a linear discriminant analysis the response to regional chemotherapy was the main prognostic factor for the 1-year survival, rate, followed by positive lymph nodes in the Lig. hepatoduodenale. The other pretherapeutic factors such as liver involvement and CEA rate were of less importance.
Adult↗
[Changes in surgery of diverticulitis].
This retrospective study investigates the surgical progress in the treatment of diverticular disease during the last two decades. We reviewed 304 patients (149 women and 155 men) operated for diverticular disease from 1970-1992 at the Surgical Clinic of Steglitz Medical Center, Free University of Berlin. Comparing the results between the first and the second decade, we observed a significant increase in the total number of patients who have been treated surgically (from 118 to 186) and in the proportion of elective surgery (from 45% to 57%). In the second decade, early elective resection in selected patients with a severe diverticulitis and primary resection for perforated diverticulitis were the procedures of choice. Through this concept the over-all operative mortality rate could be reduced from 24% in the first to 7% in the last decade of this report.
Aged↗