An increased incidence of obvious live-birth neural tube defects (i.e., spina bifida cystica and encephalocele) occurred in Jamaica 11 to 18 months after Hurricane Gilbert. The conceptions of the affected babies coincided with a rise in megaloblastic change in sickle cell patients, suggesting a wide-spread drop in dietary folate intake. A detailed history was taken from each of the 17 affected mothers (case subjects) and 51 unaffected mothers (matched control subjects). The case subjects reported a significantly lower mean intake of dietary folate in the periconceptional period (154 micrograms/day) than did the control subjects (254 micrograms/day). The temporary increase in neural tube defects was associated with a diet comparatively low in folate in the periconceptional period, suggesting the dietary level of folate that fails to protect against neural tube defects under natural conditions.
ObjectiveTo determine the results of cardiac surgery in the very elderly. Design and subjectsA retrospective study of 56 very elderly patients (mean age 82 years, range 79‐89 years) undergoing open heart surgery between 1988 and 1991. Thirty‐three patients had coronary artery bypass grafting, 12 had valve replacement alone and 11 had valve replacement with an associated procedure. SettingSt Francis Xavier Cabrini Hospital, Melbourne — a large private hospital. ResultsThere were four in‐hospital deaths (7%). The one‐year actuarial survival rate was 88%. Of the 49 survivors, 92% were in New York Heart Association (NYHA) Class III or IV before operation, whereas 96% were in NYHA Class I or II a mean of 15 months after operation. ConclusionIn very elderly patients with medically refractory cardiac symptoms, cardiac surgery has a tolerable mortality and provides excellent relief of symptoms.
SUMMARY In the present study, the dynamics of the cerebral blood flow (CBF) and ventilatory response to hypercapnia was investigated in a group of patients with cerebrovascular disease and compared to responses measured in a group of normal volunteers. There was a significant correlation between the rapidity of the transient CBF and ventilatory responses and the severity of the cerebrovascular disease. While the steady state CBF response showed no such correlation, the steady state ventilatory response was reduced in patients with severe cerebrovascular disease. Various explanations for the differences in the dynamic responses of CBF and ventilation in patients with mild or severe cerebrovascular disease compared to normal subjects are considered. Measurement of these circulatory and ventilatory responses may be sensitive means for assessing the changing status of patients with cerebrovascular disease.THE CLOSELY COORDINATED ADJUSTMENTS in ventilation and cerebral blood flow (CBF) which guard the acid-base balance of the brain may be upset in cerebrovascular disease. Cerebrovascular disease may significantly affect the usual increase in CBF that occurs with hypercapnia. 1 ' 6 It may also alter the steady state ventilatory response to CO 2 either by interfering specifically with the function of respiratory neurons or by causing generalized ischemia, thus interfering with brain metabolism. Besides disturbing steady state responses, it seems reasonable to expect that cerebrovascular disease can produce more subtle functional changes, interfering with the rapidity of CBF and ventilatory responses to the addition and removal of CO 2 from the inspired air, sometimes even before obvious changes in the magnitude of the steady state response can be observed. 11In the present study, the dynamics of the CBF and ventilatory response to hypercapnia was investigated in a group of patients with cerebrovascular disease and compared to responses measured in a group of normal volunteers. MethodsThe ventilatory and CBF response to 5% CO 2 inhalation and its removal were determined in four normal subjects and 18 patients with mild to severe cerebrovascular disease as determined by clinical and angiographical findings. The patients had had their neurological deficit for at least five days prior to study.In the normal subjects, a catheter was placed in the brachial artery and internal jugular vein under local anesthesia. The venous catheter was advanced into the jugular bulb with fluoroscopic guidance. A steady state CBF measurement was then performed by the Kety-Schmidt technique using Kr 85 after waiting 30 minutes for the subject to stabilize.12 The blood samples containing Kr 85 were measured in a liquid scintillation counter.19 During the measurement of control CBF, the subject breathed 30% O 2 in N 2 through a one-way valve. Ventilation was determined in this steady state period by measuring expired gas collected for three minutes with a dry gas meter. The inspired gas was then abruptly switched to 5% CO 2 -30% O 2 in N 2 , and...
Two cases of therapy with frankincense and myrrh in children are presented. The long history of this unusual treatment is outlined, demonstrating that for several millenia such agents have been employed in a number of medical contexts, as well as in the perfume and incense industries. Myrrh has found recent pharmacological application in the reduction of cholesterol and triglycerides, as predicted by several traditional therapies.
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