Age and ageing
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Many different types of hyperkinetic and hypokinetic movement disorders have been reported after ischaemic and haemorrhagic stroke. We searched the Medline database from 1966 to February 2008, retrieving 2942 articles from which 156 relevant case reports, case series and review articles were identified. The papers were then further reviewed and filtered and secondary references found. ⋯ They can be hyperkinetic (most commonly hemichorea-hemiballism) or hypokinetic (most commonly vascular parkinsonism). Most are caused by lesions in the basal ganglia or thalamus but can occur with strokes at many different locations in the motor circuit. Many are self limiting but treatment may be required for symptom control.
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Heyde syndrome is a triad of aortic stenosis, an acquired coagulopathy and anaemia due to bleeding from intestinal angiodysplasia. The evidence that aortic stenosis is the root cause of this coagulopathy is compelling. Resolution of anaemia usually follows aortic valve replacement. This article discusses studies linking aortic stenosis with other conditions in the triad as well as diagnosis and management of this complex pathology.
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therapeutic use of cytokines can induce delirium, and delirium often occurs during infections associated with elevated levels of cytokines. This study examined the association of demographic, clinical and biological factors (IL-1alpha, IL-1beta, IL-1RA, IL-6, TNF-alpha, IFN-gamma, LIF, IGF-I, APOE genotype) with the presence and severity of delirium. ⋯ this study finds that (i) low levels of both neuroprotective factors (IGF-I, IL-1RA) are associated with delirium, (ii) high IFN-gamma and low IGF-I have significant effects on delirium severity and (iii) otherwise the pro-inflammatory cytokines studied, APOE genotype and severity of illness do not appear to be associated, in older medically ill patients, with either delirium or severity of it.
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Comparative Study
Use of emergency departments by older people from residential care: a population based study.
to investigate the differences between emergency department (ED) presentations of older people who do and do not live in residential care facilities (RCFs). ⋯ there are different patterns of ED presentations and hospital admissions of older people who do and do not live in RCFs. The appropriateness of these differences is uncertain.
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Comment Letter
Comment on 'Care home medicine in the UK--in from the cold'.