No abstract

Near-infrared spectroscopy has been performed on the calf muscles of 38 subjects, 21 normal controls without vascular disease and 17 patients with peripheral vascular disease. Oxygen consumption was measured in the calf by calculating the rate of conversion of oxyhaemoglobin to deoxyhaemoglobin during a period of tourniquet-induced ischaemia. Postischaemic reoxygenation was also measured. Median oxygen consumption in patients with peripheral vascular disease was 0.10 ml 100 g tissue-1 min-1, while in the control group it was 0.20 ml 100 g tissue-1 min-1 (P less than 0.03, Mann-Whitney U test). The median time taken to reach maximum oxyhaemoglobin levels after ischaemia was 40 s in patients with peripheral vascular disease and 20 s in controls (P less than 0.02). The results indicate that oxygen consumption is reduced in peripheral vascular disease. Near infrared spectroscopy is a non-invasive method for assessing metabolic improvement resulting from surgical or pharmacological treatment.

Using radioactive in situ hybridization, we have mapped the expression of Huntingtin-associated protein (HAP1) mRNA in rat brain at developmental stages (E12-E19, PO-P21), in adult rats (3 months) and in 'aged' (19-21 months) rats. Using two pairs of 45mer oligonucleotide probes specific for HAP1A and a probe which recognizes regions of both the HAP1A and HAP1B mRNA sequences (panHAP1), we find that the expression of HAP1 mRNA is specific to the CNS and restricted predominantly to anatomically connected limbic structures, particularly the amygdala (medial and corticomedial nuclei), the hypothalamus (arcuate, preoptic, paraventricular and lateral hypothalamic area), bed nucleus of the stria terminalis (BNST) and the lateral septal nuclei. HAP1 mRNA was detected in embryos at E12 and displayed a prevalent distribution in the developing limbic structures by E15. In aged, 19-21-months-old, rats there is a downregulation of HAP1 mRNA expression across all CNS loci where HAP1 was previously abundant. The lowest levels of HAP1 mRNA expression corresponded with the areas of greatest pathological cell loss in Huntington's disease (HD); the caudate putamen, globus pallidus and neocortex. These observations support the suggestion that HAP1 plays an important role in the neuropathology of HD.

Stalking by patients towards psychiatrists is common and represents an important occupational risk. Formal training programmes and policy development within healthcare organizations may help manage risk.

Patients can have capacity to make decisions in one area but not in others. Many people are admitted and treated in a way that is contrary to the human rights legislation. The new Deprivation of Liberty Safeguards in England and Wales are likely to apply to a significant proportion of older inpatients. Most people wanted doctors to make treatment and admission decisions and very few wanted their family to make decisions on their behalf.