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[figure: see text] A series of 1-arylcyclohexenes have been deconjugated to the corresponding 3-arylcyclohexenes via a photosensitized electron-transfer reaction. The introduction of substituents on the aryl group has provided insight into the underlying mechanism and has defined the scope and limitations of the reaction.

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To assess the relationship between serum lipids and coronary heart disease (CHD) in an elderly population (mean age = 77.4; SEM +/- 0.4; range 70-92 years), serum total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were measured in 84 (males = 52) subjects with evidence of definite myocardial infarction and 125 (males = 77) age- and sex-matched controls free of CHD on Rose questionnaire and resting electrocardiogram. On multivariate logistic regression analysis, CHD showed inverse association with HDL-C (odds ratio for decrease by 1 s.d. = 1.6, P = 0.02) in males and positive association with TC (odds ratio for increase by 1 s.d. = 1.8, P = 0.03) and LDL-C (odds ratio for increase by 1 s.d. = 1.8, P = 0.04) in females. Of the other variables only diabetes in males (odds ratio 2.4, P = 0.05) and left ventricular hypertrophy in females (odds ratio 8.8, P = 0.03) were associated with CHD. The results suggest that further prospective studies to further evaluate the relation of serum lipids with CHD in this age group are indicated.

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In a prospective study of 539 consecutive elderly medical admissions (mean age 77.3 years; 275 men), 42 patients (7.8%; 36 men) were identified as alcohol abusers, 41 by an alcohol intake history and one by a positive response to the CAGE questionnaire; none was identified by laboratory screening (gamma glutamyltransferase and red cell mean corpuscular volume) alone. Thirteen admissions (2%) were alcohol-related. In alcohol abusers, 24% of admissions (n = 10; p less than 0.001) were alcohol-related. Alcohol abusers were predominantly men (86%; p less than 0.001) and independently mobile (88%; p less than 0.001), suggesting greater physical fitness. In these more active men (n = 167), the prevalence of alcohol abuse was 19.8% and 6% of admissions were alcohol-related. While the sensitivities of the CAGE questionnaire and laboratory screening were too low to be clinically useful, an alcohol intake history may allow for a significant opportunity in preventive medicine in this age group, particularly in the fitter men.

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Doppler ultrasound measurement of ankle/brachial systolic blood pressure ratio was carried out in 295 elderly (mean 77.3, SEM +/- 0.3, range 68-92 years; males = 180) subjects. Of these, 49.8% (n = 147; males = 86) had evidence of lower limb arterial disease (ankle/brachial systolic blood pressure ratio less than 0.96). On multivariate analyses, excluding ischaemic heart disease as an independent variable, systolic blood pressure and current cigarette pack years were positively related to lower limb arterial disease while BMI and serum high density lipoprotein cholesterol were inversely related (multiple correlation coefficient = 0.277; P less than 0.0001). On including ischaemic heart disease as an independent variable, this was positively associated with lower limb arterial disease; the relationships of the other variables were similar except for a weaker (P = 0.055) relationship with serum high density lipoprotein cholesterol (multiple correlation coefficient = 0.296; P less than 0.0001). While the relationships demonstrated were relatively weak, the findings suggest that reversible risk factors are still relevant in the development of lower limb arterial disease in the elderly.

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The degree of arterial stenosis in both the right and left extracranial (common and internal) carotid arteries (ECAS) was assessed in 118 elderly (65 years and older; male 66) stroke patients by a Duplex Pulsed Wave ultrasound system (ATL 500). Of these, 33 (28%) had severe stenosis (75-100%), 16 (14%) had moderate stenosis (30-74%) and 69 (58%) had no or minimal stenosis (0-29%). Overall, 34% (n = 40) of strokes were associated with moderate or severe stenosis in the ipsilateral extracranial carotid artery. Multivariate logistical regression analysis showed a significant (P less than 0.05) positive correlation between ECAS (as assessed in either artery) and ischaemic heart disease, systolic blood pressure and male sex (multiple correlation coefficient, r = 0.240). The results were similar when the analysis was repeated for ECAS in the 'clinically significant' (maximal stenosis ipsilateral to the stroke) arteries only (multiple correlation coefficient, r = 0.276). The relationships, however, were weak, suggesting that other factors not identified in this study are more important aetiological factors for extracranial carotid artery atherosclerosis in the elderly.

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In a retrospective study of 210 patients with pulmonary embolism diagnosed by ventilation perfusion lung scan or at post-mortem, the incidence of pulmonary embolism was greater in patients over 50 years old (1.4%; P less than 0.05). This was largely due to an increased prevalence of serious associated disease (53%; P less than 0.05). Mortality in elderly patients (70 years and older) diagnosed by ventilation perfusion lung scan was similar to that in younger age groups (P greater than 0.05). However, the number of cases first diagnosed at post-mortem (44.50%; P less than 0.05) and total mortality (55%; P less than 0.05) were highest in this age group. Of elderly patients first diagnosed at post-mortem 14 (32%; P less than 0.05) had no other associated disease and had a recorded duration of symptoms sufficient to have allowed premortem diagnosis.

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