Search

Objectives: To assess the efficacy of a leg exercise performed in supine position to prevent orthostatic hypotension (OH) in older adults. Design: Case�control study. Setting: Division of Physical Medicine and Rehabilitation, Salvatore Maugeri Foundation, Scientific Institute of Veruno, Veruno, Italy. Participants: Individuals aged 65 and older admitted with degenerative joint disease screened (n = 90) and found positive for OH (n = 42). Measurements: Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded using an automatic oscillometric device in the supine position after 10 minutes of bed rest; immediately upon standing up; and after 1, 3 and 5 minutes standing. In 42 participants, a fall in SBP of 20 mmHg or more within 3 minutes of standing was found. Participants with OH were alternately assigned to the control or exercise group. The following day, both groups were reassessed as above. In the exercise group, before standing up, participants were required to perform 10 full extensions of the lower limbs, starting from 60° flexion of hip and 90° flexion of knee and ankle joints, against the resistance of an elastic band. Results : In both participant groups, SBP, DBP, and HR were similar in the supine position. When standing, the same decrease in SBP and DBP and increase in HR occurred over a similar time-course in both participant groups. The next day, the reduction in SBP was significantly smaller at each time interval after standing up in the exercise than in the control group, but no difference between the exercise and control groups was observed in DBP or HR. Conclusion: Supine leg exercise is effective in reducing an initial fall in SBP when passing from a supine to an upright position in older adults. The duration of the effect requires further investigation.

Purple urine bag syndrome is a clinical entity first de- scribed in 1978. Its typical discoloration is worrying for clinicians. In the past, these patients sometimes reached the emergency unit only because of this ex- ceptional worrying urinary sign and underwent inva- sive diagnostic examinations including cystoscopy, without any abnormal finding. It is now clear that this astonishing phenomenon of double discoloration of the urine, appearing purple in the bag and dark blue in the test tube, results from the formation of 2 different pigments (indirubin and indigo) in very alkaline urines due to enzymes produced by gram-negative bacteria, such as indoxyl phosphatase/sulfatase, which can convert urinary metabolites of dietary tryptophan. Practicing physicians should identify purple urine bag syndrome as a usually benign medical condition diag- nosed in asymptomatic patients, which only requires treatment of bacteriuria with antibiotics, prevention of constipation, substitution of catheter and acidifica- tion of the urine. After these measures, urine typically returns to its normal color.