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Twenty elderly patients (mean age 82 years) with dizziness were examined by magnetic resonance imaging (MRI). The findings have been compared with those from nine healthy subjects of similar age who acted as a control group. The technique proved acceptable to all these patients, and in the majority (65%) the overall radiographic quality of the resulting images was adequate, good or excellent. Nineteen of the 20 patients showed evidence of abnormal high signal intensity within white matter, often close to the frontal horns but also more widely scattered within the cerebral hemispheres; similar lesions were seen in the brain-stem in eight of the patients. However these white matter changes were equally prevalent in the control group. No cause for dizziness has been shown by MRI.

A pilot study was carried out to compare the effect of ethacrynic acid and frusemide on glucose tolerance in ten elderly inpatients, who were suffering from hemiparesis. One subject had to be withdrawn. None was seriously ill, was previously known to be diabetic, or was taking a diuretic. The mean of two base-line glucose tolerance tests was compared with those after 14 days on one diuretic, after a further 11 days without a diuretic and after another 14 days period on the other diuretic. The values taken for comparison were the peak and two-hour sugar levels. No evidence emerged that either drug was inevitably diabetogenic in the short term, and indeed, if anything, they both appeared to possess slight anti-diabetic activity. The effect on carbohydrate metabolism is probably not a factor that needs to be taken into consideration when prescribing these drugs, but should hyperglycaemia develop during treatment, a change of diuretic is recommended. The glucose tolerance test was found to be more reproducible than anticipated, possibly due to the controlled circumstances. If the two-hour blood sugar is taken as the criterion, most elderly subjects showed evidence of impaired glucose tolerance.

Systolic blood pressures were measured at the ankle by Doppler ultrasound sphygmomanometry in a series of elderly patients. Twenty-four limbs were affected by severe occlusive arterial disease and in 15 limbs there was no good evidence of significant peripheral vascular insufficiency. The pressures were measured in the supine position and again with the subject sitting upright or standing. In both series there was, as anticipated, a marked increase in the pressure, so that the sitting/erect range of pressures in the ischaemic limbs overlapped considerably with the supine pressure range in the healthy limbs and were then higher than the values usually associated with rest pain and non-healing skin lesions. This postural effect almost certainly does not reflect a corresponding rise in blood flow in the normal extremity, but in the ischaemic foot it may offer a simple means of improving perfusion.

Tomographic emission scintigraphy of the brain using a stationary gamma-camera and rotating slant hole collimator, following intravenous injection of 123I-n-isopropyl p-iodoamphetamine, yields high quality images of regional cerebral blood flow. The technique has been used on 20 geriatric patients and is non-invasive, well-tolerated, and hitherto only associated with trivial adverse effects. It appears to be particularly useful in supporting a clinical diagnosis of multiinfarct disease but the demonstration of zones of underperfused but not necessarily infarcted cerebral tissue may well have wider research implications.