摘要:

ABSTRACTTo study whether the renin‐angiotensin system is related to hyperuricemia in hypertension, the serum concentration of uric acid was determined in 96 patients with various types of hypertension and various degrees of plasma renin activity (PRA). In malignant hypertension, both PRA and the serum uric acid level were higher than in essential hypertension; but in primary aldosteronism or desoxycorticosterone‐excess hypertension, they were lower than in the essential type. In renovascular hypertension, PRA was higher than in essential hypertension, but the serum uric acid levels were similar. There were no differences in PRA and serum uric acid concentration between Cushing's syndrome and essential hypertension. The serum uric acid level in high‐renin essential hypertension was higher than in either the normal‐renin or the low‐renin type. There was a significant correlation between serum uric acid concentration and PRA in the basal state, and between the change in PRA and the change in serum uric acid induced by administration of furosemide. Apparently the close correlation between the renin‐angiotensin system and the concentration of serum uric acid is related to changes in extracellular fluid volume, although an intrarenal effect of angiotensin II cannot

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb02396.x

年代:1978

数据来源: WILEY

摘要:

ABSTRACTThe relationship between age, biomedical risk factors and the progression of occlusive disease of the coronary arteries was studied in 176 patients (age range, 27–66 years) who had undergone at least two cine angiograms. The biomedical risk factors of interest were serum concentrations of cholesterol and triglycerides, smoking, hypertension, diabetes mellitus, family history of coronary disease, electrocardiographic abnormalities, obesity, and age. The findings did not reveal any significant differences in mean lipid levels between patients showing progression of disease and those who did not. However, the distribution of serum cholesterol values indicated more hypercholesterolemic patients among the disease‐progression group, and more patients with ideal cholesterol levels among the no‐progression group. The other biomedical variables did not appear to be related to the progression of coronary disease. Among the older patients, hypercholesterolemia and diabetes mellitus were related to disease progression. Among the younger patients, smoking was related to progre

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb02397.x

年代:1978

数据来源: WILEY

摘要:

ABSTRACTDiagnosis of depression in the elderly is sometimes difficult owing to the presence of ego defensive mechanisms or somatic symptoms that can disguise the affect. Depression also may precede, or be associated with a variety of medical illnesses which are common among older persons. Specific ego defenses and representative medical illnesses are discussed. The concepts of a depressive equivalent and pseudodementia, which particularly act to disguise the depression, are reviewed in detail.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb02398.x

年代:1978

数据来源: WILEY

摘要:

ABSTRACTHeavyhanded mental testing as part of a geriatric admission examination may seriously prejudice subsequent psychotherapy by the physician, and is unnecessary for the basic intended purpose. Most questions of importance in determining orientation are already part of normal casetaking. Those which are not are least threatening to the patient's morale when included as components of an examination of the central nervous system. This division agrees with the premise that only those persons unable to answer informational questions are likely to prove unable to answer orientational questions.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb02399.x

年代:1978

数据来源: WILEY

摘要:

ABSTRACTLoxapine succinate, a newly developed neuroleptic drug, was administered to two groups of geropsychiatric patients: (a) 12 with psychosis and organic brain syndrome, and (b) 14 with chronic schizophrenia. After a two‐week baseline period, loxapine was given for 12 weeks. The moderate therapeutic effect of loxapine in the “responders” was similar to that of other neuroleptic drugs. The therapeutic dosage range was found to be from 10 to 80 mg daily—about half that used for younger patients. The chief side effects were drowsiness, mild extrapyramidal symptoms, and a slight increase in blood p

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb02400.x

年代:1978

数据来源: WILEY

摘要:

ABSTRACTSome serious psychologic problems associated with the biologic processes of growing old and the sociologic states of being old are discussed in the light of a recent (1974) inquiry into the sufficiency of gerontologic resources in Canada and the adequacy of provisions for the well‐being of elderly Canadians. Many inadequacies in old‐age provisions are attributable to insufficient understanding on the part of program planners, service directors and the general public, of the personal, social and cultural needs of old people. This indicates a requirement for substantial investment in basic and applied gerontology. At present, many of the psychologic problems of old age seem to be a consequence of the demoralizing effects of personal poverty, social alienation, and cultural deprivation. Significant improvements in the conditions of life in old age will depend upon wide public understanding of the vital importance and enduring nature of the human needs of old peo

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb02401.x

年代:1978

数据来源: WILEY

摘要:

ABSTRACTThe elderly tend to be more rigid than younger adults in their attitudes and personalities, and such rigidity is correlated with poor adjustment. However, the rigidity is not the cause of the poor adjustment; rather, it is an attempted solution. One of the patterns of rigidity is an outgrowth of the lifestyle of pessimism, suspicion, self‐reliance, self‐discipline, determination, and endurance. Two case studies are presented illustrating how rigidity can channel thoughts and prevent the brooding which works itself into depression or anxiety, while simultaneously reinforcing self‐help behavior. Geriatric psychotherapy should be problem‐centered and should not launch a frontal assault on rigidity or attempt to reconstruct the patient's personality. Behavioral modification, authority, and motivation slogans can be used in conjunction with the rigidity to improve the patient's coping

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb02402.x

年代:1978

数据来源: WILEY

摘要:

ABSTRACTAn extremely rare case is reported of a primary oat‐cell carcinoma of the larynx in a 70‐year‐old man who had been treated eight years previously for squamous‐cell carcinoma of the larynx by means of supraglottic laryngectomy. A review of the literature revealed only 5 unequivocal previous reports of this primary oat‐cell tumor; the present report makes a total of 6 cases. The morphologic pattern, histogenesis and biologic behavior are discussed. The patient of this report was treated by surgical intervention and radiotherapy. He was well, six months later. Only one of the 5 patients previously reported survived for more than a few months. This type of lesion has a poor prognosis because of its tendency to metastasize early to vario

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb02403.x

年代:1978

数据来源: WILEY

摘要:

ABSTRACTA trial by any means that can possibly prevent or retard the development of arteriosclerosis is to be recommended. Arteriosclerosis is the chief cause of strokes and heart attacks. The heavy evening meal now in vogue is characteristically rich in animal fats. Normal digestion is at its peak at about the seventh hour, usually during sleep, when the body economy is at its lowest ebb. A large amount of digested material with a high content of lipids is dumped into the slow‐moving circulation. As this material, full of saturated fats, moves slowly through the arteries, the situation is ideal for clot formation, possibly resulting in a stroke, a heart attack, or sudden death. Such a catastrophe can occur in almost anyone, but is more apt to strike the high‐powered executive or the apparently healthy man past 45 who has a voracious appetite. It seems logical to postulate that a light, rather than a heavy evening meal would result in less arteriosclerosis with complications such as heart attacks and stro

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb02404.x

年代:1978

数据来源: WILEY

摘要:

ABSTRACTAlthough the causes of aging are still unknown, the effects of decrements in anatomic structure and physiologic function have led to wrong concepts and resulting discriminatory policies against old people. Cardiovascular changes are common among the aged but are not necessarily symptomatic; they may be the result of past illnesses or signs of diminished cardiac reserve. In many cases, a cardiac abnormality detected by our modern diagnostic hardware does not in itself constitute the necessity for treatment. Illustrative cases are cited. A rise in blood pressure with advanced age often is a sign of adaptation to the increased rigidity of the arterial system. Certain heart murmurs mimicking mitral insufficiency may indicate slight papillary muscle dysfunction or a clinically insignificant degree of mitral valve prolapse. On the other hand, the changing clinical status in old age may involve a diminution of symptoms. Therefore, in geriatric medicine, the physician should be on the alert for aberrant manifestations, e.g., painless myocardial infarction or atypical pulmonary embolism. Psychologic evaluation is important. There is no cardiac disorder which is typical for the older age group, but also there is none from which older people are exempt.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb02405.x

年代:1978

数据来源: WILEY