摘要:

AbstractThe future looks bright for continued advances, not only in neurosurgery but in general surgery and its subspecialties, in the light of recent new techniques involving cryosurgery and the laser. This progress has particular application to the diseases common to middle‐aged and elderly persons. The authors' studies are outlined. There are good prospects for the better treatment of neoplasms (pending discovery of how to prevent them), and also the extension of the knowledge attained to other knotty therapeutic problems. In addition, there are the advantages of new drug treatment such asl‐dopa for Parkinson's disease, or perhaps hyperbaric oxygenation for certain brain disord

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1970.tb02839.x

年代:1970

数据来源: WILEY

摘要:

AbstractSince the senior author's first publication forty years ago on the relationship of sodium and potassium to hypertension, these clinical investigations have continued, and in 1958 were established at the Geriatric Study Centre in Toronto. Here, studies were started on the urinary excretion (as an index of intake) of sodium and potassium in subjects with normal blood pressure and in patients with hypertension. Some of the findings are reported in this article, including evidence for the accuracy of the laboratory values, and determination of the normal ranges for serum sodium, serum potassium, serum chloride and blood urea nitrogen in a small group of elderly persons. These studies demonstrated: 1) in persons with normal blood pressure, the urinary excretion (and presumably the intake) of sodium averaged 3.75 gm (9.375 gm NaCl) per day; 2) sodium‐restricted diets, as applied before the study, had been grossly inadequate (excretion 2 gm sodium per day); 3) the study regimen (sodium‐restricted, potassium‐rich intake plus chlorothiazide) had a beneficial effect on hypertension; 4) the potassium supplements induced a sharp rise in the urinary excretion of potassium; and 5) the lack of serious abnormalities in the levels of serum sodium, serum potassium and blood urea nitrogen indicated the safety of this regimen within the limits of this study.The authors have continued to treat hypertension with a sodium‐restricted (400 mg daily) diet, a small dosage (250 mg daily) of chlorothiazide, and potassium (4 gm daily) supplements. The findings on groups of patients treated as long as twelve years are recorded.Hypokalemia as a complication of thiazide therapy is discussed and its potential dangers emphasized. A case of recurrent hypokalemia during a three‐year period is presented to demonstrate certain clinical manifestations and the influence of hypokalemia on the electrocardiogram. The effect of the described therapeutic regimen is also detailed in a case of renovascular hypertension engrafted on essential hypertension, and in a case of hypertension treated by the Smithwick operation. The effect of therapy on morbidity and mortality from hypertension is

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1970.tb02840.x

年代:1970

数据来源: WILEY

摘要:

AbstractA study was made of 196 patients (120 men and 76 women) with acute myocardial infarction. The mean age was 65 years, with a range of 31 to 104 years. Of the 196 patients, 69 (35.2 per cent) died. The mortality rate increased particularly after age 70, for each sex. The incidences of associated heart failure and shock also increased with age. The data indicate that: 1) the elderly patient with acute myocardial infarction is a poor risk, 2) statistics on the mortality rate should include the age of the patient, and 3) advanced age, congestive heart failure, shock, and cardiac arrhythmias are prime factors in the prognosis.The requirements for reducing the mortality rate include early and accurate diagnosis of acute myocardial infarction, and more intensive treatment before the onset of irreversible changes. The way in which the symptoms of acute myocardial infarction differ in the aged are outlined, as are the principles of treatment and specific recommendations.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1970.tb02841.x

年代:1970

数据来源: WILEY

摘要:

AbstractPermanent transvenous pacing of the heart for control of both rate and rhythm has achieved widespread acceptance in the treatment of heart block. It is now performed in adults of any age group, and there are no special contraindications. Data are presented on the results of 122 transvenous pacemaker implantations from one to three years after operation. The average age of the patients was 68, and 38 of them were over 75 years old. Episodic sinus arrest or asystole in patients with otherwise adequate cardiac rates can be detected by continuous electrocardiographic monitoring and treated by implantation of demand‐type pacemakers. Asynchronous units now are used only in very elderly patients with stable complete heart block.Displacement of the catheter has been the major problem; if recurrent, it is managed by direct epicardial insertion of the pacemaker leads through an extrapleural approach to the heart. The longevity of the power‐pack components and the battery still falls short of the manufacturers' claims. This emphasizes the need for establishment of pacemaker clinics so that sudden failure of pacemakers can be preven

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1970.tb02842.x

年代:1970

数据来源: WILEY

摘要:

AbstractThe occurrence of calcification around the hip joint of a hemiplegic limb within a few weeks of a stroke is reported in 2 cases. This is a rare complication in hemiplegia although it is observed more commonly in paraplegia. Both patients had considerable pain, which subsided after a course of radiotherapy. Possible aetological factors are discussed.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1970.tb02843.x

年代:1970

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1970.tb02844.x

年代:1970

数据来源: WILEY