摘要:

AbstractThe emergency room records of 140 patients with cardiac complaints were reviewed. The average age was 60 years. Chest pain was the most common symptom and a majority of patients with this complaint expressed fear of an acute coronary episode. Of 41 cases admitted with the initial diagnosis of myocardial infarction, only 21 had that diagnosis at the end of two weeks. Of 91 patients sent home from the emergency room, 83 were alive and well at the end of six weeks. A single patient died of acute myocardial infarction ten days after leaving the emergency room. No patient was averse to admission, and in 10 instances patients came to the emergency room equipped with personal items indicating anticipation of admission. Such studies are feasible and may elucidate further the role of the emergency room in the early care of the “coronary suspect

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1971.tb01549.x

年代:1971

数据来源: WILEY

摘要:

AbstractTo determine the possible effects of thyroid therapy on the course of atherosclerosis, 347 patients (173 males and 174 females) were selected for a five‐year study. The atherosclerosis was symptomatic in 132 patients (mean age, 64.5 years), and asymptomatic in 215 (mean age, 54.7). The asymptomatic patients were considered high risks, however, because of the presence of one or more of the following: nonspecific ECG abnormality, arterial hypertension, diabetes, or hypercholesterolemia. Of the total group, approximately 9 per cent (31 of 347) were hypothyroid by laboratory tests; the remainder were euthyroid.All patients were treated with desiccated thyroid in physiological dosage. Substantial clinical improvement was measurable in a significant number of patients in both groups. The mean serum level of total cholesterol was reduced by 22.2 per cent. A more favorable ECG pattern was observed in 14 per cent. Cardiovascular morbidity was less than predicted. Eleven deaths (mean age of patients, 75) occurred during the study; in 10 of these cases there had been one or more symptomatic episodes of atherosclerosis before treatment. The mortality rate was 58 per cent of the expected rate for a matching population as drawn from New Jersey Life Tables, and 44 per cent of the expected rate as drawn from U. S. Life Tables. Thyroid therapy deserves a more extensive trial as a possible means of modifying or preventing the effects of atherosclerosi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1971.tb01550.x

年代:1971

数据来源: WILEY

摘要:

AbstractReasons for caution in administering drugs to old people are discussed. A survey was made of the records of 33 elderly cardiac patients in a teaching hospital, 30 elderly ambulatory patients in the community, and 30 elderly patients in a geriatric hospital. The findings indicated that prescription practices were somewhat different for the hospital patients than for the community patients, but there did not seem to be any reduction in drug dosage on account of the patient's advanced age.Those who prescribe drugs for geriatric patients have a great responsibility to see that the dosage is correct and that, when the drug has to be self‐administered, the patient is given complete instructions which he can understan

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1971.tb01551.x

年代:1971

数据来源: WILEY

摘要:

AbstractA comparison was made of the proportional frequencies of deaths from ischemic heart disease (IHD) in Icelandic males of different occupational classes—farmers, seamen, laborers, craftsmen, and white‐collar workers. The study was based on the examination of death certificates for adult males for the period 1951–60. There was no evidence of significant differences in method of death certification or in diagnostic transfer.At ages 35–64 the ratio of IHD deaths to all deaths ranged from 10.4 per cent for farmers to 30.4 per cent for white‐collar workers. In between were seamen and laborers on the lower side and craftsmen on the upper side of the over‐all value, which was 20.1 per cent. At ages 75 and older there were practically no differences. Further analysis indicated an essentially similar occupational pattern with respect to mortality rates, except for a somewhat contracted range. The rates for white‐collar workers, nevertheless, were about twice as high as for the farmers.The difference in IHD mortality between farmers and white‐collar workers at least, could not be related to the amounts or composition of dietary fats, but there was evidence of an association with physical activity and overnutrition. So far this is compatible with the view that habitual positive energy balance may be more important as a risk factor for ischemic heart disease than is richness of t

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1971.tb01552.x

年代:1971

数据来源: WILEY

摘要:

AbstractThe more common causes of anemia in malignant disease are discussed. Of 78 patients requiring transfusions on the Oncology Service of the University of Wisconsin Medical Center during the period December 1968–May 1969, records were available on 65. Gross blood loss was the most common cause of the anemia (44 cases); next was suppression of the bone marrow by chemotherapy (27 cases) or radiation therapy (8 cases); tumor spread to bone marrow (18 cases); infection (15 cases); uremia (5 cases); and poor nutrition (5 cases). Directions are given for evaluation of the patient.The search for the cause of the anemia should be intensive, for only in this way can the proper diagnosis be made and the appropriate treatment recommende

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1971.tb01553.x

年代:1971

数据来源: WILEY

摘要:

AbstractThis report concerns three categories of employees who are retired from work early because of a disability for which they can claim compensation: 1) the “worn out” worker with no special plans, 2) the man who has a hobby which he intends to pursue actively, and 3) the man who wants to engage in a different occupation after retirement. Extensive tests reveal no physical basis for the disability and treatment does not alter its course. Both patient and physician are involved in the transition from occupational function to subjective non‐function. Unless the situation is recognized, rehabilitation workers and vocational counselors are led to futile activity.Most of these patients are happy in retirement. However, the fulfillment of their desires is very costly to society in time, money and frustration. It would seem to make social and economic sense to retrain certain motivated persons into new occupations before they become disabled in this manner. This applies particularly to persons in occupations that require great physical stamina and agility—occupations in which the workers wear ou

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1971.tb01554.x

年代:1971

数据来源: WILEY

摘要:

AbstractA survey of 235 elderly women (age range, 60–80+) admitted to the Obstetrics and Gynecology Department of a Municipal Governmental Hospital in Tel Aviv, Israel, revealed the following reasons for admission: postmenopausal bleeding in 117 women (50 per cent), genital prolapse in 78 women (33 per cent), and genital tumors in 40 women (17 per cent).In 48 cases, curettage and biopsy showed that bleeding was due to local proliferative changes (polyps) or diffuse changes (polyposis and hyperplasia); in 46 cases bleeding was due to atrophic degenerative changes; and in 15 cases of carcinoma of the endometrium, it was related to estrogenic stimulation. In the majority of these cases, bleeding appeared between eleven and twenty years after the menopause.Among the benign genital tumors, there were 4 cases of fibroid uterus, and 12 cases of ovarian tumor (5 functional cystic, 5 proliferative cystic, 1 endocrine thecoma type, and 1 fibroma). Three cases of malignant tumor of the ovary were all of the cystadenocarcinoma type. The patients with benign or malignant ovarian tumors complained of acute or chronic abdominal pain and postmenopausal bleeding. The other malignant tumors were: carcinoma of the cervix (3 cases), carcinoma of the vulva (2 cases), and carcinoma of the salpinx (1 case).Genital prolapse was the second leading cause of surgical intervention. In most cases the patient's age was no contraindication for surgery, and the postoperative course was no different than in younger women, when appropriate precautions were take

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1971.tb01555.x

年代:1971

数据来源: WILEY

摘要:

AbstractDysfunction of the temporomandibular joint and the associated musculature of the head and neck may be caused by physiologic imbalance or by psychologic stress. In the geriatric patient this dysfunction can cause severe pain and discomfort. Detailed steps in the diagnosis are presented, with emphasis on differentiation from pathologic conditions. Treatment consists of removal of the traumatic forces (chiefly dental abnormalities) causing the physiologic imbalance. The basic form of treatment (after initial adjunctive therapy) is in the field of prosthodontia. When such a treatment program is properly carried out, relief from symptoms can be expected in about 85 per cent of the patients.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1971.tb01556.x

年代:1971

数据来源: WILEY

摘要:

AbstractThe purpose of this study was to evaluate the effects of orphenadrine citrate (Norflex) in the syndrome of “restless legs” and nocturnal leg cramps. Of the original 32 patients, 12 were dropped from the study because of gastrointestinal intolerance to the first few doses of the drug or because they were unreliable observers; the symptoms subsided as soon as orphenadrine was discontinued. In the 20 remaining patients the drug was well tolerated; they received it in an oral dosage of 100 mg (occasionally 200 mg) daily for periods ranging from three months to one year. Orphenadrine citrate was found to be an effective therapeutic agent by itself in 16 of the 20 cases, and in combination with other drugs in 4 ca

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1971.tb01557.x

年代:1971

数据来源: WILEY

摘要:

AbstractTwo cases of an extremely rare tumor, the primary transitional‐cell carcinoma of the male prostatic urethra, are presented. The diagnostic problems of the 2 cases are emphasized in relation to a special group of elderly long‐term patients in a hospital for chronic diseases. In addition, one of the patients had two primary carcinomas and mixed widespread metastases. It is the first such case.This report of the 2 cases and the discussion of their pathologic aspects may help in the diagnosis of other primary urethral tumors in an early st

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1971.tb01558.x

年代:1971

数据来源: WILEY