摘要:

ABSTRACT:Postmenopausal women should not be denied estrogen therapy because of the controversy about the alleged causal relationship of estrogens to endometrial cancer. A prestigious team of biostatisticians reviewed three publications that claimed this relationship and concluded that no such association could be confirmed. Although the incidence of endometrial cancer has doubled in the past 25 years, there is no valid basis for the assumption that the widespread use of estrogens is the cause. The incidence also has increased in Norway and Czechoslovakia where estrogens are rarely used. Moreover, the histologic pattern of endometrial dysplasias is such that many pathologists will make a diagnosis of endometrial cancer as a safeguard for the patient. Thus the statistics for the incidence of endometrial cancer may be inflated. As a test, the administration of 200 mg of an oral progestogen over 5–10 days will convert a histologic pattern of pseudomalignancy, but not of adenocarcinoma, into one of secretory endometrium. Unopposed endogenous or exogenous estrogens may induce hyperplasia, atypical adenomatous hyperplasia or adenocarcinoma in women who are genetically predisposed. To minimize such a possibility, it is advisable to give a 5–7 day course of an oral progestogen so that the endometrium will be shed at monthly intervals. The benefits of hormone replacement therapy for the postmenopausal woman far outweigh the putative risk of endometrial ca

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb01947.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

ABSTRACT:Previous research on elderly women living in institutions has shown a positive relationship between the administration of estrogen and improved psychologic status. In the current 12‐month study, the effects of estrogen therapy were compared in 18 institutional women versus 21 noninstitutional women who volunteered to participate. Both groups received conjugated estrogens (Premarin, 0.3 mg daily) in interrupted courses. Throughout the year, the women were evaluated by means of the Eysenck Personality Inventory, the Profile of Mood States, the Lawson Morale Scale, and various self‐perception items. Statistically significant changes occurred in the areas of neuroticism, tension, morale, and subjective mood states, but the improvement was greater in the institutional subjects. The main conclusion was that estrogen therapy has a positive effect upon psychologic status, particularly for women who reside in an institut

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb01948.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

ABSTRACT:In order to study the role of the renin‐angiotensin system in patients with diabetic nephropathy, renin release and the juxtaglomerular apparatus were studied in 17 diabetic patients with proteinuria and in 23 without proteinuria; 8 normal subjects were used for controls. Despite hypertension and marked arteriosclerosis, plasma renin activity (supine posture) was normal; however, the renin response to salt restriction and upright posture was less in the diabetic patients with proteinuria than in the controls. Renal renin content, determined at autopsy, was also normal. Examination of the juxtaglomerular apparatus in the diabetic patients with proteinuria revealed hyalinization of the afferent and efferent arterioles in most of the glomeruli and various degrees of destruction of the juxtaglomerular cells. The findings suggest that renin production is not increased in diabetic patients with proteinuria plus marked vascular damage, and that the renin‐angiotensin system in patients with diabetic nephropathy apparently does not play an important role in the exacerbation of hypertension or the degree of vascular dam

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb01949.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

ABSTRACT:Psychiatric evaluation of the elderly is especially difficult for several reasons, e.g., the presence of organic impairment, the effects of multiple drug therapy, and the tendency to confuse the normal concomitants of aging with neurotic symptoms. The authors have developed and evaluated a brief series of self‐report assessment tests (GRDB) designed to assist the psychiatrist in the process of diagnosis. Coefficients of the internal consistency of the seven scales are presented. A comparison was made between 28 psychiatric patients attending a geriatric clinic and 48 well‐functioning elderly persons matched for age and sex, and living in the same community. Results showed that the geriatric outpatients functioned at a lower level of adaptation than did the control group, on all seven scales—depression, daily living skills, social interaction, cognitive skills, number of illnesses, number of life problems, and the use of drugs and alcohol. These findings provide a measure of discriminant validity. The advantages of this brief assessment instrument are disc

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb01950.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

ABSTRACT:Two approaches (normative and symptomatic) are presented for recruiting volunteers for a study of the effects of a vasodilator on the psychophysiologic functioning of elderly patients with mild to moderate cerebroarteriosclerosis. The subjects had to be at least 60 years old, in good physical and emotional health, of at least average intelligence, manifesting cognitive impairment by at least one of several test measures, maintaining themselves in the community, and active in a senior citizens program. Results of both approaches were compared for rates of volunteer response, study eligibility, and admission to the study. The normative approach emphasized data on the normal cognitive changes associated with the aging process. The symptomatic approach focused on the early diagnosis and treatment of an existing cognitive impairment. A combined total of 1,030 potential volunteers, nearly equally divided according to the two techniques, were addressed in group meetings. With the normative approach, 33 percent volunteered; of this group, 27 percent were found eligible for the study, and of these, 10 percent entered the study. With the symptomatic approach, 36 percent volunteered; of this group, 54 percent were found eligible for the study, and of these, 51 percent entered the study. Thus the symptomatic approach was five times more effective than the normative approach.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb01951.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

ABSTRACT:This study was an attempt to evaluate the effects of a controlled alcohol intake on the socialization of a group of geropsychiatric patients in a clinical setting. Although 47 patients of the Geriatric Unit were involved at various times, 16 remained in the study for the entire eight weeks. The Social Hour consisted of a half‐hour session every weekday. The alcohol served was whisky, gin, vodka, and wine. Soft drinks were available for those who preferred them. Each patient was rated on a 5‐point scale with regard to ward and off‐ward activities. A planned four‐week placebo period met with so much negativism that it had to be shortened to three days. According to our observations, the socialization process was increased significantly for these mentally ill geriatric patients during this type of Soci

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb01952.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

ABSTRACT:More attention should be paid to the profound needs of dying patients. The family physician can guide the family members and others in forming a team to help dying elderly patients in this life crisis, so that they may have a “good death.” The importance of honesty and cooperation by all those involved is emphasized, as is the need to support the patient emotionally and spiritua

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb01953.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

ABSTRACT:The present generation of those past age 70 grew up with the idea that a fractured hip meant “the beginning of the end” for the elderly. The results reported here on the treatment of 50 consecutive patients over 70 years of age who had sustained a fractured hip indicate that in this situation the orthopedic surgeon can be an important partner in geriatric medicine. He can improve the functioning and health of this special group of elderly trauma victims through reassuring them that the fracture usually can be successfully treated without undue risk to life. The present improved state of the art of anesthesiology, surgery, and pre‐ and postoperative medical care makes the surgical risk tolerable, and helps to prevent many of the complications that used to occur in elderly patients confined to bed for long periods following hip fra

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb01954.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

摘要:

ABSTRACT:A suicidal 67‐year‐old woman with manic‐depressive psychosis took an overdose of aspirin, amitriptyline and diazepam. The initial effects were pyrexia, tachycardia, hyperpnea, metabolic acidosis, electrocardiographic changes, hypo‐prothrombinemia, gastritis, and pancreatitis. Four to six weeks later, she was examined because of persistent abdominal pain with nausea, anorexia, anemia, and possibly a malabsorption syndrome. An exploratory laparotomy was performed. The surgeon found several adhesions, a small intestinal volvulus, and a nodular pancreas. This suggested previous perforation of the small bowel from enteritis, causing a “blind‐loop” syndrome. The involved section of the small bowel was resected. With appropriate treatment, the patient is well three months af

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb01955.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1978.tb01956.x

出版商:Blackwell Publishing Ltd    

年代:1978

数据来源: WILEY