摘要:

ABSTRACT:Paget's disease usually is found in patients past the age of 40. Early presenting symptoms include headache, deafness, tinnitus, and pain due to radicular compression. The diagnosis is confirmed by radiographic features and elevated levels of serum alkaline phosphatase and urinary hydroxyproline. Bony overgrowth results in pressure on nearby soft tissues such as the brain, spinal cord, and certain peripheral nerves. The abnormally soft quality of the calvarial bone permits distortion by the weight of the brain. Dorsal inclination of the plane of the foramen magnum and the projection of the odontoid process into the posterior fossa lead to stretching of the brain stem over the odontoid process and the ventral margin of the foramen. Obstructive hydrocephalus may result. Sarcoma of the cranial vault may develop in cases of Paget's disease. Once cervicomedullary or spinal compression has occurred, surgical decompression may be necessary. Three drugs—calcitonin, disodium etidronate, and mithramycin—have been used with some benefit in the treatment of Paget's dise

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01712.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

ABSTRACT:Nineteen patients with senile brain disease (including 2 with parkinsonian symptoms) were treated with amantadine in an oral dosage of 200–300 mg daily. Seven showed definite clinical benefits such as increased alertness and decreased agitation, and 2 others showed slight benefits. However, in only one instance was the benefit maintained without complications. Toxic effects such as overactivity, anxiety and visual hallucinations were observed in 8 patients. Withdrawal effects (e.g., lethargy and staggering) occurred when amantadine was discontinued. The electroencephalograms (EEGs) of all 19 patients showed a frequency increase, chiefly of occipital alpha activity, and sometimes a return to normal, irrespective of clinical changes. Toxic side effects were associated with particularly prominent EEG acceleration. In 10 of the 19 patients, the clinical changes were further validated by additional psychologic assessments. Although the value of amantadine is limited when given in this way to patients with senile brain disease, it seems important to observe its effects in drug combinations aimed at correction of neurotransmitter imbalance

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01713.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

ABSTRACT:Sexual histories were obtained in 51 men with prostatic cancer and their spouses, before and after pelvic lymphadenectomy and retropubic125I implantation. The average age of the patients was 64.7 years. Sexual activity was retained in 40 of the 41 patients who were sexually active before operation. Ten patients had been sexually inactive before operation—4 with diminished potency and 6 with complete erectile impotence. Sexual dysfunction was most often pyschogenic. At six months after the operation, 5 of these patients had resumed satisfactory sexual intercourse as a result of reassurance, encouragement and education of the remaining sexual potential. No patient was rendered completely impotent as a result of the procedure. Preservation of sexual potency represents a significant advantage of125I implantation over other therapeutic modalities in the treatment of localized prostatic carcinom

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01714.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

ABSTRACT:The relation of serum albumin concentration to age was assessed in a series of hospitalized medical patients. Those with disease states (e.g., dysproteinemia, renal insufficiency, hepatic dysfunction, malnutrition) potentially associated with abnormal serum albumin levels were excluded, leaving a study population of 11,090 patients. The mean serum albumin concentration fell progressively with each decade of age, from 3.97 gm/100 ml in subjects aged less than 40, to 3.58 gm/100 ml in those aged 80 or older (F>50.0, P<.001). The percentage of patients with a normal serum albumin level (4.0 gm/100 ml or higher) also decreased progressively with age, whereas the frequency of a low serum albumin level increased with age. Sex, primary diagnosis, blood urea nitrogen concentration, duration of hospitalization, and geographic location of the hospital did not influence the findings. The reduced serum albumin concentration in the elderly could contribute to age‐dependent changes in the clinical effects of certain albumin‐bound drugs, since pharmacologic activity can be influenced by the extent of albumin binding, in turn related to albumin concentrat

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01715.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

ABSTRACT:Huntington's disease (Huntington's chorea), a degenerative disorder of the central nervous system, is inherited in an autosomal dominant pattern. Since there is no cure for this genetic disorder, therapy has been focused on pharmacologic manipulation of the involved neurotransmitter systems. In Huntington's disease, there is a functional predominance of striatal dopaminergic activity over antagonist cholinergic and possiblygaba‐minergic systems. Many dopaminergic antagonists and cholinergic andgaba‐minergic agonists are currently used in treatment. Supportive psychiatric care for affected persons and their families is an important therapeutic adjunct in the management of Huntington's disease. The eventual therapy will depend upon accurate identification of the primary genetic def

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01716.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

ABSTRACT:It is important to have accurate information derived from basic data about geriatric patients, not only for clinical management but to anticipate changes in the demand for services and the taking of preventive action. A model is presented for computer‐oriented analysis. The collection of data is designed to cover the specific physical, physiologic and social needs of the patients both in the hospital and in the community. It must also support effective action about these needs which involve not only usage of existing facilities but the planning of preventive measures and adjustment of the provision for care. In addition, it must support clinical research when necessary. Geriatric records have specific problems, not only those of the patient's identity and clinical data but also the maintenance of psychologic and social information so that the requirements for long‐term care can be assessed. This type of record facilitates comparison between groups of patients and allows measurement of inter‐hospital performance relating to medical care and the planning of social programs in the community. Such records furnish the background of a more detailed statistical analysis for indicating the direction of national policy. By this means the prevalence of medical, psychologic and social demand can be studied and various preventive actions taken, including the monitoring of geriatric facil

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01717.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

ABSTRACT:A study was made of 73 elderly patients receiving methenamine and ascorbic acid concurrently. Each patient had an indwelling Foley catheter. Urinary pH was assessed in relation to the dosage of ascorbic acid, duration of therapy, formulation, and dosing intervals for ascorbic acid and methenamine. Statistical analysis revealed a significant increase in urinary pH when the dosage of ascorbic acid was increased. No significant relationships were found between urinary pH and the dosage forms of ascorbic acid, the salt of methenamine used, or the duration of methenamine therapy. Changes in urinary pH at different dosing intervals for ascorbic acid were found to be significant, at the 10 percent level only, for the three‐times‐daily dose schedule. These data raise a question as to the value of ascorbic acid for acidifying the urine of catheterized patients receiving methenamine ther

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01718.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

ABSTRACT:Depression in the elderly is difficult to classify and may be more of a symptom than a disease entity. The core problem with the elderly is inability to handle multiple losses. Feelings of helplessness and reduced self‐esteem are significant. The resultant depression often appears mild but the risk of suicide cannot be ignored. The family physician is the key person in the diagnosis of depression. The close relationship between physical factors and depression may make differentiation difficult. Treatment involves a sympathetic but firm approach, particularly when dealing with the hypochondriacal patient. Regression in the elderly is a serious problem that requires staff teamwork. Reactivation techniques which combat feelings of helplessness and hopelessness are of particular importance. When the patient no longer responds well to appropriate drugs, electroconvulsive treatment may be of value. Family and marital therapy should not be overlooked. The nihilist has no place in geriatric medicin

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01719.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

ABSTRACT:The character of idiopathic hypertrophic subaortic stenosis (IHSS) was studied retrospectively in a large community hospital for the six‐year period, 1968–1974. Cases were discovered by examining the records of the Cardiac Non‐Invasive Laboratory (phono‐ and echocardiography). Of the 46 cases of IHSS identified, 39 were in patients of the 50–81 age group. Thirty‐two (82 percent) of the 39 patients were women, and 25 (78 percent) of these had a significant degree of hypertension. The hypertension had been present for more than five years in 62 percent of the cases. In 84 percent of the elderly females, the cardiac murmur had been present for less than ten years, and in 65 percent for less than five years. There was no family history of IHSS. Eighteen of the 46 IHSS patients underwent cardiac catheterization which confirmed the accuracy of the cardiographic data in all cases. The results of this study indicated that IHSS is usually nonfamilial, predominates in elderly females, and tends to be acquired after a lengthy period of hypertension. Cardiographic data appear highly specific diagnostically, often rendering cardiac catheterization unnecessary. Previous studies have not clearly defined the role of hypertension in the development of IHSS, at least partly because of the highly selective nature of most series reported from referral centers. These series often contain large numbers of young

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01720.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1979.tb01721.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY