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Quality of life of 79 patients who underwent esophagectomy for esophageal cancer and survived more than one year was evaluated by a questionnaire method. About 90% of patients had a good appetite, taking ordinary solid foods, and 69% were satisfied with the daily amount of foods. About 40% of patients complained of passage disturbance on swallowing, abdominal pain or diarrhea after meal. Fifty seven per cent of patients had frequent episodes of cough and sputum, and 20% were not able to go up the stairs to the third floor because of short breath. Thirty two per cent of patients with recurrent nerve paresis and even 5% without paresis had a trouble in daily conversation. These physical distresses were thought to be useful indicators for the doctor to evaluate the quality of life of patients. Additionally, about 30% of patients had a tendency of mental depression postoperatively. Fifty six per cent of patients who had worked before operation returned to work or were doing a lighter work than before. The psychological factor and social rehabilitation were suggested to be very important, when evaluated from the patient's side. Especially in case of aggressive surgery for esophageal cancer, postoperative quality of life of patients should be carefully considered from the viewpoints of both the patient and doctor.
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PMID:[Quality of life of patients after esophagectomy for esophageal cancer]. 205 79

Among medical clinic patients consulting for IBS, symptoms of psychologic distress are common, and more than half of these patients are found to have a psychiatric diagnosis in addition to bowel dysfunction. Many investigators have therefore concluded that IBS is a psychophysiologic disorder and proposed that patients with IBS be treated with psychologic techniques. However, recent studies suggest that this association may be spurious; persons in the community who have symptoms of IBS but do not consult a doctor have no more psychologic symptoms than persons without bowel symptoms. This indicates that psychologic symptoms do not cause bowel symptoms, but, instead, influence which persons with bowel symptoms will consult a physician. The bowel symptoms and the psychologic symptoms that coexist in most patients with IBS may be best thought of as comorbid conditions. Neither causes the other, but both may be serious enough to warrant treatment. Moreover, in some patients whose bowel symptoms consist of vague complaints of abdominal pain not specifically related to defecation or to changes in the frequency or consistency of bowel habits, the psychologic disorder may be primary. Psychologic stress may exacerbate IBS whether or not the patient has a psychiatric disorder, and psychologic stress may trigger acute episodes of symptoms similar to those of IBS even in persons without IBS. However, the magnitude of this correlation is modest, suggesting that only about 10% of the variation in bowel symptoms is attributable to stress. Psychologically oriented treatments have a role in the management of IBS. Most patients who consult internists about bowel symptoms have significant levels of depression and anxiety, and they tend to notice and to worry about somatic complaints more when they experience these dysphoric affects. Psychologic treatments that reduce the level of their psychologic distress also frequently reduce the frequency and severity of complaints about bowel symptoms. Tricyclic antidepressants may be tried as a first line of treatment; they have been shown to be superior to placebo for the management of abdominal pain and diarrhea but not constipation. In patients who do not show an adequate response to antidepressants, brief psychotherapy focusing on better ways of coping with current problems, hypnosis, or behavior therapy emphasizing methods of controlling reactions to stress are recommended. Controlled trials show these treatment approaches to be superior to medical management alone. It may appear paradoxical that psychologic treatments aimed at the management of emotions are so frequently found to reduce bowel symptoms, because the motility disorder responsible for the bowel symptoms may be unrelated to the psychologic symptoms that influence the patient to seek treatment.+4
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PMID:Psychologic considerations in the irritable bowel syndrome. 206 51

A 73 year old male patient with a history of pulmonary tuberculosis was admitted to our department because of dyspnea and abdominal pain. The chest X-ray film on admission showed bilateral lung congestion. The ECG showed atrial fibrillation, left axis deviation and incomplete right bundle branch block. Five days after admission, the ECG changed into sinus rhythm and complete right bundle branch block. Eight days after admission, the patient complained of chest pain and the ECG showed ST elevation in II, III, aVF, reciprocal ST depression in V, and complete A-V block with junctional rhythm. Emergency coronary angiography revealed no significant stenosis. Echocardiography showed reduced contraction of the inferior wall and diffuse granular echoes in the myocardium. Light microscopic study revealed fibrosis, infiltration of eosinophils and histiocytes, degenerated myocardium and multinucleated giant cells. Some of the giant cells were morphologically similar to myocardium, so the myocardium might be a place of immunological reaction.
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PMID:[A case of giant cell myocarditis associated with a progressive disturbance in the conduction system]. 206 92

A discussion of unconscious psychological resistance to contraception is illustrated by the case of a woman with a 10-year history of use of oral contraceptives and IUDs marked by repeated development of side effects and changes of formulation culminating in a serious depression after tubal ligation at age 35. The woman's postligation complaints of abdominal pain resistant to analgesic treatment were the expression of a serious depressive syndrome that responded poorly to antidepressants. The request for contraception normally contains 2 propositions: the individual desires to have sexual relations, and the individual does not wish to procreate. The logical connection between these 2 propositions at the conscious level is absent at the level of the unconscious, where there is no logic or possibility of reasoning. Forgetting a pill is a relatively minor form of resistance to contraception. Other symptoms, such as pain, vertigo, nausea, nervousness, insomnia, and anxiety with the pill or unexplained pain, repeated local infections, or anxiety and depression with the IUD may be manifestations of the psychological modifications inevitably caused by the psychic symbolism of the contraceptive. The difficulty experienced by certain women in accepting in their unconscious the 2 propositions about contraception causes the symptoms to be produced. Unconscious motives for resistance to contraception may include a woman's dependence on the potential for maternity for her sexual identity, or anxiety at the degree of sexual freedom offered by the contraceptive method. The unconscious elements related to resistance are sometimes open to modification. A study of women undergoing abortion at a center in Rennes indication that 91% failed to use an effective method of contraception at the time of the pregnancy, but that 1 year later 76% had accepted a method. Only 12% at risk of undesired pregnancy were not using a method. A large part of the increased usage was probably explained by contraceptive information provided at the time of the abortion, but the very fact of the abortion may have helped some of the women resolve their feelings of ambivalence about contraception. But 53% of the contraceptive acceptors complained of side effects, mainly anxiety, decreased sexual pleasure, weight gain and menstrual problems. It appears that an abortion may influence the decision to use a method without greatly changing the resistance to contraception. The practitioner wishing to assess the potential tolerance or resistance of a woman to contraception should take the time to discuss her feelings about contraception, menstruation (which signifies absence of pregnancy and thus maternity), and her sexual and emotional life. the dialogue can continue in subsequent visits if the women had complaints about side effects.
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PMID:[Resistance to contraception]. 219 28

The article describes the health situation in relation to demographic and social class variables in a sample of 1,671 schoolchildren aged 11, 13 and 15 years in Denmark. The proportions assessing their health as excellent, good, fair, or poor were 47%, 39%, 13%, and 1%, respectively. 22% reported daily symptoms and 74% weekly symptoms (20% one symptom a week, 54% two or more symptoms). During one week, 50% suffered from bad moods, 37% insomnia, 30% depression, 26% headaches, 22% nervousness, 19% back pain, 14% abdominal pain, and 12% vertigo. 37% had used medical drugs during the last month, most frequently for headaches (25%), colds (11%), coughs (9%) and abdominal pain (8%). Girls showed poorer self-assessed health than boys, more symptoms and more use of medication. The youngest pupils had the most frequent symptoms and the oldest least. There were no health differences when place of residence or family composition were considered, but there were clear social class differences. Pupils from the lowest social class and pupils whose parents were not included in the social class classification (e.g. disability pensioners) had the poorest self-assessed health, the most frequent symptoms and the highest use of medication.
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PMID:[Social inequalities in child health status]. 221 29

Non-specific abdominal pain (NSAP) is a common cause of urgent admission to surgical wards. We studied 80 such patients prospectively. NSAP was commonest in female patients under 30. The pain was localized in the right lower quadrant in 32 patients (40%) and in 56 (70%) the pain was aggravated by movement. Viral studies failed to show any abnormality except in one patient with raised acute and convalescent titres but three patients had raised antistreptolysin 0 titres. The psychological results demonstrated that the NSAP group had the same levels of anxiety and depression as the control group and also had no evidence of increased preceding life events.
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PMID:Non-specific abdominal pain--an expensive mystery. 214 90

The objective of this prospective study was to test the hypothesis that 6 reportedly important psychosocial factors were useful criteria for diagnosing the irritable bowel syndrome. Ninety-seven new patients with entry complaints of abdominal pain, altered bowel habits, or both underwent full evaluation by board-certified or -eligible gastroenterologists in an outpatient setting. The independent measures were 6 questionnaires concerning anxiety, depression, stress, lack of social support, somatization, and abnormal illness behavior. The dependent measure, irritable bowel syndrome, was defined as the absence of an organic disease explanation for patients' entry complaints. Two other board-certified gastroenterologists, independent of the study, made this determination. Their rating was based on full review of transcripts of patients' clinic visits, laboratory data, and the results of a 9-mo telephone follow-up to patients and their physicians. Sixty-five percent of the sample had no organic disease explanation for the entry symptoms, thereby representing irritable bowel syndrome. The psychosocial predictors did not show a significant association with irritable bowel syndrome; the power of the study was 0.86. Post hoc analysis revealed that patients with organic disease, as well as patients with irritable bowel syndrome, had significantly more (p less than 0.01) psychosocial abnormality than normal subjects, which likely contributed to the inability of the psychosocial predictors to distinguish irritable bowel syndrome from organic disease. It was concluded that psychosocial criteria were of limited value in differentiating irritable bowel syndrome from organic disease but that they were determinants of health care seeking for the entire study group.
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PMID:Psychosocial factors are associated with health care seeking rather than diagnosis in irritable bowel syndrome. 229 84

Although formalin ingestions have previously been reported in the literature, technology has only recently been developed to measure both formaldehyde and formate levels in plasma. Methanol, formaldehyde, and formate levels were followed in the case reported here until the patient's death approximately 13 h after the ingestion. The clinical course was marked by an initial profound CNS depression followed by an apparent clinically quiescent period. Severe abdominal pain and retching preceded the development of seizures, DIC, severe hypotension, and cardiac arrest. Methanol levels rose throughout this 13-h course. Formate and formaldehyde levels increased until bicarbonate and ethanol therapy were instituted. The "fixing" of the stomach by formaldehyde may have produced delayed absorption following formalin ingestion. Therapeutic implications are discussed.
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PMID:Formate levels following a formalin ingestion. 232 60

The relationship of solvent exposure to self-reported neurologic and somatic symptoms as well as neuropsychological performance was examined in a sample of 567 female blue collar workers who were members of the International Brotherhood of Electrical Workers (IBEW). Structured interviews were conducted at IBEW offices. Five solvent exposure categories were derived--never exposed, exposed prior to but not during the past year, exposed during the past year but not currently, currently exposed less than 50% of the time, and currently exposed more than 50% of the time. No differences among the groups on neuropsychological performance were found. On the other hand, heightened exposure was significantly related to depression, severe headaches, light-headedness, room spinning, appetite difficulties, funny taste in mouth, weakness/fatigue, rashes, and abdominal pain after controlling for the effects of seven risk factors (age, smoking, moderate-heavy alcohol consumption, severe obesity, history of physician-diagnosed chronic illness, working in a clean room, and exposure to other chemicals). These findings are consistent with Scandinavian studies of solvent-exposed male workers and point to the need for careful prospective research.
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PMID:Health effects of long-term solvent exposure among women in blue-collar occupations. 234 72

Symptoms by age and sex were studied in two population studies from Gothenburg, Sweden. In general, men and women showed the same age-related pattern. The prevalence of the following symptoms increased with age--sleeping disturbances, pain in the joints, pain in the legs, breathlessness, and impaired hearing. Six symptoms decreased with age--general fatigue, abdominal pain, nausea, diarrhoea, cough, and headache. A group of symptoms showed a curvilinear shape with a peak at the age of 50. In general, women presented more symptoms than men. This was especially true for symptoms of depression and tension. A possible explanation is that women are more attentive to their internal state. A more probable explanation, supported by our study, is that the mental symptoms are related to the woman's situation in life with double work (responsible for both work and family).
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PMID:Symptoms by age and sex. The population studies of men and women in Gothenburg, Sweden. 235 75


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