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Query: UMLS:C0009676 (confusion)
 21,692 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A twenty-seven year old women with meningo-encephalitis and paranoid symptoms is presented. The patient was admitted to a psychiatric unit where, two months previously, her brother had been under treatment for a paranoid schizophrenic episode. The diagnostic lumbar puncture was performed after several days of increasing periods of disorientation, stupor, incontinence, posturing, and perseveration. There was no fever, no signs of meningeal irritation, and no localizing neurologic deficit. The problem of recognizing organic brain disease presenting as an acute psychotic episode is discussed. In this case, the positive family history was given inappropriate emphasis, while the good pre-morbid adjustment of the patient and the symptoms of confusion and headache were inadequately considered. Viral meningo-encephalitis, particularly that due to herpes simplex, often presents with a picture of behavioral abnormalities and minimal physical signs, and is easily confused with a functional process.
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PMID:Meningo-encephalitis presenting as an acute paranoid psychosis. 21 81

The occult neuropathic bladder is a condition of uncertain etiology about which confusion has arisen with regard to diagnosis and management. Incontinence and upper urinary tract deterioration are secondary to high intravesical pressure associated with urinary retention and functional outflow resistance. Diagnosis is a matter of exclusion, and the various methods of investigation are discussed. Development of continence and preservation of renal function may be achieved by improving bladder evacuation and preventing reflux. Diversion may be unavoidable but should be considered only when conservative methods have failed.
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PMID:Occult neuropathic bladder. 32 50

The authors report the cases of three men who presented for evaluation of a rapidly progressing dementia. All were found to have a giant aneurysmal mass in the basifrontal region, and all were successfully treated by surgical excision of the mass. The presenting syndrome included rapidly progressive and severe loss of recent memory associated with confusion, chronic headache, wide-based staggering gait disturbance, urinary urgency, frequency, and incontinence, and a fine tremor of the hands exacerbated by purposeful movements. The clinical presentation, radiological assessment, and surgical treatment are discussed.
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PMID:Aneurysmal tumors of the basifrontal region. 84 29

Though patients usually die peacefully, problems may arise in the last period of a terminal illness. In the final days new symptoms may arise or there may be exacerbation or recurrence of symptoms previously well controlled. Two hundred consecutive hospice patients were studied. The incidence was noted of pain, dyspnea, moist breathing, nausea and vomiting, confusion, restlessness, jerking and twitching, difficulty in swallowing, incontinence and retention of urine, sweating, moaning and groaning, and loss of consciousness. Each symptom is considered and the results of the management employed are noted. Many of the features appearing in the last days of a terminal illness, especially cancer, can be attributed to organic brain disease consequent to metabolic disorder associated with multi-organ failure. An awareness of the nature of the problems that may arise in the last 48 hours of life makes it possible to keep the patient comfortable to the end.
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PMID:The last 48 hours of life. 170 17

Studies based on random samples of adult deaths in 1969 and 1987 show that, although more people in the recent study were living alone in the year before they die (32 per cent compared with 15 per cent in the earlier study), there had also been an increase in the proportions living in institutions and being admitted to hospital in the 12 months before their death. More of those dying in 1987 than in 1969 had had a home help, whereas the proportion receiving care from district nurses was similar for the two studies and the amount of home visiting by general practitioners had fallen. A higher proportion of those dying of cancer in 1987 than in 1969 were thought to have known that they were dying (44 per cent against 16 per cent) and that they had cancer (73 per cent compared with 29 per cent). However, the proportion of relatives and others who thought the dying person's awareness, or lack of awareness, of the prognosis was 'best as it was' was lower for people dying of cancer in the more recent study (57 per cent against 69 per cent). The symptoms reported for those dying in 1969 and 1987 were generally similar but more of those who died in 1987 had suffered from mental confusion, depression and incontinence for a year or more. This reflects the increased age at which people were dying in the later study: longer life was sometimes associated with the prolongation of unpleasant symptoms.
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PMID:Changes in life and care in the year before death 1969-1987. 185 28

Researchers generally agree that Geriatric Evaluation and Management (GEM) Units are effective only when they are targeted at a specific group of frail, elderly patients who are most likely to benefit. Such patients are those who are neither too sick (eg, severely demented or moribund) nor too well. Various strategies for identifying such patients have been employed by investigators with little consensus on the most efficient targeting criteria. Criteria most often use for inclusion in GEM programs are various combinations of patient age, degree of functional impairment, presence of geriatric conditions (eg falls, incontinence, confusion), particular diagnostic conditions (eg, multiple disorders), and psychosocial conditions (eg, living alone, recent bereavement, low income). Commonly used exclusion factors are severe dementia, inevitable nursing home placement, and terminal illness. Outcome studies suggest that beneficial effects of GEM care are most apparent when patients are selected using specific clinical criteria. Future research on targeting should address the potential need for differing criteria in different settings (eg, inpatient vs outpatient GEM units), simplifications of criteria for greatest ease of application, and prospective evaluation of which criteria best predict functional improvement, longer survival, and reduced health care expenditures in response to GEM care.
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PMID:Targeting strategies: an overview of criteria and outcomes. 188 75

Surveys of athletes, primarily runners, have shown that digestive disorders are common, associated both with training and racing. Women, in particular, seem to suffer most commonly. Nearly half have loose stools and nausea and vomiting occur frequently after hard runs. Diarrhoea, incontinence and rectal bleeding occur with surprising frequency. Runners may use medications prophylactically to minimise some of these symptoms. Upper digestive symptoms seem to occur more commonly in multisport events such as triathlons or enduro. The published literature is difficult to analyse and the basic intestinal physiology not well studied. Most gastroenterologists are accustomed to evaluating the fasting patient at rest and exercise physiologists are seldom experienced with digestive techniques. Digestive symptoms occurring with exercise referable to the oesophagus include chest pain, gastro-oesophageal reflux symptoms, or symptoms related to alterations in motility. While little is known of the oesophageal physiology during exercise, it is believed that only minimal changes occur in most subjects. Gastro-oesophageal reflux occurs more frequently with exercise than at rest and may produce symptoms of chest pain suggestive of ischaemic disease. Acid exposure may be reduced by pretreatment with histamine H2-receptor antagonists. Oesophageal symptoms, though common, are rarely disabling to the athlete, and the clinical importance lies in confusion with ischaemic disease. Cases of acute gastric stasis following running have been reported and gastric physiology during exercise, particularly bicycling, has been more actively investigated. Gastric emptying during exercise is subject to a number of factors including calorie count, meal osmolality, meal temperature and exercise conditions. However, it is generally accepted that light exercise accelerates liquid emptying, vigorous exercise delays solid emptying and has little effect upon liquid emptying until near exhaustion. Gastric acid secretion probably changes little with exercise although some have postulated that ulcer patients may increase secretion with exercise. Some exercise-associated digestive symptoms, such as diarrhoea and abdominal pain, have been attributed to changes in intestine function. Small bowel transit is delayed by exercise when measured by breath hydrogen oral caecal transit times and motility may be reduced as well. Intestinal absorption during exercise has not been well evaluated but probably changes little in ordinary circumstances. Passive absorption of water, electrolytes and xylose are not affected by submaximal effort. Colonic transit and function is even more difficult to evaluate and published results have been conflicting. However, it is likely that many of the lower digestive complaints of runners such as diarrhoea and lower abdominal cramps are due to direct effects of exercise upon the colon.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The effect of exercise on the gastrointestinal tract. 218 30

A status passage is the process of change from one social status to another. In this report, the process of transition from lay person to nurse in respect of undertaking essential elements of patient care is described. The aspects of care included in the study are attending to hygiene needs, incontinence, altered body image, the very ill and dying person; and behavioural problems associated with attention-seeking, confusion, suicidal attempts and aggression. Student nurses mainly were expected to cope with these situations alone. The emotional effects on these students and implications of undertaking care in this manner are noted.
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PMID:Status passage into nursing: undertaking nursing care. 228 47

We studied 27 patients with acute stroke and a corresponding infarct in the anterior cerebral artery territory, as disclosed using computed tomography. Patients were selected from 1490 patients (1.8%) admitted consecutively to a community-based primary care center who underwent standard investigations. An embolic phenomenon from the internal carotid artery or from the heart explained the infarct in 17 patients (63%). Anterior cerebral artery occlusion without a potential source of embolism was found only in one Vietnamese patient. Neurologic features correlated well with the topography and size of infarct, including hemiparesis, hemihypesthesia, mutism at onset, transcortical motor aphasia, conflictual tasks impairment, mood disturbances, and, more uncommonly, incontinence, grasp reflex, hemineglect, acute confusional state, and unilateral left apraxia. These findings suggest that the etiologic spectrum of anterior cerebral artery infarcts is the same as that of middle cerebral artery infarcts.
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PMID:Anterior cerebral artery territory infarction in the Lausanne Stroke Registry. Clinical and etiologic patterns. 230 85

Immobility, confusion, and incontinence are considered the primary reasons for institutionalization of the elderly. The literature suggests that incontinence has the greatest medical, psychological, social, and economic effects on the patient and caregivers. The magnitude of the relationship of UTI and bowel incontinence is illustrated by the results of this study. Bowel incontinent patients developed UTIs almost three times as frequently as their bowel continent counterparts. The majority of the isolates found in urine cultures of the sample population are normally present in the gastrointestinal tract. Health-care providers need to be consistently aware of the possibilities of contamination and deal with the patients accordingly. Patients should be examined frequently for bowel incontinence and not allowed to sit or lie in feces for long periods.
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PMID:The risk of urinary tract infection in bowel incontinent men. 235 44


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