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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The side effects of using estrogen treatments to relieve menopausal symptoms in women are presented. Estrogens are effective in relieving headaches, vertigo, palpitations, and nervous symptoms such as depression, as well as degeneration and atrophy of the genital organs. In Norway, 2.5% of women over 45 as compared with 50% in the U.S. use estrogens to relieve menopausal symptoms. The incidence of endometrial cancer has risen from 9.2/100,000 in 1955 to 15.4 in 1974. Increased susceptibility to endometrial cancer has been linked to long-term use of estrogens, obesity, hypertension, diabetes, and nulliparity. In American studies, Premarin has been associated with increased risk of cancer related to the chemical equilinine, which has a long half-life. After menopause, the need for estrogen is met by the conversion of androstenedione, which is produced by the adrenal gland. When estrogens are taken, it may result in an overstimulation of the endometrium, which could cause cancer. Estrogens have bene found useful and safe for short-term relief of menopausal symptoms, and any patient using estrogens should be under routine observation to prevent development of cancer.
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PMID:[From the Adverse Drug Reaction Committee. Can long-term estrogen treatment induce uterine neoplasms in post-climacteric women?]. 125 36

Five-hour oral glucose tolerance tests (GTTs) differentiated 30 volunteer patients who considered themselves hypoglycemic into three major groups: those who had reactive hypoglycemia, those who were normal, and those who had diabetes. Clinical psychiatric evaluation and Minnesota Multiphasic Personality Inventory testing revealed that half of the 30 patients were experiencing a current psychiatric disorder, usually depression. Hysterical personality traits were also noted in many of the patients. The idea that reactive hypoglycemic patients have specific personality characteristics was not substantiated by the authors' data. They hypothesize that some patients with psychiatric illness may have their symptoms erroneously attributed to incidental GTT findings.
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PMID:A psychiatric study of patients referred with a diagnosis of hypoglycemia. 125 38

The past decade has seen a shift in the strategy for hypertension treatment from stepped therapy--a highly structured monolithic series of steps--to recommendations for a more individualized selection of treatment. Severe hypertension is a clear indicator to bypass traditional steps. Demographic factors, such as age, gender, and race, are often cited, but have proved to be less helpful. Concomitant medical conditions and problems are very common and are more often the crucial determinants in the selection of antihypertensive therapy. Coronary artery disease, diabetes mellitus, heart failure, azotemia, asthma, and chronic obstructive pulmonary artery disease, anxiety, and depression are all common, and each has implications for the selection of antihypertensive therapy. Blood pressure reduction is a surrogate for reduction of cardiovascular risk, and therefore, consideration of concomitant medical problems has extended to left ventricular hypertrophy, obesity, mild hyperlipidemia, and insulin resistance, as additional risk factors in hypertension. Consideration of all these factors makes it possible to individualize antihypertensive therapy in most patients today.
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PMID:Treatment of hypertension: the place of angiotensin-converting enzyme inhibitors in the nineties. 128 28

It has been assumed that patients with diabetes mellitus (DM), who are usually susceptible to bacterial infections, have a depression of the antibacterial defense mechanism. This study was undertaken to substantiate the hypothesis that phagocytosis of the reticuloendothelial system (RES) is depressed in diabetic patients. It is believed that intravenously injected colloidal suspensions whose particles are unable to pass through the capillary barrier will be phagocytized mainly by the reticuloendothelial cells in the liver and spleen. In the present study, the RES phagocytic index (RESPI) was measured in 48 subjects: 20 normal controls and 28 patients with DM. Measurements were based on the rate of disappearance (T1/2) of radioactivity in the heart (blood pooling) after rapid I.V. injection of 3mCi of Tc-99m phytate (2mg phytate). Using a gamma camera, sequential images of the liver and heart were obtained, and computer-generated time-activity curves were established. The T1/2 was then calculated. Our results revealed that the RESPI values in the DM group were significantly increased as compared to the normal control group (normal control = 4.60 +/- 1.01; DM = 6.78 +/- 3.83; P < 0.05). This prolonged half-disappearance time of blood radioactivity in diabetic patients is interpreted as a reflection of impaired phagocytotic efficiency in the reticuloendothelial system. The results of this preliminary study add support to the in vivo evidence explaining the increased susceptibility to infection in diabetic patients.
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PMID:[Phagocytosis of the reticuloendothelial system in diabetes mellitus]. 129 62

Phospholipid methylation was quantified in non-diabetic and streptozotocin diabetic rat erythrocytes. While the total mass of methylated lipids remained the same in both groups, the relative abundance of individual methylated lipid species differed significantly in diabetic erythrocytes. Moreover, incubation of erythrocytes membranes with S-adenosyl methionine, a substrate for methyl transferases, not only increased membrane lipid methylation but also decreased Na+, K+ ATPase activity significantly. These results suggest that phospholipid methylation may cause the observed depression of erythrocyte Na+, K+ ATPase activity in diabetes and could contribute to the altered rheology of erythrocytes in diabetes.
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PMID:Phospholipid N-methylation in diabetic erythrocytes: effects on membrane Na+, K+ ATPase activity. 132 Oct 9

Treatment of acute urinary incontinence should be directed toward the underlying cause, such as infection, medication side effect, atrophic vaginitis, anxiety, depression and restricted mobility. Pharmacologic treatment depends on identification of one of the four subtypes of chronic urinary incontinence: stress, urge, overflow or mixed. Stress incontinence responds to alpha-adrenergic agents, which increase sphincter tone. Urge incontinence is the most common type of incontinence in the elderly; it can be treated with anticholinergic agents, smooth muscle relaxants, estrogen replacement therapy in women and, possibly, calcium antagonists. Overflow incontinence is caused by neurologic deficits, such as diabetes, or outflow obstruction, such as from prostatic enlargement, urethral stricture and tumors. Anticholinergic agents and alpha-adrenergic agents should be considered only after existing outflow obstruction is surgically corrected or intermittent catheterization is unsuccessful.
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PMID:Urinary incontinence in the elderly: pharmacologic therapies. 821 3

The forces to produce fractures of the os calcis are combined compression and shear under a cranio-caudal impulse of 10-40 kN and a short time of stroke about 10-40 ms. The main patterns in biomechanics of calcaneal fractures are the time of stroke and the geometrical position of the foot in the moment of impact. Furthermore individual structural changes of the calcaneal cancellous bone, age, diseases as Diabetes mellitus and vascular obliterations are to be respected. Operative treatment of these fractures needs an understanding of the pathomechanism of the intracalcaneal shear-tension-forces. With plantarflexion of the foot combined with vertical forces within 40 ms to the anterior talocalcanear facette impact-fractures of the anterior part can be expected. These forces develop a posterior directed shear tension parallel to the axis of the os calcis, dividing the bone horizontally in two parts (Typ A, 44-56%), well-known as tongue-type fracture. Compression of the posterior talo-calcaneal joint leads to an impact of this structure producing the joint depression type within about 30 ms in dorsoflexion of the foot (Type B, 42%) together with sagittal shear fractures. High-energy forces are supposed to produce the so-called primary fractures of the sustentacular process in about 10 ms in a supinated position of the foot (Type C, 2-10%); these fractures represent in cases of dislocation an indication for open reduction and internal fixation. In our own experience with 45 cases in 35 patients using the lateral or/and medial approach no infection happened. Palmer's lateral approach was preferred.
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PMID:[Pathomechanical aspects of intra-articular calcaneus fractures. Typing, grading and surgical therapy]. 136 17

A weekly psychotherapy group has been established with 21 diabetic patients (mean sessions attended per patient 12.0 +/- 8.9). In this non-structured group, the topics spontaneously chosen most often for discussion included complications and fears regarding complications, diet, and relationships with physicians. Other topics included difficulties achieving diabetes control, relationships with families, devices for day to day management, pregnancy and parenting, depression and eating disorders, and occupational concerns including driving and diabetes. The presence of a physician co-therapist was found to be valuable. Examples are provided of the patients' concerns. It is felt that understanding patients' needs for information and communication with physicians and allied health professionals will enrich the caregiver-patient relationship.
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PMID:Description of a diabetes support group: lessons for diabetes caregivers. 139 75

Two recent cases of cervical necrotizing soft-tissue infection are herein presented. Case 1. A 52-year-old man with uncontrolled diabetes was hospitalized because of an erythematous swelling of the left side of his neck and high grade fever. Fetid yellowish pus exuded from the left parotid area. The swelling extended from the left temporal area to the left supraclavicular fossa, with necrosis of the parotid gland, sternocleidomastoid, masseter and a portion of the strap muscles. Wound cultures revealed Staphylococcus aureus and alpha-hemolytic streptococcus. No anaerobic bacteria were detected. Treatment consisted of intravenous administration of antibiotics, control of diabetes with insulin, and debridement of the necrotic tissue, which left an epidermal defect in the initially swollen area. Transfer of a forearm free flap was done after the growth of healthy granulation tissue over the affected area. Case 2. A 55-year-old woman with rheumatoid arthritis was transferred to our hospital after tracheotomy performed in another hospital because of dyspnea due to severe crepitant swelling of her cheeks and submandibular areas bilaterally, and her left temporal area. A copious amount of fetid pus exuded from the incisions made in the left temporal area, left cheek, and right submandibular area. There were bilateral diffuse rales. Culturing the pus revealed alpha-hemolytic streptococci, while MRSA and Pseudomonas aeruginosa were detected from cultures of sputum. No anaerobic bacteria were found. After intravenous administration of antibiotics, infected wounds and pneumonia were ameliorated, and necrotic subcutaneous tissue and fascia were debrided. The patient was discharged with a residual depression in her left cheek and a scar on her left temporal area.
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PMID:[A report of two cases of cervical necrotizing soft-tissue infection]. 140 20

Despite some evidence that neuroleptic medication is overused or misused in long-term care facilities for the elderly, there has been virtually no attention paid to the pattern of use of antidepressants in these facilities. All patients in long-term care in a geriatric hospital and a home for the aged who were receiving antidepressants were identified; 10.5% of the patients in the hospital and 12.7% in the home for the aged were receiving an antidepressant. The rate of use of antidepressants on the different units ranged from 0% to 26.8%. The most commonly prescribed antidepressant was doxepin followed by nortriptyline. The mean dose of antidepressant was 34.8 mg. Although depression was the most common reason for the prescription of an antidepressant (69% of patients receiving one), other reasons included pain, agitation, aggression, and insomnia. Patients had been receiving antidepressants for up to 10 years, with a mean duration of 32 months. The majority of patients (60%) had a history of depression predating their institutional admission. Patients receiving antidepressants were compared to a group not receiving antidepressants, who were matched for age, sex, unit, and attending physician. Patients receiving antidepressants were more likely to have a history of stroke (33.8% versus 16.9%). There was no significant difference between the two groups regarding the prevalence of dementia, Parkinson's disease, thyroid disease, malignant tumor, congestive heart failure, or diabetes mellitus. Prospective studies are required to determine the efficacy of antidepressants in this population and to identify factors that can predict a positive response to treatment.
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PMID:Pattern of use of antidepressants in long-term care facilities for the elderly. 141 68


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