Gene/Protein Disease Symptom Drug Enzyme Compound
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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Recently, renal osteodystrophy is a remarkable problem in patients on long-term hemodialysis (HD). In this retrospective study, we evaluated the perioperative management of 21 patients receiving orthopedic surgery between January 1990 and December 1992. These patients had been maintained on HD for an average of 8.6 years (range, 18 months-20 years). The primary causes of orthopedic surgery were amyloidosis, diabetic gangrene, rheumatoid arthritis and fractures. Laminectomy, replacement of arthropathy, osteosynthesis and amputation of the lower extremity were undertaken. General anesthesia was performed on six patients. Vecuronium was given to all of these patients. Isoflurane was used in 5 patients and sevoflurane in 1 patient. Regional anesthesia was used in 15 patients. During anesthesia, the average infusion rate of intravenous fluids was 2.7 ml.kg-1.h-1, and the intraoperative complications included hypertension in 16, hypotension in 12, arrhythmia in 4 and prolonged sedation in 2 patients. Postoperative complications included hyperkalemia in 2, pneumonia in 2, psychological disorder in 3, clotting fistula in 1 and delayed wound healing in 7 patients. One early death in a diabetic patient following amputation occurred on the 13th postoperative day. Preoperative HD was performed within 24 hours and postoperative HD within 72 hours of the operation. Nafamostat mesilate was used as an anticoagulant. Excessive removal of potassium must be avoided during preoperative HD to prevent arrhythmia. The well-managed elective patients gave a good result. However, extreme care in nutrition and infection control should be taken, especially in diabetic patients.
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PMID:[Perioperative management of dialysed patients for orthopedic surgery]. 777 29

We report here an autopsy case of Binswanger's disease (BD) without hypertension and associated with cerebral infarction in the terminal stage. The female patient, who was 74 years old at the time of death, had initially demonstrated manic-depressive disorder-like mental disorder, followed by dementia and neurological deficits. A brain CT scan showed white matter low attenuation bilaterally and symmetrically. BD was clinically diagnosed despite the lack of hypertension. In the terminal stage, she suffered an infarction in the left anterior cerebral artery region, and died of pneumonia. Neuropathologically, we found the infarction of the left anterior cerebral artery region, demyelination, fibrillary gliosis, lacunae and arteriosclerosis of the small arteries and arterioles in the white matter.
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PMID:An autopsy case of Binswanger's disease without hypertension and associated with cerebral infarction in the terminal stage. 820 1

The feasibility of on-site primary care services and their use by human immunodeficiency virus HIV-seropositive and seronegative injecting drug users within an outpatient methadone maintenance program are examined. A 16-month prospective study was conducted within an ongoing cohort study of HIV infection at a New York City methadone program with on-site primary care services. The study group consisted of 212 seropositive and 264 seronegative drug injectors. A computerized medical encounter data base, with frequencies of primary care visits and with diagnoses for each visit, was linked to the cohort study data base that contained information on patients' demographic characteristics, serologic status, and CD4+ T-lymphocyte counts. Eighty-one percent of the drug injectors in the study voluntarily used on-site primary care services in the methadone program. Those who were HIV-seropositive made more frequent visits than those who were seronegative (mean annual visits 8.6 versus 4.1, P < .001), which increased with declining CD4+ T-lymphocyte counts; 79 percent of those who were seropositive with CD4 counts of less than 200 cells per cubic millimeter received on-site zidovudine therapy or prophylaxis against Pneumocystis carinii pneumonia, or both. Common primary care diagnoses for patients seropositive for HIV included not only conditions specific to the human immunodeficiency virus but also bacterial pneumonia, tuberculosis, genitourinary infections, asthma, dermatologic disease, psychiatric illness, and complications of substance abuse; those who were seronegative were most frequently seen for upper respiratory infection, psychiatric illness, complications of substance abuse, musculoskeletal disease, hypertension, asthma, and diabetes mellitus. Vaginitis and cervicitis,other gynecologic diseases, and pregnancy were frequent primary care diagnoses among both seropositive and seronegative women.
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PMID:Utilization of on-site primary care services by HIV-seropositive and seronegative drug users in a methadone maintenance program. 839 79

Studies evaluating the risk of cardiovascular disease in the psychiatrically ill yield mixed results. Phobic anxiety in men is associated with an increased risk for cardiovascular disease, particularly sudden coronary death. This finding is in need of replication in women, and hypotheses regarding the potential mechanisms for this association warrant pilot testing. Other than this finding, there is only weak evidence supporting an association between psychiatric illness and risk for cardiovascular disease. This is surprising in light of the strong evidence that psychiatric illness in general is associated with elevated rates of cigarette smoking. In addition, there may also be higher rates of hypertension, hypercholesterolemia, and physical inactivity in some psychiatric disorders. Why the high rates of cigarette smoking and possibly other cardiovascular disease risk factors have not translated into consistently detectable elevated cardiovascular disease risk in individuals with psychiatric diagnoses is not apparent. Weaknesses in study designs and variations in assessment methods may partially explain the inconsistent results. Future studies of cardiovascular disease in the psychiatrically ill should be prospective, use nonclinical samples of men and women, have clear diagnostic criteria, determine order of onset of the two disorders if they coexist, and control for variability in known cardiovascular disease risk factors.
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PMID:Psychiatric illness and cardiovascular disease risk. 852 31

The authors report a case of acute mania induced by perindopril (Coversyl) in a 57 year old man with no prior history of mental illness. This Angiotensin-Converting Enzyme Inhibitor (ACEI) had been introduced eight days prior to the first signs of excitation, in order to treat recently diagnosed arterial hypertension. Without proof of reintroduction, and on the basis of clinical observations, the attribution appears plausible. Similar observations have been made for other molecules in this class of medication, such as captopril (Lopril). A review of literature regroups recent data concerning psychotropic effects of ACEIs. Several reports claim that captopril clearly acts as an antidepressant. Studies on the mood or the quality of life of treated hypertensive patients show ACEIs to have an euphoric-type positive effect compared to other anti-hypertensive treatments. Captopril and perindopril also act like potential antidepressants in experimental models of antidepression. Furthermore, pharmacologic data confirm that the most lipophilic ACEIs penetrate the central nervous system and argue in favor of the role of these molecules in activating central opioides. As these data provide evidence of mood swing in some patients, but also of an overall benefit in hypertensive populations, the clinical importance of the antidepressant effect of ACEIs needs further investigations.
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PMID:[Psychotropic effects of angiotensin-converting enzyme inhibitors: what are the arguments?]. 852 71

A key informant based survey was done in 1992 to enlist cases of chronic disorders in a rural area of Haryana. Thirty-nine villages selected purposely from a block were surveyed by a trained field worker. He made contacts with key informants like dais, anganwadi workers, health workers, teachers, village elders, etc, to enlist known cases of chronic disorders. In all 812 cases of chronic disease were encountered in 28844 population (28.2/1000). Prevalence of chronic disorders was more in higher age group. Males outnumbered females in younger age group and vice versa for higher age group. Asthma, poliomyelitis, mental illness/retardation were more prevalent in males while hypertension, obesity were reported more in females. Tuberculosis, diabetes, hypertension and asthma were significantly more prevalent in higher age group while poliomyelitis was reported more in children. Consultation rate was high in tuberculosis, asthma, hypertension and diabetes.
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PMID:Estimation of chronic disease load in a rural area of Haryana. 857 91

A case of adrenal carcinoma with severe hypertension referred for treatment of "catatonia" illustrates the need for a high index of suspicion of organic mental disorder in medical patients, even when there is clinical evidence of a psychiatric condition and a history of psychosocial stressors. This case illustrates the need for concurrent medical and psychiatric investigation when there is a problem differentiating medical from psychiatric disturbance.
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PMID:Adrenal carcinoma and hypertension presenting with catatonic stupor. 872 38

Clinical practice improvement (CPI) is a method for examining the steps of a care process to determine how to achieve the best medical outcomes at the least necessary cost over the continuum of a patient's care. This methodology includes tracking of medical care process factors (management strategies, interventions, medications), patient factors (physiologic severity of illness and psychosocial deviations at each visit), and outcomes and furnishes information that presents distinct advantages over information furnished by outcomes research or clinical trials in the designing of management protocols. The Managed Care Outcomes Project, a large-scale CPI study, examined the effects of health maintenance organization (HMO) cost-containment strategies on patient outcome and utilization of care. Approximately 13,000 patients with otitis media, arthritis, hypertension, asthma, or ulcer disease were analyzed; since all patient diagnoses and medication use were captured in the CPI model, my colleagues and I were able to assess factors in psychiatric illness diagnosis, treatment, and outcome. Among the findings were the following: (1) the majority of patients receiving psychiatric drugs do not have a specific psychiatric diagnosis; (2) a significant proportion of patients with a specific diagnosis of major depression do not receive antidepressant medication; (3) cost-containment strategies appeared to markedly limit psychiatric referral and frequency of visits and use of serotonin selective reuptake inhibitor treatment; and (4) severity of the primary illness in the study population was markedly increased in patients with a psychiatric diagnosis. Further analysis of data from this study may help to determine which processes of care for depression were associated with better outcomes.
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PMID:Overcoming obstacles to effective treatment: use of clinical practice improvement methodology. 905 4

This study describes the medical practice among a sample of indigenous healers from Thaba Nchu, Ganyesa, Kurumane, Mankwe, and Molopo regions of the North West province of South Africa. Data were obtained from interviews conducted among 35 indigenous healers recommended by heads from a sample of 40 villages. Findings indicate that 60% were Botswanan. 51% were female. 85.7% were aged 30-59 years. 77% were married, and 5.7% were divorced. 31% had a lower primary education, and 25.7% finished high primary schooling. 22.4% had no formal schooling. 60% were bone throwers, and 34.2% were bone throwers and sangomas. 54% received their training "by their ancestors through dreams." 31% received formal training in indigenous healing. 14% served an apprenticeship with an experienced healer. 94% had a period of training from 2-5 years. 57% were registered with an association for indigenous healers. 77% relied on bone throwing for diagnosis of health problems. Other treatment methods included scarification, enema, induced vomiting, ritual performance, and prevention of witchcraft. Healers treated infertility, septic sores, impotence, sexually transmitted diseases, deliveries, makgome or boswagade, asthma, mental illness, high blood pressure, palpitations, tuberculosis, alcoholism, diabetes, and cancer. Pediatric diseases that were treated included tlhogwana, ditantanyane, measles, Kwashiorkor, and whooping cough. Healers relied on the following methods for disease prevention and health promotion: home fortifying, home cleansing, personal cleansing, scarification, and cultural education in taboos. 74% made referrals to either a western trained physician (17 out of 26) or other healers. All were generalists. Clients included professionals, such as nurses, teachers, and religious ministers. Although there is potential danger in some treatment methods, healers serve an important role in health prevention and treatment.
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PMID:Indigenous healers in the North West Province: a survey of their clinical activities in health care in the rural areas. 928 40

While still in medical school at The Johns Hopkins University, participants in the Precursors Study, a longitudinal study of the precursors of coronary artery disease and other disorders, were given the Rorschach test along with other psychological and physical tests. In the present study, we looked at a cohort of 41 participants who, 8 to 24 years after having finished medical school, could be classified into five disorder groups: coronary, hypertension, mental illness, suicide, or malignant tumor. Using stepwise discriminant analysis, we found that participants' Rorschach test scores differed significantly among disorder groups. Since the Rorschach scores considerably predated the appearance of the disorders, this finding implies that the Rorschach scores were predictive of the subsequent development of the various disorders. The Rorschach scores were especially good at predicting mental illness. If this finding is not spurious, it suggests that a given Rorschach profile would be predictive long before mental illness became apparent. Consequently, it offers the possibility that some intervention might be undertaken which could either result in mental illness not occurring or, at perhaps a minimum, lessen its severity. Since the Precursors Study results discussed in this paper are some years old, it is likely that another cohort of participants have developed the various disorders. Therefore, the authors recommend that the discriminant functions derived from this effort be validated with another cohort from that study who had not yet exhibited one of the five disorders when the current analysis was undertaken. Were that not possible, we would recommend that this study simply be replicated with another cohort.
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PMID:Psychological precursors of disorders: a thought-provoking observation. 946 56


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