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Exercise testing has a definite role in pediatrics today. Different methods are presented, and the value of maximal exercise with determination of oxygen uptake and blood lactate is stressed. In children with heart disease, exercise testing with precordial electrocardiogram can be of both diagnostic and prognostic value. The cardiovascular function at different intensities of exercise is evaluated, serious dysrhythmias may be revealed, hypertension judged and the effect of drug therapy can be checked by exercise testing. It is an important way in assessing the child's functional capacity after heart surgery in the decision whether she or he should take part in physical education and sports activities and in the choice of profession. It is also of great psychological value to the parents and the patient himself. In children with other chronic diseases, e.g., diabetes, obesity, asthma, neurocirculatory dysfunctions--physical training together with exercise testing is of importance for therapy and rehabilitation.
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PMID:Exercise testing in children. 72 65

A child developed progressive communicating nonobstructive hydrocephalus as a result of increased intracranial venous pressure. The child had been treated for congenital heart disease at age 3 weeks by surgical creation of an anastomosis between his superior vena cava and right pulmonary artery. Although his cardiac symptoms were alleviated, intracranial venous hypertension resulted, giving rise to progressive head enlargement and other signs of hydrocephalus. Postmortem examination at age 3 years disclosed no other lesions that could have caused the hydrocephalus. Increased intracranial venous pressure can lead to either pseudotumor cerebri or hydrocephalus, the former in children 3 years or older, the latter in infants 18 months or less. Possible mechanisms accounting for these differences are discussed.
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PMID:Hydrocephalus caused by increased intracranial venous pressure: a clinicopathological study. 72 24

Acute cerebral vascular diseases are of social as well as clinical interest, since, together with myocardial infarct, they constitute the prime cause of death. Yet their treatment is still confined to the combatting the collateral factors of cerebral damage, since drugs of an aetiological type cannot be employed. The study of the aetiopathogenetic factors of cerebral infarct is thus of considerable importance in the establishment of its prophylactic management. An epidemiological assessment was made of prior risk factors: arterial hypertension, heart disease, and changes in fat and sugar metabolism in 1748 cases of acute cerebral vasculopathy. The data obtained are compared with those in the literature.
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PMID:[Risk factors in cerebral apoplexy. Epidemiological study]. 75 23

The role of surgery in the treatment of extracranial cerebrovascular disease is essentially a prophylactic one but it should be borne in mind that apart from preventing stroke, such procedures will or should eliminate symptoms. The authors believe that every patient suffering from cerebrovascular insufficiency should be thoroughly evaluated for extracranial cerebrovascular occlusive disease and that arteriograms should be performed on all patients who could be expected to be candidates for surgery. The various indications for surgery have been discussed. The authors believe that people who have severe bilateral disease and who are of an advanced age are probably in a higher risk group. They also believe that surgery should not be offered to people who have a complete stroke and who are in semi-coma or coma, no matter how rapidly they may be transferred to the operating theatre. The authors firmly believe that intra-operative E.E.G. monitoring is an important adjunct to the safe surgical treatment of lesions of the carotid bifurcation, not only to indicate when shunting is necessary but also to indicate how well that shunt is functioning. In spite of the frequent presence of associated heart disease, hypertension and other vascular lesions, operation can be offered with confidence to suitable candidates. Elimination of symptoms can be expected in over 90% of cases. Only one patient has suffered a stroke since leaving hospital and this occurred because of occlusion in his internal carotid artery which was not operated on. Apart from patient selection, the factors which have contributed to the authors' low morbidity and mortality have been the use of intra-operative E.E.G. monitoring, intra-operative heparinisation and the availability of excellent angiographic studies.
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PMID:The surgical management of extracranial cerebrovascular occlusive disease: a review of 200 consecutive surgical cases. 76 4

The relationship between obesity and 18 different disease conditions was examined in a cross-sectional study of 73,000 weight-conscious women (TOPS Club members). The women reported an average of 1.6 disease conditions each (based on their responses on a questionnaire). Age-specific rates of occurrence for the age group 30-49 years were calculated for each disease condition. The conditions that were found to be significantly (P smaller than 0.001) correlated with obesity were diabetes, high blood pressure, gallbladder disease, gout, thyroid disease, heart disease, arthritis, and jaundice. When the crude relative risks of obesity for each disease condition were calculated, diabetes was found to be the highest (4.5), high blood pressure was second (3.3), and gallbladder disease was third (2.7).
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PMID:Relationship of ovesity and disease in 73,532 weight-conscious women. 80 96

1. Study of a group of 50 patients suspected to have coronary artery disease. This is a complement to a previous study concerning "definite" coronary patients. 2. The method followed consisted in cross-examination of the files by three observers in order to separate the subjects who seemed really affected by coronary artery disease. This treble examination led to a rather restrictive selection. To facilitate the study, the patients were subdivided into 4 groups: patients with arterial hypertension, with diabetes mellitus, with cardiac failure, with a heart disease and miscellaneous patients. 3. The study of the 20 files which were discarded was peculiarly interesting as it provided the opportunity to underline the differential diagnosis either with common diseases (left ventricular overload, heart block, brain vascular accident), or with more specific diseases for Black Africa (endomyocardial fibrosis, aneurysm of the left ventricle, cardiomyopathy). In that respect, it is underlined that, in the absence of any anatomical or functional disease, the electrocardiogram of the healthy Black is identical to that of the White. 4. Study of the 30 patients considered as coronary made it possible to underline aetiological and epidemiological factors, although some are still lacking. However the facts observed could be compared with those reported in a previous work concerning 45 "definite" coronary patients. The overall documents thus gathered in 75 patients suggest that the African candidate to coronary artery diseases resembles his Occidental homologue, but that he might have kept a traditional diet.
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PMID:[Coronary diseases in the black African. Apropos of a 2d group of 50 patients. Diagnostic and epidemiological aspects]. 80 91

Elderly participants in Title VII congregate feeding programs in Indianapolis can be characterized generally as being retired, usually living alone, and often reporting some disease condition, particularly arthritis, hypertension, and/or heart disease. On an average weekday, the nutrient intake of these people, except for zinc, approximated the amounts suggested in the Recommended Dietary Allowances. Fifty-nine per cent of the subjects consumed less than two-thirds of the allowance for zinc. Generally, they consumed over half of their allowances for eight nutrients at the site meal. The nutritional significance of apparent low intakes of dietary zinc among subjects is not clear. Eleven per cent had hair zinc levels below 100 mcg. per gram, but none were below 70 mcg. Therefore, on the basis of hair zinc levels, none could be absolutely calssified as zinc deficient. Although hair zinc levels were not correlated to dietary zinc intake, they were inversely correlated to dietary calcium and fat intake. Taste acuity by these elderly participants was generally less than that reported for young adults. However, women had greater taste acuity for sodium chloride than men. Sixteen per cent of the subjects were particularly insensitive to the taste of sodium chloride. Finally, there was no correlation between taste acuity and dietary zinc intake.
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PMID:Zinc nutriture of elderly participants in an urban feeding program. 83 Jul 6

Over the years, hemodynamic stresses and biologic changes bring about reduced cardiac function. The addition of one or more types of organic heart disease leds to further deterioration of fuction. This is why elderly patients require special consideration and management, why their clinical manifestations and therapeutic responses differ from those in young patients. Although no single abnormality characterizes the aging process, cellular, functional, and structural changes support the existence of a cardiopathy. However, there are insufficient data to link so-called senile cardiopathy directly to otherwise unexplained heart failure. Failure is usually due to the typical reasons, i.e., coronary artery or valvular disease, hypertension, amyloidosis, and chronic pulmonary lesions. Nevertheless, the possibility of senile heart failure should not be overlooked in case of impending or actual myocardial failure. In patients over 60, edema, dyspnea, or tachycardia cannot always be attributed to heart disease. It is hazardous to diagnose and prescribe treatment for cardiac failure if the heart shadow is not enlarged on the x-ray,the circulation time is not prolonged, and the heart sounds and rhythmare normal. Other reasons for the complaints should be looked for, even when the heart rate is fast.
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PMID:Cardiopathy of aging: are the changes related to congestive heart failure? 83 76

Twenty-two cases of Coxsackie virus heart disease diagnosed from November, 1969, to December, 1971, were re-examined after a period of 42 to 68 months from the acute illness. The patients with hypertension, diabetes, chronic alcohol intake, or aged over 35 were eliminated from the trial. With the purpose of assessing myocardial function, the systolic time intervals were recorded by a noninvasive standard technique. The differences in systolic time intervals between the group of patients with previous viral myocarditis and a group of normal control subjects were not statistically significant. However, the pre-ejection period was clearly prolonged in three patients out of 10, a modification consistent with a depressed myocardial function, as in patients with cardiomyopathy.
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PMID:Coxsackie virus heart disease and cardiomyopathy. 84 36

The incidence of stroke was estimated prospectively in a total population of 2,502 persons over age 65 who resided in homes for the aged. The incidence in persons born in Asian and African countries was close to that in persons born in European countries. No sex differential was found in either ethnic group, and there was no significant increase in the incidence of stroke with advancing age in either sex. In the European population, prior heart disease was the strongest risk-increasing factor, ranking ahead of hypertension. Diabetes mellitus was not associated with a higher risk of stroke among the women; the findings for the men were inconclusive. In the Afro-Asian population, the risk of stroke was related to heart disease and diabetes mellitus but was not associated with blood pressure. Total serum cholesterol or relative weight was not associated with stroke in either group. The early establishment of programs for the control of hypertension and stroke appears most desirable.
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PMID:Stroke: incidence and risk factors. 84 97


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