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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

The objective of this study was to describe the health problems of a group dementia patients on admission and during residence in a Dutch nursing home and to compare these with figures of patients of 75 years and over from general practice. In 890 nursing home patients suffering from dementia prevalence of health problems on admission and the incidence during the residence were classified by means of the ICHPPC-2-defined. The differences between men and women were studied as was the influence of the season on the incidence during the stay. Results were compared with figures of patients of seventy five year and over from the continuous morbidity registration (CMR) from 'Nijmegen'. The most frequently occurring health problems on admission were: varicose veins of legs, acquired deformation of the spine, presbyacusis, hypertension, arthrosis, COPD, cerebrovascular disorders, heart murmur, cataract and chronic ischemic heart disease. During the residence the following health problems were frequently diagnosed: urinary tract infection, side effect of medicine, constipation, pneumonia, pressure sore, feeding problem, contusion, heart failure, cold and conjunctivitis. There were clear differences between men and women. Especially the incidence of intercurrent diseases showed great differences from the patterns in general practice. Prevalence of health problems on admission to the nursing home home agreed mor with figures from general practice. Respiratory tract infections frequently occurred in winter and urinary tract infections, pressure sores and conjunctivitis seemed to occur more in the summer. Nursing home patients with dementia have a lot of chronic and intercurrent health problems. They differ clearly from patients in general practice.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Incidence and prevalence of health problems in a group of nursing home patients with dementia. A comparison with family practice]. 780 16

Estimates for the prevalence of self-reported hearing disability and measured hearing impairment as a function of age in the adult population of Italy are reported. The study was conducted in Bari, Florence, Milan, Padua, Palermo with questionnaire and audiological assessment; neither stage showed any gross bias arising from the particular cities chosen. The results have demonstrated that: 22% of subjects think their hearing abnormal, 24.4% report some difficulty understanding speech, 14.5% experienced prolonged spontaneous tinnitus and 17% have a > or = 25 dB HL bilateral hearing impairment; hearing problems increase progressively with age and show no significant differences between men and women; the occupational groups most at risk as far as hearing impairments are concerned are manual workers and workers exposed to occupational noise; the systemic disorders most significantly connected to hearing problems are dyslipidosis, diabetes, hypertension, cardiovascular diseases, liver diseases and cervical arthrosis; among every day habits, the consumption of alcohol seems the only element of risk, above all for tinnitus.
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PMID:Epidemiology of hearing problems among adults in Italy. 866 11

The efficacy and side-effects of cyclosporin in psoriasis, namely hypertension and renal dysfunction, are dose-related. An initial dose of 3 mg/kg per day has a better risk/benefit ratio than 5 mg/kg per day. Maximum efficacy is usually reached after 2-3 months, and effects of the drug remain even after treatment stops. We therefore suggest that periodic short-term use of cyclosporin in order to combine persisting therapeutic effect with safety. Psoriatic erythroderma and arthropathy also respond rapidly to oral cyclosporin. Once patients have been successfully treated, the drug should be discontinued. Treatment must not exceed 6 months, but in the case of relapse a new cycle of the previously effective and tolerated dose can be given. The concomitant use of other therapies has been assessed in an attempt to reduce the dose of cyclosporin. There are no significant cyclosporin-sparing effects when etretinate or UVB are used adjunctively, and currently no convincing data on the risk of combining low-dose cyclosporin with immunosuppressive therapy (including methotrexate, UVB, and PUVA) in dermatological indications. The addition of topical corticosteroids or calcipotriol leads to more rapid clearing of psoriasis plaques, although relapse rates remain unchanged. Individualized short-course cyclosporin therapy is useful in controlling acute psoriasis flares and/or inducing remission; less potent agents can then be used for maintenance therapy. Short courses of low-dose cyclosporin may almost completely eliminate the risks of renal dysfunction from this drug.
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PMID:Individualized short-course cyclosporin therapy in psoriasis. 888 2

The aim was to examine the feasibility of a study of centenarians and to describe morbidity and functional capacity of centenarians in the County of Funen. A total of 51 out of 58 centenarians on Funen born on May 1, 1894 or before participated. An interview could be carried out almost completely in 80.4% of the 51 participants, cognitive testing (MMSE) in 78.4% and physical performance test (PPT) in 49%. Additional information on morbidity and activities of daily living (ADL) was collected on all 51 centenarians from family members, nursing staff, GP's, hospital registries and the National Cancer Registry. Almost 3/4 were women and 58.8% were in an old people's home. Osteoarthrosis, urinary incontinence, heart failure, dizziness and eye diseases were found to be frequently prevalent, while hypertension, diabetes, cancer and stroke were found to be rare. Based on Katz' ADL index approx. 1/3 could be considered to be independent of help, while almost everybody was dependent on help for the instrumental activities (IADL). A low average score was found at the PPT, especially the walking speed was found to be very slow. Only 32.5% scored over 23 points at the MMSE, but allowing for severe impairment of vision and hearing more than 1/3 were found to be cognitively well-functioning. Severe dementia was found among 15.7%. Dependency on help for the ADL-functions was not found to be associated with health measurement, but strongly associated with visual function, PPT and MMSE (p < 0.001). The characterization of centenarians as described in a number of foreign studies as being an homogeneous, relatively healthy and independent group could therefore not be confirmed. On the contrary, they were found to be very heterogeneous and characterized by multi-morbidity. By far the great part of them were in addition dependent on help in their activities of daily life. Approx. 1/3, however, were found to be relatively independent of help for basic functions, more than 1/3 were cognitively well-functioning, and a very small number could even manage a few outdoor functions by themselves.
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PMID:[Centenarians in the county of Funen. Morbidity and functional capacity]. 901 57

The agreement between self-reported diseases in a questionnaire survey and data from medical records was assessed in a representative sample of Finnish men and women (n = 596) aged 45-73 years. The accumulated medical record information was abstracted from the records in the health centers and the central hospital in the study region. The agreement between the two information sources was substantial (kappa 0.73-0.80) for cardiovascular diseases as a group, hypertension, angina pectoris, myocardial infarction, and diabetes. The lowest agreement (kappa < 0.55) was found for lower back disorder, hip and knee arthrosis, and claudication. These results showed that the agreement between questionnaire data and medical records was good for well-known chronic diseases that have clear diagnostic criteria and are easily communicated to the patient. Conversely, the agreement was poor for diseases with nonestablished diagnostic criteria and a fluctuating course.
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PMID:Agreement between questionnaire data and medical records of chronic diseases in middle-aged and elderly Finnish men and women. 912 3

All intramedullary femoral surgery entails embolic phenomena which explain peroperative collapses formally known as bone cement implantation syndrome, as well as perioperative fat embolism syndromes. Locally, the bigger the cavity is, the higher the number of accidents: 2.5-5 per cent for GUEPAR hinged-knee prosthesis, 1.75 per cent for total hip arthroplasty with long stem, and 0.1 per cent during classic THA with cement limited to the metaphysis. Anomalies in bone vascularization also increase risk: 10.5-13 per cent during prophylactic nailing for shaft metastases, 1-11.5 per cent during hemiarthroplasty cemented in osteoporotic bone of femoral neck fractures, and only 0.1 per cent during THA implanted because of arthrosis. Not only cement, but also rods, reamers, nails, implants, ultrasonic tool for cement extraction, increase the pressure inside the cavity. Methylmethacrylate is no longer the only incriminated factor, even if it is responsible for a major part of the compressive load. The intensity and duration of the pressure are correlated with the number of embolic phenomena and with measured cardiopulmonary parameters. The intracavity fat content is expelled (an empty cavity, as in THA revision, does not lead to embolic phenomena). Then filters through the intraosseous veins whose diameter limit the size of the extruded embolic phenomena. The ultrasonography of the inferior vena cava shows innumerable fine particles and thrombi which are already organized under the influence of procoagulant factors released from the operative shield and which remain crumbly. These emboli cross the cardiac cavities. Transesophageal echocardiography (TEE), of recent use, does quantify the amount of right atrial filling, duration of echogenesis and size of particles: the result is higher in patients who underwent cemented versus noncemented THA: however the embolism score is no an indicator of seriousness because it is not correlated with cardiorespiratory manifestations; TEE shows only one fourth of the patent foramen ovale, whereas the atrial septal defect is surely one of the most efficient systemic invasion mechanisms to produce perioperative fat embolism. Lung response is most often asymptomatic, even if all patients undergoing intramedullary surgery display an increase in pulmonary vascular resistance which is managed by the right heart only, as well as pulmonary (and sometimes systemic) microvascular fat obstruction. Common operating room monitoring procedures do not detect successive embolic phenomena before they cause pulmonary arterial hypertension which then has repercussions on the left heart and in turn causes peroperative hemodynamic accidents. Only pulmonary arterial pressure measurement with a Swan-Ganz catheter gives early and durable signs of an intolerance to embolic load. Preventive treatment is surgical as there is an inverse relation between embolic marrow and marrow eliminated by large volume washes (which is often more effective than draining). Cement indications in older patients as well as the choice of fixation techniques in femoral fractures must take into account the cardio-pulmonary condition of the patient. Resuscitation procedures dealing with these complications end in the patient's death in half of the cases.
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PMID:[Embolism and intramedullary femoral surgery]. 916 44

As part of an extensive cross-sectional survey of Norwegian physicians carried out in 1993 the 1,158 retired members of The Norwegian Medical Association were sent a questionnaire about their social situation, work activity, health and well-being. The response rate was 76%. 62% of the respondents were 75 years or older, and 13% were women. 44% were still active, doing clinical, research, or consultation work. The most prevalent complaint was lower back trouble, followed by arthrosis and hypertension. It was relatively common to prescribe one's own drugs. 6-8% of physicians under 75 years and 28% of those over 84 years needed practical help, but the great majority rated their life quality as good or excellent.
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PMID:[How are the retired physicians?]. 959 2

Obesity is an essential risk factor for hypertension, coronary heart disease and stroke as well as for metabolic disturbances, especially for type 2 diabetes, hyper- and dyslipidemia, and it is responsible for the metabolic syndrome with insulin resistance and hyperinsulinemia. Disturbances in the lung function are also induced by obesity, as a higher risk for arthrosis on the lower extremities. Some oncological diseases like breast-, endometrial-, and prostatic cancer are associated with obesity. It is evident, that the fat distribution plays an important role in the development of obesity associated diseases: the accumulation of visceral fat has a higher risk as the peripheral fat, probably due to the different metabolism.
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PMID:[Obesity: entrance port to multimorbidity]. 988 99

Intraosseous venous hypertension is considered a significant factor in the production of knee pain secondary to degenerative arthrosis, thus vascular decompression by means of tibial osteotomy is a rational option for treatment of selected patients. A preliminary report is presented of six patients with symptoms of primary or secondary degenerative arthrosis who were treated by incomplete nondisplaced proximal tibial osteotomy with good or excellent results. These patients were refractory to nonoperative treatment and were not deemed suitable candidates for angulated osteotomy, arthroscopic surgery alone, or total knee arthroplasty. Patients ranged in age from 36 to 61 years (mean age: 47 years). Follow-up ranged from .8 to 6.7 years (mean: 3.1 years). The subjects were studied postoperatively by interview, physical examination, radiographs, and bone scans. Results were assessed using the knee rating system of The Hospital for Special Surgery.
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PMID:Incomplete nondisplaced tibial osteotomy for treatment of osteoarthritic knee pain. 1014 54


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