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Kidney transplantations are being performed in every increasing numbers, and, in addition to specialist centres, nephrologists, general practitioners and urologists are more frequently being involved in the provision of aftercare. The major urological complications seen after transplantation include ureteral stenosis and necrosis, incontinence and impotence, lymphoceles, arterial stenosis, infections of the urinary tract and adnexa, as well as--the most serious complication--malignant tumours. In addition, the immunosuppression required by these patients is often associated with secondary disorders such as hypertension, steroid-related diabetes, hyperlipidemia and infections. Against the background of progressive organic deficiency it is of particular importance to identify such complications and to treat them adequately, or to prevent them from occurring, thus ensuring the longest possible survival of transplant and patient and improved quality of life.
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PMID:[Follow-up in kidney transplantation. Which complications are likely?]. 1263 37

A cure for Alzheimer's disease (AD) is still far off, and clinicians face the burden of caring for patients at all stages of dementia for the foreseeable future. Those with advanced disease suffer neurological symptoms and signs that include incontinence; problems with gait and mobility; marked cognitive, language, and functional impairment; and in about 90% of patients, significant behavior problems. Dementia precludes the ability to initiate meaningful activities or social interactions. Whether patients are resident in the community or living in a nursing home, this composite reflects a highly complex medical and neuropsychiatric management challenge. Predictable medical conditions also must be addressed (i.e., those that accompany dementia, such as parkinsonism, and those that are prevalent in any aging population, such as hypertension). Clinicians can better address these problems with awareness of current treatment options. Placebo-controlled trials of some psychotropic agents have shown modest favorable effects on behavior problems. Use of acetylcholinesterase inhibitors (AChEIs) to treat cognitive impairment and secondary behavioral symptoms derives primarily from results of placebo-controlled clinical trials. Trials in patients with moderate to severe AD, outpatients as well as nursing home residents, show overall effects similar to those seen in outpatients with milder dementia. Treatment with AChEIs may delay institutional placement. Memantine has shown benefit in trials in moderate to severe dementia, although it is not yet approved in the United States. Emerging data have expanded physicians' ability to use pharmacotherapy in patients with advanced dementia. Physicians need to enact the principle that something can be done for our afflicted parents and grandparents.
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PMID:Medical management of advanced dementia. 1280 87

Obesity is a progressive disease of unwanted fat accumulation which has multiple, organ-specific pathological consequences. The manifestations of obesity occur within virtually every subspecialty of medicine or surgery and they interact importantly to accelerate the ageing process in many organs. Many of the hazards of obesity have multiple causes (e.g., diabetes, heart disease, stroke, colonic and breast cancer, urinary incontinence, tiredness, back pain, breathlessness). All of these conditions become more prevalent with age and are also more prevalent among overweight persons, particularly those with a central fat distribution marked by a high waist circumference. Hypertension may be caused or aggravated by weight gain. It is mediated by the physical demands of an expanded circulating volume and increased metabolic rate by metabolic mechanisms related to central fat distribution and the "metabolic syndrome", and to increased sodium consumption by overweight people (because they need more food to maintain a higher metabolic rate). Since body mass index (BMI) and waist circumference increase significantly with age there is an escalation of the burden of ill health from obesity with age. The best simple indicator of disease risk with obesity is the waist circumference since this identifies people who have a high body fat content and also those who have an increased intraabdominal accumulation of fat. The quantitative burden of ill health from overweight and obesity varies within different specialties, but up to 80% of type 2 diabetes or polycystic ovarian syndrome can be attributed to obesity. Obesity is the cause of sleep apnea syndrome in around 50% of cases and heart disease in perhaps 10-20% of cases. In Scotland 80% of people with existing cardiovascular disease are overweight compared with 57% of the general population. The financial burden to health services from overweight and obesity has been incompletely assessed, although it is estimated that around 4% of total health care budgets are attributable to people having BMI > 25 kg/m(2). This is similar to the entire cost of diabetes, epilepsy or major cancers. Obesity is therefore an extremely expensive disease based on these conservative estimates from limited evaluations. More general assessments show how obesity increases the amount of time taken off work, the number of drugs prescribed and the expenditure from social services support. Thus, obesity represents a huge burden not only on the individual patient physically, psychologically, socially and financially but also on families and careers and is a huge drain on health care resources. Overweight affects well over half of all adults worldwide, progressing to BMI > 30 kg/m(2) in around 20% outside subsistence rural communities. Its rapidly increasing prevalence now described as an epidemic demands major preventive measures, as well as better medical treatment for individuals affected.
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PMID:Obesity: burdens of illness and strategies for prevention or management. 1284 36

We investigated the difficulties involved in assessing post prostatectomy voiding according to 20 nurses working in urology and dermatology wards. Problems they encountered included completing a urination (frequency/volume) chart and performing an assessment. We constructed a hourly urination chart for basic nursing education in urinary incontinence. This was used for a 76-year-old male patient with hypertension and diabetes mellitus who underwent a prostatectomy. Urination was recorded for 17 consecutive days after catheter removal. Detailed pathological findings were more distinct in the hourly rather than daily recordings of voluntary micturition. Voluntary micturition appeared 12 h after catheter removal, but it was very scanty. After the onset of urination, frequency and amount of daily voluntary micturition was inversely related to incontinence during the 17 days after catheter removal. We drafted a set of urination recovery stages to enable the analysis of a patient's urination status. Nurses understood its importance and were able to reach a consensus on how to manage patients with postoperative incontinence. We have constructed a practical system for use by specialist urology nurses.
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PMID:Urination assessment after the removal of bladder catheter using a novel urination chart. 1287 20

One thousand and thirty-one longstanding patients with subacute myelo-optico-neuropathy (SMON; 275 males, 756 females; mean age +/- S.D., 72.9 +/- 9.6 years; age at onset 37.6 +/- 9.8 years; duration of illness 35.3 +/- 4.0 years) were examined in 2002, 32 years after banning of clioquinol. At onset, 66.7% of patients were unable to walk, and 4.7% complete blindness. At present time, about 41% of patients were still difficult to walk independently, including 15.8% of completely loss of locomotion. One point six percent of patients were in complete blindness and 5.8% had severe visual impairment. The majority (95.6 - 97.7%) of patients exhibited sensory disturbances including superficial and vibratory sensations and dysesthesia. Dysautonomia was observed as leg hypothermia in 79.8%, urinary incontinence in 60.7%, and bowel disturbance in 95.3%. As complication, high incidence was revealed with cataract (56.2%), hypertension (40.2%), vertebral disease (35.5%), and limb articular disease (31.5%). These results indicate the serious sequelae of clioquinol intoxication, SMON.
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PMID:Clinical analysis of longstanding subacute myelo-optico-neuropathy: sequelae of clioquinol at 32 years after its ban. 1475 38

We studied a series of 93 patients diagnosed with craniopharyngioma during a 15-year period with respect to presenting symptom, clinical course and management. The majority (62%) of patients were men, and had presented with neurological symptoms (75%), with headaches (82%) being the most common presenting symptom. The incidence of certain endocrine and ophthalmic symptoms varied little from that in the literature, on the other hand, the incidence of certain other symptoms did differ markedly from the literature. For example, loss of libido and amenorrhoea were seen at a much lower frequency than that stated in the literature. Hypertension, sensorimotor symptoms and urinary incontinence were not seen at all in our patients. In most cases diagnosis was made by a cranial CT scan, which is more sensitive than plain radiography for detection of enlarged sella turcica (69% vs. 24%; P < 0.001). In over 90% of cases, therapy consisted of removal of a variable portion of the tumour, with or without radiotherapy. Post-operative mortality was substantially reduced in cases treated by radiotherapy (P < 0.05). The most common post-operative complications in all cases were recurrence of disease, panhypopituitarism and diabetes insipidus.
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PMID:Presentation and outcome of 93 cases of craniopharyngioma. 1496 70

Regular physical activity provides health benefits, including the reduction in risks of coronary heart disease, hypertension, type 2 diabetes mellitus, obesity, colon cancer, and premature mortality. Despite this information, most women are physically inactive. Research findings shed light on the gender differences in physiological responses to physical activity. Patterns and predictors of physical activity vary significantly by gender. Further study is needed of the benefits, barriers, and personally meaningful outcomes of physical activity for women, specifically including the frequently unspoken correlates of urinary incontinence, depression and mood disorders, and obesity.
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PMID:Physical activity and exercise in women's health. 1506 35

Vascular parkinsonism has not been well defined and the clinical correlation of vascular parkinsonism is still not clear. The aim of the study was to estimate prevalence of occurrence of vascular parkinsonism, analysis of risk factors leading to its development and to identify clinical features that suggest a vascular origin. 214 patients with Parkinson's disease were examined. Their ages ranged from 37 to 88 years (median 66.4 years). Evidence of vascular parkinsonism was assessed using a vascular rating scale previously described by Winikates and Jankovic. Statistical analysis was performed with Mann-Whitney U test, chi 2 Pearson test, chi 2 Yates test, Spearman rank correlation and Student's t test. Out of 214 patients 8 were proved to have developed Parkinson's disease due to vascular disease, what gave 3.74%. Out of risk factors for stroke 5 patients had hypertension, 3 had diabetes mellitus, 2 suffered from heart disease, 2 had infarctus myocardii, 1 had hyperlipidemia, 1 had atrial fibrillation. Additionally, those patients had neuroimaging (CT or MRI) evidence of vascular disease in one or more vascular territories. Patients with vascular parkinsonism were older, had shorter duration of disease, were more likely to present rigidity rather than tremor. Dementia and incontinence were more common in vascular group than in Parkinson's disease group. Patients with vascular parkinsonism were also significantly more likely to have corticospinal findings. Proving that Parkinson's disease had vascular etiology is extremely difficult. The test results are inconclusive.
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PMID:[Clinical correlation of vascular parkinsonism]. 1509 42

Quality of life is an important indicator in assessing the burden of disease, especially for chronic conditions. The Health Utilities Index (HUI) is a recently developed system for measuring the overall health status and health-related quality of life (HRQL) of individuals, clinical groups, and general populations. Using the HUI (constructed based on eight attributes: vision, hearing, speech, mobility, dexterity, cognition, emotion, and pain/discomfort) to measure the HRQL for chronic disease patients and to detect possible associations between HUI system and various chronic conditions, this study provides information to improve the management of chronic diseases. This study is of interest to data analysts, policy makers, and public health practitioners involved in descriptive clinical studies, clinical trials, program evaluation, population health planning, and assessments. Based on the Canadian Community Health Survey (CCHS) for 2000-01, the HUI was used to measure the quality of life for individuals living with various chronic conditions (Alzheimer/other dementia, effects of stroke, urinary incontinence, arthritis/rheumatism, bowel disorder, cataracts, back problems, stomach/intestinal ulcers, emphysema/COPD, chronic bronchitis, epilepsy, heart disease, diabetes, migraine headaches, glaucoma, asthma, fibromyalgia, cancers, high blood pressure, multiple sclerosis, thyroid condition, and other remaining chronic diseases). Logistic Regression Model was employed to estimate the associations between the overall HUI scores and various chronic conditions. The HUI scores ranged from 0.00 (corresponding to a state close to death) to 1.00 (corresponding to perfect health); negative scores reflect health states considered worse than death. The mean HUI score by sex and age group indicated the typical quality of life for persons with various chronic conditions. Logistic Regression results showed a strong relationship between low HUI scores (< or = 0.5 and 0.06-1.0) and certain chronic conditions. Age- and sex-adjusted Odds Ratio (OR) and p values showed an effect among individuals diagnosed with each chronic disease on the overall HUI score. Results of this study showed that arthritis/rheumatism, heart disease, high blood pressure, cataracts, and diabetes had a severe impact on HRQL. Urinary incontinence, Alzheimer/other dementia, effects of stroke, cancers, thyroid condition, and back problems have a moderate impact. Food allergy, allergy other than food, asthma, migraine headaches, and other remaining chronic diseases have a relatively mild effect. It is concluded that major chronic diseases with significant health burden were associated with poor HRQL. The HUI scores facilitate the measurement and interpretation of results of health burden and the HRQL for individuals with chronic diseases and can be useful for development of strategies for the prevention and control of chronic diseases.
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PMID:Using Health Utility Index (HUI) for measuring the impact on health-related quality of Life (HRQL) among individuals with chronic diseases. 1534 14

The effect of cardiac failure (CF) and comorbidity on disability in older persons was studied in a cross-sectional survey. The whole population aged 65 + years (n=652; 628 eligible) living in a small town near Florence (Italy) was enrolled. Finally, 459 individuals (73.0% of eligible) underwent a multidimensional evaluation. CF was defined as a NYHA II-IV class in the presence of an obviously abnormal ECG. Disability was assessed by the 14-item WHO scale. Comorbid conditions that had a prevalence >5% and might be considered pathophysiologically unrelated to CF were also identified. The univariate association of CF with disability was analyzed. Multivariate associations were estimated as well, by taking simultaneously into account the effect of comorbid conditions that had an independent effect on disability and were considered as either confounders or effect modifiers of that association. Prevalence of CF [6.1% in the whole study population) was higher with advancing age ( >or=75 years: 8.3 versus 65-74 years: 4.5%, odds ratio, OR: 1.93, 95% confidence interval, CI: 1.02-4.18), in the presence of hypertension (OR: 2.87, 95% CI: 1.32-6.23), and among individuals who were living alone (OR: 2.44, 95% CI: 1.10-5.56). CF was associated with a higher prevalence of disability (38.5 versus 19.5% OR 2.67, 95% CI: 1.21-5.92). Comorbidity modified the association of CF with disability following two patterns: while the independent effect of CF on the prevalence of disability was similar in the absence or in the presence of chronic obstructive pulmonary disease, hearing impairment, gastrointestinal tract disease, or osteoarthritis, such effect was much larger in the presence than in the absence of visual impairment, previous stroke, or urinary incontinence. The composite pathophysiological pathways of such different interactions are still to be elucidated.
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PMID:Variable effect of comorbidity on the association of chronic cardiac failure with disability in community-dwelling older persons. 1537 48


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