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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A variety of disorders affect the muscles or the neuromuscular junction of dogs and cats, most often causing weakness, exercise intolerance, and muscular pain or atrophy. The myopathies are infectious, immune-mediated, inherited or acquired secondary to systemic disease. Acquired myasthenia gravis is a common disorder of the neuromuscular junction, which clinically resembles a myopathy. Reaching a specific diagnosis is essential to determine optimal therapy and prognosis for each of the commonly recognized disorders.
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PMID:Selected disorders of muscle and the neuromuscular junction. 1068 Feb 9

Despite intensive effort to cure breast cancer, treatment generally fails, as evidenced by the age adjusted mortality from breast cancer. For 60 years, breast cancer mortality remained virtually constant. As treatment failed to improve the life prospect of the average patient, it is based on false premises, e.g., Halsted's hypothesis, according to which the tumor is the only threat to the patient. Yet there is more to cancer than just the tumor. Two hallmarks of cancer, cachexia, and paraneoplasia, are usually ignored, since it is assumed that they are caused by the tumor. But, what if it is the other way around, and cancer is first of all a cachexia accompanied by a tumor? At least this could explain why in most cancers treatment fails. Cancer is a chronic systemic disease with local manifestations. Like arteriosclerosis, that is also systemic and manifested solely by its local manifestations, e.g., stroke and myocardial infarction. In the same way as treatment of an ailing heart does not cure the underlying arteriosclerosis, tumor removal does not cure cancer, since being "metabolically" systemic. It is proposed here that carcinogens deplete a vital substance and induce a metabolic deficiency that ends in cachexia. In order to survive, the organism grows a protective organ, the tumor, that replenishes the missing substance. During pre-clinical phase of cancer, deficiency is slight and compensated even by a minute tumor. With time it gets worse and the tumor has to grow more and more in order to make up for the loss, causing pain and secondary damage to vital functions. The patient seeks help and the disease starts its clinical course. When deficiency worsens, the patient becomes cachectic and dies. Such a metabolic relationship exists in pernicious anemia, that illustrates how a tumor might be protective. Cancer is viewed here as pernicious cachexia induced by the loss of a vital metabolite and compensated by the tumor. Until the discovery of the missing substance, treatment ought to preserve the tumor and alleviate its secondary manifestations.
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PMID:Pernicious cachexia: a different view of cancer. 1069 3

Painful sensation of heavy or swollen legs are non-specific symptoms frequently associated with chronic venous insufficiency. Clinical evaluation is the first step in defining the cause of the complaint and offering adequate treatment. When a heavy or swollen leg is associated with oedema, venous insufficiency, lymphatic or systemic disease must be considered. If symptoms occur during walking a vascular or nervous disease must be suspected. Associated erythema suggests infection (erysipelas). If clinical data are the cornerstone of diagnosis, difficulty may arise from the high frequency of superficial venous insufficiency and the readiness of linking too quickly any non specific complaint to this particular venous disease.
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PMID:[Heavy and swollen legs]. 1100 97

The objective was to analyze psychiatric disorders and psychosocial dysfunction in patients with systemic lupus erythematosus (SLE), studied longitudinally during active and subsequent inactive stage of their disease. During a 6 month period of study, we selected 20 consecutive patients with SLE who presented with a SLE flare. All patients fulfilled the 1982 revised criteria of the American College of Rheumatology for the classification of SLE. When patients entered the study, we performed psychiatric (CIS, RDC, STAI, HD, BDI, GHQ and MMS) psychosocial (GAS and VAS-P) scores assessment. One year later, we repeated the psychiatric and psychosocial assessment when patients showed inactive disease. The 20 patients evaluated were women, with a mean age of 34 y (SE 14.4, range 20-57). According to CIS evaluation, we diagnosed 8 (40%) psychiatric cases in the acute episode of SLE. The RDC diagnosis showed generalized anxiety in 5 patients, panic disorders in 2 patients and generalized anxiety plus depressive symptoms in one patient. One year later, when patients did not show disease activity, we diagnosed 2 (10%) psychiatric cases (P<0.05). When SLE patients were clinically inactive, they showed lower levels of psychological distress (GHQ scale, 1.8 vs 5.6, P<0.001), with a lower grade of anxiety measured by both HA (3.2 vs 8.2, P<0.01) and STAI-S (7.95 vs 20.90, P<0.001) scales. We also found a lower score in pain perception (VAS-P) (2.80 vs 4.25, P<0. 01) and higher occupational activity (VAS-P) (83.9 vs 66.2, P<0.01) and general functioning (GAS) (93.75 vs 83.50, P<0.05) during the inactive stage. No significant differences were found when we compared cognitive impairment, grade of depression and physical disability between inactive and active stages. We conclude that in SLE patients, psychiatric and psychosocial disorders during acute episodes are usually mild and seem to be related to the psychological impact of disease activity on patients. This type of psychiatric pathology is similar to that which would be expected in other groups coping with a stressful event, indicating that our patients did not react in a way specifically determined by their systemic disease.
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PMID:Psychiatric and psychosocial disorders in patients with systemic lupus erythematosus: a longitudinal study of active and inactive stages of the disease. 1103 32

Problems in the foot develop as a result of the aging process or systemic disease. Common causes of pain and disability in the elderly are nail and skin problems, predominantly corns and calluses, along with circulatory and structural problems. Because patients with orthopaedic conditions may have preexisting foot problems, it is important for nurses to distinguish between minor foot problems that can easily be treated and more serious conditions that require referral to a specialist. This article discusses pathophysiology of the aging foot, a comprehensive foot assessment, common foot problems with nursing interventions, pressure relief and shoewear, and nurses' qualifications for providing foot and nail care.
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PMID:Foot care: focus on the elderly. 1106 15

Headaches can constitute a direct symptom and possibly the preliminary symptom of several autoimmune diseases and systemic vasculitis. In the majority of cases, the characteristics of the headache are not on their own sufficient to establish a certain diagnosis, which has to be based on the clinical context and on other migraine-associated signs. In practice, three main categories of headache can be indicative of systemic disease: craniofacial pain; migraine and pseudo-migraine; and headache caused by intracranial hypertension.
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PMID:[Headache as an indicator of systemic disease]. 1107 50

Approximately 10% of women and 5% of men at age 70 experience severe recurrent or constant headaches. Severe headache presenting for the first time in a patient over age 50 is unusual and requires a thorough medical and neurologic examination. Primary headache etiologies in older patients include migraine, tension-type, cluster, and the rare hypnic headache. For all of these, effective pain control includes pharmacologic and nonpharmacologic interventions. Secondary etiologies include temporal arteritis, medication-induced headache, cerebrovascular or cardiac ischemia, and intracranial hemorrhage or tumors. Head pain may also be cervicogenic or related to glaucoma or sleep apnea. In secondary cases, pain management is specific to treatment of the underlying structural or systemic disease.
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PMID:Geriatric headache. How to make the diagnosis and manage the pain. 1113 53

The purpose of this study was to evaluate which factors might influence health care attitudes such as anxiety about dental care by older adults in Israel. The study population consisted of 103 non-institutionalized patients (46 men and 57 women) over the age of 65 who attended a dental clinic that provided services for older adults during a one-year period. Socio-demographic information and information about the subjects' general health and their level of concern about health problems were obtained from self-reported questionnaires, while the dental anxiety level was found by means of a dental anxiety scale (DAS). Ninety-nine percent of the patients suffered from a major systemic disease such as diabetes, hypertension, atherosclerosis, respiratory disease, and rheumatic disease. Both unmarried and first-time patients expressed high anxiety scores. Patients with 12 or fewer years of formal schooling demonstrated significantly higher dental anxiety. Among patients who regularly attended a synagogue or a social club, concern about oral health was significantly higher than for the rest (p < 0.02). No association was found between having dentures and gender, or between having dentures and level of education. The reason for visiting the clinic (inability to eat, pain, or esthetics) was not associated with any other health concern or with dental anxiety levels. This study determined that patients who were unmarried, less educated, or attending the facility for the first time were more likely to experience dental anxiety. These patients merit special consideration.
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PMID:Non-institutionalized elderly dental patients in Israel: socio-demographics, health concerns, and dental anxiety. 1120 80

The aetiology of mouth ulcers is diverse and may include several types of trauma, systemic disease and infection. The size, depth, outline, base, aspect of the floor, pain, time of evolution and resolution of oral ulcers are discussed. Both past and present medical history, biopsy, blood tests and microbiological tests are also considered in order to assure precise identification. This paper reports a case of a lip ulcer caused by Klebsiella pneumoniae.
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PMID:A rare case of lip ulcer infected by Klebsiella pneumoniae: case report. 1121 Feb 65

Acute low back pain is a common reason for patient calls or visits to a primary care clinician. Despite a large differential diagnosis, the precise etiology is rarely identified, although musculoligamentous processes are usually suspected. For most patients, back symptoms are nonspecific, meaning that there is no evidence for radicular symptoms or underlying systemic disease. Because episodes of acute, nonspecific low back pain are usually self-limited, many patients treat themselves without contacting their primary care clinician. When patients do call or schedule a visit, evaluation and management by primary care clinicians is appropriate. The history and physical examination usually provide clues to the rare but potentially serious causes of low back pain, as well as to identify patients at risk for prolonged recovery. Diagnostic testing, including plain x-rays, is often unnecessary during the initial evaluation. For patients with acute, nonspecific low back pain, the primary emphasis of treatment should be conservative care, time, reassurance, and education. Current recommendations focus on activity as tolerated (though not active exercise while pain is severe) and minimal if any bed rest. Referral for physical treatments is most appropriate for patients whose symptoms are not improving over 2 to 4 weeks. Specialty referral should be considered for patients with a progressive neurologic deficit, failure of conservative therapy, or an uncertain or serious diagnosis. The prognosis for most patients is good, although recurrence is common. Thus, educating patients about the natural history of acute low back pain and how to prevent future episodes can help ensure reasonable expectations.
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PMID:Evaluating and managing acute low back pain in the primary care setting. 1125 64


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