Biomedical subjects
Publications and source records attributed to Z Kalvach.
The author presents an account of contemporary approaches to the problem of maltreatment, abuse and neglect of senior citizens. He draws attention to risk factors, clinical manifestations and different forms of maltreatment. Briefly basic remedies are discussed. Special attention is devoted to maltreatment and unsuitable treatment in facilities for long-term care.
The political abuse of psychiatry in the former USSR was enabled by: 1. a disproportionate pointing up of the medical criteria of mental disorder to the detriment of the social ones, above all by circumventing the sociological labelling process; 2. lack of control of involuntary psychiatric hospitalisation by the law; 3. an obsolete definition of psychiatry. The author suggests a definition of psychiatry taking into consideration both the above mentioned criteria and making the importance of the legal control of involuntary psychiatric hospitalisation more evident.
The authors draw attention to doubts regarding diagnostic psychiatric classification and underrating of an accurate terminology, particularly during the last 15 years. They analyze advantages, the purpose and sense of diagnostic classification patterns and expectations from this pattern. They submit arguments for the statement that psychiatric diagnosis is essential for the mutual understanding, for assessment of therapy, prognosis and evaluation and also for psychiatric research.
OGTT prolonged to 4 hours was performed in untreated 50 obese outpatients (mean age 37.9 years and BMI 37.2). Parallel to glucose, insulin, growth hormone (GH), cortisol, beta-hydroxybutyrate (BOHB), nonesterified fatty acids (NEFA) and indirect calorimetry (RQ) were estimated at hourly intervals. Basal values of thyroxine (T4), triiodothyronine (T3), total cholesterol and triacylglycerols were also obtained. Mean glycemia after overnight fasting as well as after 75 g glucose reached upper limits of the normal range. The subsequent decrease was slower. Insulinemia followed a similar trend. The initial drop of GH after the glucose load reverted to an increase above the basal value. A similar pattern was observed with cortisolemia, but the decrease and increase were less important. The basal value of RQ was rather low and glucose ingestion produced only a small increase, followed by a greater decrease. Serum levels of NEFA and BOHB sharply decreased one hour after glucose intake and afterwards regained the initial values. The mean basal values of T4 and T3 were within the normal range--the low T3 syndrome was not involved in the large majority of cases. Cholesterol and triacylglycerols approached the upper normal limit. The correlations brought additional information. Insulinemia increased parallel with the amount of body fat. The basal level was decisive for most hormones and substrates--the high or low set level could be followed in the course of the whole test. Increased insulinemia and increased glycemia suggested the presence of a mild insulin resistance with the participation of GH and cortisol. Increased levels of fasting insulinemia and glycemia were present also in obese subjects with a normal OGTT. The correlations permitted to disclose insulin-like effects of GH on basal conditions. Increased BOHB was responsible for a high cholesterol. It is suggested that even small fluctuations of glycemia related to food intake may produce a substantial modification of the hormonal status in obese subjects and initiate or support the metabolic disorders in obesity. In this respect a greater role is ascribed to the phase of decreasing glycemia in comparison to the increasing phase. Lipids are the prevailing source of energy in insulin resistant subjects. The rather stable values of indirect calorimetry indicate that energy metabolism of obese subject works on a low, pre-set level-independently on the supply of some relevant hormones and substrates.
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A case report deals with an observation of a 58 year old woman with small-cell cancer of the lung metastasizing to regional lymph nodes. Quickly and early before any manifestation of the underlying fatal illness a paraneoplastic encephalopathy developed with psychiatric and neurological signs of cerebellar ataxia and secondary epilepsy.
The authors discuss the characteristic and justification of a specific geriatric regime, or geriatric departments, and give an account of their experience assembled in tests of this regime under conditions of the geriatric centre of the Third Medical Clinic, Prague, in particular with regard to the general orientation as regards hospitalization of geriatric patients.
The authors discuss individual nursing components of the specific geriatric regime. Attention is paid to problems of activation of geriatric patients, cooperation with their families, the system of controlled visits, an individual approach focused on comprehensive solution of the situation in life. Special attention is paid to rationalization of the diagnostic and therapeutic programme with an effort to reduce the administration of tranquillizers.
Geriatric patients account for some 60% of the patients who se their health community doctor who thus is also the geriatrician of the first line. According to experience from abroad (Sweden) it is assumed that general practitioners will take over the medical and social care of aged subjects. The authors describe activities associated with this role. They draw attention to the hitherto inadequate collaboration of doctors with the patients' families.
The paper discusses the main problems in gerontology, geriatrics and care of old persons. It stresses the importance of the geriatric discipline and a new conception of providing health care and social services to persons of high age.
Fourteen obese women (BMI 37.2 +/- 7.3) were treated with a very low energy diet containing 1555 kJ (370 kcal) for 14 days. Weight loss occurred in all cases (4.2-10.7 kg, mean 6.46 +/- 1.68 kg), although usual weight-reducing regimens have not succeeded before. There were no complications and results of usual biochemical tests did not change. Body mass index and concentrations of serum total cholesterol decreased significantly, insulin levels fell in the first and fourth hour of a glucose tolerance test. Also serum triiodothyronine concentrations declined significantly but not below the lower limit of normal results. We concluded that short-term very low energy diet treatment enable a safe decline of excessive body mass in out-patients, including those resistant to usual reducing diets.
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There is indirect evidence that smoking induces higher enzymatic activity which accelerates the metabolism of many drugs. This influence is inferred from the frequency and magnitude of drug side effects. We could demonstrate that smokers need higher doses of neuroleptic drugs than nonsmokers.
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