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PubMed1990

Marital functioning after cardiac surgery.

Using Barnhill's components of family health functioning, we examined the relationships of spouse anxiety, coping methods, couple responsibility for compliance, and reported compliance with marital couple functioning. Five psychosocial scales were returned by mail by 136 Mended Heart members and spouses from five geographic regions. By multiple regression analysis, confrontive coping strategies and spouse trait anxiety were the two factors predictive of couple marital functioning. When marital functioning scores were examined separately, spouses' confrontive behaviors and patient reported compliance for diet, stress, and smoking prescriptions were predictive of both spouse and patient marital functioning. In addition, spouse marital functioning was predicted by state anxiety and patient compliance, and patient marital functioning by compliance and shared responsibility for compliance. Further studies should evaluate spouse inclusion in rehabilitation programs during hospitalization and convalescence and examine interactional strategies that facilitate confrontive behaviors and patient compliance to promote couple marital functioning after the cardiac event.

Adaptation, Psychological↗
PubMed1979

Why am I here?

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Aged↗
PubMed1988

Nephrolithiasis.

The management of the patient presenting to the Emergency Department with nephrolithiasis or renal colic should include evaluation of the patient for concurrent diseases, risk factors for stone formation, and possible etiologies for stones. Suspicion of ureterolithiasis is based on a cogent history and physical examination and reinforced by a finding of hematuria. Diagnosis should be based upon a promptly performed intravenous pyelogram, unless the patient is truly allergic to contrast media or has substantial risk of a contrast-induced renal failure. A solitary flat plate of the abdomen adds no useful information and is an unnecessary expense to the patient. Essential laboratory data include a urinalysis, CBC, and electrolyte, BUN, creatinine, and serum calcium levels. A urine culture should be obtained in all patients because urinalysis alone may not be sufficient to exlude a urinary tract infection. Initial treatment of the patient with an uncomplicated renal colic should include hydration, relief of pain, and reassurance. Evaluation by a consultant may be done as an outpatient on a nonemergent basis. If the colic has not resolved after 72 hours, hospitalization generally is recommended. If the patient has vomiting, dehydration, a complete obstruction, or a solitary kidney, hospitalization in indicated and urgent consultation recommended. If the patient has fever or other signs of infection, emergent consultation and immediate hospitalization are essential. Retained obstructing stones are generally managed by urologic consultants. It is in the care of the patient with the retained stone that greatest advances have been made in the past 10 years. Patients should be counseled that the retained stone no longer calls for extended hospitalization and convalescence.

Colic↗
PubMed1985

Endoscopic sphincterotomy in the treatment of choledocholithiasis and ampullar stenosis. Experience with 202 patients.

Endoscopic sphincterotomy (EST) was performed on 202 patients (265 EST) in the 5-year period 1978-1983 because of choledocholithiasis or benign stenosis of the ampulla of Vater. The indications for EST in choledocholithiasis included residual or recurrent stone(s) in 80 cholecystectomized patients, and 96 had choledocholithiasis with the gallbladder in situ. Ductal calculi passed spontaneously after EST in 87 cases (50%) and were actively extracted in 73 (41%). Ductal clearance failed in 16 patients. The overall success rate thus was 91%. Ampullar stenosis was successfully treated in 26 patients. Sphincter stenosis after EST was diagnosed in one patient. Immediate complications of EST arose in 31 patients (11.7%), one of whom died. Emergency laparotomy was required in three cases (1.1%). EST with or without stone extraction is a relatively safe procedure for managing choledocholithiasis in high-risk patients before cholecystectomy is considered, and also for stones retained or reformed after cholecystectomy. Endoscopic treatment may offer appreciable clinical and financial benefits by reducing morbidity and mortality rates and shortening hospitalization and convalescence time.

Adult↗
PubMed1979

Endoscopic management of choledocholithiasis and papillary stenosis.

Endoscopic papillotomy was performed in 50 of 53 patients, 31 females, with an age range of 29 to 87 years, a mean of 63.1. The indications for the procedure included retained or recurrent choledocholithiasis, primary choledocholithiasis and papillary stenosis, which were responsible for persistent or intermittent cholestasis. The procedure was successful in all but three patients in whom the primary diagnosis was papillary stenosis. The major complications were bleeding in three patients, pancreatitis in one patient and an infected pseudocyst in one patient. Surgical intervention was not required, and there were no deaths. Endoscopic papillotomy has proved to be safe, producing a permanent biliary enteric fistula, thus reducing the probability of formation of recurrent stones. It has been shown to reduce hospitalization and convalescence, permitting an earlier return to normal activity.

Adult↗