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PubMed2005

[Pathological cataracts in systemic diseases].

PURPOSE: To show the physiopathological mechanisms which determines the appearance of the pathological cataract and types of cataract and clinical manifestations of the systemic disease and operative complications. METHOD: Retrospective study that includes 22 patients hospitalized in clinic with pathological cataract diagnosis, appeared in following systemic disease: diabetes mellitus, skin disease, endocrine disease, SNC disease. RESULTS: Generally the patients had posterior subcapsular cataract or nuclear and posterior subcapsular cataract with fast evolution to intumescent cataract. Phacoemulsification with IOLCP performed at all patients. Good evolution and not surgery complications. CONCLUSIONS: The difficult of the surgery was connected with the risk of the posterior capsular break ( the majority cases were soft cataract) and also connected with the capsulorhexis making in intumescent cataracts. The post surgery evolution was not different compared with a usually cataract.

Adult↗
PubMed2005

Collecting a set of psoriasis family material through a patient organisation; clinical characterisation and presence of additional disorders.

BACKGROUND: The aim of the present study was to describe the clinical characteristics of a population of psoriatics sampled from a patient organisation and not from hospitals or out-patient clinics. Furthermore, we wanted to compare siblings with and without psoriasis regarding the occurrence of other diseases. METHODS: At the end of 1991, we initiated a project which aimed to study genetic factors leading to psoriasis. Firstly, we sent questionnaires to all the members of the Swedish Psoriasis Association. We then examined 1,217 individuals (570 with psoriasis) from 310 families, in their homes in the southern part of Sweden. All the available family members were examined clinically and asked about the course of the skin disease and the occurrence of other diseases. The eight hundred members of the proband generation were divided into two groups, with or without psoriasis, and their clinical features were compared. RESULTS: Most individuals in this study population had a mild form of psoriasis. The siblings with psoriasis had joint complaints significantly more frequently than their siblings without the skin disease and those with joint complaints had more widespread skin disease. Among the other studied concomitant diseases (iritis, heart or hypertension disease, endocrine disease, inflammatory bowel disease and neurological disease), we were not able to find any difference. Seventy-seven of 570 persons were found to be in remission (13.5%). Females had a mean onset 2.5 years earlier than males. We were not able to find any correlation between the extent of the skin disease and age at onset. Twice as many persons with joint complaints were found among those with psoriasis than among those without, 28% versus 13%. Almost half (48%) the psoriatics who also had joint complaints had psoriasis lesions on their nails. Endocrine disorders were found in 9% of those without any allele for Cw6, but only in 1% of those who had Cw6. In fact, none of 183 Cw6 carriers had diabetes, as compared to the population prevalence of 3-5% in Sweden. CONCLUSION: With the exception of joint complaints, persons with psoriasis, collected from a patient organisation, did not have an increased frequency of (studied) co-existing diseases.

Adolescent↗
PubMed2003

Current status and future directions of geriatric general surgery.

As the population ages and requires more health care, a significant part of this is in surgical services. As elderly patients account for a growing proportion of most surgeons' practices, it is apparent that this patient group has special requirements, differences in outcomes, and different physiology from other patients encountered in the typical surgical practice. The greater frequency of emergency operations in older than in younger patients, with higher morbidity and mortality rates, compounds these differences. This paper reviews the current status of general surgery in older patients with a special focus on emergency procedures, major abdominal surgery, biliary disease, endocrine disease, and breast cancer. Each of these areas is a source of considerable interest to general surgeons.

Aged↗
PubMed1989

Normal exophthalmometric values in children.

We used a Hertel exophthalmometer to measure the degree of ocular protrusion in 852 subjects who had no history of orbital trauma or disease, endocrine disease, severe myopia, buphthalmos, or craniofacial deformities. The subjects ranged in age from 3 to 10 years. No statistically significant difference was observed between boys and girls or between right and left eyes in each age group. The mean normal protrusion values ranged from 9.11 mm in the 3-year-old group to 11.67 mm in the 10-year-old group. The mean outer orbital margin distance ranged from 78.7 mm in the 3-year-old group to 89.1 mm in the 10-year-old group. The data obtained were tabulated to plot percentile distribution curves of normal exophthalmometric values and outer orbital margin distance in children. No subject had more than 2 mm of asymmetry between the eyes.

Age Factors↗
PubMed1995

Subclinical Addison's disease: a cause of persistent abnormalities in transaminase values.

A common reason for referring patients to hepatologists is persistently abnormal serum transaminase levels with vague constitutional symptoms. In the United Kingdom, these abnormalities are most often caused by a fatty liver either related to obesity or alcohol abuse; they are less commonly caused by chronic liver disease, particularly chronic viral hepatitis, autoimmune hepatitis, or chronic biliary disease. Endocrine disease is rarely a cause of these abnormalities, although hypothyroidism and hyperthyroidism are well-recognized causes. Addison's disease has been only reported once in the literature by R. G. Olsson as a cause of increased transaminase levels associated with constitutional symptoms; it is not mentioned in textbooks on hepatology. Three patients with Addison's disease are reported here, all of whom had increased serum transaminase levels for more than 6 months before the recognition of the hypoadrenalism with resolution to normal after steroid replacement. Hepatologists should consider subclinical Addison's disease as a cause of persistently increased transaminase levels with constitutional symptoms in the absence of evidence for fatty liver as well as viral and autoimmune markers.

Addison Disease↗
PubMed2005

Impact of severe acute respiratory syndrome (SARS) outbreaks on the use of emergency department medical resources.

BACKGROUND: The impact of the severe acute respiratory syndrome (SARS) outbreak in 2003 on the emergency department (ED) medical needs of adult patients has not been elucidated. The purpose of this study was to investigate the demographic and clinical characteristics of ED adult patients before, during and after the SARS epidemic in a SARS-dedicated hospital. METHODS: A retrospective, ED chart review was conducted, and demographic data were obtained from a computer database, for a total of 17,586 patients. Patient information, including age, gender, mode of arrival, triage category, time of visit, main diagnosis, use of ED services, and status after the ED visit, were collected and compared for pre-, early-, peak-, late-, and post-SARS epidemic stages. RESULTS: Demographic data demonstrated a significant decrease in patient attendances per day, with a mean reduction of 92.5 +/- 8.3 patients (43.7 +/- 3.9% reduction in rate; p < 0.01) during peak- versus pre-epidemic stages, but revealed no differences in patient age and gender. The numbers of patients with ambulance transport, inter-hospital referral, and critical illnesses, including DOA, categorized as triage 1, or admitted to a ward or intensive care unit after the ED visit, were not influenced by the SARS epidemic. The number of patients with upper airway infections and suicide attempts from drug overdoses increased, but not statistically significantly. The number of patients with other diagnoses decreased progressively from early- to peak-epidemic stages, but returned to their earlier levels at the post-epidemic stage. Statistically significant decreases (p < 0.05) were noted in mean attendance at peak-versus pre- and early-epidemic stages for patients with cardiovascular disease, inflammatory or functional bowel disease, endocrine disease, dizziness or vertigo, or trauma. CONCLUSION: The SARS outbreak did not eliminate the need of critically ill patients for advanced medical support. However, besides an overall decrease in patient numbers, the SARS epidemic markedly altered demographic information, clinical characteristics, and the use of medical services by adult patients in the ED of a SARS-dedicated hospital.

Adult↗
PubMed1984

Patterns of mortality among migrants to England and Wales from the Indian subcontinent.

Causes of deaths in immigrants to England and Wales from the Indian subcontinent were assessed by ethnic subgroup. Observed and expected deaths for 1975-7 were aggregated to calculate proportional mortality ratios. Observed mortality due to infective and parasitic diseases, endocrine diseases (notably diabetes), diseases of the circulatory system (notably ischaemic heart disease and cerebrovascular disease, in males), and diseases of the digestive system (notably cirrhosis of the liver) exceeded expected mortality. Fewer than expected deaths were due to malignant neoplasms (notably lung cancer and chronic bronchitis); proportional mortality ratios for cancer were lower for Hindu groups than for Moslems and were lowest for Punjabis. Mortality due to ischaemic heart disease, high in all groups, was highest in Moslems. Significantly more Punjabi males died from cerebrovascular disease and cirrhosis of the liver. Diabetes was commonest among Gujaratis. The variation seen in the patterns of mortality in the different ethnic groups indicates the need for further epidemiological and health service research centred on these communities.

Adolescent↗
PubMed1993

[A case of indomethacin-inhibited recurrent periodical attacks of Mollaret's meningitis].

A 65-year-old woman was admitted to our hospital on May 28, 1990, because of recurrent high fever, over 39 degrees C, headache and general fatigue. In June 1988, she suffered the first episode of high fever, headache and general fatigue. Since then, those symptoms attacked her recurrently at intervals of 7 to 10 days. She was admitted to a hospital for two months in 1988. However, the etiology was unclear and treatment, including antibiotics, was not effective. After admission to our hospital, the symptoms of high fever, headache and general fatigue developed suddenly, lasted for 2 to 4 days, then disappeared spontaneously. These symptoms recurred periodically at intervals of 7 to 10 days. Findings of lumbar puncture during the period with severe symptoms revealed a leukocytic pleocytosis (polymorphonuclear neutrophil count: 1,324/3 mm3, mononuclear cell count: 48/3 mm3, without Mollaret cells) increased protein (0.81 g/l) and decreased glucose (0.28 g/l). Cerebrospinal fluid (CSF) examination during the period without symptoms showed a dramatic decrease of pleocytosis (polymorphonuclear neutrophil count: 5/3 mm3, mononuclear cell count: 17/3 mm3, without Mollaret cells) with improved protein (0/64 g/l) and glucose (0.40 g/l). Various examinations revealed no evidence of infection, malignancy, collagen disease, endocrine disease or any disorders in the nervous system. Moreover, bacterial cultures of blood and CSF were negative and a brain CT scan showed no abnormal findings. We diagnosed this case as Mollaret's meningitis and gave 25 mg indomethacin after every meal (75 mg/day). Her symptoms were improved abruptly and the duration of symptoms shortened and symptom-free intervals became longer.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMedDate not supplied

[Results of medical selection of drivers and candidates for drivers of motor vehicles].

The aim of this study is the analysis of medical selection of drivers and candidates for car drivers. The examination included 41,561 drivers (36,008 candidates for car drivers sent to preliminary medical examination, 5,175 professional drivers sent to periodic medical examination and 378 drivers sent to special medical examination). At the preliminary medical examination, 1.5% of candidates for car drivers were declared to be incapable of driving and 8.4% of candidates had a limited driving ability. At the periodic medical examination, 8.2% of drivers were declared to be incapable to driving and 26% of drivers had a limited driving ability. At the special medical examination, 34.9% of drivers were declared to be incapable for driving and 54.3% of drivers had a limited driving ability. The reasons for driving incapability and for limited driving ability were the disturbances of psychologic-psychiatric and neurologic state, cardiovascular diseases, endocrine diseases and sight disturbances. In our opinion, medical selection of drivers and candidates for car drivers is a significant preventive measure of traffic trauma. New, more subtle methods for determination of the latent disturbances must be developed. Periodic medical examination for amateurs in the period between the preliminary medical examination and 65 years of age must biobligatory.

Automobile Driving↗
PubMed1992

[Immunology and psychiatry].

This review of scientific literature comes within the interest arisen from ten years by psychoneuroimmunology, a field connecting several disciplines and illustrating in a new way the psychosomatic relationships. A first category of works has been dedicated to the study of psychiatric disorders associated with various diseases concerning immunity (systemic diseases, endocrine diseases, cancers, infectious diseases), but also to the possible effect of distressing life events on the upset activation of immune functions, or even to the discovery of predisposing personality profiles (type C profile, depressive vulnerability). A second category of works concerns the analysis of the immune disturbances associated with certain psychiatric diseases, such as depression or schizophrenia, but also with some distressing life conditions, like bereavement. Animal experimentation and human experimentation provide various informations on the factors conditioning the immunomodulating effects of stress, sometimes in the direction of an inhibition, sometimes in the direction of an activation of immune functions. Finally, several papers shed light on the immunomodulating effects of psychotropic drugs. All these works open new horizons to the scientific knowledge and let us glimpse an extension to the use of psychologic therapeutics, as well of pharmacological ones as of non pharmacological.

Autoimmune Diseases↗
PubMed1975

[Hypolipidemias].

Hypolipidemias can be divided in primary, familial and hereditary forms and symptomatic forms which may accompany other diseases. The primary hypolipidemias (abetalipoproteinemia, hypobetalipoproteinemia and analphalipoproteinemia) are very rare. Severe hypolipidemia can be found in some peoples (e.g. the Masai). This article is chiefly devoted to secondary hypolipidemias such as those associated with malabsorption, malnutrition and maldigestion including protein-losing gastroenteropathy, with liver diseases, endocrine diseases (hyperthyroidism, hirsutism) and anemia. Finally, the hypolipidemias secondary to the formation of autoantibodies against HDL and LDL in M-gradient, carcinoma and rheumatoid arthritis are briefly reviewed.

Abetalipoproteinemia↗
PubMed1989

Hypoglycemia. Definition, clinical presentations, classification, and laboratory tests.

Hypoglycemia can be defined as the occurrence of a wide variety of symptoms in association with a plasma glucose concentration of 50 mg per dl or less. It may be asymptomatic, and the relief of the symptoms by administration of glucose is not sufficient to establish a diagnosis. Although the symptoms may be quite variable, they can be classified as adrenergic or neuroglycopenic. Hypothermia, hyperthermia, or localizing neurologic findings may be seen as a consequence of hypoglycemia. Severe, repeated episodes of hypoglycemia can cause a distal neuropathy that is primarily motor but can also have a sensory component. Hypoglycemia can be classified as fasting, reactive, surreptitious, or artifactual. Some causes of hypoglycemia are unique to infants and children. Underlying diseases such as liver disease, endocrine disease, or renal disease can be diagnosed by the characteristic physical findings and laboratory tests. Other causes of hypoglycemia can be identified by a variety of diagnostic tests involving measurement of glucose, insulin, C-peptide, and other related compounds.

Blood Glucose↗
PubMed1993

The effects of age, gender, race and concomitant disease on postoperative complications.

The purpose of this study was to identify factors from simple past medical history which could alert surgeons to patients at increased risk of postoperative complications. Five hundred and fourteen patients undergoing elective surgery were studied prospectively. Factors evaluated included the patients' age, gender, race and the presence in the past medical history of coronary artery disease, congestive heart failure, cardiac dysrhythmias, respiratory disease, endocrine disease, peripheral atherosclerosis, renal disease, neuropsychiatric disease, hypertension, diabetes mellitus, prior major surgery and prior or active malignancy. All complications were recorded. The data were analysed by univariate and multivariate statistical methods. Gender, race and age were not associated with any complications. Coronary artery disease, respiratory disease, atherosclerotic peripheral vascular disease, neuropsychiatric disease, malignancy, the absence of prior major surgery, hypertension and diabetes mellitus were associated with specific postoperative complications by univariate analysis. Malignancy, diabetes mellitus, peripheral atherosclerosis, coronary artery disease, neuropsychiatric disease, renal disease and respiratory disease were independent predictors of complications as determined by multivariate analysis. Of interest is the phenomenon that the risk of postoperative complications when a combination of risk factors was present was greater than what would be predicted by the cumulative risk of these factors. This study helps identify those patients which by simple history may be at increased risk of postoperative complications and may require aggressive preoperative evaluation.

Age Factors↗
PubMed1994

Preoperative laboratory screening based on age, gender, and concomitant medical diseases.

BACKGROUND: The purpose of this study was to determine the most efficient preoperative laboratory screening for elective surgery. METHODS: Five hundred twenty patients undergoing elective operations on the general, vascular, thoracic, and head and neck surgical services were eligible for the study. The patient characteristics evaluated were age, gender, race, American Society of Anesthesiologists physical status classification, ponderal index, presence of concomitant respiratory disease, coronary artery disease, other heart disease, kidney disease, endocrine disease, malignancy, peripheral vascular disease, hypertension, diabetes mellitus, and neuropsychiatric disease. Preoperative laboratory screening included electrolytes, blood urea nitrogen, creatinine, and glucose levels, hemogram, nutritional studies (total protein and albumin levels and total lymphocyte count), coagulation studies (prothrombin time, partial thromboplastin time, and platelet count), urinalysis, electrocardiogram, and chest radiograph. Univariate analysis was done by Pearson's Chi square with Yate's correction. Significant p values were adjusted with Bonferroni's correction. Multivariate analysis was done with stepwise logistic regression. RESULTS: Univariate analysis showed age, gender, and the specific concomitant illness were associated with specific abnormal preoperative laboratory test results. Similarly, multivariate analysis showed specific predictors based on these risk factors. CONCLUSIONS: Routine preoperative laboratory testing is neither useful nor cost-effective. Appropriate preoperative laboratory testing can be based on age, gender, concomitant medical diseases, and type of operation to be performed.

Adult↗
PubMed2003

Opiate drug use: a potential contributor to the endocrine and metabolic complications in human immunodeficiency virus disease.

Endocrine and metabolic abnormalities are common in human immunodeficiency virus (HIV) disease and have been attributed to both the disease and its treatment. Other risk factors and behaviors may also be important. Approximately 28% of new HIV infections occur in users of injection drugs, such as opiates. We focus on the effects of opiates on multiple endocrine systems and their potential to contribute to the metabolic and endocrine problems in HIV. Opiate use has been associated with hypogonadism, adrenal dysfunction, reduced bone mineral density, and growth-hormone abnormalities. In addition, some studies have suggested abnormalities in glucose and lipid metabolism among opiate users. Although much of the evidence should be viewed as preliminary, these potential abnormalities should be kept in mind when treating opiate-dependent patients infected with HIV.

Body Composition↗