Thyroid diseases in black patients

During the 26-year period, January 1, 1950 to December 31, 1975, inclusively, there were 680 thyroidectomies for clinical evidence of primary thyroid disease performed at the Howard University Hospital (0.6 percent of routine surgicals). There were 595 female and 85 male patients (ratio 7:1). All of the patients were black. In the 680 cases, the incidence of carcinoma was 4.6 percent, adenoma 11.3 percent, nodular goiter 51.9 percent, diffuse hyperplasia 21.3 percent, various thyroiditis 7.1 percent, and miscellaneous conditions 3.8 percent. A statistical analysis, together with a brief review of the literature on each entity, will be presented.     

Secondary prevention of cardiovascular diseases in the elderly

Secondary prevention in cardiovascular diseases has its meaning also in elderly people. It is specific in some factors. The currently known facts gradually include measures which are not associated with old age of individuals. They include: influencing of the deteriorated adaptation of old organism to internal and external effects, decreased physical activity, restricted self-sufficiency, social isolation, incorrect life style, polymorbidity and subsequent polypragmatic therapy, etc.. Prolongation of life span of man, the struggle against CVD and the improvement of the quality of life of patients can be secured only by means of a complex of rational preventive measures. (Ref. 22.)     

Systemic diseases in elderly dental patients

There has been increasing interest in gender disparities in clinical decisionmaking. Few studies have examined this issue in nationally representative samples or focussed on primary care. In addition, few of the studies have examined the role of physician gender. The 1987 National Medical Expenditure Survey was used to examine the relationship between physician gender and screening deficiency in women for three gender-sensitive tests (breast examinations, Papanicolaou tests, and mammograms) and one gender-neutral test (blood pressure checks). Women reporting a female physician as their usual provider compared with those reporting a male physician were less likely to be deficient for Papanicolaou tests and mammograms. There was a smaller, but nonsignificant similar trend for breast examinations. No gender bias was evident for blood pressure checks. These results persisted after multivariate adjustment for patient age, race, education, income, insurance status, subjective health status, other health behaviors, and attitude toward health care and health insurance. The results confirm the existence of physician gender bias in clinical decision making and represent one area for quality improvement.     

社区老年慢性病健康管理模式的探讨

随着我国人口老龄化问题日益突出,慢性非传染性疾病已占据疾病谱和死因谱的首位,成为全球范围内的重大公共卫生问题,世界卫生组织预测2020年非传染性疾病将占我国死亡原因的79% .     

Thyroid gland and thyroid status in patients with chronic liver diseases

We have conducted a prospective study aimed to analyse contraceptive use among women seeking for legal abortion in the State University Hospital "Ma?chin dom"--Sofia. Our date demonstrate that the patients were well informed about the existing contraceptive methods. On the contrary the percentage of women-using contraception and especially those, using highly effective ones is relatively low. The patients claim the possible side effects of the high effective contraception as a reason against use.     

Prevalence of cardiovascular diseases in elderly Chinese people in Taiwan

PURPOSE: To analyze whether nonmechanical trephination with an excimer laser influences post-operative blood-aqueous barrier breakdown after penetrating keratoplasty. METHODS: Patients undergoing penetrating keratoplasty for keratoconus or Fuchs dystrophy were prospectively randomly assigned to trephination by either excimer laser or conventional mechanical handheld motorized trephine. All surgery was performed by one surgeon, and preoperative, intraoperative, and postoperative treatment was identical in both groups. Aqueous flare was quantitatively determined postoperatively in a masked fashion by laser flare-cell meter. For statistical analysis, the nonparametric Wilcoxon-Mann-Whitney test was used. RESULTS: A total of 52 eyes of 52 patients were examined (Fuchs dystrophy, 10; keratoconus, 42). During the early postoperative period (days 3 to 9), eyes that had undergone nonmechanical excimer laser trephination (25/52) showed significantly (P < .005) lower flare values than did eyes that had undergone mechanical trephination (27/ 52). In both groups, flare values returned to normal levels by 6 weeks postoperatively. CONCLUSION: Early postoperative blood-aqueous barrier breakdown is less pronounced after penetrating keratoplasty with nonmechanical excimer laser trephination.     

Sex chromatin in cardiovascular diseases in elderly and senile women

In women aged 60--79 years the author determined the frequency of sex chromatin in epithelial cells of buccal mucosa. A higher frequency was found in women with cardiovascular diseases, especially with arterial hypertension and acute disturbances of coronary of cerebral circulation. The role of hormonal factors in the pathogenesis of cardiovascular diseases in elderly women is discussed.     

Medications and chronic diseases as risk factors for falling injuries in the elderly

Diseases and medications associated with the occurrence of falls leading to medical treatment in elderly Finns (65 yrs or older) during a one-year period are presented. The design was that of a case-control study involving 380 fallers seeking medical treatment and 342 unmatched controls selected randomly from the population register. The occurrence of a fall was shown by logistic regression analysis to be related to advanced age, presence of benzodiazepine in the serum, hypertrophy of the prostate, poor mental capacity, presence of chronic lung disease and asthma, use of analgesics and use of digitalis in the men, and to advanced age, poor mental capacity, presence of benzodiazepine in the serum, use of analgesics and non-occurrence of lower limb arthrosis in the women. The corresponding log-linear models showed advanced age and the presence of benzodiazepine in the serum to be independent risk factors for falling both in the men and women. Furthermore, the use of analgesics was related to falling in the women with normal mental capacities. No disease was independently associated with falls. The results suggest caution in the use of benzodiazepines among the elderly.     

Trace elements in ribs of elderly people and elemental variation in the presence of chronic diseases

Element concentrations in ribs obtained from elderly Japanese people (17 males and 28 females; mean age, 81.5 years) were determined by atomic absorption spectrometry (AAS), inductively coupled plasma atomic emission spectrometry (ICP-AES), and ICP mass spectrometry (ICP-MS). Nine elements--Na, Mg, P, K, Ca, Fe, Zn, Sr, and Pb--were determinable in most of the subjects by a combination of AAS and ICP-AES. The levels of these elements were generally comparable with those obtained in our previous study on ribs from younger Japanese. By the use of ICP-MS, Sn (median, 0.79 micrograms/g dry bone) and Ba (1.3 micrograms/g) were determinable in all of the subjects analysed (n = 35) and 18 other elements at lower concentration levels were also detected in some of the subjects. An exploratory statistical analysis was carried out to find element(s) of which level(s) in rib vary in the presence of degenerative chronic diseases, using information obtained from pathological autopsy reports and medical histories of the present subjects. It indicated that (i) Pb and Zn, (ii) Ba, and (iii) Sr levels in the ribs varied in the presence of cancer, cerebrovascular damage, and bone problems, respectively. The present results were discussed in relation to the results of the previous epidemiologic and experimental studies.     

Implications of oral infections on systemic diseases in the institutionalized elderly with a special focus on pneumonia

Systemic infection in the elderly patient living in a chronic care setting presents a significant burden to the health care system. The extent to which oral organisms cause systemic infections through hematogenous dissemination in the institutionalized elderly is still unknown. A more likely and common route of systemic infection by oral microorganisms is through aspiration of oropharyngeal fluids containing oral pathogenic microorganisms, which colonize the lower respiratory tract and cause pneumonia. Respiratory pathogens emerge in the dental plaque of elderly patients with very poor oral hygiene and severe periodontal disease. In the chronic care setting, aspiration of oropharyngeal fluids contaminated with these bacteria occurs in patients with diminished host defenses, resulting in bacterial pneumonia. This is also a problem in intensive care units in the hospital setting. In one study, pre-rinsing with a 0.12% chlorhexidine gluconate mouthwash significantly lowered the mortality rate from postsurgical pneumonia in patients undergoing open heart surgery. Selective digestive decontamination, a technique involving the topical application of antimicrobials to reduce the risk of colonization of the respiratory tract, has been used to reduce the incidence of nosocomial pneumonia in the acute care setting of hospitals. This technique has not been employed in the nursing home setting. Whether improving oral hygiene would also lower the risk in either of these settings has not been studied. A number of obstacles must be overcome in designing studies to investigate the relationship between oral infections and lung infections in the institutionalized elderly. Ethical issues must be addressed, and full collaboration of the medical team is required. Future studies should establish whether reducing the risk for pneumonia in the institutionalized elderly is possible through improved oral health.     

Identification, diagnosis, and treatment of acid-related diseases in the elderly: implications for long-term care

Acid-related disorders such as peptic ulcer disease and gastroesophageal reflux disease occur frequently in the elderly and are associated with a high frequency of morbidity and mortality. The proton pump inhibitors lansoprazole and omeprazole produce faster rates of healing and greater symptomatic relief in patients with acid-related disorders than histamine2-receptor antagonists, are well tolerated, and are associated with few adverse events. Compared with omeprazole, which interacts with diazepam, warfarin, and phenytoin, lansoprazole produces only a minor increase in theophylline clearance. Proton pump inhibitors in combination with antibiotic therapy can eradicate Helicobacter pylori, the main risk factor in the recurrence of peptic ulcer disease, obviating the need for maintenance therapy. Long-term acid suppression with proton pump inhibitors may be necessary to prevent the recurrence of gastroesophageal reflux disease. The safety and efficacy profile of these agents makes them ideal for the treatment of acid-related diseases in elderly patients.     

Thyroid follicles in the head-kidney of teleosts

One view of the aims and objectives of continuing education is presented. Problems in the form of educational material and access to present educational opportunities are outlined together with some suggestions for overcoming these problems. Self evaluation is emphasised as an important means of maintaining educational standards rather than "re-licensure". Several new approaches are presented which attempt to increase access and acceptability in continuing education.