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1.
Psychological Aspects of Headache   总被引:1,自引:0,他引:1       下载免费PDF全文
Headache is considered as a non-specific syndrome illustrating the concept of pain as an emotion. Viewed in this way, its meaning looms larger than its site.

Pain indicates dis-ease of the patient, sometimes with his body, but more often with his life. No pain is “imaginary”, nor can some pain be assigned to physiological and some to psychological pathways. Such a decision is often merely a judgmental one.

Just as the “brain” cannot easily be separated from the “mind”, so to believe that some pain is “physical” and some “emotional” is a distortion. All painful syndromes are mixed and the problem is to decipher the meaning of the pain. Only rarely will headache respond to physical measures alone.

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2.
Besides complete and careful preoperative investigation of thoracopagus conjoined twins, monitoring of the various parameters, such as arterial blood pressure, central venous pressure, blood pH, and temperature, are most essential for accurate blood replacement, maintenance of normal body chemistry and thermoregulation. Equally important is continued monitoring in the postoperative period when assisted ventilation may be required as well.

Twin “A” returned from the operating room in excellent condition, breathing spontaneously through an endotracheal tube. Twin “B” returned on positive-pressure-assisted ventilation; this was to prove a poor prognostic sign as this twin died eight hours postoperatively.

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3.
The Probability of Death Following a Fracture of the Hip   总被引:3,自引:0,他引:3       下载免费PDF全文
All patients 45 years of age and over admitted with fractures of the hip to hospitals in the Atlantic Health Region of Nova Scotia were followed up over a two-year period. Actuarial methods were used to estimate survivorship from the date of fracture in 202 patients.

Over-all, it was estimated that only 63.8% would be alive by one year post-fracture. This is 70% of the survival rate expected in the general population of corresponding age and sex. The period of greatest mortality was within the first 12 weeks. Patients surviving to one year could be considered “cured”, for after that their survivorship was at least as favourable as that of the “normal” population.

Mortality was greatest in males in those 75 years of age and over and especially in patients who were relatively immobilized prior to their fracture. In this “dependent” group the relative survival ratio at one year was only 38%.

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4.
Various attempts to define the concept of “mental health” are examined. Value judgments permeate much mental health literature. Their use militates against obtaining an objective definition, capable of universal application. The acceptance of a definition including a value judgment implies taking an attitude toward a particular society and its social ideals.

Present limits of competence only allow us to describe “mental health” conceptually. Such “untechnical” proposals are liable to be confused with “technical” (“scientific”) propositions. Multiple criteria are likely to be helpful in improving our concept of “mental health”.

The intrusion of morals into the world of health is discussed as part of the contemporary intellectual dilemma of determined human behaviour versus human responsibility and the reality of moral values.

It is suggested that “mental health” might consist simply of an individual's possession of insight into his own personality, combined with an honest recognition and acceptance of his condition.

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5.
Non-adipose body mass (NAB) is an approximate indicator of total muscle mass and body protein content. The indirect measurement of NAB in obese man is of interest because of its relationship to muscle mass and, therefore, to physical fitness. Furthermore, NAB might reflect reduced body protein in instances of suspected “metabolic obesity”.

Adipose tissue mass and NAB were derived from measurements of body weight and total body water in 48 obese and 19 normally nourished women with the aid of previously determined constants for the water fractions of adipose tissue and NAB.

The mean NAB was increased in 23 moderately obese patients (42.1 kg. vs. 35.2 kg. for the controls). A higher mean NAB (51.3 kg.) was found in eight grossly obese women.

It was concluded that obese women have a larger than normal mean muscle mass.

A height-weight table gave a grossly misleading estimate of the degree of obesity in two unusually muscular siblings.

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6.
Applicants to Canadian Medical Schools for 1966-67   总被引:2,自引:2,他引:0       下载免费PDF全文
An examination of applicants to Canadian medical schools for 1966-67 revealed that 4534 applications were received for the approximately 974 available places. The number of Canadian applications was 2866 and these were made by 1815 individual applicants, an increase of 48 over 1965-66. United States applicants declined from 1143 to 1013.

Evaluations made by the schools concerning the acceptability of the Canadian applicants disclosed that 55 applicants who rated as “acceptable” by one or more schools failed to gain admission to any medical school in 1966-67 (as compared to 36 in 1965-66). However, of those applicants who did find a place 76 were evaluated as “marginal” or “unacceptable”, while another 126 were rated as “acceptable” by one school but “marginal” and/or “acceptable” by one or more other schools.

These results were interpreted to imply that the Canadian medical schools were still experiencing difficulty in attracting well-qualified applicants for study in medicine.

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7.
Concepts of hypertension have changed and changes in terminology to reflect this state of affairs are suggested. Statistically, the best mortality experience is associated with blood pressure commonly regarded as subnormal, and increments of blood pressure above this level are associated with progressive increases in mortality. The terms “normal”, “benign” and “essential” in relation to blood pressure should be abandoned. “Optimal”, “acceptable” and “hypertensive” ranges of blood pressure are suggested. Hypertension is regarded as a symptom of disease, rather than as a disease in itself, and “hypertension”, when used as a diagnostic label, should be qualified always by the primary disease, if known, or by the modifying phrase, “of unknown cause”, if not known.  相似文献   

8.
A report of six cases   总被引:1,自引:1,他引:0       下载免费PDF全文
Six cases of gonococcal arthritis are described. Three presented during the initial “bacteremic stage” with polyarthralgia, fever, skin lesions and sterile synovial fluid. Two presented during the “septic joint stage” with positive synovial culture, and one presented during the “stage of residual deformity”. Transient electrocardiographic changes were noted in two of the six cases. All responded to antibiotic therapy. One required additional surgical intervention.

The condition is common, coinciding with the rising incidence of symptomatic and asymptomatic gonorrhea. Gonococcal infection must be considered in the differential diagnosis of migratory polyarthralgia, tenosynovitis, oligoarthritis, fever or unusual skin lesions. Criteria for diagnosis, lines of treatment and relevant literature are reviewed.

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9.
Long-Stay Patients in Canadian Mental Hospitals, 1955-1963   总被引:2,自引:2,他引:0       下载免费PDF全文
Changes in the number and characteristics of patients in Canadian mental hospitals during 1955-1963 were studied in order to assess the future need for long-term hospital care.

Despite marked increases in the number of first admissions and readmissions, the average number of patients in hospital decreased 6% from 49,537 in 1955 to 46,498 in 1963.

Patients who were “long stay” in 1955 continued to leave hospital at the same rate during the years 1960-1963 as during 1955-1959. No “hard core” of long-stay patients with reduced potential for discharge seemed to have formed by 1963.

Since 1955 the number of “admissions” remaining continuously hospitalized has progressively decreased for the elderly and for patients with psychoses. No build-up of new long-stay patients from patients with repeated short admissions was evident.

The estimate of the Royal Commission on Health Services that the ratio of patients in mental hospitals could be reduced from 3.0 per 1000 in 1961 to 1.5 per 1000 by 1971 seems feasible.

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10.
Modern Aspects of the Treatment of Hemophilia   总被引:1,自引:1,他引:0       下载免费PDF全文
The prognosis of hemophilic hemorrhages is greatly dependent on the therapy which is administered during the first three to five days. To prevent overloading of the circulation, highly active preparations of the antihemophilic factor should be available.

A survey of the recently developed concentrated products of this factor and of their suitability for clinical use is presented. The authors describe their own experiences in the treatment of a number of patients with hemophilia A by administration of so-called “two-donor” fibrinogen.

The effect of this “two-donor” fibrinogen was not inferior to results obtained else-where with the so-called I-O product, prepared from a much greater quantity of blood plasma.

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11.
The profile of mortality in Newfoundland was analysed for all deaths occurring in 1969 of persons 35 to 69 years of age, of whom the total was 1036. An exceptionally high cardiovascular mortality (793 deaths/100,000) was noted for St. John's, the capital city of Newfoundland, a city which has an extremely soft drinking-water supply. This high rate corresponds to that observed in the “high mortality belt” reported for the east coast of the United States, and in conjunction with data from mainland Canada, extends the belt across the entire eastern aspect of North America. The proportion of cardiovascular deaths of men occurring outside the hospital was less within hard drinking-water areas in Newfoundland than in the soft water areas of the province. Thus, the statistics reported here of cardiovascular mortality confirm evidence reported elsewhere on “macro-geographic” variations in this disease(s) as well as “micro-geographic” regional variations which may be dependent upon local environmental factors.  相似文献   

12.
Tuberculosis: A Challenge to the General Practitioner   总被引:1,自引:1,他引:0       下载免费PDF全文
Of 157 patients dying of tuberculosis in Ontario (1960) 132 (87.4%) suffered from the pulmonary form of the disease (incidence 2.6 per 100,000). In the same year, 1632 of 1847, or 88.3%, active new cases reported had the pulmonary type and 183 additional cases were reported without details as to type of disease. Thus, in 1960, a total of 2030 new cases of tuberculosis were reported in Ontario.

Of 1367 patients with pulmonary tuberculosis (reinfection type), 357 (26.1%) had “far advanced” disease and 613 (44.8%) had “moderately advanced” disease.

This high percentage of patients with “moderately advanced” to “far advanced” disease at the time of diagnosis constitutes the real challenge to physicians in private practice, who made the diagnosis in 45% of cases.

Emergence of resistant strains of bacteria increases the urgency of prompt diagnosis and treatment. The most vulnerable population segment is the 15-30 year age-group, many of whom are negative intracutaneous reactors. A high index of suspicion is necessary, particularly in certain segments of the population with a high incidence of infection, combined with a careful history, meticulous physical examination, intracutaneous tests, chest and other radiographs, and appropriate bacteriological studies.

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13.
Methadone          下载免费PDF全文
Methadone and acetylmethadol, although possessing almost all of morphine's pharmacological properties, differ from other morphine-like drugs in their longer action, more gradual and less intense withdrawal syndrome, and blockade of euphoric effect of other opiates in addicts. A high percentage of patients maintained on methadone are better able to hold employment or to be otherwise socially productive than when dependent on heroin or morphine.

A review of published results and procedures used in methadone maintenance treatment programs for heroin dependence is presented. Former heroin addicts are usually maintained on 80 to 120 mg. (high dose) or 20 to 60 mg. (low dose) oral methadone daily. Some programs are reported to have produced 80% success (patients employed or otherwise socially productive). Selection of patients, availability of allied therapeutic and rehabilitative facilities, strict control of supply, record keeping and periodic evaluation are considered essential.

Different criteria (“drug-free” vs. “socially productive”) for judging “success” of treatment of heroin-dependent persons by methadone maintenance and administrative problems in large-scale treatment programs constitute the principal aspects of controversy.

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14.
The histopathologic lesions of regional enteritis and ulcerative colitis, particularly in their early stages, are distinct and distinguishable, irrespective of the sites that are involved. Regional enteritis is characterized by lymphangiectasis, lymphedema, lymphoid hyperplasia, and granulomatous inflammation of the submucosal and subserosal layers of intestine, whereas chronic ulcerative colitis is an exudative, ulcerative disorder of the mucosal layer that commences with “crypt abscesses” and only in its later stages progresses to deeper coats of the wall.

Electron microscopy of a rectal biopsy from a juvenile patient with chronic ulcerative colitis for five years disclosed a labyrinthine system of clefts and compartments between columnar, mucosal epithelial cells. Regenerated colonic epithelial cells were of primitive, germinal type and featured a “vesicular” rather than a “goblet” pattern of mucus secretion. Clusters of small “clavate fimbriae” projected from the tips of microvilli. Each of these newly recognized substructures measured 30 to 60 mμ. in diameter, and was enclosed by a tri-laminar “unit membrane”, derived from the surface plasma membrane of the cell.

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15.

Objective:

To analyze the mechanism of neuroprotection of insulin and which blood glucose range was benefit for insulin exerting neuroprotective action.

Data Sources:

The study is based on the data from PubMed.

Study Selection:

Articles were selected with the search terms “insulin”, “blood glucose”, “neuroprotection”, “brain”, “glycogen”, “cerebral ischemia”, “neuronal necrosis”, “glutamate”, “γ-aminobutyric acid”.

Results:

Insulin has neuroprotection. The mechanisms include the regulation of neurotransmitter, promoting glycogen synthesis, and inhibition of neuronal necrosis and apoptosis. Insulin could play its role in neuroprotection by avoiding hypoglycemia and hyperglycemia.

Conclusions:

Intermittent and long-term infusion insulin may be a benefit for patients with ischemic brain damage at blood glucose 6–9 mmol/L.  相似文献   

16.
Staphylococcus albus in Wound Infection and in Septicemia   总被引:11,自引:1,他引:10       下载免费PDF全文
Coagulase-negative Staphylococcus albus was considered to be the causal agent in 53 (4.4%) of 1200 wound infections investigated in a large general hospital over the eight-year period 1957-1964. There was clinical evidence of morbidity in these patients, with fever, but the infection cleared spontaneously, usually in a week or two, and antibiotics were unnecessary.

Of much greater importance was the finding of this organism in blood cultures on repeated occasions, with associated clinical septicemia. Twelve patients were so affected, of whom six died, a mortality rate of 50%. Such data emphasize the tragic mistake of dismissing the report of Staph. albus in a blood culture as “only a contaminant”, and of failure to recognize that the organism can cause serious disease. This is particularly true in poor-risk patients, and in those who have undergone cardiac surgery.

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17.
Long-term bone calcium metabolism was measured using a whole body counter apparatus and the radioisotopes calcium-47 and strontium-85. Strontium was given with calcium in a single intravenous injection in order to estimate long-term retention of calcium. Calcium-47, with a short radio-active half-life, was measured directly for 20 days, and then indirectly from strontium retention for periods up to 200 days.

The standard parameters of calcium transport were measured and, as well, a new parameter, calcium accretion to the fixed bone pool. These studies were carried out on 13 subjects, six of whom were selected “normals” and seven were patients with osteoporosis. Calcium accretion to the fixed bone pool, the new index of bone formation, varied from 100 to 210 mg. of calcium daily in normal subjects and from 70 to 340 mg./day in patients with osteoporosis. These values are one-third of those for the accretion to the total bone pool, the previously reported bone formation rate.

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18.
Seven partial endocardial cushion defects have been diagnosed and treated surgically without mortality—six of the ostium primum type and one with a defect from left ventricle to right atrium. The last patient likely has an associated cardiomyopathy. The most serious complication of repair is damage to the bundle of His.

The electrocardiogram is helpful in diagnosis, showing left axis deviation in standard leads and right ventricular hypertrophy in chest leads (92%). The vector-cardiogram in the frontal plane shows counterclockwise rotation with the loop usually above the isoelectric line (97%). This is due to congenital aberration of the left bundle branch rather than to left ventricular hypertrophy from mitral incompetence. Radiography demonstrates moderate cardiac enlargement with right-sided hypertrophy, a prominent pulmonary artery, and pleonemic lung fields. Cardiac catheterization reveals a moderate rise in oxygen saturation at atrial level and a further minimal increase at ventricular level. The left atrial trace may show a minimal “c-v” configuration, with the “v” wave equal to the “a”.

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19.
Abnormalities of tyrosine metabolism are discussed under four headings: (1) accumulation of tyrosine and its metabolites secondary to severe liver damage, vitamin C deficiency, etc.; (2) transient neonatal tyrosinemia; (3) hereditary tyrosinosis with hepatorenal dysfunction where elevation of tyrosine and methionine levels in the plasma may be a secondary manifestation of an unknown disease process; and (4) “essential tyrosinemia” or tyrosinosis without hepatorenal dysfunction which may represent a kkrimary fault in the metabolism of tyrosine.

A new case of tyrosinosis without hepatorenal dysfunction in a 13-year-old mentally retarded girl is reported. Clinical findings, laboratory investigations and results of dietary management and normalization of the plasma tyrosine level and of urinary metabolites are presented and compared with the features of three similar cases in the liteature. It is suggested that these cases represent “essential tyrosinemia” where there is a primary genetic defect in tyrosine metabolism.

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20.
A consecutive series of 1530 patients with carcinoma of the breast has been reviewed to study the influence of age and marital status on the disease.

The risk of developing breast cancer increases with age, though a peak may be reached at 75 years. The risk of developing a tumour of advanced clinical stage at presentation apparently increases with age. Local recurrence rates and mortality rates are similar at all ages. It is concluded that the therapy required is similar in all age groups.

The increased risk of developing breast cancer in “never married” women is in the postmenopausal period. Survival rates and the distribution of the various presenting clinical stages are similar in both single and married patients.

Though ageing and marital status have an initiating effect on breast cancer, they do not have a continuing effect on the established disease.

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