Upper gastrointestinal bleeding in the aged: A prospective study utilizing a younger age group as control

Summary 1. Consecutive patients admitted for acute upper gastrointestinal bleeding were investigated by means of early esophagogastroscopy and upper gastrointestinal X-ray over a period exceeding 3 years. The series included 100 patients above the age of 60 and 181 below 60. 2. An acute gastric lesion (erosive gastritis or acute gastric ulcer) was the leading over-all source of bleeding in patients over and under 60 (27.0% and 24.8%, respectively). In nonmassive bleeding episodes, an acute gastric lesion was again the leading source in both groups (35.7% and 26.3%, respectively). 3. In massive bleeding, duodenal ulcer was the leading source in those over 60 (33.3%), while esophageal varices was the leading cause of bleeding in those below 60 (34.0%). 4. No statistically significant difference was noted in the severity of bleeding episodes in the over- and under-60 groups, nor was there any statistically significant difference in the over-all mortality of the 2 groups. 5. Early esophagogastroscopy was both safe and significant in establishing the sources of bleeding in the old age group.Supported in part by Clinical Research Center Grant AM-05576-03 from the National Institute of Arthritis and Metabolic Disease, U. S. Public Health Service, and by Contract U-1373 from the Health Research Council of the City of New York, New York, N. Y.     

The child guidance clinic: Catalyst and coordinator in community treatment of the psychotic child

Over a period of four years a child guidance clinic has maintained a program for the treatment of psychotic children in the community. A total of 27 community agencies has assisted with the care of 25 children. The primary role assumed by the clinic was that of catalyst and coordinator of the other agencies' work rather than the usual role of treatment of children in relative isolation. Clinic workers actively solicited the aid of family members and community agencies. In this program it was essential to maintain open communication at frequent intervals between the clinic and other agencies.     

Ferromagnetic materials in patients: detection before MR imaging

A number of surgical clips and other metallic materials embedded within patients have ferromagnetic properties that present a potential hazard when in the strong fields associated with magnetic resonance imaging. Several types of magnetometers and metal detectors were investigated as possible pre-imaging screening devices. The sensitivities and costs of these devices are given.     

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Current aspects of forensic lawFrom October 2004 to March 2005

     

Lymphedema after complete axillary node dissection for melanoma: assessment using a new, objective definition

OBJECTIVES: The objectives of this study were to define appropriate criteria for assessing the presence of lymphedema, and to report the prevalence and risk factors for development of upper limb lymphedema after level I-III axillary dissection for melanoma. SUMMARY BACKGROUND DATA: The lack of a consistent and reliable objective definition for lymphedema remains a significant barrier to appreciating its prevalence after axillary dissection for melanoma (or breast carcinoma). METHODS: Lymphedema was assessed in 107 patients (82 male, 25 female) who had previously undergone complete level I-III axillary dissection. Of the 107 patients, 17 had also received postoperative axillary radiotherapy. Arm volume was measured using a water displacement technique. Change in volume of the arm on the side of the dissection was referenced to the volume of the other (control) arm. Volume measurements were corrected for the effect of handedness using corrections derived from a control group. Classification and regression tree (CART) analysis was used to determine a threshold fractional arm volume increase above which volume changes were considered to indicate lymphedema. RESULTS: Based on the CART analysis results, lymphedema was defined as an increase in arm volume greater than 16% of the volume of the control arm. Using this definition, lymphedema prevalence for patients in the present study was 10% after complete level I-III axillary dissection for melanoma and 53% after additional axillary radiotherapy. Radiotherapy and wound complications were independent risk factors for the development of lymphedema. CONCLUSIONS: A suggested objective definition for arm lymphedema after axillary dissection is an arm volume increase of greater than 16% of the volume of the control arm.