Lebensqualität und Schmerz bei Patienten einer medizinisch-geriatrischen Abteilung

BACKGROUND: To determine objective and subjective indications of quality of life in hospitalized geriatric patients. METHODS: Data were collected on 267 items using standardized interviews of 90 patients, including B-L and SF-36. RESULTS: In comparison to the control population, geriatric patients have worse SF-36 values; 91% have pain, and 63% depression and elevated B-L values. Pain therapy is usually with non-opiates and with warm/cold physical therapies. CONCLUSION: Pain therapy in the geriatric population surveyed does not reach the same standard as is usually offered to hospitalized medical and surgical patients.     

Organization of lumbar spinal outflow to distal colon and pelvic organs

The lumbar sympathetic outflow projects through the lumbar splanchnic, lumbar colonic, and hypogastric nerves (and to a lesser degree through the sacral sympathetic chain and pelvic nerves). It is thought to be involved in the regulation of the storage and evacuation functions of the following three organ systems: lower urinary tract, hindgut, and reproductive organs. In addition, it controls vascular resistance and capacitance. Thus the target tissues of the postganglionic neurons are vascular smooth muscle, visceral smooth muscles, probably secretory epithelia, and also neurons in the enteric nervous system and the pelvic ganglia. The preganglionic neurons are situated in the caudal part of the spinal representation, neurons associated with the colon being located rostral to those associated with the pelvic organs. Most lie medial to the classical intermediolateral cell column that may contain mainly vasoconstrictor neurons. Most (if not all) preganglionic neurons are cholinergic; some also contain an identified peptide. Most of the postganglionic neurons are situated in the inferior mesenteric ganglion (or equivalent structures); again, those projecting to the colon lie rostral to those projecting to the pelvic organs. Others lie in intercalated prevertebral ganglia, in the pelvic plexus, and in sacral paravertebral ganglia. The majority is noradrenergic, and most also contain one or several peptides, the topographical distribution of which appears to characterize functional subgroups of neurons. The terminations of noradrenergic axons in many pelvic organs probably make close contact with both vascular and nonvascular effectors. In the colon, most endings are located in the enteric plexuses. The responses of these organs to electrical stimulation of visceral nerves, and their reflex responses (together with those observed in the efferent axons of visceral nerve trunks) to electrical and natural stimulation of afferent fibers, lead to the general conclusion that several distinct classes of pre- and postganglionic neurons exist. 1) Vasoconstrictor neurons demonstrate ongoing activity with cardiac rhythm and appropriate reflexes to stimulation of cardiovascular afferent receptors and respond only weakly to natural stimulation of visceral receptors. 2) MR neurons respond to visceral stimuli but are not influenced from arterial baro- and chemoreceptors. These show at least two different response patterns consistent with their separate involvement in the reciprocal behavior of the colon and bladder. 3) Other neurons are silent in anesthetized animals and do not respond to any stimuli used thus far.(ABSTRACT TRUNCATED AT 400 WORDS)