Treatment of displaced subcapital fractures with the Charnley-Hastings hemiarthroplasty.

Between December 1982 and June 1986, 98 displaced subcapital femoral neck fractures were treated using the Charnley-Hastings bipolar hemiarthroplasty. Although the patients were elderly, often with associated medical problems, the operation was well tolerated and the mortality at one and six months was 14.4% and 24.5% respectively. Fifty-four hips were reviewed after an average follow-up of 33 months; 64.8% of patients had a good or excellent result. The fair or poor results were seen mainly in patients with poor pre-operative mobility and multiple medical problems. A significant cause of morbidity was dislocation (two interprosthetic) which occurred in six hips. There were two cases of deep sepsis but neither patient was fit for further surgery. There were no cases of acetabular erosion requiring revision surgery.

Anemia in the elderly. Symptoms, causes, and therapies.

Anemia is common in the elderly, but it is not a normal manifestation of aging and should be evaluated as it would be in a younger person. History taking, physical examination, assessment of red cell morphology, and simple laboratory evaluations (ie, reticulocyte count, iron studies, vitamin levels, sometimes bone marrow examination) usually elucidate the cause. Hypoproliferation of red cells is the most common form of anemia in the elderly, caused more often by chronic disease or iron deficiency and less often by vitamin deficiencies or bone marrow infiltration. Anemia with an elevated reticulocyte count, seen less often in the elderly, suggests acute blood loss or hemolysis. In some patients, the cause is not obvious, and anemia is likely due to increased sensitivity of the hematopoietic system to multiple insults and decreased homeostatic reserve. Transfusions should be used judiciously in patients with symptomatic anemia who are likely to benefit from increased oxygen delivery after transfusion.

MMPI changes following behavioral treatment of chronic low back pain.

A large sample of patients with chronic low back pain were studied on admission to a behaviorally oriented in-patient pain program, at program completion, and at 1 month follow-up. Cluster analysis of admissions MMPI scores were used to identify 4 patient subgroups each for males and females. There were no subgroup differences found on any of the admissions demographic, pain report, or physical function measures, or differential treatment outcome based on subgroup. All groups began with high levels of pain and disability, yet improved dramatically following treatment. There was a general normalization of the MMPI reflected by elevated MMPI scales found at admission showing significant decreases at follow-up testing. Subgroups derived from follow-up MMPI testing were related to physical functioning at follow-up and pain report measures, with the elevated subgroups showing higher levels of continued pain and disability.

Prevention of psychosocial problems in children with chronic illness.

Children with chronic illness and disability are at considerably increased risk of psychosocial problems, such as neurosis, attention deficit and poor adjustment to school. Health care professionals, especially primary care physicians, can do a great deal to prevent such problems in these children and their families. The approach outlined here is based on an understanding of the transactional model of development, in which the child interacts with--and to some extent creates--the social environment, and on a "noncategorical" concept in which common elements in chronic illness are recognized and emphasized. The physician's role is to inform the family of the child's condition as soon as possible, to offer hope, encouragement and guidance, to watch the child's development, to maintain a shared view of the child and family, and, if possible, to ensure continuity of care.

Psychiatric disorder in a sample of the general population with and without chronic medical conditions.

The authors studied data on psychiatric disorders and eight chronic medical conditions in a community sample of 2,554 persons. The sex- and age-adjusted prevalence of any psychiatric disorder in the preceding 6 months was 24.7% and of lifetime psychiatric disorder was 42.2% among persons with one or more medical conditions, compared to 17.5% and 33.0%, respectively, for persons with no medical condition. Persons with chronic medical conditions were more likely to have lifetime substance use disorders and recent affective and anxiety disorders. Arthritis, cancer, lung disease, neurological disorder, heart disease, and physical handicap were strongly associated with psychiatric disorders, but hypertension and diabetes were not.

The role of aging and chronic disease in sexual dysfunction.

Sexual dysfunction is so highly prevalent in elderly males that it is often considered an inevitable consequence of "normal aging." To determine if other factors are related to an age-associated decline in sexual function, we surveyed two groups of elderly male veterans in a geriatric ambulatory care clinic: aged 65 to 75 years ("young-old") and aged over 75 ("old-old"). We compared their survey responses with responses from a general medical clinic for unstable medical patients, aged under 65 ("old-young"). Of 347 subjects surveyed, 225 completed a health and sexual function questionnaire (response rate = 65%). Absent libido was reported by 30% of old-young, 31% of young-old, and 47% of old-old. Erectile dysfunction was reported in 26% of old-young, 27% of young-old, and 50% of old-old (P less than .01). We used ordinal logistic regression and found overall sexual dysfunction to be significantly related to subjective poor health, diabetes mellitus, and incontinence (P less than .05), while controlling for age. These data suggest that, although sexual dysfunction is more common in the aged, it is often related more to comorbid illness than aging alone.

Mechanisms of erythroid suppression in the anemia of chronic disease.

The mechanism underlying the hypoproliferative anemia in patients with chronic diseases has not been clearly defined. We have examined the effects of marrow macrophages from anemic patients with chronic diseases and normals to determine if they suppress erythroid progenitors in vitro. We found that marrow macrophages from patients with the anemia of chronic disease (ACD) significantly suppressed erythroid progenitor cell growth, whereas marrow macrophages from normals did not. Since ACD is seen in conditions that activate macrophages, we then determined if activated macrophages could suppress erythroid progenitor cell growth. Peritoneal macrophages activated by chronic Cryptococcus neoformans infection significantly suppressed erythroid progenitor cell growth, although resting macrophages did not. We then examined the effects of a product of activated macrophages, tumor necrosis factor (TNF), for its effects on CFU-E and BFU-E. TNF significantly suppressed CFU-E and BFU-E growth in concentrations as low as 10(-11)-10(-12) M. Preincubation of marrow samples with TNF for as little as 15 minutes was sufficient to suppress CFU-E and BFU-E growth. Addition of TNF, after the onset of culture could only suppress CFU-E and BFU-E if added within the first 48 hours. TNF (10(-10)-10(-11) M) also inhibited the growth of hematopoietic cell lines K562, HL60, and HEL cells. These cell lines expressed low numbers of high affinity TNF receptors, with 80%-90% of the cells expressing TNF receptors.

Manifestaçöes articulares da doença inflamatória intestinal / Articular manifestations of inflammatory bowel disease

É apresentada uma revisäo das manifestaçöes articulares da retocolite ulcerativa e doença de Crohn, discutindo-se o conceito de espondiloartropatias seronegativas. Chama-se a atençäo para a diferença entre a forma que compromete somente o esqueleto apendicular, cujas manifestaçöes artículares apresentam uma correlaçäo com a atividade da doença no intestino e a forma que compromete o esqueleto axial, mimetizando a espondilite anquilosante, e na qual as manifestaçöes articulares tem seu curso natural independentemente da atividade intestinal. É abordado de maneira suscinta o tratamento do comprometimento articular enfatizando-se a importância da fisioterapia para o tratamento das alteraçöes do esqueleto axial

Anemia of chronic disorders.

Anemia of chronic disorders is a common anemia found in many clients with long-term illnesses. It is a normocytic, normochromic anemia and is usually mild. It is frequently overlooked, though, in the general workup of the underlying disease or misdiagnosed as other common forms of anemia. However, the treatments for these anemias are either ineffectual or harmful to the client with anemia of chronic disorders. Therefore, it is important to be aware of and to differentiate anemia of chronic disorders from other anemias.

[Body illness and changes in verbal communication. Study of the alexithymic phenomenon in somatic disease]. / Il corpo malato e le modificazioni della communicazione verbale. Studio del fenomeno alessitimico nella sofferenza somatica.

The Schalling--Sifneos Personality Scale was administered to several groups of subjects (patient suffering from chronic hepatitis or from ulcerative colitis, patients undergoing chronic periodic haemodialysis, encephalopathic patient and healthy subjects) in order to assess the presence of alexithymia in healthy subjects, in patients suffering from chronic organic pathologies and in psychosomatic patients. The results obtained permit one to distinguish the psychosomatic patients from other groups of subjects: compared to healthy subjects, patients suffering from ulcerous rectocolitis obtained higher average scores, while compared to patients suffering from other organic pathologies their scores showed a wider scatter. A distinction is therefore proposed between primary alexithymia, of a distinctive cognitive-affective kind which predisposes towards psychosomatic pathology, and secondary alexithymia which is associated with stressful situations, such as illness, and which is essentially defensive in origin.

Clinical assessment: physical and psychological functioning.

This article has provided evidence that children with chronic disorders of all kinds are at increased risk for psychosocial disturbances. That they are also likely to experience some degree of physical disability is self-evident. Accordingly, in the comprehensive care provided for these children the pediatrician is obliged to attempt to assess the status of functioning in these domains. A variety of methods for doing so in the context of a busy office practice has been presented.

Effects of chronic medical illness and dementia on the dexamethasone suppression test.

The dexamethasone suppression test (DST) was performed on 26 elderly male outpatients in a geriatric medical clinic. Patients with depression were excluded. All patients had two or more medical diagnoses. Fourteen patients also met DSM-III criteria for dementia. No patient had an abnormal DST result. The authors suggest that neither chronic medical illness nor dementia causes false-positive DST results in this patient population in an outpatient setting, and discuss the findings in relation to previous reports.

[Ophthalmologic complications in chronic inflammatory intestinal diseases]. / Ophthalmologische Komplikationen bei chronisch-entzündlichen Darmkrankheiten.

Through investigations which we performed ophthalmological complications in chronic inflammatory intestinal disease are revealed. It could be demonstrated that in most cases ocular symptoms are associated with joint troubles which in their turn depend on the severity of the general disease. Especially in elderly patients with longstanding history it is important to co-operate with representatives of other medical branches in the control of ocular complaints, since there may quickly occur functional deterioration when the eye is also involved.