Assuntos
Doenças da Aorta/complicações , Vacina BCG/uso terapêutico , Carcinoma de Células de Transição/terapia , Duodenopatias/complicações , Fístula Intestinal/complicações , Neoplasias da Bexiga Urinária/terapia , Fístula Vascular/complicações , Administração Intravesical , Idoso , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Vacina BCG/efeitos adversos , Carcinoma de Células de Transição/complicações , Diagnóstico Diferencial , Duodenopatias/diagnóstico por imagem , Duodenopatias/cirurgia , Hemorragia Gastrointestinal/etiologia , Granuloma/complicações , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/cirurgia , Masculino , Tomografia Computadorizada por Raios X , Neoplasias da Bexiga Urinária/complicações , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgiaRESUMO
STUDY OBJECTIVE: To test reports that beta blockers, particularly lipophilic forms, impair cognitive function and cause psychiatric disturbances. DESIGN: Randomized, double-blind, controlled crossover trial with eight-week treatment periods. PATIENTS: Sequential sample of 42 male veterans, with untreated diastolic blood pressures (DBP) between 90 and 110 mmHg, aged 35-64 years. INTERVENTIONS: Propranolol-LA, 80-mg tablets, or atenolol, 50-mg tablets, were given daily, incremented by one tablet at weekly intervals until DBP less than or equal to 90 mmHg. Hydrochlorothiazide was added, if necessary. MAIN RESULTS: Repeated-measures ANOVA was performed on all cognitive tests. Cognitive test performance was not affected by beta blocker therapy in seven of nine tests and was enhanced on Trail Making Test. Performance was impaired only on Digit Cancellation. Neither Speilberger's State Trait Anxiety Inventory nor the Beck Depression Inventory was affected by either beta blocker. CONCLUSIONS: Atenolol or propranolol therapy does not impair cognitive function or contribute significantly to psychiatric side effects.
Assuntos
Atenolol/uso terapêutico , Cognição/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Propranolol/uso terapêutico , Análise de Variância , Atenolol/administração & dosagem , Atenção/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Cognição/fisiologia , Método Duplo-Cego , Esquema de Medicação , Avaliação de Medicamentos , Humanos , Hipertensão/fisiopatologia , Masculino , Escala de Ansiedade Manifesta , Memória/efeitos dos fármacos , Pessoa de Meia-Idade , Testes Neuropsicológicos/métodos , Projetos Piloto , Propranolol/administração & dosagem , Escalas de Graduação Psiquiátrica , Ensaios Clínicos Controlados Aleatórios como Assunto , Tempo de Reação/efeitos dos fármacos , Inquéritos e Questionários , Fatores de TempoRESUMO
Clinicians in the 1980s rely on the physical examination to a lesser degree than their predecessors in making diagnostic and therapeutic decisions. The major criticisms are that the physical examination lacks sensitivity for many common diseases and has not been subjected to the same scientific scrutiny afforded laboratory testing. On the positive side, the physical examination is a series of diagnostic maneuvers that permit physicians to test hypotheses generated during history taking, to determine disease severity, and to lessen clinical uncertainty. Furthermore, the physical examination fosters the development of personalized medical care and a bond of mutual trust between patient and doctor. The challenge for tomorrow is to determine the operating characteristics of physical examination techniques and the clinical utility of physical findings. For preclinical students, emphasis should be directed at basic examination principles and sequencing. Many model programs have used patient instructors and other innovative techniques. Clinical students and postgraduate trainees need emphasis on interpretation of physical findings and their integration into the clinical context. There is no substitute for bedside teaching at this level.
