Biomedical subjects
Publications and source records attributed to J Herrmann.
Enormous changes continue to occur in how Americans receive their health care. Hospitals are redesigning their institutions to accommodate their changing delivery patterns. The result: costs are down, inpatient stays are shorter, patients are satisfied, staffs are very, very nervous.
Post-acute rehabilitation care is growing by the day. A few large companies, born in the 1980s, are bringing a once obscure niche of care into its financial and clinical maturity. Here is what's happening and an analysis of why.
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Synthetic tyrosine-phosphorylated peptides were subjected to protein sequence analysis using a gas-phase sequencer and on-line phenylthiohydantoin (PTH) amino acid analysis. Our data show that phosphotyrosine is stable to the gas-phase sequencing chemistry and can be detected as its PTH-derivative during routine sequence analysis without the need of prior tyrosine radiolabeling.
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Hyper- and hypothyroidism in the elderly do--as many other diseases--not present with the typical clinical picture known from textbook descriptions. Thus hyperthyroidism may be the cause of common complaints and symptoms such as weight loss, fatigue, lack of appetite and cardiac failure with tachycardiac arrhythmias. Due to completely unspecific symptoms and signs, the hypothyroid elderly patient will initially be presented to a psychiatrist, neurologist, dermatologist, gastroenterologist or ENT-specialist rather than to an endocrinologist or geriatrician. The serious consequences which may result from overlooking hyper- and hypothyroidism in the elderly can be prevented if the possibility of thyroid disease is more frequently taken into consideration, if the diagnosis is based on modern in-vitro measurements, and if hyper- and hypothyroidism are systematically looked for in groups at risk, i.e. in inhabitants of old people's, homes, nursing homes as well as in patients of psychiatric and geriatric hospitals.
Patients with Graves' or Plummer's disease have usually definitively been treated by surgery or radioiodine. If, however, the patient does not accept either form of treatment or the risk of surgery or the inconveniences of the radioiodine treatment by far out-weight the expected benefit for the patient, alternative therapeutic approaches should be explained and been offered to the patient: 1) It must be clear, whether any treatment is necessary at all: Small compensated autonomous adenomas with euthyroidism must not be eliminated in every case, the same applies for cases of remaining subclinical hyperthyroidism after radioiodide or surgery if the amount of remaining functional tissue is small. 2) Isolated autonomous adenomas may, under certain conditions, be eliminated by alcohol injections. This novel approach should be considered particularly for elderly patients, since it can be done on an outpatient basis. 3) For very old and very frail patients a continuous and lifelong medical treatment represents and adequate alternative to surgery and radioiodine. Small amounts of carbimazole or methimazole in a single daily dose combined with small amounts of thyroxine may safely control the hyperthyroidism, again on outpatient conditions.