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PubMed2005

Aortic coarctation suspected by Doppler echocardiography of renal arteries in hypertensive patients referred to a hospital outpatient hypertension clinic.

Coarctation of the aorta is the fourth most frequent form of congenital cardiovascular disease, which is diagnosed by the presence of higher blood pressures in the arms than in the legs. In this report we describe 3 cases of aortic coarctation, in which the correct diagnosis was suspected only months or years after the detection of hypertension, when a renal ultrasound examination was requested, despite the fact that the hallmarks of the disease were present at the physical examination in all patients. A marked reduction in renal flow velocities was suggestive of proximal aortic stenosis in all 3 cases. We conclude that the diagnosis of aortic coarctation, an uncommon but not so rare form of secondary hypertension, by renal ultrasonography rather than by a complete physical examination, reflects a commitment failure of physicians in everyday management of hypertension.

Adolescent↗
PubMedDate not supplied

[Taenia sp and other intestinal cestode infections in individuals from public outpatient clinics and hospitals from the northern section of Santiago, Chile (1985-1994)].

During 1985-1994 period, 70,642 parasitological stool examinations were performed. The exam was made to each patient which presenting gastrointestinal symptoms or nutritional problems, specially in children. 59,960 out of the 70,642 examinations corresponded to 1 month--15 years old children, 4,280 to 16-30 years old individuals and 6.402 to up to 30 years old adults. The infection rates (x 100,000) were: Taenia sp., 86; Hymenolepis nana, 1,165; Diphyllobotrium sp., 4 and Hymenolepis diminuta, 1. In this period, 11 cases of infection by Taenia saginata were detected, and none Taenia sodium infection. Although infections rates by intestinal cesdodes were higher in males than females, in the Taenia sp. infection the difference was not statistical significative. Médico-veterinary control of animals slaughtered in abbatoirs and the improvement of sanitary conditions in the last two decades have contributed to the control of most of human intestinal cestodiases.

Adolescent↗
PubMed1990

Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment.

OBJECTIVE: To compare chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin. DESIGN: Randomised controlled trial. Allocation to chiropractic or hospital management by minimisation to establish groups for analysis of results according to initial referral clinic, length of current episode, history, and severity of back pain. Patients were followed up for up two years. SETTING: Chiropractic and hospital outpatient clinics in 11 centres. PATIENTS: 741 Patients aged 18-65 who had no contraindications to manipulation and who had not been treated within the past month. INTERVENTIONS: Treatment at the discretion of the chiropractors, who used chiropractic manipulation in most patients, or of the hospital staff, who most commonly used Maitland mobilisation or manipulation, or both. MAIN OUTCOME MEASURES: Changes in the score on the Oswestry pain disability questionnaire and in the results of tests of straight leg raising and lumbar flexion. RESULTS: Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain. A benefit of about 7% points on the Oswestry scale was seen at two years. The benefit of chiropractic treatment became more evident throughout the follow up period. Secondary outcome measures also showed that chiropractic was more beneficial. CONCLUSIONS: For patients with low back pain in whom manipulation is not contraindicated chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.

Adolescent↗
PubMed1983

Patterns of physician use among low-income, chronically ill persons.

The authors present new results from the 1978 National Health Interview Survey concerning the use of physician services by the least healthy segment of the low-income population: those who are limited in their activities due to chronic conditions. Poor and nonpoor persons with chronic activity limitations report similar levels of physician visits. However, lower-income persons report more severe chronic conditions and hence appear to use less physician care relative to their needs. In addition, low-income persons with chronic activity limitations report more visits in hospital outpatient clinics and emergency rooms and fewer in doctor's offices compared with others with such limitations, and they are more likely to report hospital outpatient departments as their usual source of care. Unfortunately, hospital-based ambulatory care is often more episodic and fragmented than care provided in other settings. The authors concluded that care for this population could be improved greatly by restructuring responsibility for the care of the chronically ill within hospital outpatient departments.

Adolescent↗