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PubMed2006

[The obese patient's therapeutic course].

Obesity as a chronic disease needs a global approach taking into account, not only usual anthropometrical measurements allowing to define severity and the type of obesity (BMI and waist circumference) but also others parameters to evaluate the patient's morbid conscience and his level of motivation towards a potential treatment. Obese patient's possible therapeutic course is developed in this article according to three important parameters: eating disorders, motivation and capacity of introspection. The aim is to give tools to the generalist to select patients needing a multidisciplinary follow up in a specialized centre and those who can be treated in the office.

Decision Trees↗
PubMedDate not supplied

[Vasovagal syndrome].

The vaso-vagal syndrome, the most frequent accident may appear during dental treatments, can involve breve conscience loss. In case of important bradycardia, the medical treatment consists in an intravenous injection of atropine sulfate. Prevention of this syndrome consists in an anxiolytic and/or vagolytic premedication.

Anti-Anxiety Agents↗
PubMed2006

[Heart disease and pregnancy].

This report is about one of the main frequent causes of mother mortality, with the main purpose of creating conscience and alerting to medical population about the importance of the adequate and opportune cardiology and obstetric diagnosis and treatment. Also refers the main hemodynamic changes in pregnant woman, the risk of death according to the specific suffering, and the obstetric and cardiological control parameters; trying to diminish as much as possible the perinatal and mother mortality.

Female↗
PubMed2006

[Prognosis of stroke in department of neurology of Dakar].

INTRODUCTION: The general objective of this study was to determine the morbid-mortality of stroke followed in the Department of neurology of Dakar. MATERIALS AND METHODS: This prospective and longitudinal studywas carried out from August 2003 at May 2005 and concerned 170 patients hospitalized or seen in external consultation for cerebral vascular accident confirmed by the cerebral tomodensitometry. All the patients were subjected to a protocol allowing determining the sociodemographic data, the therapeutic itinerary, the nature and the mechanism of stroke. The follow-up was monthly for 12 months. RESULTS: The patients were old 25 to 90 years. The mean age was 61 +/- 13 years. The sex-ratio is 0.68. The ischemic cerebral vascular accidents represented 64.7% against 35.3% for the hemorrhagic vascular accidents. In 71.7 the AVCH was related to arterial hypertension. For the AVCI, a cardiopathy emboligene was objectified in 16.36% of the cases. The HTA constituted the principal factor of risk and was observed in 63.53% of the cases. The mortality rate was 28.8% (between j0 and j30) and 50.6% at one year. The age constitutes a factor of bad prognosis. For the sex the statistical analysis shows a no significant difference (p = 0.703). The repetition of stroke constitutes a factor of bad prognosis. 52.4% of the patients having an antecedent of stroke had died precociously. Mortality was higher in the AVCH with p = 0.043. The existence of disorders of conscience of start constituted a factor of bad vital prognosis. Among the 84 survivors after one year of follow-up, 49 had found their functional autonomy and 35 kept after-effects. CONCLUSION: Stroke is responsible for a strong mortality. The advanced age, the repetition of cerebral vascular accident, the hemorrhagic nature of the cerebral vascular accident constitutes factors of bad vital prognosis.

Adult↗
PubMedDate not supplied

Protection of third parties in current legislation and preventive practice.

The problem of safety and the management of risks to third parties, which may be caused by a change in the mental or physical health of an employee, is one which affects a number of different areas (infectious diseases, psychiatric illnesses, conditions of drug and alcohol abuse, etc.). Italian legislation deals with the issue of fitness for work through a variety of laws, decrees and regulations which, because many of them were issued in different historical circumstances, are not always mutually harmonized. The growing complexity of the workplace makes the role of the Occupational Physician more complex, and to this person the law assigns the exclusive task of monitoring the health of employees in the cases covered by the current regulations. In our opinion, the Occupational Physician, to the best of his knowledge and conscience, having taken into consideration all the aforementioned factors, must take each case on its merits, in the most responsible manner possible, weighing up the complexity and delicacy of the aspects discussed earlier, and decide to deliver a verdict of fitness and/or to break or not to break the obligation of confidentiality, tending, in our view, to favour the need to safeguard collective health, or that of third parties, should there be a conflict of interest.

Humans↗
PubMed2006

Ethical misconduct by abuse of conscientious objection laws.

This paper addresses laws and practices urged by conservative religious organizations that invoke conscientious objection in order to deny patients access to lawful procedures. Many are reproductive health services, such as contraception, sterilization and abortion, on which women's health depends. Religious institutions that historically served a mission to provide healthcare are now perverting this commitment in order to deny care. Physicians who followed their calling honourably in a spirit of self-sacrifice are being urged to sacrifice patients' interests to promote their own, compromising their professional ethics by conflict of interest. The shield tolerant societies allowed to protect religious conscience is abused by religiously-influenced agencies that beat it into a sword to compel patients, particularly women, to comply with religious values they do not share. This is unethical unless accompanied by objectors' duty of referral to non-objecting practitioners, and governmental responsibility to ensure supply of and patients' access to such practitioners.

Ethics, Medical↗
PubMedDate not supplied

[Treatment and control of hypertension in Croatia. The BEL-AH study].

Poor control of blood pressure (BP) is one of the main reasons for high cardiovascular mortality and morbidity. The aim of this study was to analyse control of BP in outpatient settings in four biggest towns in Croatia. The study included 412 medical doctors (GP) and 7031 middle-aged patients (62.9 +/- 11.5 years). Mean BP in treated patients was 162.9 +/- 16.8/95.6 +/- 9.9 mmHg. There were no statistically significant differences in systolic (p = 0.173) and diastolic (p = 0.561) BP between men and women. In this group of patients only 8% achieved target BP values. In contrast, and surprisingly, 44.5% of medical doctors and 72% of patients were satisfied with obtained BP control. Higher percentage of male patients vs. female were satisfied with blood pressure control (81.9%:66.9%). BMI < 25 was registered in 22.9% of hypertensive patients, and there was statistically significant difference in BMI between men and women (chi2 = 56.769, p < 0.001). In this study we found a statistically significant difference of hypertension in regard to BMI in both sexes (chi2 = 46.339, p < 0.001; chi(z)2 = 45.992, p = 0.024). BMI was in correlation with severity of hypertension as well as with obtained treatment result. BMI was in correlation with the number of prescribed drugs. According to this, patients with BMI < 25 were prescribed less drugs than those with BMI > 30 (1.4:1,6 p = 0.001). BP control in Croatia is, according to this study, very poor. The main reason for such situation is, beside obesity which determines the stage of hypertension and BP control in both sexes, insufficiently developed conscience in patients and doctors about the importance of stronger blood pressure control. The results indicate the necessity for the more intensive education of the population.

Blood Pressure↗
PubMed1991

[Role of benzodiazepines in neuroanesthesia].

For the induction of anesthesia in neurosurgical patients, the choice between thiopental and midazolam cannot be done on the basis of their respective cardiovascular, respiratory or cerebral effects, since they are similar. Among the advantages of midazolam are the absence of histamine release and excitatory effects. On the contrary the onset and the duration of action as well as the intensity of sedation are less predictable with midazolam when compared to thiopental. Therefore thiopental remains the first drug of choice in this clinical setting. For preoperative sedation in neurosurgical patients, the use of benzodiazepines should be limited, since they can induce respiratory depression mainly in patients with cranial trauma or with chronic obstructive pulmonary disease. The preoperative administration of a benzodiazepine in neurosurgical patients who are under chronic treatment should be decided individually, according to the level of the conscience of the patient and on the half life of the drug.

Anesthesia, Intravenous↗
PubMed1991

[Effectiveness of regional anesthesia for loco-regional carotid surgery. Retrospective review of 147 interventions].

The Authors present a retrospective review that compares general anesthesia with regional anesthesia performed during carotid endarterectomy surgery. The study includes 147 procedures, performed on 144 patients: 76 had general anesthesia and 71 had regional anesthesia. After emphasizing the importance of conscience preservation during regional anesthesia to allow a simple and secure monitoring of the patient's neurologic functions, the Authors point out the decrease of peri- and postoperative accidents, whether neurologic or not, obtained with regional anesthesia. Another essential advantage of this technique is the possibility to insert the transitory shunt only when objectively necessary, ulteriorly reducing neurologic complications. Cervical plexus block is primarily indicated for high risk patients with instable neurologic simptomatology, severe stenosis of the contralateral carotid, coronary heart disease. The technique has proved to be of easy execution, safe and well accepted by the patient and the surgeon.

Aged↗
PubMed1991

Social images of suicide.

Emile Durkheim's analysis of historical attitudes of societies toward suicide led him to claim that (1) the social disapproval of suicidal conduct increased constantly from ancient times to the present; (2) such increased disapproval was generated by the growing emphasis put on the dignity and sacredness of the individual; (3) the condemnation of suicidal conduct was therefore essentially moral, and it expressed the strong reaction of the collective conscience against offenses to the cult of the individual. In this study we show that Durkheim's interpretation of the historical evidence is erroneous: not increasing condemnation of suicide, but rather tolerance or mild aversion is the typical social response to suicide. Also, when confronted with the historical evidence, Durkheim's claim that increased disapproval of suicide accompanied increased consideration for the dignity of the individual is shown to be unfounded. Our argument develops in four steps. First, we survey the historical evidence on views of suicidal conduct from classical times to the nineteenth-century; second, we present the moral statistics literature on suicide which flourished during Durkheim's lifetime; third, we analyze Durkheim's own theory of anomic suicide. In the conclusion we propose an alternative interpretation of the historical evidence on attitudes on suicide, and a different framework in which to highlight their significance in contemporary society.

Attitude↗
PubMed1991

The primary prevention role of the nurse in eating disorders.

Mental health depends on establishing an equilibrium between bodily needs, drives, and demands from the environment. A balance must be maintained between the basic human urges, self-centered wishes, and the demands of both conscience and society at every stage of human development. Eating and feeding behaviors are bound up with family dynamics and are often a barometer of the family's emotional climate and parent-child interactions. A positive feeding relationship is a concrete measure parents can be taught to provide for the child's healthy psychosocial development. Although the development of eating disorders is complex and caused by a multiplicity of factors, community-wide education by nurses about nutrition and feeding at successive developmental levels from infancy to old age can decrease the incidence of eating disorders in the community. Evaluation of prevention programs is essential to guarantee the refinement of preventive efforts over time.

Community Health Nursing↗
PubMed1991

Thomas Hodgkin and Hodgkin's disease. Two paradigms appropriate to medicine today.

Thomas Hodgkin was an investigator whose contributions extended over a wide range of medicine. While he is known for Hodgkin's disease, this was not his major interest. That this is so has more to do with his successors than him. He had a highly committed social conscience and was outspoken in advocacy of his positions. This greatly limited his professional career. The history of Hodgkin's disease is one of hypothesis generation, which allowed for its effective treatment even without an understanding of its etiology, illustrating the approximate nature of scientific discovery and the importance of chance in historical attribution. Hodgkin, as a scientist, healer, and socially committed individual, embodied the many characteristics that are desirable for today's physician, while the evolution of knowledge about Hodgkin's disease and its treatment is an instructive model for future medical advances.

England↗
PubMed1991

Medical practice as a public trust.

Medicine as a profession is entrusted with the responsibility to prevent disease and treat the sick--a responsibility that has both personal and social dimensions. The profession's social conscience is being called upon anew as Americans devise an ethic of the common provision of health care.

Delivery of Health Care↗
PubMed1991

[Professor Jules François Memorial Lecture. Code of ethics and its practice in ophthalmology].

Several Articles are shown from the code of ophthalmological ethics written by late Professor Jules François. Some examples found in the history of ophthalmological practice that complied with these articles are demonstrated. In the modern society with aging population, ophthalmic surgery must be done with great care; long-term prognosis should always be taken into consideration for the patients to be able to maintain high quality of life throughout their life-span. To achieve this, meticulous and continuous care of patients by means of best possible noninvasive techniques must be exercised and this is a conscience of ophthalmologists.

Ethics, Medical↗
PubMedDate not supplied

[Duration and temporality].

The notion of temporality in living is in perpetual motion between passive temporality and creative conscience. Human existence is not purely immanent, a flow of transcedence continually runs through it. Melancholia is a lose of creativity accompanied by a feeling that time as lived has stopped, time being lived as a new mode of space. Maniac temporality is an improductive and unsociable furious flight toward. The melancholic feeling out of time is crushed by the problematic of alterity, sin and eternity. The maniac lives an imaginary and deceptive problematic. The ambivalent ideal of the schizophrenic is both a return to biological life as well as a fascination by formal thought.

Bipolar Disorder↗
PubMed1990

[Post-traumatic coma and pre-traumatic memory].

Instead of thinking that it is impossible to enter in the internal world of a comatose patient, we are now put before a new and encouraging prospective, that of the possibility, even though minimal, of influencing the vital residual organisation of the patient and to induce him perhaps to accept again external stimulations, which previously were too intense. As loss of conscience often causes loss of memory, our intention was to examine the problem of memory loss in comatose patients after accidents. The analysis of 50 questionnaires distributed to trauma-patients awakening from a comatose state and interviews give clear indications that: 1) the patients remember absolutely nothing during the time of the coma; 2) in the majority of cases (34) the patients remember in the moment preceding the accident a clear autodestructive tendency especially if they were the cause of the accident; and 3) almost all patients (41) agree to have benefited greatly from the trauma itself and from its memory.

Amnesia↗
PubMedDate not supplied

[Respiratory function in patients immediately after surgery of the thorax or upper abdomen].

The study deals with the patients in the first postoperative hour following the operation in the upper abdomen or thorax. We considered the respiratory function of the patients in the first postoperative hour and how the respiratory function is influenced by the residua of general anesthesia at that time. Statistically significant decrease of postoperative SaO2 values was found and many patients were hypoxemic after the operation. We found decreased minute ventilation in the first postoperative hour in both groups of patients. Anyway the minute ventilation was more decreased in the abdominal group of patients who recovered from intravenous anesthesia. The conscience as well was more slowly returned to the patients in the abdominal group. In the first 30 minutes more abdominal patients suffered from the muscular weakness following intraoperative relaxation. But this first half an hour after the operation they had satisfactory level of analgesia left. To the contrary the postoperative pain was more severe in the thoracal group of patients. Postoperative gas exchange was more often and more seriously disturbed in the thoracal group of patients who in majority suffered from previous lung disease, which means they had greater ventilation/perfusion imbalance and greater right to left shunt. In the abdominal group only the patients who had relatively short intravenous anesthesia were found hypoxemic in the first postoperative hour. We think that in these patients the gas exchange abnormalities immediately after the operation are also caused by the hypoventilation which often follows general anesthesia.

Abdomen↗
PubMed1978

[Heat stroke and disseminated intravascular coagulation. Apropos of 2 cases].

Two cases of fatal heat stroke, concerning a 20 year-old soldier and a 44 year-old psychiatric patient, treated with neuroleptics, are reported. The clinical picture, starting suddenly with coma and hyperthermia, was quite identical for both. Secondarily, while hyperthermia decreases and the conscience improved partially, an hemorrhagic syndrome similar to a consumption coagulopathy, acute renal insufficiency and acute hepatic failure appear. Death occurred after aggravated neurological disorders and respiratory distress. The anatomical lesions spread on all the viscera include tubular nephritis, and hepatic centro-lobular necrosis and an interstitial and alveolar oedema with hemorrhages and hyaline membranes in the lungs.

Acute Kidney Injury↗