[Reintegration of convalescents and of the chronically ill in the work force].
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Cerebral circulation and psychological state of 93 myocardial infarction patients aged from 29 to 60 years have been studied. The comparison of data concerning cerebral circulation with psychological profile of these patients enables us to make a conclusion that there is interrelation between the state of cerebral hemodynamics which ensures brain homeostasis and psychological adaptation of patients with myocardial infarction at different stages of the disease
The authors submit information concerning after-treatment units in the Czech Republic; these units are attached to specialized in-patient wards. These units have a small capacity and do not influence the expenditure of the department and only partly protract the period of hospitalization. The volume of curative and nursing care is balanced. Patients are hospitalized in these units for after-care or for other reasons, e.g. social reasons, lack of space in sanatoria for chronic patients, in old age pensioners' homes, etc. It would be better to replace the units for after-treatment by "day hospitals or departments" attached to in-patient departments or clinics.
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For this study an extensive oral examination was performed in 111 women between 21 and 48 years of age recreating themselves in special rest homes. A mean DMF-T of 19.1 and a mean DMF-S of 62.5 was found; women with a low education (Sonderschule) showed an especially high DMF-S of 85.0, participants with a secondary education (Abitur) had a DMF-S-Index less by half. The oral hygiene of the women was insufficient (mean QHI 2.6), papilla bleeding was easy to provoke in most of them. 98% of the women needed periodontal treatment, 10.8% showed a probing depth of 6-8 mm. 60.8% of 942 examined restorations needed to be renewed, the reason was mostly marginal leakage.
Blood pressure ambulatory monitoring has provided numerous and interesting informations on the clinical as well as investigational setting of arterial hypertension. The vast majority of data have been obtained registering blood pressure during the normal daily activities of the patients and surprisingly few studies have been undertaken to evaluate blood pressure behaviour in inpatients. We observed the 24 hours pattern of blood pressure in hypertensive and normotensive inpatients, using an automated sphygmomanometer (Omega 1400), whose performance was previously evaluated by us. The results demonstrate that blood pressure monitoring in inpatients could be a useful tool in managing hypertensive patients.
Twelve patients undergoing elective cholecystectomy received as analgesic medication a single dose of methylprednisolone (30 mg/kg) preoperatively and thoracic epidural analgesia with plain bupivacaine for 48 hours + epidural morphine 4 mg and systemic indomethacin 100 mg, both every 8 hours for 96 hours. Assessments of pain, various parameters of response to injury, peak flow and subjective fatigue were made preoperatively, before and 3 and 6 hours after skin incision and 1, 2, 4 and 8 days postoperatively. These patients were matched with 24 from a previous study who were treated with either intermittent nicomorphine and acetaminophen or with epidural analgesia + systemic indomethacin as analgesic medication. Preoperative methylprednisolone resulted in improved pain relief, with concomitantly reduced need for epidural bupivacaine, prevention of hyperthermic response, improved postoperative pulmonary function and lessened fatigue, while the leucocytic and acute phase responses were unmodified. There were no side effects. These results may be explained by inhibition of various trauma-induced inflammatory mediators.
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The Borg's indices, the rate of perceived exertion have been widely accepted to evaluate subjective symptoms semi-quantitatively in exercise tests. We applied the indices to evaluate the efficacy of our home exercise program in patients with acute myocardial infarction. Eighty-five patients were entered in our home exercise program after their discharge from the hospital. This program consisted of everyday 2 km walk-jog exercise for 1 month keeping their heart rate at 100-110/min during the exercise. Before and 1 month after their discharge, they underwent treadmill exercise tests with expiratory gas analysis and a measurement of blood lactate. In the treadmill tests performed before and after the training, VO2 and heart rate increased linearly with Borg's indices, however VE and blood lactate had disproportionate increases after Borg's 13 which is considered to be the anaerobic threshold (AT). In fact, AT measured individually by expiratory gas analysis and blood lactate, appeared at Borg's 13 in 53% of the patients. After 1 month physical training, VO2 and heart rate significantly increased at the same Borg's indices, but there was no significant changes in blood lactate at the same Borg's score before and after the training. These results suggest that, in patients with acute myocardial infarction, exercise performance significantly increased at any score of subjective symptoms and that Borg's indices may reflect the blood lactate levels. It is concluded that Borg's indices, closely related to the dynamics of blood lactate, are not only useful in quantifying subjective symptoms but also to estimate the efficacy of physical training.