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PubMed1993

[Drug therapy of rheumatoid arthritis].

Continuous, computer-aided registration of large numbers of patients with rheumatoid arthritis (RA) had lead to a revised concept of the prognosis. More patients than previously throught develop severe progressive, erosive, deforming, and crippling disease. Most of the permanent damage develops within the first 10 years of the course of the disease. The patients die 10-15 years before the background population, even though the cause of death is rarely a direct consequence of the disease. Because of these observations, the treatment strategy is now becoming more aggressive than previously. Treatment with slow acting anti-rheumatic drugs (SAARDs) is started within the first year. Synovitis activity is monitored continuously, and in case of primary or secondary resistance to one SAARD the drug is replaced by another one for as long as the disease is active. This procedure makes it necessary that all patients with suspected RA be evaluated early and repeatedly by rheumatologists during the whole course of the disease. The drug treatment should be conducted with close cooperation between the general practitioners and the rheumatologists.

Anti-Inflammatory Agents↗
PubMedDate not supplied

[Psychological status of Croatian refugees in Hungary].

This presentation addresses the capability of Croatian refugees from Baranja to acclimatize themselves in the Republic of Hungary. The authors assessed the mental health of 100 refugees through a psychiatric interview using a questionnaire, specifically designed for the purpose of this research. Their ages ranged from 10 to 82 years, average age 38 years. The assessment of mental health of the refugees was conducted 6 weeks following their placement in a camp (social institution) of a small town (Maria Jüd) in Hungary. The authors found that refugees fled their homes and homeland in front of barbarous combined forces of local Serbs whom they identified as terrorists and Yugoslav Federal Army. Leaving homes and country was sudden and unexpected, but by their own will. The departure was accompanied by fear, anxiety, disbelief, despair, anger and rarely by panic behaviour. Fear for children's safety was on the first place, than fear from exposure to violent injury--torture and crippling, while threat for ones own life and life of relatives as well as loss of property were of milder intensity. Among the most dominant feelings refugees manifested during an interview were: home--and homeland sickness and uncertainty about the future. In 61% of the examinees, these feelings prevailed. Forty-two per cent of the subjects experienced emotional and psychosomatic disorders, primarily Beard's "neurasthenic syndrome". Only 5% of the refugees needed psychiatric help, mainly those who had psychic problems before they fled their homes. The authors conclude that Croats from Baranja who took refuge in Hungary had acclimatizational problems even 6 weeks after displacement, which were manifested as emotional and psychosomatic reactions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1993

[Surgical treatment of hip dislocations in children and damages caused by conservative treatment methods].

For the major requirements of the operative technique and other special problems of operation it is reasonable to discuss among the questions of the reduction of CHD the reoperations and the reconstructive surgery of hips, badly damaged by the conservative treatment, separately. We have analysed the results of 19 own cases with an average follow up of 6.3 years (3-12 years). The average age of the patients was 4.8 years. In 7 patients only conservative treatment was carried out previously, the others were also operated. The Roentgenogram revealed severe ischaemic necrosis in 10 hips. The dislocation could be reduced in every case, to the reduction however it was obligatory to add femoral osteotomy and correction of the acetabulum. The later operation was performed frequently in the second sitting. As a direct result of the operation a state, corresponding to the II. degree of Severin's radiological classification was always reached, in cases of severe ischaemic necrosis however the result later grew worse and at the follow up it corresponded only to the degrees III. and IV. (mediocre, poor). Thus the circulatory damage, suffered during the early treatment determined the late results. This was the reason that the result of the follow up examinations were better in patients in whom early surgery was performed than in patients with forced conservative treatment. The results summarized fall far behind the results of the group with primary surgery of the CHD. Without the operations described these patients would live as limping cripples, with these operations however we have improved their state significantly for the time until TEP can be performed.

Adult↗
PubMed1993

Swedish obese subjects (SOS)--an intervention study of obesity. Baseline evaluation of health and psychosocial functioning in the first 1743 subjects examined.

This part of an on-going intervention trial analyses impacts of obesity on psychosocial factors and health. The study sample comprised 800 obese men (BMI > or = 34 kg/m2) and 943 women (BMI > or = 38 kg/m2) ranging in age from 37 to 57 years. All participants completed standardized health-related quality of life measures, a validated obesity-specific eating inventory and study-specific questionnaires on current and past health status, use of medical care and medications, socioeconomic status, dietary habits, physical activity habits, weight history and familial history of obesity. Chronic patients and population samples were used as reference. The obese reported distinctly poorer current health and less positive mood states than the reference subjects, women being worse than men. Anxiety and/or depression on a level indicating psychiatric morbidity were more often seen in the obese and again women reported more affliction than men. Furthermore, the average poor mental well-being was worst than in chronically ill or injured patients, such as rheumatoid, cancer survivors and spinal cord injured persons. Predictors of perceived health and psychosocial functioning could be discerned using a comprehensive system of statistical analyses (16-28% explained variance). A background of both somatic and psychiatric morbidity was decisive for the health and psychosocial functioning in the obese; joint symptoms and angina pectoris dominated among somatic variables. Physical inactivity was the most prominent of traditional risk factors. The number of dieting attempts and body image were important weight correlates. Our results provide further evidence to the effect that severe obesity is a crippling condition.

Adult↗
PubMed1976

Nutritional problems in the African region.

Energy-calorie malnutrition (ECM) is the commonest nutritional problem in developing countries in Africa: 0.5-5% of the population under 6 years of age suffer from the severe forms and 4-40% from the moderate forms. It is possible that as many as two-thirds of the preschool children in developing countries in Africa suffer from some EPM (protein-calorie malnutrition). The recent Sahelian drought and civil wars in some countries in Africa have increased the size of the problem and the severity and prevalence of EPM in several parts of Africa. The aetiological factors of EPM in Africa include shortage of calories and protein, as well as increasing and recent tendency to abandon too early breast feeding, sensory deprivation, psychological and emotional trauma, ignorance, superstition and cultural taboos. The evidence available at the moment does not clearly indicate that effects of EPM on learning and behaviour are permanent, although the functions of the brain in the acutely malnourished child are defective. Malnutrition impairs immunological capability and surveillance, and hence augments the mortality and morbidity of infections such as measles especially by impairing cell-mediated immunity and, to a lesser extent, synthesis of immunoglobulins. Endemic goitre (prevalence varies from 2 to 90% in various age groups) in several parts of Africa is due to either iodine deficiency (Ethiopia) or to the goitrogenic effect of cassava diet (Zaire and Nigeria). Deficiencies of vitamins A, B complex and D have been reported in several parts of Africa, albeit sporadically. Dietary intoxications include: a) aflatoxins which may be important in the pathogenesis of hepatic carcinoma, one of the commonest neoplasms in developing countries in Africa; b) chronic cyanide intoxication from cassava (manihot) food derivatives, which on circumstancial evidence seems to be an important aetiological factor of a crippling neurological disease, the tropical ataxic neuropathy in Nigeria and Tanzania; c) organophosphate insecticides. The rarity of certain diseases in the Africans may be related specifically to the African diet, especially the high fibre and low animal fat content of many of the African diets. Examples of such diseases are atherosclerosis in the non-hypertensive non-diabetic population, cancer of the large bowel, varicose veins and perhaps multiple sclerosis.

Africa↗
PubMed1993

Politics and the nurse manager.

Sometimes, the "games being played" in our job settings cripple our ability to be powerful, effective participants in the world of work. Power, which is the ability to obtain, retain and move resources, requires two sets of attributes: competence and political savoir-faire. Much attention is given to improving competence but little time is spent in learning the intricacies of political behavior. The most important strategy is to learn to "read the environment" through observation, listening, reading, detachment and analysis.

Humans↗
PubMed1993

Physiological bases of breast cancer prevention.

The relevance of this work lies in the possibility of extrapolating conclusions drawn here to the human situation, since we have assessed the validity of the rat model for the study of breast cancer in women through comparative studies in these two species (Russo and Russo, 1988). The novelty of our studies is the evidence that hCG protects the mammary gland against carcinogenic initiation and progression, mimicking the physiological process of pregnancy, without crippling other reproductive or endocrine functions (Russo et al, 1990d; Russo and Russo, 1992). The importance of both differentiation and cell proliferation in tumour initiation and progression, which we have stressed in previous publications (Russo and Russo, 1980, 1987, 1988; Russo et al, 1982) validates the use of these end-points for assessing the effect of hormones under the influence of hCG on the mammary gland initiated in the process of carcinogenesis. Collectively, our results provide solid bases for developing physiological means of breast cancer prevention and control.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed1993

[Soft tissue sarcoma. Combined treatment of drug therapy, radiotherapy and conservative surgery].

The preliminary results of a prospective and cooperative protocol for the treatment of soft tissue sarcomas of trunk and extremities, stages IB-IIIB are presented. Thirty one patients (17 males, 22 with a tumor larger than 5 cm) aged 16 to 68 years, were treated with one dose of epirubicin 70 mg/m2 i.v. and radiotherapy (3000 rads in 10 fractions) Two or three weeks later an ample surgical complications occurred in 6 patients and were all of infectious origin. The median follow up period has been of 26 months. During this period 5 patients presented late surgical complications (edema in 4 and a pathological fracture in 1), 2 patients had a local tumor recurrence and distant metastases appeared in 7. Actuarial survival was 60% at 48 months. Ninety six percent of surviving patients conserved their extremity. It is concluded that with this treatment modality local recurrence is acceptable, morbidity is low and that the majority of patients do not require amputations or crippling resection.

Adolescent↗
PubMed1993

Child health in the Third World.

Malnutrition, immunisable illness and diarrhoeal diseases are the main causes of morbidity and mortality in Third World children. War and other disasters, rapid social change and AIDS add to these problems, and the debts of Third World countries cripple their efforts to deal with them. The World Summit for Children formulated an ambitious set of goals for the world's children by the year 2000 and there are signs that improvements in basic child health services can be achieved in this decade.

Child Health Services↗
PubMed1993

[The matrix metalloproteinase gene family: structure, function, expression, and role in destructive joint disease].

The matrix metalloproteinases, i.e. collagenases, gelatinases and stromelysins, are members of a gene family. They are capable of degrading every component of the extracellular matrix. Tissue destruction observed in inflammatory joint disease is largely accounted for by the action of these enzymes. Among the most potent inducers of metalloproteinase expression are the inflammatory cytokines IL-1 and TNF-alpha. Studies of mechanisms of induction by these mediators at the transcriptional level have improved our understanding of the biological controls of metalloproteinase synthesis. Cytokine inhibitors might serve to inhibit or postpone the crippling consequences of metalloproteinase action.

Arthritis↗
PubMed1993

Anxiety disorders. Focus on obsessive-compulsive disorder.

Obsessive-compulsive disorder was once thought to be rare. Recent epidemiologic surveys reveal the lifetime prevalence rate to be as high as 3%. We now have greater understanding of the neurophysiologic and neurochemical basis of this very crippling disorder. Although obsessive-compulsive disorder often starts in adolescence or early adulthood and can last a lifetime, effective treatment enables most patients to lead relatively normal lives.

Adolescent↗
PubMed1993

[Forgotten expertise about chiropractic].

Two forgotten experts on chiropractic are revived to expose the lack of scientific foundation of osteopathy, chiropractic and manual medicine. It is reemphasized that for the majority of patients with back complaints a precise and tangible pathologic finding explaining the pain can not be established. Likewise the correlation between radiologic, tomographic and patho-anatomic alterations with the patients complaints leaves much to be desired, particularly for the spinal column. Back ailments plagued humanity already in ancient times, their crippling effects seem, however, to be of iatrogenic origin originating in the 20th century. To explain the success stories of manual healers it is important to distinguish between medical science and the actions of the healer.

Chiropractic↗
PubMedDate not supplied

Surgical treatment of the duplicated thumb.

Fifteen patients with 18 duplicated thumbs were treated surgically at The Shriners Hospital for Crippled Children, Springfield Unit, between 1925 and 1990. We compared the outcome of patients treated by ablation of the extra thumb with that of patients treated by ablation and radial collateral ligament reconstruction. Three patients with four duplicated thumbs, all from the ablation-only group, required additional surgical treatment for the following reasons: joint instability, contracture, angulation of the digit, and bony prominence. No patient from the ablation-plus-ligament-reconstruction group has required further operative treatment.

Child↗
PubMed1993

The epidemiology of lathyrism in north and central Ethiopia.

Lathyrism is a neurotoxic disorder caused by excessive, prolonged consumption of the hardy, environmentally tolerant legume, the grass-pea, Lathyrus sativus, which contains the neurotoxic amino acid beta-N-oxalylamino-L-alanine acid (BOAA). The disease develops after heavy consumption of grass-pea for over two months. It is uniformly manifested by a predominantly motor spastic paraparesis with varying degrees of disability. A door-to-door epidemiological survey for the disease using trained lay health workers was carried out in the major areas of northwest and central Ethiopia where L. sativus is grown. For security reasons, some of the other endemic areas wre not accessible for the survey. The survey involved a population of 1,011,272. A total of 3,026 affected persons were identified. The disease was found to be widespread in the northwest and central highland areas of the country. The prevalence rates ranged from 1/10,000 to 7.5/1,000. The highest prevalences were in North and South Gonder, and East and West Gojam. The male:female ratio of cases was 2.6:1; the females exhibited a milder form of the disease. The cultivation of L. sativus is increasing in Ethiopia, which makes the development of low-BOAA strains very important in order to control the high incidence of lathyrism, a crippling disease which affects the productive young members of the society.

Adolescent↗
PubMed1993

Bone and joint tuberculosis in childhood in a children's hospital, Addis Abeba.

The records of children admitted to the Ethio-Swedish Children's Hospital with the diagnosis of bone and/or joint tuberculosis (TB) between 1985 and 1990 were reviewed. There were 41 patients: 25 (61%) males and 16 (39%) females. The diagnosis was based on history, clinical and radiologic findings supported by a positive PPD reaction and elevated erythrocyte sedimentation rate (ESR). A high index of suspicion based on epidemiologic considerations was also important. Whereas in ambulatory patients the commonest site of bone involvement was the spine, in this series of hospitalized patients the most common site of skeletal TB was the hip joint (22 patients) compared to spinal involvement (14 patients) suggesting the more incapacitating and crippling nature of hip joint disease. In the remaining 5 patients, the knee (1), the ankle (1) a metatarsal (2) or a phalanx (1) were involved. The period of hospital stay ranged from 3 to 180 days, with a mean of 56. Mean hospital stay was much longer for patients with TB arthritis of the hip joint than for those with spondylitis, 71 and 43 days respectively. The need for early diagnosis and treatment aiming at full restoration of function of the involved joint is emphasized. In TB spondylitis, early diagnosis and treatment should aim to minimize deformity and prevent paraplegia.

Child↗
PubMedDate not supplied

Home infusion of intravenous immune globulin in human immunodeficiency virus-infected children.

Intravenous immune globulin (IVIG) is administered prophylactically to reduce the development of secondary infections in human immunodeficiency virus (HIV)-infected children whose helper-inducer T-cell (CD4) lymphocyte count is greater than 200 cells/mm3. By progressively crippling the body's immune system, HIV allows opportunistic infections, which account for approximately 90% of AIDS-related deaths, to develop. In a recently published controlled study conducted by the National Institute for Child Health and Development (N Eng J Med 1991:325:73-80), children who received monthly infusions of IVIG experienced significantly more time free of infection. Home administration of IVIG is safe, convenient, and cost-effective. The first dose of IVIG, however, is administered in a hospital or clinic under physician supervision. Mild side effects occur in approximately 3% to 5% of patients; at least 90% of these effects are related to the infusion rate. In this article, a suggested protocol for home administration including commonly reported side effects and precautionary measures of anaphylaxis is presented.

AIDS-Related Opportunistic Infections↗
PubMed1993

Low-frequency vibration emitted from unstable hip in human neonate.

Developmental dysplasia of the hip (DDH) continues to be an orthopedic enigma. Some authors still believe it is a purely birth phenomenon. Even with widespread birth screening, however, DDH continues to become evident later than three months of age, long after a satisfactory outcome can be guaranteed. In an effort to reduce the number of late manifestations, the authors have developed a noninvasive form of screening for DDH called vibration arthrometry. Five hundred neonates were examined in local maternity hospitals, according to the guidelines of Ortolani and Barlow. The new method involves the attachment of miniature accelerometers around the infant's pelvis. Using this method, it was possible to elicit vibration events from approximately one fourth (255 hips) of the hips tested; vibrations were recorded from normal hips (125), from "clicky" hips (128), and from unstable hips (two). Differences between "nil-felt" (clinically silent) and "click-felt" (palpable clicking on testing) were significant. Vibration testing can be seen as an aid in the manual palpation necessary to detect this crippling condition.

Female↗
PubMed1993

Avascular necrosis of the femoral head in sickle cell disease. An integrated classification.

Avascular necrosis of the femoral head (ANFH) is one of the crippling complications of sickle cell disease (SCD), and to date there is no classification that could identify patients in the early phase of the necrosis. Based on the experience of 66 ANFH in 43 patients with SC hemoglobinopathy, the necrosed hips were classified into four grades, Grade I to Grave IV, based on patient history, clinical evaluation, and radiologic examination. In Grade I, the patient complains of the mildest symptoms with minimal clinical signs and radiologic changes. The most severe form, Grade IV, is where the findings are unbearable pain with disability and marked roentgenographic evidence of osteonecrosis. This classification identifies patients in Grade I and II, which, with early diagnosis and proper management, could delay further deterioration of the necrosed femoral head.

Adolescent↗