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The optimal management of chronic non-malignant pain in the elderly is founded first on comprehensive assessment and classification of the pain. The resulting pain diagnosis both targets appropriate areas for intervention and guides an often necessary multimodal approach to therapy. The indications for these various therapies, referral strategies, and guidelines for analgesic pharmacotherapy in the elderly are discussed.
Effective early treatment of this serious condition is necessary to prevent death. Urgent exploration by the most experienced surgeon available should include wide excision of all necrotic or dubious tissue, and adequate drainage of deep fascial planes. Deep and apparently healthy tissues must be exposed and the surgeon must be prepared to proceed to laparotomy, and even diverting colostomy and/or suprapubic cystotomy when necessary. Cross matched blood must be available, and we have found hydrogen peroxide irrigation useful. Pus, tissues, and blood samples for bacteriological culture and sensitivity should always be sent, but broad spectrum antibiotics should be started without delay to prevent systemic complications. In addition to the urgent initial surgery, repeated daily examination of all wounds is necessary, usually under general anaesthesia to allow full inspection, further débridement, irrigation and change of dressings, until the infective process is halted. This is a serious condition with a high mortality which we believe may be reduced by early diagnosis and appropriate aggressive surgery.
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A simplified approach to the management of major lesions of the diabetic foot is presented. Two nosological types, the angiopathic foot and the neuropathic foot, are proposed, on the basis of diagnostic, therapeutic, prognostic and preventive criteria. A ten years personal experience is discussed.
This article describes a specific strategy for family intervention that can be used by any clinician, including the neurologist. The techniques do not require an extensive commitment of time and can be shared by members of the treatment team. The physician is in contact with the family early in the course of treatment and is therefore uniquely positioned to initiate a therapeutic program that can be carried out by other members of the treatment team.
A questionnaire survey of laboratory animal facilities sought to determine employer practices and policies regarding allergy to laboratory animals. Information from 159 American institutions and 93 facilities from 20 other nations indicates that an effective program to control the problem of occupational allergy to laboratory animals remains to be developed.
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The concept of labile hypertension (also called borderline hypertension) has been proposed to define those patients in whom blood pressure is sometimes below, sometimes above the frontier which separates normal and high blood pressure. Current evidence does not support the individualization of this concept, since numerous studies have demonstrated a similar or even higher blood pressure variability in hypertensive patients than that found in normotensive patients. The main objective, when measuring blood pressure, is to assess the risk of a cardiovascular event. It has been shown that the average value of several blood pressure determinations provides a better estimate of cardiovascular risk, and correlates better with hypertensive target organ disease, than a single blood pressure measurement. Therefore, we propose to define these so-called labile hypertensive patients on the basis of the average and to classify them into the category of mild hypertension, the later being defined as a diastolic blood pressure between 90 and 105 mmHg on several occasions according to the WHO. The increase in cardiovascular risk carried by a mild elevation in blood pressure, either untreated or treated with general health measures, is small, approximately 3% per year. Moreover, whereas the beneficial effects of pharmacological antihypertensive therapy have been demonstrated on a whole population basis, these effects remain controversial on an individual basis. Thus, it appears justified to give these hypertensive patients general health measures advice without any pharmacological therapy during the first months of follow-up. During this time, blood pressure measurements are repeated so that blood pressure status, and thus the need for pharmacological therapy, can be assessed more precisely.