Nephrotic Syndrome in Chronic Lymphocytic Leukaemia

Two patients with chronic lymphocytic leukaemia and the nephrotic syndrome are described in whom deposits were shown in renal glomerular basement membranes in a pattern suggesting immune-complex glomerulonephritis. This renal lesion has been described in one case of squamous carcinoma of the bronchus, in one case of Burkitt''s lymphoma, and in three cases of Hodgkin''s disease though not previously in chronic lymphocytic leukaemia. Immune-complex glomerulonephritis is, however, a recognized finding in mice infected with leukaemogenic viruses     

The effects of levodopa therapy in patients with Parkinson's disease I. Clinical response

Eighty-eight patients with Parkinson''s disease were treated with levodopa. A group of elderly patients 65 years and older was compared with a second group under the age of 65, and it was found that generally the younger patients could be treated with greater success than the older ones. Most of the elderly could not tolerate the large doses required to produce optimal physical recovery. Severity of complications forced discontinuance of treatment in a larger percentage of elderly patients. The rate of complications was about equal in the two groups, except the incidence of confusion, which was significantly higher in the elderly. Of the two deaths that occurred, both were in the older group. Results of treatment were better in patients whose families gave positive support.     

急性冠脉综合征患者发生冠脉血管完全闭塞病变的影响因素分析

目的:探讨急性冠脉综合征(acute coronary syndrome,ACS)患者发生冠脉血管完全闭塞病变的影响因素。方法:从2013年在我院诊断为ACS且行冠状动脉造影检查患者中随机筛选出120例患者为研究对象,记录其基线及临床资料,回顾其造影图像,计算SYNTAX积分,根据是否存在完全闭塞病变分组,分析慢性完全闭塞病变的影响因素。结果:与不完全闭塞病变组相比,完全闭塞病变组吸烟(61.1%,P=0.041)、糖尿病(35.2%,P=0.025)、高脂血症(55.6%,P=0.033)发生率高,入院静息心率(77.07±11.99,P=0.023)高,中性粒细胞/淋巴细胞比值(Neutrophil-to-Lymphocyte Ratio,NLR)水平(8.69±9.46,P0.001)显著升高,左室射血分数(left ventricular ejection fraction,LVEF)(50.39±8.36,P=0.001)显著降低。多因素分析显示年龄(P=0.043)、急性心梗(acute myocardial infarction,AMI)的发生(P=0.003)、LVEF(P=0.002)、NLR(P=0.002)、脂蛋白(a)(P=0.039)、SYNTAX积分(P=0.002)和完全闭塞病变独立正相关。结论:ACS患者发生慢性完全闭塞病变与年龄、静息心率、吸烟史、高脂血症相关,与冠脉病变复杂程度、左室功能下降密切相关。NLR作为新型炎症标志之一,可预测ACS患者完全闭塞病变。     

针对性健康教育对老年2型糖尿病患者糖代谢及生活质量的影响*

摘要目的：观察针对性健康教育对老年2 型糖尿病患者的干预效果及对生活质量的影响,为糖尿病的临床护理提供参考。方法： 将120 例老年2 型糖尿病患者随机分为两组,对照组实施常规健康教育,观察组根据患者的文化水平、心理状况、遵医态度、实际 需求实施针对性健康教育,护理3 个月后观察患者餐后2h 血糖（2hPG）、空腹血糖（FPG）、糖化血红蛋白（HbA1c）变化,并采用抑 郁自评量表(SDS)、焦虑自评量表(SAS)、生活质量评定表(QOL)对患者的生活质量进行评定。结果：观察组护理后2hPG、FPG、 HbA1c 分别为（9.3± 1.4）mmol/L、(6.9± 2.1) mmol/L、（5.1± 1.3）%,低于对照组的（11.3± 1.8）mmol/L、(8.4± 2.6) mmol/L、（6.9± 1.5）%（P<0.05);观察组完全从医率为65.00 %,高于对照组的40.00 %（P<0.01);观察组护理后总体健康评分为（92.84± 7.19) 分, 高于对照组的（84.62± 6.91）分（P<0.05)。结论：针对性健康教育有利于提高老年2型糖尿病患者的从医性,提高血糖控制效率,改 善患者的身心功能,提高生活质量。     

GENERAL ANESTHESIA FOR EYE OPERATIONS—A Consideration of Some Pertinent Factors Involved in Administration

In the administration of general anesthesia for surgical operations on the eye, care must be taken to consider the patient''s total physiological condition. A patient with eye problems may have generalized changes of more than moderate extent. Most patients are in the age group in which the incidence of cardiovascular and pulmonary problems is relatively high. If the patient is in a younger age group, perhaps diabetes or the collagen diseases must be suspected. Care must be taken to prevent undue strains to the eye during and immediately after the operation.Constant care and an awareness of possible complication is necessary for successful management in these cases.     

Nephrotic Syndrome Due to Primary Renal Disease in Adults: I. Survey of Incidence in South-east England

In a prospective survey of the nephritic syndrome due to primary renal disease in adult patients in the South-east Metropolitan Region of England 50 patients were seen in a two-year period—a minimum annual incidence of 9·0 new cases per million adult population. The frequency distribution of the three main histological groups was “minimal change” 30%, membranous nephropathy 12%, and proliferative glomerulonephritis 58%. The higher proportion of patients with minimal histological change compared with that found in most previously published series may be explained by the avoidance of selection of patients for inclusion. The much lower incidence of membranous nephropathy probably reflects the use of stricter histological criteria for this diagnosis.     

盐酸普拉克索联合美多巴对老年帕金森病的临床疗效及对运动功能的影响

目的:研究盐酸普拉克索联合美多巴对老年帕金森病的临床疗效及对运动功能的影响。方法:选择2014年3月~2015年8月在我院进行诊治的老年帕金森病患者210例,随机分为观察组和对照组,对照组给予美多巴,观察组给予盐酸普拉克索联合美多巴,比较两组的临床疗效,治疗前后运动功能、生活质量的变化情况和不良反应的发生情况。结果:观察组的治疗有效率为85.71%,明显高于对照组的65.71%(P0.05);治疗12周后,观察组UPDRS评分与治疗前和对照组相比均明显降低(P0.05);治疗12周后,观察组生理、心理、独立性、社会关系和环境等方面的评分与治疗前和对照组相比均明显升高(P0.05);两组间恶心、呕吐、开关现象、精神症状等不良反应发生率相比无明显差异(P0.05)。结论:盐酸普拉克索联合美多巴对老年帕金森病疗效显著,能明显改善运动功能,且用药安全,值得推广应用。     

早期康复护理对肠内营养治疗的高血压颅内出血 患者预后的影响

目的：研究早期康复护理对肠内营养治疗的高血压颅内出血患者预后的影响。方法：选取2010 年1 月~2012 年10 月间入 院诊治的高血压颅内出血并应用肠内营养支持治疗的患者120 例,随机分为实验组（60 例）和对照组（60 例）。对照组应用常规护 理办法,实验组在其基础上应用早期康复护理,随访1 年后观察两组患者预后的生活质量情况、GCS（格拉斯哥昏迷指数）评分以 及并发症的发生情况。结果：随访1 年后,实验组的生活质量显著高于对照组（P<0.05）;护理干预前两组患者的GCS 评分无差异, 护理干预后实验组的GCS 评分显著高于对照组（P<0.05）;实验组在肺部感染、下肢静脉血栓、肩手综合征等并发症的发生例数均 显著低于对照组（P<0.05）。结论：针对肠内营养支持治疗的高血压颅内出血患者应用早期康复护理可有效改善患者的昏迷程度、 预防并发症,有助于提高患者的生活质量。     

Chronic renal failure in children.

Seventy-seven children with chronic renal failure were examined at one hospital in the province of Quebec between 1970 and 1975; this represents an incidence of 2.5 per million population per year. The entities responsible for chronic renal failure were urinary tract malformation (in 36%), chronic glomerulonephritis (in 22%), congenital renal parenchymal malformation (in 21%) and hereditary nephropathy (in 13%). The evolution of chronic renal failure in children with either vesicoureteral reflux or a posterior urethral valve seemed to be related more to the initial severity of the disease than to the age at the time of diagnosis. Hence any screening program designed to detect kidney disease in schoolchildren would not prevent chronic renal failure, since at that age renal parenchymal damage seems to be irreversible. The manner in which chronic glomerulonephritis evolved depended on whether the nephrotic syndrome was present and on the type of histologic lesion. Children with congenital renal hypoplasia or dysplasia often presented with seizures due to hypertensive encephalopathy without obvious symptoms or signs of pre-existing renal disease. Among patients with familial nephropathy many of those with cystinosis underwent successful renal transplantation early in life.     

Parathyroid hormone and 25-hydroxyvitamin D concentrations in sick and normal elderly people.

Serum 25-hydroxyvitamin D and immunoreactive parathyroid hormone concentrations were measured in normal elderly subjects living at home and in sick elderly patients in hospital. Normal old people tended to have high 25-hydroxyvitamin D and low parathyroid hormone concentrations; in the sick elderly this pattern was reversed. The raised serum parathyroid hormone concentrations in the sick elderly were not due to poor renal function and may have been a response to vitamin D deficiency. A high serum parathyroid hormone concentration in an elderly patient must be interpreted in the light of the patient''s general health and nutritional state. Caution is needed in diagnosing primary hyperparathyroidism in this age group.     

Controlled Trial of Prednisone in Adult Patients with the Nephrotic Syndrome

A multi-centre controlled trial of steroid treatment of the nephrotic syndrome was carried out on 125 patients. Of these, 64 were controls and 61 received prednisone in a recommended dose range of 20-30 mg./24 hours. The actual initial dose averaged 29 mg./24 hours. Treatment was continued for a variable period, but not less than six months. More than 10 mg./24 hours was given on average for 12 months to all patients, and for longer periods to some. Patients were classified, on the basis of biopsy specimens, into three groups: A, minimal change; B, membranous nephropathy; and C, proliferative glomerulonephritis. In groups B and C prednisone did not have any strikingly favourable effect on proteinuria or on renal function as compared with the control group. In group A, however, prednisone reduced proteinuria to a striking and statistically significant extent. It had little if any effect on long-term renal function in any group. The death rate was higher in the combined prednisone groups (17/61) than in the control groups (12/64). This difference was not statistically significant, but there was a significantly higher number of deaths from cardiovascular disease in the prednisone group, whereas the numbers of deaths from renal failure were not significantly different in the two groups.     

Measuring Frailty in HIV-infected Individuals. Identification of Frail Patients is the First Step to Amelioration and Reversal of Frailty

A simple, validated protocol consisting of a battery of tests is available to identify elderly patients with frailty syndrome. This syndrome of decreased reserve and resistance to stressors increases in incidence with increasing age. In the elderly, frailty may pursue a step-wise loss of function from non-frail to pre-frail to frail. We studied frailty in HIV-infected patients and found that ~20% are frail using the Fried phenotype using stringent criteria developed for the elderly^1,2. In HIV infection the syndrome occurs at a younger age.HIV patients were checked for 1) unintentional weight loss; 2) slowness as determined by walking speed; 3) weakness as measured by a grip dynamometer; 4) exhaustion by responses to a depression scale; and 5) low physical activity was determined by assessing kilocalories expended in a week''s time. Pre-frailty was present with any two of five criteria and frailty was present if any three of the five criteria were abnormal.The tests take approximately 10-15 min to complete and they can be performed by medical assistants during routine clinic visits. Test results are scored by referring to standard tables. Understanding which of the five components contribute to frailty in an individual patient can allow the clinician to address relevant underlying problems, many of which are not evident in routine HIV clinic visits.     

肾病综合征患儿行为问卷调查及相关影响因素分析

目的:分析肾病综合征(NS)患儿的行为调查和相关影响因素。方法:选择2015年1月~2016年3月我院住院或者门诊治疗的患儿60例作为观察组,并选择同期同年龄组健康体检儿童50例作为对照组。采用自编人口学调查问卷表调查研究对象家庭状况、患病情况、活动情况和激素使用情况,采用Rutter儿童行为问卷(父母问卷)进行儿童行为调查。采用x~2检验进行单因素分析,采用logistic回归分析进行多因素分析。结果:观察组NS患儿A行为发生率(18.33%)、N行为发生率(20.00%)和总行为问题发生率(38.33%)均高于对照组,差异有统计学意义(P0.05)。Logistic回归分析结果显示,发病持续时间、复发次数、总住院天数、日均户外活动时间、激素持续时间和激素使用总量是影响NS患儿总行为问题的因素,日均户外活动时间是NS患儿总行为问题的保护因素。结论:NS患儿较健康儿童存在更严重的行为问题,其行为问题受发病持续时间、复发次数、总住院天数、日均户外活动时间、激素持续时间和激素使用总量等因素的影响。     

关节置换法与内固定法治疗老年骨质疏松合并股骨粗隆间骨折的临床对比分析

目的:探讨关节置换法和内固定法对老年骨质疏松合并股骨粗隆间骨折患者的治疗效果。方法:选择2011年12月到2014年12月在我院收治的96例老年骨质疏松合并股骨粗隆间骨折患者,随机分为对照组和实验组,分别采用内固定法和关节置换法进行治疗,对比两组临床疗效、并发症发生率和骨密度值。结果:实验组患者下地时间和并发症发生率均明显小于对照组(P0.05)。实验组的优良率(95.83%)明显高于对照组(70.83%),具有显著性差异(P0.05)。治疗后,两组患者骨密度值均明显高于治疗前(P0.05),实验组骨密度值明显高于对照组(P0.05)。结论:关节置换法治疗老年骨质疏松合并股骨粗隆间骨折的临床效果优于内固定法,能明显降低并发症发生率,增强骨密度,改善患者预后。     

Clinical assessment of the elderly patient.

The examination of an elderly patient often requires special techniques and attention to the patient''s comfort and ease. This paper outlines a reasonable approach to each phase of the interview and discusses the particular medical problems of this age group. Older people are often slow to bring their troubles to medical attention because their symptoms are vague or because they accept their disability as part of old age. Sometimes they have difficulty in communicating effectively with the physician. Simple patience can ease an otherwise frustrating situation.     

El anciano en la unidad de cuidados intensivos

Admission of elderly patients to intensive care units (ICU) is an increasing phenomenon. The severity of the disease causing admission and the basal functional patient's status are conditions more important than age to predict mortality and long term functional outcome. Studies demonstrate that elderly ICU survivors recover after discharge the majority part of their functional capability and perception of quality of life. On the contrary, these patients develop higher number of geriatric syndromes, mainly confusional syndrome.The culture of geriatric comprehensive assessment should be implemented in ICU and especially after discharge. The use of simple and validates scales (Barthel's Index, Lawton's Index and EuroQol-5D…) must be incorporated into the clinical practice. This is a good tool that could be useful for the specialists involved in the usually difficult decision of whether an elderly patient should or not be admitted to an ICU.     

Low T3 syndrome in cancer patients in relation to weight loss, intravenous hyperalimentation therapy and age

In order to investigate the relation of weight loss and intravenous hyperalimentation therapy to low T3 syndrome, serum T3, T4. rT3 and TBG were determined by radioimmunoassay in 105 cancer patients. The cancer patients were classified into 3 groups, Group I, II and III depending on the grade of weight loss, ranging up to a 5% change in weight loss from a healthy condition, from 5 to 9%, and more than 10%, respectively. Cancer patients under age 59 showed no significant difference in serum T3, T4, rT3 and TBG among these 3 groups. However serum T3 and T3/T4 in cancer patients at age 60 and over were significantly reduced in group III, compared to groups I and II. Serum rT3 values were significantly elevated in group III of elderly cancer patients. The incidence of low T3 syndrome in group III of elderly cancer patients was also significantly higher than in groups I and II. In three out of 5 cancer patients with low T3 syndrome, serum T3 values increased after the intravenous hyperalimentation therapy, whereas no significant change in serum T3 values was observed in two patients who died within one day after the final examination. It is concluded that weight loss produced different effects on peripheral conversion of T4 to T3 between cancer patients under age 59 and over age 60 and glucose plays an important role in the pathogenesis of low T3 syndrome except cases with very poor prognosis.     

Symptoms of craniomandibular disorders in elderly Brazilian wearers of complete dentures

Objective: Investigate the incidence of symptoms of craniomandibular disorder in elderly Brazilian wearers of full dentures. Design: In this cross‐sectional study, a questionnaire based on Helkimo's anamnestic index was applied to a group of 65‐year‐olds or older individuals who wear a set of full dentures. Setting: Interviews were carried out at the dental clinics of the University of Taubaté and the University of Vale do Paraíba, Brazil. Subjects: From a total of 384 patients, 84 elderly wearers of full dentures were interviewed. Main outcome measures: The questionnaire identified the most commonly related symptoms of craniomandibular disorders. Results: The patient's average age was 73.5 years (ranging from 65 to 89 years), 81% of them females. Only 5% reported pain when opening their mouths, and the same percentage complained of temporomandibular joint luxation and a sensation of tired muscles during mastication. Similar rates were found for pain in the temporomandibular joint area (6%), pain in the temporal muscle area (7%), difficulty to move the mandible in the morning (4%) and pain during excursive (protrusive and lateral) movements (8%). The highest rates were found for pain in the masseter muscle area (39%) and articular noises (24%). Conclusion: The incidence of craniomandibular disorder symptoms was low in this group of elderly wearers of full dentures, except for pain in the masseter (39%) and articular noises (24%).     

Histological Reassessment of Three Kidneys Originally Described by Richard Bright in 1827-36

Portions of kidney from three patients with renal disease that were originally described by Richard Bright between 1827 and 1836 have been preserved in the Gordon Museum at Guy''s Hospital. Histological study has shown that two cases fall into the current diagnostic category of mesangiocapillary (membranoproliferative) glomerulonephritis. One of these patients had a five-year clinical history and died with chronic renal failure and uraemia. The other patient died after three to four months with a severe nephrotic syndrome. The third patient was a young woman with chronic “phthisis pulmonalis” and renal amyloidosis.