Arch Intern Med
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The purpose of this study was to determine the relationship between hearing status and cognitive status initially and at 5-year follow-up in a cohort of healthy elderly men and women and to relate the results to published reports on this topic. Volunteers older than 60 years with no major illnesses and taking no long-term prescription medications were examined. Baseline testing of hearing and cognition was performed in 224 subjects; 112 subjects underwent cognitive testing at 5-year follow-up. ⋯ The power of the study was 90% to detect a correlation of .30 between measures of hearing and cognition. There was no evidence for a major effect of hearing acuity on cognitive function over time in this group of healthy elderly. Review of published studies suggests that hearing ability is related to cognitive status in demented subjects, but there is little to suggest that in the normal elderly, hearing impairment leads to cognitive decline.
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Sarcoidosis is a multisystem disorder of unknown cause. The disease is characterized by the presence of noncaseating granulomas in the affected tissue system. ⋯ The disease appears in the differential diagnosis of many infectious and noninfectious neurological syndromes. We have reviewed all aspects of neurosarcoidosis from the point of view of practicing internists, including the clinical manifestations, cerebrospinal fluid and radiographic changes, differential diagnosis, and treatment.
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Review Case Reports
Pneumothorax complicating small-bore feeding tube placement.
Small-bore Silastic feeding tubes are being used with increasing frequency for short- and long-term enteral hyperalimentation. We present three cases where these flexible tubes were passed into the tracheobronchial tree and then out into the pleural space. The result in each case was a pneumothorax or hydropneumothorax. ⋯ The traditional methods of assessing proper nasogastric tube placement are inadequate when applied to these small tubes. Only a chest roentgenogram can assure placement in the stomach. Education of hospital staff on methods to avoid malposition of feeding tubes has resulted in an absence of pulmonary complications over a subsequent 1-year period.
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Review Randomized Controlled Trial Clinical Trial
Randomized trial of postoperative patient-controlled analgesia vs intramuscular narcotics in frail elderly men.
Postoperative use of as-needed intramuscular narcotics is potentially hazardous in frail elderly patients. Patient-controlled analgesia (PCA) allows patients to self-administer small boluses of narcotic, allowing better dose titration, enhanced responsiveness to variability in narcotic requirements, and reduction in serum narcotic level fluctuation. Although theoretically useful, this method has not bee well studied in the elderly or medically ill. ⋯ Patients who had previously received intramuscular injections reported that PCA was easier to use and provided better analgesia. Serum morphine levels showed significantly less variability on postoperative day 1 with PCA, compared with intramuscular injections. We conclude that PCA is an improved method of postoperative analgesia in high-risk elderly men with normal mental status, compared with as-needed intramuscular injections.
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Review Case Reports
Hypoglycemic coma in anorexia nervosa. Case report and review of the literature.
Clinically significant hypoglycemia is an unusual complication of anorexia nervosa. We describe a 44-year-old woman with a 5-year history of anorexia nervosa who presented with hypoglycemic coma and eventually experienced sudden death. ⋯ Nine previously reported cases of severe hypoglycemia in anorexia nervosa are reviewed (six of the patients involved also died). The presence of severe hypoglycemia in anorexia nervosa implies a grave prognosis and mandates aggressive medical and nutritional therapy to improve the chance of survival.