Prosthetic use in elderly patients with dysvascular above-knee and through-knee amputations.

Fifty-five patients with vascular insufficiency resulting in above-knee (AK) and through-knee (TK) amputations were studied to determine factors related to prosthetic candidacy and functional outcome. Chart review showed that the only difference between patients who were fitted with prostheses and those who were not fitted with prostheses was their respective number of medical complications. Twenty-three of 31 patients with prostheses were evaluated 7 to 35 months after receiving the prostheses. Ten (44%) of these patients wore their prostheses all day every day and used wheelchairs minimally or not at all. Over half of the patients evaluated used their wheelchairs most of the time. Two (9%) of the 23 patients had stopped wearing their prostheses. Patients who demonstrated increased walking distances and velocities at follow-up used their prostheses more and their wheelchairs less than did the other patients. Neither gait factors nor hip range of motion at discharge was predictive of continued prosthetic use. Functional outcome and prosthetic use were limited in this group of elderly patients with dysvascular AK and TK amputations. The results of this study may serve as a basis for clinical determination of prosthetic candidacy and functional goals.

Effect of circuit exercise training on physical fitness of alcoholic patients.

A group of patients with chronic alcoholism who participated in a circuit training exercise program were compared on a stair climbing task to a group of patients who did not participate in the program. After three weeks, the patients in the exercise group had gained significantly in the number of stairs which they could climb when compared to the patients in the nonexercise group. The time required to return to the heart rate before stair climbing was significantly shorter for exercising patients than for nonexercising patients. The circuit training exercise program, therefore, appears to be an effective method for improving the fitness level of alcoholic patients.

Ambulation, activity level, and pain. Outcomes of a program for spinal pain.

The purpose of this study was to investigate changes in ambulation distance, activity level, medical care sought, and perceived pain in 49 patients with chronic spinal pain who completed an inpatient rehabilitation program. Therapy included patient education, reduction in pain medications, increased quotas for activity and ambulation, and reinforcement of nonpain behaviors. Change was measured by a 12-minute walk, an activity check list, and pain and activity self-ratings. Tests were administered at admission and discharge and at one, three, and six months after discharge. Patients improved significantly in walking distance, frequency of both exercises and physical conditioning activities performed, and pain self-rating. Medical care sought decreased. Activity self-rating on a 10-point scale was unchanged. This program had a positive effect on a number of factors and warrants consideration for patients with chronic spinal pain.

Assistive devices and home modifications in geriatric rehabilitation.

Many older adults have difficulty with functional activities and do not recognize that help is available to them. Many assistive devices and home modifications exist that promote greater independence and safety for older individuals in the areas of mobility, self-care, and home management. Many factors must be considered in selecting an assistive device for an individual in order to meet the unique needs of that person.

Deaths among female patients with carcinoma of the breast treated by a surgical procedure only.

The postoperative mortality from carcinoma of the breast is low, and it appears to be getting lower. Mortality is highest for the women in the older age group and for those with the most advanced stage of disease. Surgeons who generally consider these factors in deciding whether or not to perform an operation may wish to review their own experience in light of these data. In general, while surgical mortality for carcinoma of the breast is not zero, it certainly is low. The historical data collected in the Surveillance, Epidemiology and End Results Program do not contain details on the extent of the operations actually performed, and this should influence the mortality. With proper safeguards for protecting the confidentiality of the medical records, it may be possible for qualified persons interested in surgical research to review a sample of the detailed records that contributed to the series reported herein to determine the exact extent of the operation and the curative or palliative purpose, and to help elucidate the actual causes and patterns of early deaths.

A comparison of Hodgkin's disease in Alameda County, California, and Connecticut: histologic subtype and age distribution.

A comparison of the histologic patterns of Hodgkin's disease in Alameda County, California and Connecticut was made in relation to age. All Hodgkin's disease cases from the Alameda County Cancer Registry diagnosed between 1960 and 1969 for which adequate material was available for evaluation were reviewed and histologically subtyped according to the Rye classification (159 cases). The age-specific relative frequencies and incidence rates for the histologic subtypes of Hodgkin's disease in Alameda County were estimated and compared to those estimated for Hodgkin's disease in Connecticut. The morphologic ex pression of Hodgkin's disease in both areas was similar and characteristic of economically developed regions with high living standards. The comparison supports the hypothesis that the host immune capacity, influenced by socioeconomic factors, has a strong and measurable effect on the pathogenesis of Hodgkin's disease.