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The prevalence of older-age bipolar disorder (OABD) is increasing as a consequence of a rapidly aging population. It is not clear whether there are differences in clinical characteristics of OABD between older and younger adults. Furthermore, little is known about the prevalence of residual symptoms and subsyndromal symptoms in older adults. This study explored the prevalence and associated factors of residual symptoms and subsyndromal symptoms in patients with OABD who are euthymic and compared older to younger adults.

This is the most important moral issue (and pro-life) issue facing us today. There is no excuse for continued denial and delay. Lawrence Mick Dayton, Ohio In spite of the [...]

The subject which I am about to touch upon is an ever interesting one. I would like to relate the early history of our instructors in surgery, in the line of intestinal anastomosis, but were I to attempt such a task I would be called a monopolist of time. Suffice it for me to state, that they, even 150 years ago, realized the necessity of some speedy and safe method for dealing with this most important branch of surgery. They were evidently not satisfied with the suture method, as is manifest by their numerous attempts to call unto their aid mechanical means, such as steel rings, rawhide, turnips, bone, catgut, rings, gelatin, etc. Denan, in an article in "Receuil de la Société Royale de Médecine de Marseille," l'an 1826, described his device for intestinal anastomosis, consisting of steel rings connected with a spring, and laid stress upon the pressure necrosis

Last winter, having contemplated a trip to South America, I was appointed by Dr. A. M. Corwin, chairman of the Chicago Medical Society Council Commission on Medical Education, of which I am a member, to obtain data regarding the medical schools in the countries which I should visit. I also received a similar request from Dr. N. P. Colwell, secretary of the Council on Medical Education of the American Medical Association. It is to record briefly my findings in this direction, as far as I could obtain knowledge of the facts on a hurried visit, that this article is written.I left New York Jan. 20, 1912, and arrived at Buenos Aires during the height of the Argentine summer, when the colleges were all closed and many of the faculty members away on their vacations. The weather was sweltering, but I was able to find well-informed physicians and through

Having observed that the men in general practice with whom I come in contact are for the most part unfamiliar with the use of gutta-percha tissue in surgery, I felt that it might be worth while to call attention to this agent.This unfamiliarity is explained by the fact that practically nothing is said about gutta-percha tissue in textbooks of surgery, and that past and current medical literature presents the same dearth of information on the subject.In order that the experience of others might be included in this presentation, inquiries as to its uses were sent to a number of men prominent in surgical work, in the United States, Canada and England. Forty-nine replied. Of this number, twenty-six make use of it in various ways and find it satisfactory. One considers it inferior to oiled silk because of its impervious quality. One believes

I fear that I have chosen for my paper a subject which may seem old and of comparatively little interest to some, and have consulted therein rather my own tastes and inclinations. The diversity of surgical conditions, brought about in the course of some pelvic or abdominal operation, to the ureters is sufficiently large and the number of cases met with great enough to make the subject of interest to every surgeon.Again, the numerous pathologic conditions to which the urinary bladder is heir, which must sooner or later terminate fatally unless some means of relief can be afforded, have been sufficient incentive for experimenting in search of some surgical means that would furnish relief to those unfortunate sufferers.The establishment of an artificial communication between the ureters and the intestines by means of surgical procedure should not be one of choice, but of necessity. It is applicable only in

EXPERIMENT 4. —A male pug cur, weight 22 pounds, was operated on May 6, 1899, and killed May 21. At the postmortem the abdominal incision was found firmly united. The omentum was partly adherent around the site of the anastomosis. The bladder was empty and greatly contracted. On opening the bladder no appreciable changes were noticed, and the opening between the bladder and rectum admitted the tip of a finger. The rectal mucosa below and a slight distance above the fistulous opening was reddened, probably by the urine. Both kidneys looked bluish, not enlarged, nor thickened; the capsule stripped easily and was not thickened. On cut section the pelvis was found undilated, perfectly smooth and to all appearances normal. The proportion of cortex to medulla was normal. All other organs were found to be perfectly healthy. BACTERIOLOGIC EXAMINATION. —A blood-serum and a glycerin-agar tube were inoculated from the pelvis of

Aus der in einer anzahl der Fälle vorgenommenen sorgfältigen bakteriologischen und histologischen Untersuchung ergiebt sich ohne Zweifel, dass bei Hunden die von mir geübte Methode der Blasen-Mastdarm-Anastomose vorgenommen werden kann, ohne zu einer Infection der Nieren zu führen. In zwei der obigen Fälle hat die Untersuchung mit Sicherheit die Abwesenheit jeder Infection ergeben. Wenn ein derartiges Resultat bei Hunden, die man nicht unter das beste Regime bringen und wo eine angemessene Nachbehandlung nicht stattfinden kann, erzielt wurde, so darf man beim Menschen wohl bessere Erfolge erwarten, da sich bei ihm angemessene Nachbehandlung, wie Auswaschung der Blase gut durchführen lässt. Als Vortheile der Blasen-Mastdarm-Anastomose lassen sich anführen:Leichte Ausführbarkeit und kurze Operationsdauer.Keine Gefahr einer Ureterenstrictur durch die Darmnarbe; keine Gefahr von Nekrose, wie sie bei der Implantation des Trigonum nach Maydl vorkommen.Verhältnissmässig geringe Gefahr der Infection.Die Operation kann nicht nur bei Ekstrophie der Blase, sondern auch bei anderen pathologischen Veränderungen dieses Organs Anwendung finden.

The object of all surgical operations, especially in abdominal work, should be to secure primary union. There is no reason why this principle is not as applicable to the surgery of the liver, providing a proper technic can be employed, so that when the cut liver surfaces are coaptated, the continuity of the organ will be re-established, and complete control of hemorrhage secured.That liver surgery has failed to keep pace with the surgery of other abdominal organs can easily be ascertained on perusing the literature of the subject. The first and principal reason was the fear of hemorrhage, which, according to Kocher, is almost as true to-day as in the time of Theden, 1795. The lack of knowledge of the healing and regenerative power of the organ offers a second explanation. A third, the danger of infection, resulting in peritonitis, and, fourth, cholemia due to the escape of bile

Obstructive dysmenorrhea and sterility most commonly depend on a pathologie anteflexion of the uterus. One must lay emphasis on and distinguish such an anteflexion, as opposed to the physiologic anteflexion of the normal uterus, if one is to get successful results from any corrective measures that may be instituted. With the distinction between the physiologic and pathologic anteflexions clearly in mind, I wish to present an operation for the correction of the latter, an operation that has successfully corrected the dysmenorrhea in all properly selected cases. It has frequently ended a long period of sterility, and the resulting pregnancy has been terminated in two casesFig. 3.—Removal of the wedge-shaped tissue; a, wedge when removed, leaving trough-shaped cavity. sterility, was defeated.In 1910, Pozzi presented his operation for dysmenorrhea and sterility before the American Gynecological Society. This attempts to correct the so-called "pinhole os," in which there is a slight

Mrs. H., aged 50 years, consulted me at St. Elizabeth's Hospital in September, 1898, and gave the following brief history: At about the age of 14 she was taken sick with pain in the abdomen. No diagnosis was made by her physician, and, after many months of suffering a spontaneous opening appeared at the umbilicus, with a discharge of large quantities of pus. About twenty years before I saw her, a fecal fistula appeared through the same opening, discharging both pus and feces.On examination a large, hard, immovable mass could be palpated, irregular in outline and extending from the site of the fistula along the left iliac region far into the pelvis. A vaginal examination revealed both anterior and posterior culs-de-sac filled with a hard mass and the uterus firmly fixed.On September 17 an incision was made around the fistula, and on opening the abdomen, the intestines were

In the spring of 1898 a series of experiments on the unilateral and bilateral implantation of the severed ureters into the rectum was conducted after a special method of my own, with the object of relieving many of the grave pathologic conditions arising in the bladder, that are aggravated by the presence of urine, or in congenital malformations, as exstrophy, as well as the avoidance of a nephrectomy for neoplasms involving the ureters, or injuries to the ureters in laparotomies. The ultimate results of these were discouraging, although the operative technic was all that could have been wished for. From the knowledge and experience gained, and keeping in mind the numerous pathologic conditions to which the bladder is heir, the plan of anastomosing the bladder to the rectum seemed feasible and was carried out on fifteen dogs, with good results. After looking over all the available literature upon the subject

Mrs. A. S., 38 years old, presented herself March, 1899, with a large tumor on the right thigh. Her mothers' family were healthy, also that of the father, with the exception of one brother dying at 40 with consumption, probably contracted by exposure during the Civil War. Menstruation began when she was 15 years of age and was regular up to within the last two months, when it stopped. She has been married twice, to her first husband when she was 16, and by him had two children, one still-born and one living six years, dying of "slow fever." At 19 she married her second husband, and has had one child, now 8 years old and healthy. Her first husband died of consumption. She has been in good health up to the present illness, which began about two years ago with slight tenderness about the right thigh. Two months later

HISTORY. —Mr. B., a retired farmer, aged 62, presented himself at my office complaining of pain in the abdomen, and alternate attacks of constipation and diarrhea. The personal and family history was negative. The patient had always been well, with the exception of having been confined to his bed for a few days, some years ago, on account of having been kicked in the abdomen by a horse. Examination of the abdomen revealed a mass about the size of an orange in the cecal region. The patient had observed the occurrence of ribbon stools. OPERATION. —April 29, 1910, at the German Hospital, I did a laparotomy and found an extensive involvement of the cecum, appendix and adjacent glands. A macroscopic diagnosis of carcinoma was made and the following operation performed: The ileum was clamped and divided three inches from the ileocecal junction. The cut proximal end was closed and inverted