Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 25
Filter
1.
Can J Psychiatry ; 46(7): 649-51, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11582828

ABSTRACT

OBJECTIVE: To compare the relation between peritraumatic dissociation and acute stress and the early development of posttraumatic stress disorder (PTSD) in victims of general crime. METHOD: A total of 48 subjects were assessed within 24 hours of the trauma, using the Peritraumatic Dissociative Experiences Questionnaire Self-Report Version (PDEQ-SRV). They were followed longitudinally to assess acute stress (2 weeks after the assault,) using the Standford Acute Stress Reaction Questionnaire (SASRQ), and posttraumatic stress (at 5 weeks), using the Clinician-Administered PTSD Scale (CAPS) and the Impact of Event Scale (IES). RESULTS: Among PTSD subjects mean PDEQ scores were significantly higher (mean 3, SD 0.9) than in those without PTSD (mean 2.3, SD 0.7) (t = 2.78, df 46, P = 0.007). Among PTSD subjects, mean SASRQ scores were significantly higher (mean 97.9, SD 29.2) than in those without PTSD (mean 54.8, SD 28.2) (t = 4.9, df 46, P = 0.00007). CONCLUSIONS: High levels of peritraumatic dissociation and acute stress following violent assault are risk factors for early PTSD. Identifying acute reexperiencing can help the clinician identify subjects at highest risk.


Subject(s)
Crime Victims/psychology , Crime , Dissociative Disorders/etiology , Stress Disorders, Post-Traumatic/psychology , Stress, Psychological/etiology , Acute Disease , Adult , Dissociative Disorders/diagnosis , Female , Follow-Up Studies , Humans , Male , Severity of Illness Index , Stress, Psychological/diagnosis , Surveys and Questionnaires , Time Factors
3.
Ann Thorac Surg ; 70(3): 702-10, 2000 Sep.
Article in English | MEDLINE | ID: mdl-11016297

ABSTRACT

BACKGROUND: In this study we explored different risk model options to provide clinicians with predictions for resource utilization. The hypotheses were that predictors of mortality are not predictive of resource consumption, and that there is a correlation between cost estimates derived using a cost-to-charge ratio or a product-line costing approach. METHODS: From March 1992 to June 1995, 2,481 University of Colorado Hospital patients admitted for ischemic heart disease were classified by diagnosis-related group code as having undergone or experienced coronary bypass procedures (CBP), percutaneous cardiovascular procedures (PCVP), acute myocardial infarction (AMI), and other cardiac-related discharges (Other). For each diagnosis-related group, Cox proportional hazards models were developed to determine predictors of cost, charges, and length of stay. RESULTS: The diagnosis groups differed in the clinical factors that predicted resource use. As the two costing methods were highly correlated, either approach may be used to assess relative resource consumption provided costs are reconciled to audited financial statements. CONCLUSIONS: To develop valid prediction models for costs of care, the clinical risk factors that are traditionally used to predict risk-adjusted mortality may need to be expanded.


Subject(s)
Costs and Cost Analysis , Fees and Charges , Length of Stay , Myocardial Ischemia/economics , Aged , Colorado , Diagnosis-Related Groups , Female , Humans , Male , Middle Aged , Models, Theoretical , Myocardial Ischemia/mortality , Myocardial Ischemia/therapy , Risk Factors , Severity of Illness Index
5.
Can J Psychiatry ; 45(10): 932-4, 2000 Dec.
Article in French | MEDLINE | ID: mdl-11190364

ABSTRACT

OBJECTIVES: Acute stress responses following a trauma indicate a sensitivity to posttraumatic stress disorder (PTSD), and is often comorbid with depression. Earlier exposure to a traumatic event can be an additional risk factor in PTSD development. METHOD: Eight injured patients hospitalized after a major air disaster were monitored and assessed for a month. The symptoms of acute stress response (ASR), PTSD, and depression were assessed using DSM-IV criteria immediately following the accident, then each week thereafter. The Impact of Event Scale (IES) was completed on the 30th day (D30). RESULTS: Four patients presented with an ASR, and 3 of them had a PTSD at D30. Of those 3 patients with PTSD, 2 presented with an associated depression. These 2 patients had been exposed to a traumatic event before the disaster; and a significant relation was found between the history of the earlier trauma and the PTSD associated with depression. CONCLUSION: The traumatized victims with a history of earlier traumas seem more susceptible to developing a PTSD associated with depression.


Subject(s)
Accidents, Aviation/psychology , Adjustment Disorders/diagnosis , Stress Disorders, Post-Traumatic/diagnosis , Adjustment Disorders/psychology , Crisis Intervention , Follow-Up Studies , Humans , Life Change Events , Male , Middle Aged , Personality Inventory , Recurrence , Risk Factors , Stress Disorders, Post-Traumatic/psychology , Wounds and Injuries/psychology
7.
9.
Dig Dis Sci ; 41(4): 749-53, 1996 Apr.
Article in English | MEDLINE | ID: mdl-8674396

ABSTRACT

Our objective was to monitor serum and urine biochemical changes after oral sodium phosphate cleansing in a prospectively designed study. The study subjects were seven healthy, asymptomatic adults. Sodium phosphate 45 ml diluted in 45 ml water was given orally at baseline and 12 hr later. Calcium, ionized calcium, phosphorus, sodium, potassium, creatinine, and PTH were analyzed at 2, 4, 6, 9, 12, 14, 16, 18, 21 and 24 hr after the first challenge. Urinary calcium, phosphorus, sodium, potassium, and cyclic AMP were analyzed at baseline and every 2 hr after oral sodium phosphate. Blood pressure, pulse, and respiratory rate were recorded every 2 hr and symptom questionnaires using visual analog scales were completed. A marked rise in phosphorus (peak range 3.6-12.4 mg/dl, P < 0.001) and falls in calcium (P < 0.001) and ionized calcium (P < 0.001) were seen. Rises seen in PTH and urinary cAMP confirmed the physiologic significance of the biochemical effect. There were no significant changes in other serum and urine laboratory or clinical assessments. Reported significant symptoms included bloating, cramps, abdominal pain, and nausea. Significant hypocalcemia and hyperphosphatemia after oral sodium phosphate raises concern about its use in normal individuals. Oral sodium phosphate should not be administered in patients with cardiopulmonary, renal, or hepatic disease.


Subject(s)
Hypocalcemia/chemically induced , Phosphates/adverse effects , Phosphorus/blood , Water-Electrolyte Imbalance/chemically induced , Abdominal Pain/chemically induced , Administration, Oral , Adult , Colonoscopy , Female , Humans , Male , Nausea/chemically induced , Phosphates/administration & dosage , Prospective Studies , Therapeutic Irrigation
10.
Ann Thorac Surg ; 61(1): 17-20, 1996 Jan.
Article in English | MEDLINE | ID: mdl-8561546

ABSTRACT

BACKGROUND: The purpose of this study was to determine whether risk-adjusted coronary artery bypass grafting mortality rates are significantly related to coronary artery bypass grafting surgical procedure volume within the Department of Veterans Affairs hospital system. METHODS: From April 1987 to September 1992, expected mortality rates were calculated for 23,986 coronary artery bypass grafting procedures performed at 44 different Veterans Affairs hospitals. RESULTS: This study found a statistically significant relationship between annual hospital coronary artery bypass grafting volume and observed mortality rates (p < 0.02). However, no statistically significant relationship between coronary artery bypass grafting volume and risk-adjusted operative mortality was found (p = 0.10). Using analysis of variance on hospital-level data, hospitals with 100 or less cases per year have higher observed to expected mortality ratios than hospitals performing more than 100 cases per year (p = 0.03). Using Poisson regression models, however, a volume threshold could not be found. CONCLUSIONS: These findings are consistent with the current Veterans Affairs policy requirements to periodically review quality at low-volume hospitals.


Subject(s)
Coronary Artery Bypass/mortality , Hospitals, Veterans/statistics & numerical data , Analysis of Variance , Coronary Artery Bypass/statistics & numerical data , Hospital Mortality , Humans , Poisson Distribution , Risk Factors
12.
Horm Metab Res ; 25(7): 348-52, 1993 Jul.
Article in English | MEDLINE | ID: mdl-8406318

ABSTRACT

Extrapancreatic activity of the sulfonylurea, glipizide, was evaluated in the neonatal streptozotocin-induced rat model of noninsulin-dependent diabetes. Two day old Wistar rats were given a bolus of streptozotocin (90 mg/kg i.p.) to cause noninsulin-dependent diabetes; these animals became severely glucose intolerant and eventually developed a cardiomyopathy characterized by reduced heart rate, contractility and cardiac output. Male littermates injected with citrate buffer served as nondiabetic controls. At four weeks of age, the nondiabetic and NIDD rats were administered by gavage either glipizide (2.5 mg/kg) or the methyl cellulose vehicle. Throughout the treatment protocol, no difference in the degree of glucose intolerance was observed between the glipizide-treated and vehicle-treated animals. Glipizide therapy also was ineffective in improving plasma insulin levels, which were significantly depressed in the diabetic group. Yet, animals treated with glipizide for one year exhibited improved myocardial contractile function relative to the vehicle-fed or ad lib fed diabetic animals. Heart rate was significantly elevated and there was a tendency for both the rate of relaxation and contractility to be elevated in sulfonylurea-treated group. Glipizide also reduced the degree of insulin resistance in the heart. Since these changes occur in the absence of changes in glucose tolerance or insulin levels, the heart appears to be very sensitive to the direct effects of the sulfonylureas.


Subject(s)
Diabetes Mellitus, Experimental/pathology , Diabetes Mellitus, Type 2/pathology , Glipizide/pharmacology , Myocardium/pathology , Animals , Animals, Newborn/physiology , Blood Glucose/metabolism , Cardiac Output, Low/chemically induced , Glucose/metabolism , Glucose Tolerance Test , Heart Rate/drug effects , Insulin/blood , Insulin Resistance/physiology , Lactates/blood , Male , Myocardial Contraction/drug effects , Perfusion , Rats , Rats, Wistar
13.
South Med J ; 86(2): 235-8, 1993 Feb.
Article in English | MEDLINE | ID: mdl-8434302

ABSTRACT

Cases of coexisting Cushing's disease and unilateral adrenal tumor are rare, and there are conflicting reports in the literature regarding both the pathophysiology and the incidence. We have reported the case of a patient with a biochemically inactive incidental adrenal mass in whom pituitary-dependent Cushing's syndrome developed during follow-up. Authors of past reports have suggested that transitional change is responsible for the adrenal disease. A complete review of the literature has shown that cases of coexisting pituitary Cushing's disease and unilateral adrenal tumor, although rare, are more common than was previously believed. After studying a case in which the adrenal mass was present before disease developed, we suggest that the coexistence may be incidental in some cases.


Subject(s)
Adenoma/diagnosis , Adrenal Gland Neoplasms/diagnosis , Cushing Syndrome/diagnosis , 17-Hydroxycorticosteroids/urine , Adenoma/complications , Adenoma/epidemiology , Adrenal Gland Neoplasms/complications , Adrenal Gland Neoplasms/epidemiology , Adult , Comorbidity , Cushing Syndrome/complications , Cushing Syndrome/epidemiology , Dehydroepiandrosterone/blood , Dexamethasone , Female , Humans , Hydrocortisone/blood , Hydrocortisone/urine , Male , Middle Aged , Prevalence , Tomography, X-Ray Computed
14.
Am J Clin Pathol ; 95(2): 207-17, 1991 Feb.
Article in English | MEDLINE | ID: mdl-1899530

ABSTRACT

The performance of the Coulter STKS (Coulter, Hialeah, FL) was evaluated in a busy computerized teaching hospital laboratory. The STKS was compared with a Coulter S Plus IV and manually performed 400 white blood-cell differentials. The measured blood-count parameters (i.e., white blood cells [WBCs], red blood cells [RBCs], hemoglobulin [Hb], mean corpuscular volume [MCV], and platelets [PLTs]), compared very well between the two aperture impedance-based systems; precision, linearity, and lack of carryover were excellent. The STKS WBC differential (DIFF), derived from a combination of aperture impedance, aperture conductance, and laser light scatter, also was precise; linear and carryover were insignificant. The DIFFs (n = 424) compared well to the manual WBC differentials, with r values of 0.97, 0.97, 0.73, and 0.86 for neutrophils, lymphocytes, monocytes, and eosinophils, respectively. The DIFF and Suspect Flagging system produced 6.2% false negatives and 2.6% false positives when compared with the manual technique. These were further investigated and discussed. STKS DIFFs were stable for 18 to 24 hours in normal samples anticoagulated with K2EDTA and stored at 20 degrees C prior to analysis. Storage in the same anticoagulant at 4 degrees C and immediate aspiration preserved the DIFF analysis for considerably longer than 24 hours. These performance characteristics make the STKS a significant advancement in automated hematology.


Subject(s)
Autoanalysis , Blood Cell Count/instrumentation , Autoanalysis/standards , Autoanalysis/statistics & numerical data , Blood Preservation , Edetic Acid , Eosinophils/cytology , Evaluation Studies as Topic , False Negative Reactions , False Positive Reactions , Humans , Leukocyte Count/instrumentation , Lymphocytes/cytology , Monocytes/cytology , Neutrophils/cytology , Quality Control , Regression Analysis
15.
Med Lab Sci ; 47(4): 285-96, 1990 Oct.
Article in English | MEDLINE | ID: mdl-2283932

ABSTRACT

Four automated haematology analysers--the Coulter S + IV, Coulter STKS, Sysmex NE8000, and Technicon H1--were evaluated for operational and quantitative differences. The measured blood count parameters (red cell, white cell and platelet counts, mean cell volume [MCV], haematocrit and haemoglobin) all compared well with the S + IV, although the MCV showed the greatest variation. Of the white cell differential parameters, neutrophils, lymphocytes and eosinophils correlated well with manually performed 400 cell differential counts. Mononuclear cell and monocyte counts generated by the S + IV and NE8000 (respectively) compared poorly with the manual method. The STKS, NE8000 and H1 gave an acceptable five cell population differential from samples stored in K2EDTA for up to 18 h, although the monocyte count from the NE8000 showed considerable variation during that period. All instruments were shown to operate efficiently in either primary or secondary operating mode, but the STKS and NE8000 were considerably faster than the H1, and easier to use in the automated mode.


Subject(s)
Blood Cell Count/instrumentation , Evaluation Studies as Topic , Humans , Leukocyte Count/instrumentation , Regression Analysis
16.
J Clin Endocrinol Metab ; 60(2): 263-8, 1985 Feb.
Article in English | MEDLINE | ID: mdl-3965490

ABSTRACT

Decreased testicular function occurs as a concomitant of aging in men and is accentuated by the presence of systemic illness. Previous studies identified an intrinsic Leydig cell defect, as reflected by high LH to testosterone ratios and impaired hCG responsiveness in older men. This study questioned whether a qualitative change in LH secretion, as reflected by secretion of LH with an altered ratio of biological to immunological LH (B/I) activity, might occur during aging. To examine this possibility, we measured the levels of plasma LH by RIA and rat interstitial cell testosterone bioassay in 67 men, ranging from 20-80 yr of age. Mean LH levels measured by immunoassay were similar in healthy men older than 40 yr [11.4 +/- 1.0 (+/- SE) mIU/ml; n = 22] and those younger than 40 yr (9.4 +/- 0.6; n = 18; P less than 0.01). Mean bioactive LH levels were also similar (30.0 +/- 4.8 vs. 36.7 +/- 3.3). LH B/I ratios, however, were significantly lower in older men (2.52 +/- 0.33) compared to those in younger (4.10 +/- 0.34; P less than 0.01) men. Regression analysis confirmed the expected inverse relationship of B/I ratio with age (r = -0.47; P less than 0.01) and plasma testosterone with age (r = -0.35; P less than 0.05). Systemic illness independently lowered B/I LH ratios. Systemically ill men over 40 yr of age had lower ratios (1.05 +/- 0.08; n = 27) than age-matched healthy men (2.52 +/- 0.33; n = 22; P less than 0.01). The significant changes in B/I ratio among subgroups reflected modest changes in LH immunoactivity and larger alterations in LH bioactivity in certain subgroups. These findings indicate that the qualitative nature of LH secreted by the pituitary, as reflected by altered LH B/I ratios, may vary as a function of aging and illness in men.


Subject(s)
Aging , Disease/blood , Luteinizing Hormone/blood , Pituitary Gland/physiology , Testis/physiology , Adult , Aged , Humans , Male , Middle Aged , Pituitary Gland/physiopathology , Radioimmunoassay , Testis/physiopathology , Testosterone/blood
17.
Hum Genet ; 69(1): 79-85, 1985.
Article in English | MEDLINE | ID: mdl-3967892

ABSTRACT

Among women with 46,XY gonadal dysgenesis, there is a high incidence of gonadal tumors. Because of evidence of a connection between occurrence of those tumors, H-Y phenotype, and breast development, we surveyed 55 cases of 46,XY gonadal dysgenesis and 12 related cases involving chromosomal and/or skeletal abnormalities. Our survey, including three new cases presented here, indicates that H-Y phenotype but not breast development may be related to the development of the gonadoblastoma-dysgerminoma. Thus among women with 46,XY gonadal dysgenesis, there are H-Y- and H-Y+ classes, but gonadal tumors are found almost exclusively in the H-Y+ class. Yet one of our patients may represent an exception to the association of H-Y+ phenotype and gonadal tumors in this syndrome.


Subject(s)
Breast/growth & development , Dysgerminoma/genetics , Gonadal Dysgenesis, 46,XY/genetics , Gonadal Dysgenesis/genetics , H-Y Antigen/genetics , Ovarian Neoplasms/genetics , Adolescent , Adult , Cell Transformation, Neoplastic , Child , Dihydrotestosterone/analysis , Dysgerminoma/etiology , Estradiol/analysis , Estrone/analysis , Female , Gonadal Dysgenesis, 46,XY/metabolism , Humans , Hydrocortisone/analysis , Ovarian Neoplasms/etiology , Phenotype , Prolactin/analysis , Testosterone/analysis
19.
20.
J Clin Endocrinol Metab ; 55(4): 649-53, 1982 Oct.
Article in English | MEDLINE | ID: mdl-6809778

ABSTRACT

We tested the hypothesis that suppressive effects of endogenous opiate substances are involved in certain hypogonadotropic states. For this purpose, we studied gonadotropin secretion in idiopathic hypopituitarism (five children), constitutionally delayed adolescence (five boys), and Kallmann's syndrome (three men). Endogenous opiate pathways were antagonized by the iv infusion of naloxone hydrochloride at a dose previously shown to elicit a prompt and significant increase in serum levels of LH in normal men. Under these conditions, naloxone did not increase serially sampled serum concentrations or mean urinary levels of LH: or FSH in eight patients with idiopathic hypopituitarism or Kallmann's syndrome. Gonadotropin concentrations in four of five patients with constitutional delay of adolescence also were unaffected. In one boy with clinical and biochemical indices of late pubertal development, naloxone elicited a significant increase in LH levels in blood and urine, similar to the pattern observed in normal men. In contrast to results in experimental animals, naloxone did not suppress serum PRL concentration significantly in any subject. These observations suggest that: 1) endogenous opiate mechanisms are unlikely to constitute a principal factor in maintaining hypogonadotropism in idiopathic hypopituitarism, delayed adolescence, or Kallmann's syndrome, at least acutely; 2) endogenous opiate mechanisms also cannot be implicated in the acute regulation or PRL secretion in children; and 3) the capability of adult men, but not early pubertal boys, to respond with increased gonadotropin secretion during inhibition of opiate receptors suggests that maturation of the opiate-related neuroendocrine system occurs during the course of sexual development in the human.


Subject(s)
Follicle Stimulating Hormone/metabolism , Hypogonadism/metabolism , Hypopituitarism/metabolism , Luteinizing Hormone/metabolism , Naloxone , Puberty, Delayed/metabolism , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Prolactin/metabolism , Syndrome
SELECTION OF CITATIONS
SEARCH DETAIL
...