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A Wald

Publications and source records attributed to A Wald.

At least 91 records · Page 5Linked to original sources
PubMed1995

Measuring health-related quality of life in persons with genital herpes.

A disease-specific measure was needed for use in an international clinical trial to evaluate an investigational drug for genital herpes. A new measure was developed initially in the UK and translated and adapted for use in France, Italy, Germany, Denmark, Spain and the USA. This paper describes the translation and adaptation of the USA measure. It also describes the assessment of internal consistency, reproducibility, content validity, and construct validity (convergent and discriminant) of the measure. Two outcome measures of the final genital herpes-specific measure were developed: (1) a 21-item symptoms subscale; and (2) a 20-item HRQOL subscale. Each measure was scored and analyzed separately; the psychometric testing discussed in this paper refers to the HRQOL subscale only. The internal consistency of the HRQOL subscale is high (r = 0.93), as is the reproducibility measured with a two week interval (r = 0.85). Convergent validity is moderate to high. (Fleming Self-Regard subscale, r = 0.48; SF-36 Social Functioning dimension r = 0.59; SF-36 Mental Health dimension r = 0.50). The number of herpes outbreaks in the past year was a significant predictor of scores on the HRQOL subscale (0-1 outbreaks, mean = 82.1; 2+ outbreaks, mean = 72.1, p = 0.058) suggesting discriminant validity. The measure is currently in a phase III clinical trial including anti-viral therapy where the question of responsiveness can be addressed.

Adult↗
PubMed1995

Intraoperative data acquisition for the study of cerebral dysfunction following cardiopulmonary bypass.

As a first step in our study to document postoperative cerebral dysfunction, and to determine whether global cerebral blood flow can be implicated in the etiology of this postoperative change, we have assembled a flexible data acquisition system to acquire and record data from four independent sources, three in digital form and one analog. Each of the monitors that we use has a different requirement: One has eight channels of analog output; the other three have RS-232 digital outputs, each with a data stream with different characteristics. The central element of our data collection is a personal computer running the data acquisition and analysis program, LabVIEW for Windows (National Instruments, Austin, TX). All data are processed through separate LabVIEW global variables; the data strings are concatenated and stored on the hard disk in a spreadsheet format for further analysis. We illustrate an intraoperative recording made during cardiopulmonary bypass (CPB) by showing a graph of the mean arterial pressure (MAP), mixed venous oxyhemoglobin saturation recorded from the jugular bulb (JVO2Sat), and temperature measured from the nasopharynx. A decrease in the MAP after unclamping the aorta is accompanied by a decrease in JVO2Sat.

Blood Pressure↗
PubMed1995

Do standard monitoring sites reflect true brain temperature when profound hypothermia is rapidly induced and reversed?

BACKGROUND: Brain temperature is closely approximated by most body temperature measurements under normal anesthetic conditions. However, when thermal autoregulation is overridden, large temperature gradients may prevail. This study sought to determine which of the standard temperature monitoring sites best approximates brain temperature when deep hypothermia is rapidly induced and reversed during cardiopulmonary bypass. METHODS: Twenty-seven patients underwent cardiopulmonary bypass and deep hypothermic circulatory arrest in order for each to have a giant cerebral aneurysm surgically clipped. Brain temperatures were measured directly with a thermocouple embedded in the cerebral cortex. Eight other body temperatures were monitored simultaneously with less invasive sensors at standard sites. RESULTS: Brain temperature decreased from 32.6 +/- 1.4 degrees C (mean +/- SD) to 16.7 +/- 1.7 degrees C in 28 +/- 7 min, for an average cerebral cooling rate of 0.59 +/- 0.15 degrees C/min. Circulatory arrest lasted 24 +/- 15 min and was followed by 63 +/- 17 min of rewarming at 0.31 +/- 0.09 degrees C/min. None of the monitored sites tracked cerebral temperature well throughout the entire hypothermic period. During rapid temperature change, nasopharyngeal, esophageal, and pulmonary artery temperatures corresponded to brain temperature with smaller mean differences than did those of the tympanic membrane, bladder, rectum, axilla, and sole of the foot. At circulatory arrest, nasopharyngeal, esophageal, and pulmonary artery mean temperatures were within 1 degree C of brain temperature, even though individual patients frequently exhibited disparate values at those sites. CONCLUSIONS: When profound hypothermia is rapidly induced and reversed, temperature measurements made at standard monitoring sites may not reflect cerebral temperature. Measurements from the nasopharynx, esophagus, and pulmonary artery tend to match brain temperature best but only with an array of data can one feel comfortable disregarding discordant readings.

Adult↗
PubMed1995

Incontinence and anorectal dysfunction in patients with diabetes mellitus.

The elucidation of the pathogenesis of faecal incontinence in patients with advanced diabetes mellitus has progressed during the last 15 years. In contrast to earlier concepts which promoted the concept that high stool volumes overwhelm normal continence mechanisms, recent studies indicate that the vast majority of diabetic patients with faecal incontinence have normal or only moderately increased daily stool volumes, but also exhibit multiple abnormalities of anorectal sensory and motor functions. These changes are not observed in continent diabetic patients. Treatment consists of pharmacologic and dietary interventions to modulate diarrhoea, and biofeedback techniques to improve rectal sensory thresholds and striated muscle responsiveness of continence mechanisms. This dual approach is often successful and is free of risks.

Anal Canal↗
PubMed1995

Hepatitis E.

Explore the source record for details and available documents.

Adult↗
PubMed1994

Constipation in the elderly: influence of dietary, psychological, and physiological factors.

OBJECTIVE: To identify dietary, psychological, and physiological characteristics of older individuals with chronic constipation, compared with a control group of individuals without constipation, and identify correlates of colonic transit time. DESIGN: Cohort study. SETTING: University hospital and affiliated clinics. PARTICIPANTS: Eighteen constipated and 18 control subjects who were nondemented, ambulatory, community-dwelling outpatients over the age of 60 years. MEASURES: Measures included a 1-week food diary, diet questionnaire, bowel diary, the Hopkins Symptom Checklist (SCL-90R), colonic transit study, and medical history, including queries about activity, medications, medical illnesses, and bowel symptoms. MAIN RESULTS: Constipated subjects reported consuming fewer meals per day compared with control subjects (P < 0.01) and a tendency to consume fewer calories (P = 0.07). There were no differences between groups on fiber or fluid intake or any of the other dietary parameters. However, slow colonic transit was significantly related to low caloric intake (P < 0.0001), higher percent of protein in the diet (P < 0.05), low fluid intake (P < 0.05), and to psychological symptoms of somatization, obsessive-compulsiveness, depression, anxiety, and the global severity index (P < 0.05). Transit times were unrelated to crude or dietary fiber intake, activity level, or age. CONCLUSIONS: The data suggest that constipation in this older population is related to caloric intake rather than fiber consumption or other dietary qualities. Psychological distress is associated with slowed colonic transit and should be investigated further as a possible etiologic factor in constipation.

Aged↗
PubMed1994

A randomized, double-blind, comparative trial comparing high- and standard-dose oral acyclovir for first-episode genital herpes infections.

Orally administered acyclovir ameliorates the clinical course and decreases the duration of viral shedding in patients with first-episode genital herpes infections. We investigated in a randomized, double-blind, comparative trial whether a higher (4 g) than standard (1 g) daily dose of oral acyclovir results in greater clinical benefit and influences the time to first recurrence. A total of 139 patients with first-episode genital herpes were randomized to receive orally 4 or 1 g of acyclovir daily. A total of 52 subjects were excluded from the efficacy analysis because most had recurrent disease. Of 87 eligible subjects, 28 (32%) had primary herpes simplex virus type 1 (HSV-1) infections, 48 (55%) had primary HSV-2 infections, and 11 (13%) had nonprimary HSV-2 infections. We did not find any statistically significant differences in the duration of symptoms or viral shedding between the two dose groups, nor did the median time to first recurrence differ between the two groups. Initiation of therapy with either dose within the first 3 days of the appearance of symptoms shortened the duration of the first episode. Adverse gastrointestinal effects developed in 8% of subjects receiving the higher dose, whereas no adverse reactions were observed among those receiving the standard dose (P = 0.10). We conclude that, in comparison with standard therapy, higher-dose oral acyclovir does not result in additional clinical benefit or modify the time to first recurrence. The present study may have implications for the development and efficacy of congeners of acyclovir which provide higher levels in blood than the standard dose of acyclovir.

Acyclovir↗
PubMed1994

Cervical antibodies in patients with oral herpes simplex virus type 1 (HSV-1) infection: local anamnestic responses after genital HSV-2 infection.

Herpes simplex virus (HSV)-specific immunoglobulin A, immunoglobulin G, and secretory-component-containing immunoglobulins were identified in cervical and salivary secretions from six subjects with oral HSV type 1 (HSV-1) infections. Anamnestic cervical and salivary antibody responses were detected in two HSV-1-seropositive women with newly acquired genital HSV-2 infections. These data implicate the common mucosal immune system in antibody responses to HSV.

Adult↗
PubMed1994

Colonic and anorectal motility testing in clinical practice.

Colonic and anorectal motor activity can be evaluated by a variety of diagnostic techniques. These include anorectal and colonic manometry, radiographic and scintigraphic studies of defecation and continence, colonic transit using radioopaque markers or radioisotopes, neurophysiological studies of pelvic floor striated muscles and pudendal nerves, and anal endosonography. This article reviews these techniques and assesses their value and limitations in evaluating patients with constipation, defecatory disorders, and fecal incontinence.

Anal Canal↗
PubMed1994

Clinical evaluation and treatment of constipation.

Constipation is a symptom but can generally be defined as less than three bowel movements per week. The history and physical examination should be evaluated for stool size, frequency, and straining and discomfort on defecation. The influence of age, gender, and society should also be considered. The etiologies of constipation can be classified as 1. dietary; 2. drug induced; 3. metabolic; 4. neurologic; or 5. anatomic. If hard or small stools are part of the initial evaluation, then a dietary approach of increased dietary fiber intake can be used as a therapeutic trial. If it does not succeed or the history and physical evaluation indicate an etiology other than dietary, then barium-contrast enema, flexible sigmoidoscopy, colonoscopy, transit time, or anorectal manometry can be used selectively in further evaluation. Detailed methods of treatment are described, such as how to increase fiber intake by use of dietary history and recommendation of appropriate fiber, food, or supplement intake. Methods of using behavioral changes such as laxation and toilet-training programs are described. In selected situations pharmacologic therapy and, rarely, surgical intervention, can be useful.

Adult↗
PubMed1993

Scintigraphic studies of rectal emptying in patients with constipation and defecatory difficulty.

We prospectively evaluated 38 adult patients with chronic constipation with and without defecatory difficulties using a newly described scintigraphic test to measure rectal emptying and compared them to 20 healthy controls. All patients underwent anorectal manometry, and 30 who complained of infrequent defecation underwent a colonic transit study using radiopaque markers. Control subjects promptly evacuated both 100 ml and 200 ml artificial stool in a characteristic fashion, but three evacuated none of the 100-ml volume and two had no evacuation of the 200-ml stool (inhibited controls). Constipated patients exhibited three patterns of emptying: (1) normal emptying of both volumes (47%); (2) poor emptying of both volumes or inhibited defecation (29%); and (3) normal emptying of the 200-ml but abnormal evacuation of the 100-ml volume (24%). An abnormal expulsion pattern during manometry occurred in 21% of patients and was strongly associated with the inhibited defecation pattern. However, defecation patterns could not be predicted on the basis of age, gender, symptoms, duration of complaints, colonic transit, or other rectal manometric parameters. Although rectal scintigraphy has potential advantages as a diagnostic test in terms of quantitation and decreased radiation exposure, the inability of the test to distinguish patients with slow transit constipation and defecatory complaints makes the potential utility of this test of uncertain value in clinical and investigative settings.

Adult↗
PubMed1993

Physiologic and psychologic characteristics of an elderly population with chronic constipation.

OBJECTIVES: To characterize colorectal physiologic parameters and psychological profiles in subjects > or = 60 yr with chronic constipation who have not sought medical advice. METHODS: Colorectal physiologic studies and psychologic profiles were obtained in 18 self-identified constipated subjects and 17 nonconstipated control subjects. Constipation was defined as two or fewer bowel movements/week and/or defecatory difficulty for at least 6 months. All subjects underwent colonic transit with radiopaque markers, anorectal manometry and completed a self rated inventory assessing psychological distress (SCL-90-R). RESULTS: Slow colonic transit occurred in five constipated subjects. Pelvic floor dyssynergia and/or increased rectal compliance were found in nine subjects versus only two controls. One-third of constipated subjects scored in the top 10th percentile for global psychologic distress with higher scores for somatization, depression, and anxiety than control subjects. Neither physiologic nor psychologic abnormalities were predictable on the basis of patterns of bowel complaints. CONCLUSIONS: Colorectal physiologic and psychologic dysfunctions are common in elderly constipated subjects who do not seek medical attention for bowel dysfunction.

Aged↗
PubMed1993

Obesity and weight reduction do not influence gastric emptying and antral motility.

A dual radioisotope technique was used to measure gastric emptying of a mixed solid and liquid meal in 30 obese (> 125% of ideal body weight) subjects and 23 age- and sex-matched nonobese control subjects. Gastroduodenal motility studies were also performed on seven obese and 10 nonobese subjects to compare postprandial antral motility. In addition, eight obese subjects underwent gastric emptying studies before and after substantial weight reduction (mean 8.3%). Gastric emptying of both solids and liquids was similar in obese and nonobese subjects, and antral motility indices did not differ between the groups. Gastric emptying rates before and after substantial weight reduction were similar. We conclude that neither gastric emptying nor antral motility appear to be abnormal in morbidly obese subjects; neither does gastric emptying appear to be affected by substantial acute weight reduction.

Adult↗