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Biomedical subjects

A Wald

Publications and source records attributed to A Wald.

At least 127 records · Page 7Linked to original sources
PubMed1989

Fluorescent light interferes with pulse oximetry.

Arterial oxygen saturation (SaO2) values displayed on the pulse oximeter dropped dramatically in 3 children undergoing neurosurgical procedures when a hand-held fluorescent light was used to observe the patients. Pulse rates were unchanged on both the electrocardiograph and pulse oximeter. Electromagnetic interference was excluded as the cause of desaturation. A great deal of energy was emitted by the hand-held light in the 660-nm region, which is one of the wavelengths used by the oximeter. False readings of pulse rate and SaO2 values caused by ambient light could be avoided if oximeter probes were manufactured of black opaque material that does not transmit light or enclosed in an opaque plastic housing.

Child, Preschool↗
PubMed1989

Influence of gender and menopause on gastric emptying and motility.

The aims of this study were to determine (a) if there are differences in gastric emptying rates of a mixed liquid and solid meal between men and women, (b) if menopausal status affects gastric emptying, and (c) whether differences in solid emptying rates are associated with alterations in postprandial antral motility parameters. A dual-isotope technique was used to measure gastric emptying in 20 men, 18 premenopausal women, 14 postmenopausal women, and 8 postmenopausal women taking estrogen and progesterone hormone replacement. A multilumen perfusion catheter was used to measure antral motility in 6 men and 6 premenopausal women. Premenopausal women, postmenopausal women, and postmenopausal women taking oral estrogen and progesterone had slower gastric emptying of liquids than did men (p less than 0.025, less than 0.05, and less than 0.025, respectively). Both premenopausal women and postmenopausal women taking sex hormone replacement therapy had slower emptying of solids than did men (p less than 0.025 and less than 0.05) but, in contrast to liquids, postmenopausal women not on hormone replacement emptied solids at a rate similar to that of men. There were no differences in postprandial antral motility parameters between men and premenopausal women. These findings support the hypothesis that sex steroid hormones have variable inhibitory effects on gastric emptying of a mixed meal and this should be considered when studying gastric emptying in disorders that occur predominantly in premenopausal women.

Adult↗
PubMed1989

Psychological and physiological characteristics of patients with severe idiopathic constipation.

This study prospectively evaluated psychological profiles and selected parameters of colonic and anorectal sensorimotor function in 25 consecutive patients who were referred for severe idiopathic constipation. Measurement of colonic transit of radiopaque markers divided patients into those with normal transit (n = 10) and those with slow transit (n = 15). As measured by the Hopkins Symptom Checklist, patients with normal transit constipation demonstrated significantly higher scores for psychological distress in the global symptoms index and nine clinical subscales than did those with slow transit constipation and gastrointestinal control subjects (n = 25). Both groups with constipation had decreased rectal sensation compared with controls but there was no relationship to rectal compliance or threshold of internal sphincter relaxation. There was also no relation between abnormalities of anorectal parameters, including expulsion dynamics, and psychological profiles in two groups. Measurement of colonic transit and psychological profiles in patients with severe idiopathic constipation identify two groups of patients with respect to possible pathogenesis of symptoms. Accordingly, different therapeutic approaches may be required, one behaviourally and psychologically based and the other focused on the possible modification of disordered colonic transit.

Adolescent↗
PubMed1989

Colonic and anorectal dysfunction associated with multiple sclerosis.

Gastrointestinal symptoms are common in patients with multiple sclerosis. In a recent survey of 280 unselected patients with multiple sclerosis, 68% reported constipation and/or fecal incontinence. In contrast to bladder dysfunction which has been extensively studied, bowel dysfunction in this disease has received relatively little attention. This review outlines the clinical features and pathophysiology of constipation and fecal incontinence in multiple sclerosis and presents treatment options and suggestions for investigation of colonic and anorectal dysfunction in this population.

Colon↗
PubMed1989

Does gender or the menstrual cycle affect colonic transit?

Controversy exists as to whether slowing of colonic transit occurs in the high progesterone luteal phase of the menstrual cycle. To clarify this issue, colonic transit studies using radiopaque markers were performed on 10 women in the follicular phase, 10 women in the luteal phase of the menstrual cycle, and five women on oral contraceptives, and the results were compared with transit times in 11 male controls. No significant differences in colonic transit were found between either phase of the menstrual cycle. Colonic transit in women was slower than in men, but this was not statistically significant. In the clinical setting, therefore, colonic transit studies can be performed throughout the menstrual cycle or when taking oral contraceptives. In addition, a single standard for normal values can be used for both men and women.

Adult↗
PubMed1987

Normal variation in radionuclide esophageal transit studies.

We studied the esophageal transit of aqueous 99mTc-sulfur colloid in 16 normal subjects, 8 of them twice. Condensed dynamic images having a spatial and a temporal dimension fell into four patterns: (1) idealized form, (2) retrograde motion, (3) splitting of the bolus, and (4) generation of a substantial residual component. The retrograde index quantifying retrograde motion in the first swallow (RI), the rapid component mean transit time through the esophagus in the first swallow (MTT), and the residual fractions after the first, second, and fourth swallows [RF(1), RF(2), and RF(4)] were computed. The intrasubject and intersubject variation of the quantitative results suggest that normal subjects have sporadic aberrant swallows with high RI and/or RF(1). RF(2) and RF(4) showed a significant positive correlation with age.

Adult↗
PubMed1986

Fecal incontinence. Effective nonsurgical treatments.

Management of the patient with fecal soiling begins with a careful evaluation of possible contributing factors, followed by anorectal examination, neurologic and psychosocial testing, and workup for chronic diarrhea, if present. In many patients, these procedures should be supplemented by radiologic and manometric studies to determine if structural or functional anorectal abnormalities are present. Therapeutic approaches include behavioral, pharmacologic, and surgical methods, which should be carefully considered in relation to the underlying cause of incontinence. For the experienced physician, therapy can be gratifyingly effective in many patients with fecal soiling and can dramatically improve their quality of life.

Adult↗
PubMed1986

Utility of fecal fat concentrations as screening test in pancreatic insufficiency.

We explored the utility of fecal fat concentration (gram fecal fat per 100 gram wet stool weight) as a screening test for pancreatic steatorrhea. Data were analyzed on 24 patients with pancreatic insufficiency and steatorrhea, six groups of patients (N = 70) with nonpancreatic causes of steatorrhea, and 31 controls without steatorrhea. Patients with pancreatic steatorrhea had significantly (P less than 0.05) higher mean fecal fat concentrations than all groups except for patients with hepatobiliary disease. Using a fecal fat concentration of greater than 9.5% as a cutoff point in all patients with steatorrhea, the test was 41.7% sensitive and 92.0% specific for the diagnosis of pancreatic insufficiency. For patients with fecal fat excretion greater than 20 g/day, the test increased in sensitivity to 61.5% but specificity dropped to 85.3%. Measurements of fecal fat concentrations are therefore only moderately helpful, and further evidence is required to secure a diagnosis of pancreatic steatorrhea.

Celiac Disease↗
PubMed1986

Celiac sprue complicated by lymphoma presenting with multiple gastric ulcers.

A 40-yr-old woman with celiac sprue, which had responded clinically and histologically to gluten elimination, subsequently developed gastrointestinal lymphoma. Although this has been described in the small intestine of patients with celiac sprue, the unique feature in this patient was her initial presentation with multiple gastric ulcers refractory to conventional medical therapy. This case demonstrates that lymphoma complicating celiac sprue may present with multiple refractory gastric ulcers in addition to those occurring in the small intestine.

Adult↗
PubMed1986

Prevalence of behavior problems and mental health utilization among encopretic children: implications for behavioral pediatrics.

The psychiatric literature traditionally has viewed encopretic children as having severe and characteristic behavior problems. Current psychiatric views as expressed in the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition (DSM-III), and in the pediatric literature, however, tend to regard the behavior problems of encopretic children as being rather mild or secondary to the consequences of the encopresis itself. Using a behavioral checklist with empirically derived factors (the Child Behavior Checklist), 55 children presenting for medical treatment of their encopresis have been assessed. Numerous behavior problems are reported on parental ratings, but the overall severity of behavior problems in this group of children falls below that found in children with behavior problems who are referred for mental health services. Most children presenting for medical management of encopresis have not been seen or evaluated by mental health services. Encopresis is a disorder in which psychological evaluation and intervention by the pediatrician may be advisable.

Adolescent↗
PubMed1986

Colonic transit and anorectal manometry in chronic idiopathic constipation.

Twenty-one patients with refractory idiopathic constipation underwent studies of segmental colonic transit of radiopaque markers and anorectal manometry to determine the utility of these tests in planning therapy and in predicting subsequent clinical outcome. Colonic transit studies defined three groups: normal transit (n = 6), colonic inertia (n = 8), and distal slowing (n = 7). Normal transit was universally associated with evidence of psychosocial disturbances. During follow-ups ranging from 23.2 to 26.7 months, six of eight patients with colonic inertia failed to improve compared with only one of seven with distal slowing. Anorectal manometry was useful in excluding abnormalities of anorectal function. Segmental colonic transit of radiopaque markers is a simple and useful test in the evaluation of refractory idiopathic constipation and appears to have both prognostic and therapeutic utility in selected cases.

Adolescent↗
PubMed1984

Anorectal sensorimotor dysfunction in fecal incontinence and diabetes mellitus. Modification with biofeedback therapy.

We studied anorectal sensory and motor function in 14 diabetics with fecal incontinence and compared the results with those in 13 continent diabetics, 31 nondiabetics with fecal incontinence, and 11 continent nondiabetics. The threshold volume at which diabetic patients with fecal incontinence experienced rectal sensation was higher (25.0 +/- 3.4 ml [mean +/- S.E.M.]) than that in continent diabetics (13.0 +/- 2.4 ml) or nondiabetics with or without incontinence (14.5 +/- 1.5 and 12.5 +/- 1.8 ml, respectively; P less than 0.02). Biofeedback conditioning in 11 incontinent diabetics led to normal sensory thresholds in six of seven patients with pretreatment thresholds above 20 ml; five of these six became continent. Biofeedback also improved external-sphincter function in nine diabetics, eight of whom became continent. Overall, 8 of 11 diabetics had a reduction in fecal soiling after biofeedback therapy. We conclude that fecal incontinence in diabetics may be caused by decreased rectal sensation or impaired function of the external sphincter or both, and that these abnormalities can often be improved by biofeedback therapy with resultant reestablishment of bowel control.

Adult↗