Biomedical subjects

D E Stewart

Publications and source records attributed to D E Stewart.

At least 91 records · Page 5Linked to original sources

PubMed1990

The changing faces of somatization.

The prevalence of several diseases popularized by the media is examined in a group of 50 consecutive patients allegedly suffering from environmental hypersensitivity disorder. Ninety percent of patients reported suffering from at least one other "fashionable" condition, including food allergies that cause psychological symptoms, postinfectious neuromyasthenia, candidiasis hypersensitivity, and severe premenstrual syndrome. Each of the conditions named above was endorsed by at least 50% of patients. Multiple endorsements were common, and the patients' attribution of the etiology of their symptoms varied with time. Physicians must become adept at identifying and managing somatizing patients, and the public must be educated about somatization and provided with reliable information about "fashionable" illnesses.

Adult↗

PubMed1990

Psychosocial aspects of chronic, clinically unconfirmed vulvovaginitis.

Women with chronic symptoms of vulvovaginitis referred to a university vulvovaginitis clinic were assessed on psychological and social (including sexual) variables to determine whether differences existed among women with unconfirmed vulvovaginitis, women with confirmed vulvovaginitis, and healthy controls. Eighty-three consecutive women with chronic symptoms of vulvovaginitis and 32 asymptomatic control women completed clinical examinations, cultures, and the following psychological tests or questionnaires: the Brief Symptom Inventory, the Center for Epidemiologic Studies--Depression Scale, the Dyadic Adjustment Scale, a sexual behavior and response questionnaire (Campion), and a study questionnaire. Statistical analyses (chi 2 and analysis of variance) were performed on the confirmed and unconfirmed vulvovaginitis and control groups of women. Women with confirmed and unconfirmed vulvovaginitis scored higher than control women on several psychological variables, but women with unconfirmed vulvovaginitis were found to be significantly more emotionally distressed on psychological tests and to report more discomfort during sexual intercourse than both women with confirmed vulvovaginitis and healthy controls. Psychosocial inquiry is important in the clinical assessment and management of such women.

Adult↗

PubMed1990

Pseudocyesis--a review and report of six cases.

Pseudocyesis is a rare condition in which a woman believes herself to be pregnant when she is not. Its incidence has fallen in the last fifty years, probably due to a number of sociocultural and medical factors. Six cases are described which show common features of recent pregnancy loss or infertility, psychological and medical naivete, social isolation, recent loss and membership in a cultural or religious group that focuses on childbearing as the central role of women. Etiology includes psychological, sociocultural and endocrine factors which interact with each other demonstrating the reciprocal interplay between mind and body. Guidelines are provided for the assessment and management of this ancient and fascinating condition.

Adjustment Disorders↗

PubMed1989

Electron transport in sulfate-reducing bacteria. Molecular modeling and NMR studies of the rubredoxin--tetraheme-cytochrome-c3 complex.

A hypothetical model of the complex formed between the iron-sulfur protein rubredoxin and the tetraheme cytochrome c3 from the sulfate-reducing bacteria Desulfovibrio vulgaris (Hildenborough) has been proposed utilizing computer graphic modeling, computational methods and NMR spectroscopy. The proposed complex appears feasible on the basis of complementary electrostatic interaction and steric factors and is consistent with the data from NMR experiments. In this model, the non-heme iron atom of rubredoxin is in close proximity to heme 1 of cytochrome c3. The complex is stabilized by charge-pair interactions and hydrogen bonds. This complex is compared to the flavodoxin-cytochrome c3 complex previously proposed [Stewart, D. E., LeGall, J., Moura, I., Moura, J. J. G., Peck, H. D. Jr, Xavier, A. V., Weiner, P. K. & Wampler, J. E. (1988) Biochemistry 27, 2444-2450] and new NMR data shows that both proteins interact with the same heme group of the cytochrome as postulated.

Binding Sites↗

PubMed1989

The low-frequency dependence of respiratory system resistance and elastance in normal dogs.

The resistance (R) and elastance (E) of the respiratory system were determined by fitting the equation: pressure = R x flow + E x volume to data obtained from normal anesthetized/paralyzed dogs during mechanical ventilation at different frequencies (5 to 50 breaths per min) and tidal volumes. R exhibited a 50% decrease with increasing frequency while E showed a less marked but still distinct increase with frequency. Volume-time profiles were also recorded in the same animals during passive expiration, and the frequency dependence of resistance and elastance from 0 to 1 Hz predicted from the bi-exponential curves fitted to the profiles. The way in which resistance and elastance were predicted to vary with frequency was similar to the variations determined from regular ventilation data. There were, however, some systematic differences between the actual values of resistance and elastance obtained by the two methods which may reflect certain nonlinear characteristics of the respiratory system such as static hysteresis. Nonlinearities were also evident in that both the resistances and the elastances at all frequencies showed a slight decrease with increasing tidal volume. We conclude that a large part of the mechanical behaviour of the normal canine respiratory system at low frequencies can be accounted for in terms of a two-compartment model describing a homogeneous alveolar region surrounded by viscoelastic tissue.

Airway Resistance↗

PubMed1989

Positive changes in the premenstrual period.

Positive or creative changes in the premenstrual week have been described. This study examines the perceptions of 100 healthy women as to whether they experience positive premenstrual changes and to what extent these occur alone or in combination with negative changes. Sixty-six percent of the women reported at least one positive premenstrual change, most frequently increased sexual interest and enjoyment, tendency to clean and tidy, tendency to get things done, more attractive breasts, more energy and more creative ideas. There was a weak negative correlation between the number of negative premenstrual changes and the number of positive changes reported. There were no statistically significant associations for age (under or over 30 years), marital status, oral contraceptive use or cycle regularity for positive, negative or total number of premenstrual changes. To complement the current interest in negative symptoms, further studies of positive premenstrual changes are required.

Adaptation, Psychological↗

PubMed1989

Psychiatric admission of mentally ill mothers with their infants.

There is a greatly increased risk of a woman developing a psychiatric illness requiring hospital admission during the early postpartum period. Admission of the mother has usually meant separating her from her infant at a time when bonding and attachment are developing. Nearly 40 years ago English psychiatrists began admitting infants with their mentally ill mothers, and although the theoretical basis for this is sound, there are few systematic studies of the practical problems encountered, or the outcomes. This paper compares a group of 32 psychiatrically ill postpartum women who were admitted to a Canadian general hospital psychiatric unit with their infants to a group of 26 psychiatrically ill postpartum women hospitalized on the same unit who refused admission of their infants. The women admitted with their infants were more likely to be older, living with the infants' father, in a stable residence and job, in hospital for a longer time, and caring for their babies at 2 year follow-up in contrast to the women who were admitted without their infants. The two groups were diagnostically different with joint admission mothers likely to suffer from an affective psychotic illness, while the mothers without infants were more likely to suffer from personality disorder or substance abuse. The effects of mother-infant admission and some of the practical problems encountered are discussed.

Adult↗

PubMed1989

Motivation for motherhood and the experience of pregnancy.

It is frequently assumed that becoming a mother is an essential step in the development of female identity. Although female hormones may increase a woman's readiness to care for an infant, there is no clear cut evidence of a hormonal basis for maternal feelings. A woman's desire to have and raise children is affected by cultural expectations and opportunities. Current analytical thinking, while viewing reproductive choice as being an important component of feminine identity, does not emphasize the necessity of having a child to feel feminine. Once pregnant, the woman works through issues related to body image, relationship with mother and husband, concerns for the fetus, fears about the future and her new vision of herself.

Animals↗

PubMed1989

Infertility by choice or by nature.

Sexually active women have only recently had the ability to make a conscious decision to delay or refrain from bearing children. This is not only the result of the availability of effective contraceptive methods but also due to attitudinal changes in society and individuals. These reproductive choices may result, for some women, in conflict over the use of contraceptives, and the decision or timing of pregnancy. However, infertility imposed by nature in the form of inability to conceive, miscarriage or stillbirth removes the woman's sense of control over this important aspect of her life and frequently results in severe distress. The psychological issues surrounding these reproductive choices and events are reviewed and discussed.

Adaptation, Psychological↗

PubMed1989

Idiopathic anejaculation treated by electroejaculation.

Idiopathic anejaculation is a relatively rare cause of sexual dysfunction that usually presents as an infertility problem. When such patients have nocturnal emissions the problem is usually considered psychogenic and referral is made to a psychiatrist. Various treatments for this condition have been described including psychotherapy, sexual, marital and behavioral therapy, vibratory stimulation of the penis and pharmacotherapy. A patient with idiopathic anejaculation referred by an infertility clinic is described in which all of the above treatments failed over a five-year period. A newly described procedure in humans, electroejaculation, was employed to obtain semen which was used to artificially inseminate the wife resulting in the first reported successful pregnancy by electroejaculation done for idiopathic anejaculation.

Adult↗

PubMed1988

Unconventional cancer remedies.

Unproven and disproven remedies continue to abound for illnesses for which conventional treatment is only partially effective. This is particularly true with cancer, for which up to 50% of patients may be receiving unorthodox therapy. This article examines unconventional cancer remedies, their adverse effects, their common factors and the basis for their appeal, as well as what motivates and characterizes patients who choose these treatments. Also discussed is an approach that may be used by the conventional physician for patients who are likely to seek unorthodox treatment. This approach will help patients make the best decision about their treatment and protect them from the hazards of unconventional remedies.

Acquired Immunodeficiency Syndrome↗

PubMed1988

A hypothetical model of the flavodoxin-tetraheme cytochrome c3 complex of sulfate-reducing bacteria.

A hypothetical model of the flavodoxin-tetraheme cytochrome c3 electron-transfer complex from the sulfate-reducing bacterium Desulfovibrio vulgaris has been constructed by using interactive computer graphics based on electrostatic potential field calculations and previous NMR experiments. Features of the proposed complex are (1) van der Waals contact between the flavin mononucleotide prosthetic group of flavodoxin and one heme of the cytochrome, (2) unique complementarity of electrostatic fields between the region surrounding this heme and the region surrounding the exposed portion of the flavin mononucleotide group of flavodoxin, and (3) no steric interferences between the two polypeptide chains in the complex. This complex is consistent with all structural and spectroscopic data available.

Cytochrome c Group↗

PubMed1988

Prophylactic lithium in postpartum affective psychosis.

Women with a history of bipolar affective disorder or postpartum affective psychosis have a greatly increased risk for recurrence of psychosis following subsequent pregnancies. The use of lithium carbonate for prophylaxis of postpartum psychosis in such women remains controversial. Four women are described with a history of puerperal affective psychosis, who were given lithium prophylactically following delivery and had no recurrence of postpartum psychosis. The rationale for the timing, dosage, and monitoring of lithium administration in this situation is discussed. Given the apparent safety of lithium prophylaxis relative to the dangers of postpartum affective psychosis, more effort should be directed to definitive research to resolve whether lithium prophylaxis is indicated for this population, as contemporary knowledge and these four cases would suggest.

Adult↗

PubMed1988

Thyroid function in psychosis following childbirth.

Postpartum thyroiditis has been suggested as a cause of psychosis following pregnancy. However, 30 hospitalized psychotic postpartum women and 30 control subjects matched for age and time since delivery showed no significant differences in thyroid function or the presence of thyroid antibodies.

Adolescent↗

PubMed1988

The psychiatrist's role in determining competency to consent in the general hospital.

In the general hospital, consultation-liaison psychiatrists are frequently consulted regarding issues of competency to consent to medical and surgical procedures and treatments. It is necessary that psychiatrists practicing in this setting have a thorough awareness of both the legal aspects of competency and consent and the clinical situations which can arise. In this paper we discuss the legal basis for consent and various definitions proposed for mental competency to consent to treatment. We describe a number of typical situations which lead to psychiatric consultation and suggest an appropriate approach to their resolution.

Forensic Psychiatry↗

PubMed1988

Psychiatric consultation-liaison services to an obstetrics and gynecology department.

This paper describes the psychiatric consultation-liaison services provided to an Obstetrics and Gynecology Department. Clinical services are provided both by program consultation and by individual inpatient and outpatient referral. Clinical problems in obstetrics and gynecology that result in psychiatric referral are discussed. Research interests which play an important role in the program are described. Educational activities are directed toward ward and clinic staff, undergraduate medical students, residents and the practising specialist. The combination of well articulated consumer requests, interested gynecologists and obstetricians, broadened gynecology residency training objectives, and greater involvement of consultation-liaison psychiatrists suggests a promising future for psychosomatic obstetrics and gynecology.

Female↗

PubMed1987

A dose response study comparing Duovent vs salbutamol.

The dose response profiles of Duovent (fenoterol 0.1 mg/ipratropium 0.04 mg per puff) and salbutamol (0.1 mg per puff) were determined in a double-blind, controlled study. Twenty-one patients with asthma and nine patients with chronic bronchitis received 1, 2, 4, and 6 puffs of either Duovent or salbutamol on separate days. FEV1, pulse and tremor were recorded at baseline and up to 360 minutes after inhalation of test medication. Duovent and salbutamol produced an effective bronchodilator response at all dose levels, however, at 2, 4 and 6 puffs, the improvement with Duovent was significantly greater than with salbutamol alone in both asthmatic and chronic bronchitic patients. Two puffs of Duovent produced a significantly greater bronchodilation than all doses of salbutamol. There was no difference in the bronchodilator response between 1-6 puffs of salbutamol indicating maximal dose was achieved with one puff. There was an incremental improvement in FEV1 with 1, 2, and 4 puffs of Duovent but no difference between 4 and 6 puffs. There was no difference in pulse rate or tremor between salbutamol or Duovent at any dose level. We conclude that Duovent produces a greater and more prolonged bronchodilator response than salbutamol in both asthmatic and chronic bronchitic patients.

Adult↗

PubMed1987

Increase in the cholinergic cardiac plexus in sympathetically aneural chick hearts.

Embryonic chick hearts were made sympathetically aneural by removal of premigratory neural crest over somites 10-20. The cholinergic cardiac plexus was assessed at 12 to 15 days of incubation using morphological and biochemical techniques. The cholinergic innervation to the heart was increased by 50 to 100% due to both hypertrophy and hyperplasia of the ganglion cells as well as their terminals. The additional cells were an expansion of the normal population of cholinergic neurons in the heart rather than from some extra source. The expanded population of neurons did not express an adrenergic phenotype in response to the absence of adrenergic cardiac innervation.

Acetylcholinesterase↗