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Biomedical subjects

D S Bell

Publications and source records attributed to D S Bell.

At least 19 recordsLinked to original sources
PubMed1992

Chronic fatigue syndrome. Recent advances in diagnosis and treatment.

Chronic fatigue syndrome is a chronic debilitating illness that is marked in the majority of cases by sudden onset of fatigue and flulike symptoms. Symptoms subsequently relapse and remit and may persist for years. Physical examination typically reveals relatively minor, nonspecific abnormalities in an apparently well patient. Although immunologic abnormalities are associated with chronic fatigue syndrome, tests for these features are expensive, nonspecific, and generally reserved for research purposes. The diagnosis is made on the basis of new onset of severe fatigue, a characteristic pattern of symptoms, and exclusion of other illnesses. Treatment is aimed at alleviating symptoms and helping patients adjust to the debilitating and chronic nature of the illness.

Diagnosis, Differential↗
PubMed1992

Factors predicting efficacy of phentolamine-papaverine intracorporeal injection for treatment of erectile dysfunction in diabetic male.

Thirty-three diabetic men were instructed in the use of phentolamine-papaverine injections for the treatment of erectile dysfunction over a two-year period. Of these, 12 reported a satisfactory response and 21 reported a nonsatisfactory response. The responders and the nonresponders were retrospectively studied to identify characteristics that would predict a satisfactory response. No difference was found between the two groups in the duration of diabetes, the presence of retinopathy, neuropathy, nephropathy, peripheral vascular disease, or ischemic heart disease. The utilization of insulin, the prevalence of type II diabetes, or the use of drugs which would cause impotence, did not differ between the two groups. There was no difference in the serum testosterone levels between the two groups. Age was the only predictive factor. Only 1 of 14 patients over age sixty had a satisfactory response to treatment while 11 of 19 patients under age sixty had a satisfactory response. Five of the responders and 2 of the nonresponders proceeded to penile implant surgery and reported satisfactory results. While older diabetic men may choose a trial of intracorporeal injections, they should be counselled regarding the high failure rate and alternative forms of therapy.

Age Factors↗
PubMed1992

Daily stress variability, learned resourcefulness, regimen adherence, and metabolic control in type I diabetes mellitus: evaluation of a path model.

A model of daily stress and metabolic control in Type I diabetes was tested in which stress has dual effects upon glycemic level: (a) direct, through psychophysiological mechanisms, and (b) mediated, through regimen adherence. Learned resourcefulness was postulated to moderate both effects. Two approaches to measuring daily stress were also compared: stress mean and variability. Daily stress and adherence were measured in 62 adult diabetics on six occasions over 2 months, after which glycosylated hemoglobin levels were obtained. Stress had a direct association with metabolic control that was not mediated by adherence. Although learned resourcefulness failed to moderate this relationship, it did relate directly to metabolic control, in the unexpected direction. The variables combined to explain 37% of the variance in metabolic control. The utility of the intraindividual approach to daily stress measurement was supported.

Adaptation, Psychological↗
PubMed1992

Exercise for patients with diabetes. Benefits, risks, precautions.

Exercise is beneficial in both prevention and control of non-insulin-dependent (type II) diabetes. Whether a patient has insulin-dependent or type II diabetes, a regular exercise program can produce positive changes in the lipid profile, reduce blood pressure and weight, and improve other cardiovascular risk factors. The risks of an exercise program include precipitation of cardiovascular events, damage to the soft tissue and joints of the feet, visual loss, early and delayed hypoglycemia, and hyperglycemia and ketosis. Consequently, a comprehensive clinical assessment to identify potentially harmful diabetic complications and to determine the patient's fitness level is needed before a suitable exercise program can be prescribed. With careful manipulation of insulin doses and home monitoring of blood glucose levels, exercise need not adversely affect glycemic control. Moreover, the metabolic and cardiovascular benefits that result from a sensible exercise program can greatly improve the quality of life for most diabetic patients.

Diabetes Complications↗
PubMed1992

Visual impact of adaptive speckle reduction on US B-mode images.

Adaptive speckle reduction, which is designed to improve image contrast, dramatically alters the familiar appearance of the ultrasonographic B-mode scan. The acceptability to radiologists of this alternative method of display was assessed. Four experienced radiologists selected B-mode scans from 83 liver and 71 breast examinations and graded the change in diagnostically important features after adaptive speckle reduction. There was no loss of important anatomic detail in the smoothed images and a net reduction in image artifacts. Removal of speckle noise improved definition of lesion margins in 38.3% of cases and enhanced visibility of metastases in 35.4% of liver studies and 7.7% of breast lesions. In 42.1% of cases, the textural information in the image was judged to be enhanced. Image information in general was said to be better seen in 49.5% of cases. The preliminary radiologic experience with speckle-reduced B-mode echograms is favorable and does not indicate generation of any substantial image artifacts.

Breast Neoplasms↗
PubMed1992

Microalbuminuria associated with diabetic neuropathy.

OBJECTIVE: To test the hypothesis that microalbuminuria may show an independent statistical association with diabetic neuropathy. RESEARCH DESIGN AND METHODS: An observational study of a prospectively identified cohort was conducted at the University Medical Center. The cohort consisted of 78 consecutive diabetic patients who fulfilled the criteria of having diabetes for greater than 10 yr, a normal serum creatinine, urine negative for macroalbuminuria by a commonly used dipstick method, a blood glucose less than 13.8 mM (less than 250 mg/dl), and an HbA1 less than 11% (normal range 5.5-8.5%). Medical record review established the presence of chronic complications of diabetes. Urine albumin level was measured by radioimmunoassay. Albumin concn greater than or equal to 15 mg/L was used as a cutoff value for microalbuminuria. RESULTS: Twenty-five of 78 patients (32%) showed microalbuminuria. Of these, 51% had neuropathy, 39% had retinopathy, 35% arterial hypertension, 17% peripheral vascular disease, and 15% ischemic heart disease. After adjusting for age, sex, and type and duration of diabetes, diabetic neuropathy and hypertension showed a significant association with microalbuminuria. After adjusting for other diabetic complications, diabetic neuropathy showed a significant association with microalbuminuria. CONCLUSIONS: Microalbuminuria is independently associated with diabetic neuropathy. This association lends support to the theory of a vascular etiology for diabetic distal symmetrical neuropathy.

Albuminuria↗
PubMed1992

Form-based clinical input from a structured vocabulary: initial application in ultrasound reporting.

Ultra-STAR (Ultrasound Structured Attribute Reporting) allows a sonographer to record reports using a hierarchic standardized vocabulary. Reports are constructed interactively by using checkboxes and radio buttons in a graphical user interface to select concepts from the vocabulary. Concepts are presented in small windows that open when needed to record further detail. Preliminary reports are printed for the referring physician. Reports are later finalized by an attending radiologist and uploaded to the hospital's information system. Clinicians involved so far prefer an outline report to a natural language format.

Medical Records Systems, Computerized↗
PubMed1991

Retroviral sequences related to human T-lymphotropic virus type II in patients with chronic fatigue immune dysfunction syndrome.

Chronic fatigue immune dysfunction syndrome (CFIDS) is a recently recognized illness characterized by debilitating fatigue as well as immunological and neurological abnormalities [Straus, S.E. (1988) J. Inf. Dis. 157, 405-412]. Once thought to be caused by Epstein-Barr virus, it is now thought to have a different but unknown etiology. We evaluated 30 adult and pediatric CFIDS patients from six eastern states for the presence of human T-lymphotropic virus (HTLV) types I and II by Western immunoblotting, polymearse chain reaction, and in situ hybridization of blood samples. The majority of patients were positive for HTLV antibodies by Western blotting and for HTLV-II gag sequences by polymerase chain reaction and in situ hybridization. Twenty nonexposure healthy controls were negative in all assays. These data support an association between an HTLV-II-like virus and CFIDS.

Adolescent↗
PubMed1991

Autoantibodies in black women with class A1 or class GB diabetes mellitus.

No marker except repeated fasting glucose determinations has proven useful to ascertain prospectively which women with gestational diabetes mellitus will remain euglycemic by diet modification or will require insulin therapy. We screened 183 black women with gestational diabetes mellitus to determine if the presence of islet cell, mitochondrial, nuclear, DNA, parietal cell, smooth muscle, thyroid microsomal, thyroid thyroglobulin autoantibodies, or rheumatoid factor predicted the need for insulin therapy to maintain euglycemia in women with gestational diabetes mellitus. One hundred forty-two women maintained normal fasting plasma glucose levels with dietary modifications and 41 required institution of split-dose insulin therapy. We found no significant differences in the prevalence of these autoantibodies in black women with Class GB versus Class A1 diabetes mellitus. We conclude that screening for autoantibodies in women with gestational diabetes mellitus is not useful in determining which patients will subsequently require insulin therapy during their pregnancies.

Antibodies, Antinuclear↗
PubMed1991

Histocompatibility antigen subtypes in black women with class A1 or class GB diabetes mellitus.

Insulin-dependent diabetes mellitus is associated with an increased frequency of certain histocompatibility antigens located on chromosome six, the most common types being B-8, B-15, DR-3, DR-4, and DR-7. We therefore theorized that screening for these subtypes may allow the identification of those women with gestational diabetes who will remain euglycemic on dietary modification (class A1) compared with those who will require insulin to achieve euglycemia (class GB). From 1982 to 1987, 228 black women with gestational diabetes were screened for the above histocompatibility antigens. As theorized, certain histocompatibility antigen subtypes were more common in women with class GB gestational diabetes mellitus; DR-2 (41.8% versus 23.7% p = 0.015), B-15 (p = 0.07), and DR-3 (p = 0.08). However, because of the low sensitivity (42%), specificity (75%), and positive predictive value (36%), this test is impractical in the clinical management of women with gestational diabetes mellitus.

Black People↗
PubMed1991

Lower limb problems in diabetic patients. What are the causes? What are the remedies?

Peripheral neuropathy, infection, and peripheral vascular disease can produce serious problems in diabetic patients, particularly in the lower limbs. Ulceration of the foot may progress to gangrene and ultimately necessitate amputation. Distal symmetric polyneuropathy causes sensory loss. Such loss in patients with peripheral vascular disease creates a high risk for foot ulcers, which are vulnerable to infection. Treatment includes relief of neuropathic pain and antibiotic therapy for infection. Pentoxifylline (Trental) improves microvascular flow and appears to be effective against peripheral vascular disease. Aldose reductase inhibitors are being investigated as therapy for diabetic neuropathy. Prevention is the mainstay of management in these patients. Patient education is essential to help maintain health and prevent the potential adverse effects of diabetes.

Amputation, Surgical↗
PubMed1991

Diabetic nephropathy: changing concepts of pathogenesis and treatment.

The metabolic changes which accompany hyperglycemia in a person with diabetes are thought to cause renal hyperperfusion and intraglomerular hypertension, especially in the person with a predisposition to essential hypertension. Intraglomerular hypertension causing deposition of protein in the mesangium leads to glomerulosclerosis and renal failure. Screening for microalbuminuria can predict which type I diabetic patients will develop nephropathy. The decline in renal function in established diabetic nephropathy can be slowed with aggressive treatment of hypertension. The use of ACE inhibitors may also decrease intraglomerular hypertension. Whether similar treatment in the person with preclinical diabetic nephropathy would delay or prevent the onset of diabetic nephropathy is being investigated. Restricted protein intake, anti-platelet and rheolitic drugs may have a role in the treatment of established diabetic nephropathy. In end stage renal failure, renal transplantation is the treatment of choice. When transplantation cannot be performed, chronic ambulatory peritoneal dialysis is preferable to hemodialysis.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1991

Dosage accuracy of self-mixed vs premixed insulin.

The accuracy of patients and health care professionals in drawing up the components of a split-mix insulin regimen and of premixed insulin at three dosages (30 units, 10 units, and 5 units) was assessed with both 30-U and 100-U syringes. Both patients and professionals were inaccurate with both syringes. At low doses tested and with both syringes, patients and professionals showed greater accuracy with premixed insulin than with self-mixed insulin. Errors in drawing up insulin involved errors mainly in the ratio rather than the total volume of insulin drawn. Accuracy improved with higher doses of insulin. The patients' perception of their skill level in drawing up and mixing insulin correlated with the objective measurements of their skill. The improved accuracy in dosing with premixed insulin might explain the previously observed improved glycemic control in patients taking premixed insulin.

Adult↗