Search PubMed⌕ Search

Biomedical subjects

D Spiegel

Publications and source records attributed to D Spiegel.

At least 91 records · Page 5Linked to original sources
PubMed1996

[Single dose intraoperative administration of 5-fluorouracil (5-FU) in trabeculectomy. Long-term results of a pilot study].

5-Fluorouracil (5-FU) improves the success of trabeculectomy. Since in vitro studies showed a prolonged effect of 36 days of growth inhibition with a single dose of 5-FU, 5-FU is applied intraoperatively. To evaluate the effect of intraoperatively applied 5-FU, we compared 13 (low-risk) patients with intraoperative application of 5-FU to a control group matched by age, diagnosis, sex and stage of glaucoma. Postoperatively on day 4 the IOP was significant lower (4.8 mmHg) in the 5-FU-group in comparison to the untreated group (P = 0.005; power 0.80). After 1 week the difference decreased to 2 mmHg and was not significant any more (P = 0.16). After 1 week a lower mean intraocular pressure of 2 mmHg was found with a P-value of 0.16. It may be that these results are not just due to an antiproliferative mechanism; a direct toxic effect of 5-FU should be considered. 5-FU side effects such as corneal complications and inflammatory reaction were not increased in the 5-FU group. However, one case of persistent hypotony was seen in the 5-FU group. This study found intraoperative use of 5-FU to be a safe procedure with a pronounced capacity to lower IOP in the direct postoperative phase. However, this effect may not be based on an antiproliferative effect alone, but might be of toxic origin.

Aged↗
PubMed1996

Left hemisphere superiority for event-related potential effects of hypnotic obstruction.

Twenty-two highly hypnotizable subjects were run in a visual target detection task which compared hypnotic obstruction of the left and right visual fields over separate blocks. The visual event-related potentials (ERPs) to non-target stimuli revealed that hypnotic obstruction reduced the P200 component to stimuli in the right hemifield, but did not affect P200 for stimulation in the left hemifield. The earlier P100 and N100 were also reduced to hypnotic obstruction but not as preferentially for either hemifield, while the P300 was not significantly changed. Right visual field left hemisphere P200 reduction predicted suppression of behavioral response (button press) to hypnotically obstructed targets in both hemifields. The results are discussed in terms of Farah's model of a left hemisphere mechanism for image generation, and how highly hypnotizable subjects might use this mechanism to comply successfully with the suggestion of a hallucinated visually opaque barrier.

Adult↗
PubMed1996

Is macrosomia predictable, and are shoulder dystocia and birth trauma preventable?

OBJECTIVE: To assess our ability to detect macrosomic fetuses, and to examine the relationship between prenatal diagnosis of macrosomia and the incidence of shoulder dystocia and birth trauma. METHODS: We instituted a protocol for routine detection of macrosomic fetuses, defined as weight estimated to be at least 4500 g. Fetal weight was estimated by ultrasonography when there was clinical suspicion of macrosomia. We collected data on these pregnancies as well as on deliveries of macrosomic infants, shoulder dystocia, and birth trauma. RESULTS: During the 14-month study period, there were 4480 deliveries. There were 23 macrosomic newborns (0.5%), of whom 17 were born vaginally. Six of these 17 (35%) vaginal deliveries were complicated by shoulder dystocia, and one infant sustained brachial plexus injury. The overall frequency of shoulder dystocia was 2%, the majority (93%) occurring in infants weighing less than 4500 g. Eleven newborns sustained brachial plexus injury (0.2%), and 39 had isolated clavicular fracture. Six of nine cephalic deliveries that resulted in brachial plexus injury were associated with shoulder dystocia. The sensitivity and predictive value of the study protocol were 17% (four of 23) and 36% (four of 11), respectively. Surprisingly, clinical estimation alone had a sensitivity of 43% (ten of 23) and a positive predictive value of 53% (ten of 19). CONCLUSION: The ability to predict macrosomia is limited. The predictive value of clinical estimation of fetal weight alone may be slightly higher than when it is combined with ultrasonography. Because most cases of shoulder dystocia and birth trauma occur in nonmacrosomic infants, these conditions are practically impossible to prevent.

Birth Injuries↗
PubMed1996

Coping styles associated with psychological adjustment to advanced breast cancer.

The aim of this study was to determine whether psychological adjustment to advanced breast cancer was positively associated with expressing emotion and adopting a fighting spirit and negatively associated with denial and fatalism. Total mood disturbance on the Profile of Mood States was used as the measure of psychological adjustment. The Courtauld Emotional Control Scale measured emotional expression, and the Mental Adjustment to Cancer measured fighting spirit, denial, and fatalism. The sample included 101 women with a diagnosis of metastatic or recurrent breast cancer. Fighting spirit and emotional expressiveness were found to be associated with better adjustment. No association was found between mood disturbance and denial or fatalism. Because this was a cross-sectional study, no conclusions regarding a causal relationship between adjustment and emotional expressiveness or adjustment and fighting spirit were possible.

Adaptation, Psychological↗
PubMed1996

Self-hypnotic relaxation during interventional radiological procedures: effects on pain perception and intravenous drug use.

The authors evaluated whether self-hypnotic relaxation can reduce the need for intravenous conscious sedation during interventional radiological procedures. Sixteen patients were randomized to a test group, and 14 patients were randomized to a control group. All had patient-controlled analgesia. Test patients additionally had self-hypnotic relaxation and underwent a Hypnotic Induction Profile test. Compared to controls, test patients used less drugs (0.28 vs. 2.01 drug units; p < .01) and reported less pain (median pain rating 2 vs. 5 on a 0-10 scale; p < .01). Significantly more control patients exhibited oxygen desaturation and/or needed interruptions of their procedures for hemodynamic instability. Benefit did not correlate with hypnotizability. Self-hypnotic relaxation can reduce drug use and improve procedural safety.

Aged↗
PubMed1996

Hypnotizability and traumatic experience: a diathesis-stress model of dissociative symptomatology.

OBJECTIVE: The authors propose a diathesis-stress model to describe how pathological dissociation may arise from an interaction between innate hypnotizability and traumatic experience. METHOD: To support the proposition that pathological dissociation may reflect autohypnotic process, the authors highlight clinical and research data indicating parallels between controlled hypnotic dissociative states and uncontrolled pathological dissociative symptoms and summarize evidence of hypnotizability in persons with psychiatric disorders that manifest these symptoms. The authors present this evidence by examining dissociative symptomatology in four psychological domains: perception, behavior and will, affect, and memory and identity. In addition, modern cognitive and neuropsychological models of dissociation are briefly reviewed. RESULTS: Several lines of evidence converge in support of the role of autohypnosis in pathological dissociation. There is considerable evidence that controlled formal hypnosis can produce a variety of dissociations of awareness and control that resemble many of the symptoms in uncontrolled pathological dissociative conditions; and it is possible to discern in dissociative pathology the features of absorption, dissociation, and suggestibility/automaticity that characterize formal hypnotic states. There is also accumulating evidence of high levels of hypnotic capacity in all groups with dissociative symptomatology that have been systematically assessed. In addition, the widespread and successful therapeutic use of hypnosis in the treatment of many dissociative symptoms and conditions (and the potential for hypnosis to induce dissociative symptomatology) also supports the assumption that hypnosis and pathological dissociation share an underlying process. CONCLUSIONS: High hypnotizability may be a diathesis for pathological dissociative states, particularly under conditions of acute traumatic stress.

Adult↗
PubMed1996

Cancer and depression.

Half of all cancer patients have a psychiatric disorder, usually an adjustment disorder with depression. Anxiety about illness, such as cancer, often leads to delay in diagnosis, which has been estimated to reduce prospects of long-term cancer survival by 10% to 20%. Although earlier studies showed that depressed individuals were at higher risk for cancer incidence, later studies have not confirmed this predictive relationship. Nonetheless, effective psychotherapeutic treatment for depression has been found to affect the course of cancer. Psychotherapy for medically ill patients results in reduced anxiety and depression, and often pain reduction. In three randomised studies, psychotherapy resulted in longer survival time for patients with breast cancer (18 months), lymphoma, and malignant melanoma. The physiological mechanisms for these findings have not yet been determined, but four fundamental possibilities for psychotherapeutic effects on physiological change include health maintenance behaviour, health-care utilisation, endocrine environment, and immune function. Thus, effective treatment of depression in cancer patients results in better patient adjustment, reduced symptoms, reduced cost of care, and may influence disease course. The treatment of depression in these patients may be considered a part of medical as well as psychiatric treatment.

Adaptation, Psychological↗
PubMed1995

When disaster strikes, acute stress disorder may follow.

During and immediately following a traumatic event, people may manifest a pattern of dissociative and anxiety symptoms and other reactions, referred to as Acute Stress Disorder. A review of the empirical literature on psychological reactions to trauma suggest that this pattern of symptoms has often been identified across different kinds of traumatic events. It is likely to constitute a psychological adaptation to a stressful event, limiting painful thoughts and feelings associated with the event and allowing the person to function at least minimally. Continuation of these symptoms, however, may impair the person's quality of life and disrupt social and other functioning. If symptoms last beyond a month following the traumatic event, Post Traumatic Stress Disorder (PTSD) may ensue, continuing for months or even years after the precipitating event. Hence, it is important to be able to identify this pattern of reactions that may be manifested in reaction to trauma, so that appropriate intervention can be provided. Although it was not officially recognized in the 3rd edition Diagnostic and Statistical Manual (DSM-III-R), Acute Stress Disorder is included as a separate diagnosis in the DSM-IV.

Adaptation, Psychological↗
PubMed1995

Sonographic estimation of umbilical coiling index and correlation with Doppler flow characteristics.

OBJECTIVE: To quantitate umbilical vascular coiling antenatally, and to correlate the coiling index with Doppler flow characteristics in umbilical vessels. METHODS: We studied 45 normal term fetuses within 24 hours before delivery. The umbilical coiling index was calculated using sonographic longitudinal views of cord vessels from several segments antenatally, and by dividing the total number of helices by the cord length (in centimeters) postnatally. Doppler flow velocities were obtained from umbilical arteries and vein in each cord. Flow characteristics were correlated with the umbilical coiling index. RESULTS: The mean (+/- standard deviation) umbilical coiling index was 0.44 +/- 0.11 in the antepartum period and 0.28 +/- 0.08 after birth. Regression analysis showed a significant linear trend (r = 0.71, P < .001). The correlations between sonographic coiling index and umbilical arterial Doppler flow characteristics (mean velocity, pulsatility index, resistance index, and systolic-diastolic ratio) were not significant. The sonographic coiling index was related to time-averaged velocity and flow in the umbilical vein. A good correlation was found between umbilical vein flow and the coiling index, with a significant linear trend (r = 0.59, P < .001). CONCLUSION: An intrauterine umbilical coiling index can be determined by ultrasound and correlates well with the actual index at birth. The sonographic umbilical coiling index is related to Doppler flow characteristics in the umbilical vein.

Female↗
PubMed1995

[Lens astigmatism in connection with implantation of a foldable one-piece silicone lens in a patient].

BACKGROUND: The use of one-piece plate-haptic Silicon lenses has become more frequent especially in combination with small incision cataract surgery. Different complications as before are to be expected. CASE REPORT: Six weeks after cataract surgery and implantation of a one-piece plate-haptic Silicon lens a lens astigmatism of 3.5 dpt was noted. The astigmatism occurred after successfully performed retinal detachment surgery in this eye. The development of the astigmatism was considered to be due to a capsular shrinkage of the anterior capsular ring. The retinal detachment surgery was performed with the use of SF6 gas, which is known as a factor for increasing inflammation. After a Nd: YAG incision of the anterior capsule the astigmatism disappeared immediately. CONCLUSION: Capsular shrinkage can induce a significant lens astigmatism in combination with soft one-piece plate-haptic Silicon lenses. Intraocular inflammation seems to play an important role. Astigmatism after implantation of one-piece plate-haptic Silicon lenses in combination with signs of capsular shrinkage can be explained by lens astigmatism only.

Aged↗
PubMed1995

[Etiology of secondary glaucoma at university clinics in Munich and Nairobi].

Glaucoma is one of the most common blinding diseases worldwide. For early detection and treatment of this insidious ailment investigations of risk factors are necessary, most of which require extensive technically demanding and time consuming procedures. Basic information on risk factors for the development of glaucomatous damage is essential for diagnosis of glaucoma, for the identification of groups at risk, and for the planning of prevention and intervention programs. Epidemiological data on secondary glaucomas is especially scarce, while at the same time the strict distinction between primary and secondary glaucomas has been abandoned with changing pathophysiological rationale. We compared the distribution of the main causes of secondary glaucomas in the university eye clinics in Munich and Nairobi, with the aim of finding possible risk factors and obtaining basic information that might be used in preventive programs. We examined 150 patients in Munich and 132 in Nairobi in 1991 and 1992. In addition to tests of visual acuity and intraocular pressure, gonioscopy, ophthalmoscopic assessment of the optic disc and perimetry were performed. Eyes with intraocular pressures above 22 mmHg and a detectable causative condition were selected for the study. The average age of the patients in Munich was 65 years, and most of them presented with glaucoma caused by iris neovascularization (42%), followed by exfoliation syndrome (14%), intraocular inflammation (11%), trauma (10%) and preceding ocular surgery (9%). In Kenya patients were significantly younger, with an average age of 41 years. Here most glaucomas were posttraumatic (40%); 70% of these patients were aged under 30. Other causes were earlier operations (17%), inflammation (16%), lentogenous changes (10%) and neovascularizations (10%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Essentials of psychotherapeutic intervention for cancer patients.

Psychosocial treatments, including group, individual and family psychotherapies, are of proven efficacy, and deserve inclusion as standard components of biomedical treatment for cancer patients. Anxiety and depression are very common (and treatable) problems among cancer patients, most of whom can benefit from intervention. Psychotherapy, both group and individual, employs three fundamental approaches: emotional expression, social support, and cognitive symptom-management skills. Psychotherapy has been shown to be effective in improving quality of life. Results of studies of various psychotherapies include reduction in depression, anxiety, and pain, and improved coping skills, and, in some cases, there is evidence of extended survival time.

Adaptation, Psychological↗
PubMed1995

Calcium pyrophosphate dihydrate crystal deposition disease in the elderly.

Calcium pyrophosphate dihydrate deposition disease can mimic a large number of joint diseases. We report on three patients with predominantly systemic symptoms. Diagnostic pitfalls and treatment delays in these patients are discussed. Once the diagnosis is considered, confirmation is readily obtained by examination of the joint fluid and treatment promptly relieves symptoms.

Aged↗
PubMed1994

Pain and depression in patients with cancer.

BACKGROUND: Although the existence of a relationship between depression and pain in patients with cancer has been known for many years, the influence of one upon the other is still poorly understood. It has been thought that depressed individuals complain of pain more because of their psychiatric illness. Evidence from two studies indicate that pain may induce clinical depression. METHODS: In the first study, the authors examined both current and lifetime psychiatric diagnoses among patients with cancer who had high and low pain symptoms to examine the strength of the relationship between depression and cancer pain. The sample consisted of 72 women and 24 men, with 39 women and 9 men in the high pain group, and 33 women and 15 men in the low pain group. In the second study, 35 patients with metastatic carcinoma of the breast were examined for pain intensity and frequency and mood disturbance. RESULTS: The prevalence of depressive disorders of all types was found to be significantly higher in the high pain than in the low pain group across measures, 33 versus 13% (chi-square [degrees of freedom = 1] = 5.90, P < 0.05). Furthermore, there was a significantly higher history of major depression in the low pain group than in the high pain group (chi-square [degrees of freedom = 1] = 3.86, P < 0.05). Also, in comparison with patients in the low pain group, patients in the high pain group were significantly more anxious and emotionally distressed. In the second study, pain intensity correlated significantly with fatigue, vigor, and total mood disturbance, and pain frequency correlated significantly with fatigue, vigor, and depression. CONCLUSIONS: This study confirms the high concomitant occurrence of pain and psychiatric morbidity and suggests that pain may play a causal role in producing depression.

Adult↗
PubMed1994

Health caring. Psychosocial support for patients with cancer.

Psychosocial treatments, including group, individual, and family therapies, are of proven efficacy and deserve inclusion as standard components of biomedical treatment for patients with cancer. Four issues regarding such treatment are reviewed. The first is need. Significant anxiety and depression are common (and treatable) problems among the medically ill and represent a major aspect of the burden of illness. Even those with less severe emotional reactions need help coping with the stress of serious illness. The second is methods. Psychotherapy, both group and individual, provides valuable emotional and social support and teaches important symptom management skills. The third is outcome. Psychotherapy has been shown to be effective in improving quality of life and enhancing the ability of the medically ill to cope with their illness. Results of various psychotherapies include reducing depression and anxiety, improving coping skills, and in some cases, extending survival time. The fourth is cost offset. Appropriate psychotherapeutic intervention saves money by reducing unnecessary office visits, diagnostic tests, medical procedures, and hospital admittance.

Anxiety↗