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Biomedical subjects

D Walsh

Publications and source records attributed to D Walsh.

At least 19 recordsLinked to original sources
PubMed1992

On familial factors in the attentional deficit in schizophrenia: a review and report of two new subject samples.

We review the literature on attentional impairment in schizophrenics and their first-degree relatives and present new information from ongoing family studies of the disorder in Ireland and Israel. Subjects were administered a neuropsychological test battery (the NIMH Attention Battery) intended to measure four different elements of attention: encode, focus/execute, sustain, and shift. Results from both samples indicated that schizophrenic subjects performed most poorly on the tests, the control subjects performed best, and the scores of the relatives fell somewhere between the other two groups. Separation among subject groups was most significant for those tests comprising the focus/execute and sustain elements. Some of the results indicate, as well, that tests of auditory sustained attention may be the most discriminating of all. Overall comparison of the Irish and Israeli cohorts revealed striking differences. While within cohort differences remained, subjects from the Irish sample performed more poorly on many of the tests than Israeli subjects. This between-cohort difference was not found in the sustain element, as measured by the Continuous Performance Test. The socio-cultural implications of these findings are discussed with respect to future neuropsychological studies of schizophrenia.

Adult↗
PubMed1992

A safe, new approach to establishing a pneumoperitoneum at laparoscopy.

The traditional method of establishing a pneumoperitoneum before laparoscopic surgery is via a Verres needle inserted in the midline below the umbilicus while tenting the abdominal wall with the hand. A new approach is described in which preliminary surgical exposure and tenting of the linea alba immediately above the umbilicus is achieved before needle insertion through the superior margin of the umbilical ring. The advantages of this new technique over the conventional method are discussed. Further technical features important in the safe formation of the pneumoperitoneum are emphasized.

Adolescent↗
PubMed1992

Individualized ramp treadmill. Observations on a new protocol.

The many different approaches to exercise testing have hindered the consistent interpretation of hemodynamic, electrocardiographic, and ventilatory gas exchange responses. One of the most influential approaches is the choice of the exercise protocol. Recent data suggest that the protocol can have an important impact on test sensitivity, the reason for test termination, the ST/HR slope calculation, the interpretation of gas exchange responses, and the accuracy with which oxygen uptake is predicted from work rate. Recent recommendations for optimizing the test have focused on the test duration, reducing the increments in work rate, and individualizing the test relative to the purpose of the test and the subject tested. We describe a treadmill test which considers these recommendations for optimizing exercise testing.

Adult↗
PubMed1991

Treatment of unknown primary melanoma.

Sixty-four patients with unknown primary melanoma were identified among 1045 new patients with melanoma (6%) seen during an 11-year period. Their mean age was 44.5 years (median age, 42.7 years). Of these, 39 (59%) were men, and 25 (38%) were women. In 34, only one site was involved. Common single sites were the axilla (29%), groin (24%), and neck (32%). Most of the melanomas (88%) were melanotic. Patients with localized melanoma surgically treated (n = 34) had a median survival of 53 months, and a 5-year survival rate of 45%. The respective rates for disseminated melanoma were 7 months and 10% (P = 0.00001). Localized, unknown primary melanoma should be treated with radical excision because a substantial proportion of patients so treated survive 5 years.

Adolescent↗
PubMed1991

The ventilatory threshold: method, protocol, and evaluator agreement.

To evaluate the effects of different methods of detection, exercise modes, protocols, and reviewers on oxygen uptake (VO2) at the ventilatory threshold (ATge), 17 men with heart disease (mean age 59 +/- 6 years) and six healthy men (mean age 60 +/- 11 years) underwent six exercise tests on different days. Each subject performed three treadmill tests (Bruce, Balke, and ramp) and three bicycle ergometer tests (50 W/stage, 25 W/stage, and ramp) in random order. The ventilatory threshold was determined for each of the six exercise tests by three independent, blinded reviewers by means of graphic plots of three commonly used methods of determination: (1) changes in the ventilatory equivalents for VO2 and VCO2, (2) changes in end-tidal oxygen and carbon dioxide pressures, and (3) the intersection of the slope of VCO2 and VO2 (V slope). The largest variability in the ATge was observed with changes in the exercise protocol. The greatest absolute (ml/min) and percentage differences in oxygen uptake at the ATge as a result of changes in protocol, method of determination, and observers were 336 (36%), 125 (12%), and 70 (7%), respectively. The overall intraclass correlation coefficient for VO2 at the ATge among the three reviewers was 0.60 and among the three protocols was 0.85 (p less than 0.01). The V slope method of detection had consistently good agreement among reviewers and was least affected by the protocol. The variance in the ATge (excluding intersubject and error variance) accounted for by differences in protocol, method, and reviewer was 82%, 14%, and 4%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Anaerobic Threshold↗
PubMed1991

Symptoms of pancreatic cancer.

We describe the symptoms, physical findings, treatment interventions, risk factors, and length of survival in persons with pancreatic cancer referred to a palliative care service (PCS) in a tertiary care facility. Data were collected prospectively over a 2-yr period using a standard clinical assessment tool in 39 patients with unresectable pancreatic cancer. Common symptoms include pain (82%), anorexia (64%), early satiety (62%), xerostomia and sleep problems (both 54%), and weight loss (51%). Analyzed retrospectively, 82% had at least one known risk factor for the development of pancreatic cancer. Twenty-five people presented to the PCS within 1 mo of diagnosis; in this group, length of survival was analyzed according to the presence of specific symptoms, and a significant inverse relationship between the presence of dyspnea and length of survival was found. As there is no effective treatment for surgically unresectable pancreatic cancer, palliation of common symptoms should be the primary emphasis of therapy.

Adult↗
PubMed1991

Comparison of the ramp versus standard exercise protocols.

To compare the hemodynamic and gas exchange responses of ramp treadmill and cycle ergometer tests with standard exercise protocols used clinically, 10 patients with chronic heart failure, 10 with coronary artery disease who were asymptomatic during exercise, 11 with coronary artery disease who were limited by angina during exercise and 10 age-matched normal subjects performed maximal exercise using six different exercise protocols. Gas exchange data were collected continuously during each of the following protocols, performed on separate days in randomized order: Bruce, Balke and an individualized ramp treadmill; 25 W/stage, 50 W/stage and an individualized ramp cycle ergometer test. Maximal oxygen uptake was 16% greater on the treadmill protocols combined (21.4 +/- 8 ml/kg per min) versus the cycle ergometer protocols combined (18.1 +/- 7 ml/kg per min) (p less than 0.01), although no differences were observed in maximal heart rate (131 +/- 24 versus 126 +/- 24 beats/min for the treadmill and cycle ergometer protocols, respectively). No major differences were observed in maximal heart rate or maximal oxygen uptake among the various treadmill protocols or among the various cycle ergometer protocols. The ratio of oxygen uptake to work rate, expressed as a slope, was highest for the ramp tests (slope +/- SEE ml/kg per min = 0.80 +/- 2.5 and 0.78 +/- 1.7 for ramp treadmill and ramp cycle ergometer, respectively). The slopes were poorest for the tests with the largest increments in work (0.62 +/- 4.0 and 0.59 +/- 2.8 for the Bruce treadmill and 50 W/stage cycle ergometer, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1978

Suicide past and present--the temporal constancy of under-reporting.

It is known that official suicide statistics underestimate the incidence of suicide, but it is not clear whether the extent of under-reporting remains constant. An examination of coroners' records in Dublin from 1900 to 1904 and comparison with a similar series in 1964--68 suggests that the underestimation was of similar proportions in both series. It is suggested, therefore, that official suicide statistics are likely to reflect valid temporal changes in suicide and are therefore of value for the study of socio-economic influences on trends in suicide frequency.

Coroners and Medical Examiners↗