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Biomedical subjects

H Merskey

Publications and source records attributed to H Merskey.

At least 55 records · Page 3Linked to original sources
PubMed1995

Environmental exposures in elderly Canadians with Parkinson's disease.

BACKGROUND: Etiologic hypotheses for Parkinson's disease have implicated environmental factors, genetic factors, or a combination of the two. METHODS: Data from a survey of elderly Canadians (n = 10,263) with regard to their history of Parkinson's disease and previous environmental exposures were analyzed. Exposure to various environmental factors was compared between 87 patients with Parkinson's disease and 2070 elderly controls without Parkinson's disease. RESULTS: Exposure to plastic resins (OR (odd ratio) = 8.79), epoxy resins (OR = 6.94), glues (OR = 4.26), paints (OR = 3.84), and petroleum (OR = 2.30) products was significantly (p < 0.05) associated with Parkinson's disease. CONCLUSION: These substances deserve further exploration with respect to the possible development of parkinsonism.

Adhesives↗
PubMed1994

Lack of difference in brain hyperintensities between patients with early Alzheimer's disease and control subjects.

OBJECTIVE: To rate magnetic resonance image signal hyperintensities in clearly defined white and deep gray matter areas in patients with early Alzheimer's disease and controls. DESIGN: Prospective series. The National Institute for Neurological Disorders and Stroke--The Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer's disease. Blinded assessment. SETTING: University hospital, dementia study group. SUBJECTS: Thirty-four patients with Alzheimer's disease. Thirty-eight age-matched healthy community volunteers. MEASURES: Frequency of hyperintensities in axial magnetic resonance images (1.5-T system) seen both in the proton density and T2-weighted scans examined in vascular centrencephalon, centrum semiovale, watershed, periventricular, and subcortical white matter. Periventricular hyperintensities classification include caps, thin lining, and smooth and irregular halo. Hyperintensities in other areas include small and large focal, focal confluent, and diffusely confluent. The hyperintensities were counted and rated using a five-point scale and the Fazekas method. RESULTS: No difference in the ratings, frequency, or extent of the hyperintensities between patients with early Alzheimer's disease and controls. Majority of patients and controls had two or fewer hyperintensities and they were mostly small foci, caps, and thin linings. The hyperintensities are associated with arterial hypertension, diabetes, cardiac disorder, and age in different combinations, but not with Alzheimer's disease. CONCLUSION: Tiny hyperintensities on magnetic resonance images are frequent both in patients with early Alzheimer's disease and in healthy controls; most of the lesions are not related to brain ischemia. When age and vascular risk factors were taken into account, no difference between patients with early Alzheimer's disease and control subjects could be detected.

Aged↗
PubMed1994

Electroencephalography as an aid in the exclusion of Alzheimer's disease.

OBJECTIVE: To determine the usefulness or otherwise of the awake electroencephalogram (EEG) in the diagnosis of Alzheimer's disease (AD). DESIGN: Prospective collection of one or more awake EEGs in patients diagnosed as having AD or mixed AD and multi-infarct dementia according to current systematic criteria with analysis of those cases confirmed by postmortem examination. Systematized blind interpretation of EEGs. SETTING: Tertiary care practice with both ambulatory and hospitalized patients, ie, neurological department in general hospital and psychogeriatric unit in psychiatric hospital. PATIENTS: A series of 86 subjects with AD and 17 with mixed AD and multi-infarct dementia being those members of a consecutive series on whom postmortem information was available. Awake EEGs in 56 age- and sex-matched control subjects. RESULTS: Seventy-five patients with AD (87.2%) and 13 of the mixed group (76.5%) had abnormal EEGs on first testing, giving a sensitivity of 87.2% for uncomplicated AD. Ultimately, 79 (92%) of 86 patients with AD had abnormal EEGs. Twenty (35%) of 56 EEGs for matching control subjects were abnormal. Moderately abnormal or severely abnormal EEGs were found in 10 (50%) of 20 of the patients with AD of less than 4 year's duration compared with two (4.1%) of 49 of the control subjects, giving a specificity of 95.9% for EEGs with this degree of abnormality. The normal EEG had a negative predictive value of 0.825 with respect to the diagnosis of AD in these populations. CONCLUSIONS: Widespread availability, low cost, and high sensitivity support the use of the awake EEG in the diagnosis of AD.

Aged↗
PubMed1994

Logic, truth and language in concepts of pain.

Logic and language influence our ideas about the truth of pain, and can alter our understanding of it. Physicians should not tell their patients that there is nothing wrong with them if all their test results are negative, as this denies their patients' experiences of pain. Popular methods of conceptualizing pain may be erroneous. Diagrams of pain or disability are misleading and unhelpful--it is not usually possible to distinguish their components in practice. Giving patients a high or low score for pain behaviour, depression or for health locus of control can influence our views on aetiology in a seriously misleading way. Anyway, aetiological attributions are not always possible from analyses of the experience of pain. The problems of logic and language inherent in assigning pain to emotional causes, in using behavioural approaches, and in defining idiopathic pain and somatization are discussed. The IASP definition of pain is important and useful, provided that it is used appropriately. The recommended version is now 'an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.'

Humans↗
PubMed1994

Prospective study on the relationship between depressive symptoms and chronic musculoskeletal pain.

Chronic pain and depression often coexist, but there is still uncertainty about the nature of this relationship. Virtually all the available data are cross-sectional and therefore do not clarify the causal relationship between the two variables. In epidemiological studies, chronic pain has often been defined fairly liberally in terms of the actual duration. In this study, the definition of chronic pain was based upon self-reports of pain present for most of the days in at least 1 month of the 12 months preceding the interview. We tested the hypotheses that depression causes pain and that pain causes depression in a sample of 2324 subjects who were assessed for the presence of musculo-skeletal pain and the presence of depression, using for the latter a standardized published instrument called the Center for Epidemiologic Studies Depression scale (CES-D). The subjects were first examined using the National Health and Nutrition Survey (NHANES 1) of the United States National Center for Health Statistics from 1974 to 1975, and were followed-up from 1981 to 1984. Those with data on both occasions represent 76% of an initial population of 3059 persons. On logistic regression analysis depressive symptoms at year 1 significantly predicted the development of chronic musculo-skeletal pain at year 8 with an odds ratio of 2.14 for the depressed subjects compared with the non-depressed subjects. In patients in whom pain was present at baseline no socio-demographic variable alone predicted its persistence; however, male sex and white race together with 2 items of the CES-D did predict the persistence of existing pain.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Fluphenazine treatment of DSM-III-R male schizophrenic patients among the Xhosa.

A comparison of fluphenazine decanoate depot injection used alone and fluphenazine decanoate with fluphenazine HCl i.m. was undertaken in South African Xhosa patients with schizophrenia diagnosed according to DSM-III-R. The combined treatment significantly shortened the length of hospital stay to a mean of 30.5 days from a mean of 40.7 days for the single therapy group. The combined treatment group also obtained significantly higher improvement ratings one week after the start of treatment than the single treatment patients.

Adolescent↗
PubMed1994

Famotidine as an adjunct treatment of resistant schizophrenia.

Some patients suffering from schizophrenia fail to respond to or tolerate adequate doses of available antipsychotic medications. Thus, innovative pharmacotherapeutic approaches, such as augmentation strategies, play an important role in the management of these treatment-resistant patients. A recent case report suggested that the administration of famotidine to a patient suffering from schizophrenia with peptic ulcer disease was associated with improvement in the deficit symptoms of schizophrenia. Famotidine is a potent highly selective H2 receptor antagonist which crosses the blood-brain barrier. Impressed by this finding, famotidine was prescribed to some of our treatment-resistant patients suffering from schizophrenia who demonstrated significant deficit symptoms of schizophrenia. The subjects were 12 (eight male, four female) treatment-resistant psychotic patients whose antipsychotic medications were augmented with famotidine in an open trial. They ranged in age from 21 to 48 years with a mean age of 32.75 years. Seven of the 12 subjects made significant improvement resulting in discharge from hospital. Paranoid disturbances as well as absence of comorbid substance use were predictors of good response to famotidine augmentation of the antipsychotic medications. The results implied that H2 receptor activity in the brain might play a role in the pathogenesis of deficit syndromes in schizophrenia. Further studies of this strategy are recommended, since it may open a window of understanding of the negative (deficit) syndrome and its treatment.

Adult↗
PubMed1993

Hysteria, or "suffocation of the mother".

OBJECTIVE: To understand or explain the surprising adherence of prominent physicians throughout the centuries to terms suggesting that the womb could move and cause suffocation, choking or difficulty in swallowing. DATA SOURCES: Hippocratic writings on hysterical symptoms and the views of subsequent authors and contexts surrounding such views. DATA SYNTHESIS: Physicians who followed Hippocrates repeatedly related difficulties in breathing or choking and difficulties in swallowing to the uterus, although most recognized that the womb did not rise out of the pelvis, except partially, when enlarged by pregnancy. Respiratory and gastrointestinal symptoms were often associated with anxiety. The effects may have been attributed to the womb, because it was recognized that the womb, when enlarged, can cause difficulty in breathing. Anxiety was also reported more often in women and may have been attributed to the womb for that reason. CONCLUSION: The suffocation of the mother can be understood as anxiety with dyspnea, and globus hystericus reflects anxiety with a choking sensation or difficulty in swallowing.

Anxiety↗
PubMed1993

Temporal lobe atrophy on magnetic resonance imaging in the diagnosis of early Alzheimer's disease.

OBJECTIVE: To evaluate the use of simple ratings and linear measures of atrophy in the temporal lobe structures obtained with magnetic resonance imaging coronal scans in the diagnosis of early Alzheimer's disease. DESIGN: Prospective series. The National Institute for Neurological Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer's disease. Blinded assessment. SETTING: Dementia study in a university hospital. SUBJECTS: Patients with Alzheimer's disease (n = 34), scoring 150 or more on the Extended Scale for Dementia, and age-matched healthy community volunteers (n = 39) who had both magnetic resonance imaging coronal scans and a psychometric assessment using the Extended Scale for Dementia within 6 months were included. MEASURES MAIN MEASURES: T1-weighted magnetic resonance imaging coronal scans, a 1.5-T system. The degree of atrophy rated (0 to 4) in both sides of the temporal neocortex, entorhinal cortex, hippocampal formation, temporal horns, third ventricle, lateral ventricles, and frontal and parietal cortex. Linear measures: the area of hippocampus and the maximal transverse width of temporal horns. RESULTS: Differentiation between patients with Alzheimer's disease and controls was limited by considerable variations in sensitivity and specificity. Receiver operating characteristics analysis revealed a clear order of discrimination, the entorhinal cortex and the temporal neocortex being the two best, followed by the temporal horns and hippocampal formation. For a given specificity of 90%, the corresponding sensitivity for the entorhinal cortex, temporal neocortex, temporal horns, and hippocampal formation was 95%, 63%, 56%, and 41%, respectively. Linear measures differed significantly but showed considerable overlap. CONCLUSION: The presence of rated atrophy in selected temporal structures makes the diagnosis of Alzheimer's disease more likely, but the absence does not rule out the possibility of early Alzheimer's disease.

Adult↗