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Biomedical subjects

K Wilhelm

Publications and source records attributed to K Wilhelm.

At least 145 records · Page 8Linked to original sources
PubMed1995

Suppression of development of experimental autoimmune thyroiditis by oral administration of thyroglobulin.

Experimental autoimmune thyroiditis (EAT), which to some extent represents an experimental model of human chronic lymphocytic thyroiditis, is an organ-specific autoimmune disease characterized by autoantibody production to thyroid antigens (Ag) and mononuclear infiltration of the thyroid gland. EAT induced by immunization with human thyroglobulin (hTG) with Freund's adjuvant in CBA/J (H-2K) mice is associated with prominent B and T cell responses. We report that oral administration of hTG effectively reduces the immune responses in EAT in mice in an Ag-specific manner. Both cellular and humoral immune responses are reduced in a dose-dependent manner. Histological evidence of disease is dramatically reduced. Suppression of the immune responses is seen 2 weeks after Ag challenge, with partial inhibition of proliferative and antibody responses. Six weeks after immunization, further inhibition is observed of both T and B cell responses. Hyporesponsiveness of T and B cell reactivity is seen only to hTG; T and B cell responses to other immunogens are not affected, including purified protein derivative and the nonrelated Ag BSA. This model may provide the basis for immunotherapy of autoimmune thyroid diseases in man.

Administration, Oral↗
PubMed1995

[Computerized tomography image of pulmonary alveolar proteinosis].

Pulmonary alveolar proteinosis is a rare disease of uncertain etiology. It progresses with alveolar deposits of PAS-positive material, exhibits in the long-term interstitial changes of the lung skeleton, and can be complicated by superinfections. The computed tomographic image is characterized by geographically sharply delineated alveolar infiltrates, faint, ground-glass-like parenchymal turbidity, with well bordered interstitial structures and recesses in the subpleural space.

Adult↗
PubMed1994

A brief self-report depression measure assessing mood state and social impairment.

Many measures of depression severity appear confounded by including depressive sub-typing features. We report the design of a brief (11 item) self-report scale of depression severity (the AUSSI), assessing both mood state and social impairment domains, and designed to be independent of sub-typing features. Mood severity and functional impairment scores demonstrated some independence in a sample of 360 patients. Patients with a 'melancholic' depressive type (categorised by four differing systems) differed from residual 'non-melancholic' depressed patients by having higher impairment scores, but the assigned groups did not differ, in the main, by mood severity scores. Advantages of the measure are summarised.

Affect↗
PubMed1994

Sex differences in lifetime depression rates: fact or artefact?

To isolate determinants of any female preponderance in depressive disorder, we earlier selected a sample of young adults, then similar in terms of several potential social determinants of depression and with equivalent rates of lifetime depression. We now report a 10-year review, which initially suggested a female preponderance in DIS-generated RDC and DSM-III lifetime depressive categories. The presence of sex differences in rates of lifetime depression was influenced by the definition of caseness used and the vantage point from which rates were determined. The longitudinal design and earlier corroborative witness reports established, however, clear evidence of instability in prevalence estimates, together with a sex effect on stability. Men were more likely to 'forget' episodes, while women were more likely to 'remember' episodes that had generally not previously reached 'case' criteria. When correction was made for such artefactual influences, a sex difference in lifetime depression rates was no longer evident. Such findings require review in general community samples, and suggest modifications to 'case' definition in epidemiological enquiries.

Adult↗
PubMed1994

[The MRT of scaphoid pseudarthrosis with Gd-DTPA. Its staging and clinical correlation].

During a period of two years, 134 patients with pseudo-arthrosis of the scaphoid were examined by conventional radiography and by MRI in the course of a prospective study. The aim of the study was to define radiological staging using contrast enhanced MRI in order to improve the prognostic criteria. All MRI examinations were carried out with a 1.5 tesla scanner (SP63) using a surface coil and T1 weighted spin echo sequences in sagittal and frontal projection and frontal FLASH T2 sequences and axial spin echo T2 sequences. The T1 weighted SE sequences in frontal projection were carried out before and after iv contrast (0.1 mmol Gd-DTPA/kg KG). All sequences were compared with conventional radiographs and the operative findings. Eight patients in stage 0 showed high signal intensity of both fragments in T1 weighted SE sequences and at surgery there was good vascularisation. In 22 cases there was reduced signal intensity in at least one fragment (stage I). 45 patients with scaphoid pseudo-arthrosis showed complete signal loss but marked contrast uptake with still vital nuclei at surgery (stage II). In 22 patients, there was no increase in signal intensity after contrast and complete loss of vitality of the fragments at surgery. Staging was not possible in 37 patients because of previous operative intervention. The use of contrast enhanced MRI provides additional information compared with conventional radiography or plain MRI.

Adolescent↗
PubMed1994

Career choice and experience of distress amongst interns: a survey of New South Wales internship 1987-1990.

Successive cohorts of interns assigned to a Sydney teaching hospital since 1987 were interviewed at the beginning and end of their intern year to document factors influencing career choice and psychological morbidity, with comparisons between the graduates of the three NSW medical faculties. Intellectual challenge and altruism were the two most reported motivating factors in choosing Medicine. Many interns expressed regret at their career choice. Apart from anger, self-reported psychological morbidity during internship was low. Interns' evaluation of the relevance of their undergraduate training declined during internship, except for Newcastle graduates. Increased "hands on" clinical experience during undergraduate years, career guidance, assertiveness training, and time management skills should be included in the undergraduate curriculum. More registrar teaching, frequent performance feedback, regular grievance sessions and decreased clerical activities contribute to more enriching intern experiences.

Adult↗
PubMed1994

Defining melancholia: properties of a refined sign-based measure.

We hypothesised that psychomotor disturbance is specific to the melancholic subtype of depression and capable of defining melancholia more precisely than symptom-based criteria sets. We studied 413 depressed patients, and examined the utility of a refined, operationally driven set of clinician-rated signs, principally against a set of historically accepted symptoms of endogeneity. We specified items defining psychomotor disturbance generally as well as those weighted either to agitation or to retardation. We demonstrated the system's capacity to differentiate 'melancholic' and 'non-melancholic' depression (and the comparable success of DSM-III-R and Newcastle criteria systems) by reference to several patient, illness and treatment response variables, to an independent measure of psychomotor disturbance (reaction time) and to a biological marker (the dexamethasone suppression test).

Adult↗
PubMed1994

Patient satisfaction with a mood disorders unit: elements and components.

Patient satisfaction is an indicator of effective service provision and may influence compliance with treatment. Of 265 patients attending a specialised mood disorders unit and surveyed at least two years after their initial contact, 221 (83%) replied. Characteristics of responders and non-responders were compared on demographic and clinical information from index assessment and follow-up. Sixty-four percent of responders were very satisfied and 21% partly satisfied with their management. Components of satisfaction included perceived competence of clinical management; the unit's administrative and after-treatment accessibility; and the support of staff and other patients. Those with a more adequate personality and melancholic depression at baseline assessment were more satisfied. A low current mood state at time of survey was associated with lower satisfaction in non-melancholics only. There were interactions between improvement in condition, diagnosis, personality and satisfaction. The survey provided a framework for formulating treatment programmes and was a useful quality assurance tool.

Adolescent↗
PubMed1994

Treatment resistant depression in an Australian context. I: The utility of the term and approaches to management.

The concept of "treatment resistant depression" (TRD) has generally been defined in terms of failure to respond to a standard course of somatic therapy with little reference to diagnostic sub-types or relevant psychosocial factors. In this paper we examine problems with the use of the term "treatment resistant depression" and then outline an approach to TRD employed in an Australian mood disorders unit. After discussing the need for a biopsychosocial assessment, multimodal management strategies for melancholic and non-melancholic TRD patients are described.

Affective Disorders, Psychotic↗
PubMed1994

Treatment resistant depression in an Australian context. II: Outcome of a series of patients.

The clinical characteristics and treatment outcome of a series of 107 patients referred to a mood disorders unit with an episode of "treatment resistant" Major Depression are reviewed. Subjects were categorised by diagnosis (into melancholic and non-melancholic subtypes) and by adequacy of previous treatment. At subsequent review (mean period of 37.5 months) these patients were re-assessed both in terms of outcome and which treatments had been considered to be most effective. Forty one percent of the patient group were fully recovered and a further 43% were partially improved. Different treatments were considered effective for melancholic and non-melancholic sub-types.

Adult↗
PubMed1994

The clinical significance of serial creatine phosphokinase estimations in acute ward admissions.

The aim of the study was to assess the effects of a number of physical factors on serial total creatine phosphokinase (CK) levels within the first few days of admission to an acute psychiatric ward. Patients (n = 17) who received parenteral injections within 48 hours of admission were compared with those (n = 30) who did not, looking at factors such as method of admission, alcohol use, presence of restraint and serial CK estimations. Those receiving injections had significantly raised CK levels over the first few days post-admission; these levels tended to normalise over 72 hours of admission. A small number of the patients who were given intramuscular injections demonstrated CK levels of over 1000 U/L. It is suggested that where CK levels are elevated, NMS should be excluded on clinical grounds. CK levels should return to normal over the next 72 hours (in the absence of NMS) if there are no further intramuscular injections.

Adolescent↗
PubMed1994

[Computerized tomography of bronchial arteries before and after embolization].

The whole mediastinal course of dilated bronchial arteries can be reliably visualised by spiral CT, as shown by angiography and embolisation. Based on volume acquisition in a breathhold discontinuity artifacts are avoided, thin overlapping sections are reconstructed, and a three-dimensional display of the bronchial arteries is performed. The therapeutic success of bronchial artery embolisation in a patient suffering from a tuberculous destroyed lung and hemoptysis was documented by spiral CT.

Adult↗
PubMed1994

Colonic and anorectal dysfunction in a patient with the tethered cord syndrome.

Although visceral dysfunction is commonly encountered in the tethered cord syndrome, alteration of intestinal motor and sensory function has not yet been specifically addressed in this neurological disorder. We report the case of a 54-yr-old woman with a rare form of adult onset tethered cord syndrome who presented to us for preoperative assessment of marked constipation, urinary and fecal incontinence, and a rectal prolapse. It is shown that the tethered cord syndrome causes complex clinical patterns of bowel dysfunction and that careful efforts are mandatory to differentiate their underlying pathology. Specific diagnostic procedures directed to intestinal motility and perception were of decisive importance in enabling us to apply the appropriate treatment to our patient.

Colon↗
PubMed1994

[Extrapulmonary manifestation of sarcoidosis in the breast].

Sarcoidosis is, pathologico-anatomically speaking, a granulomatous disease that can involve almost any organ. However, a histologically confirmed involvement of the mammary gland after exclusion by differential diagnosis of granulomatous mastitis and mycobacterial or fungal sonographic and mammographic image would rather suggest a fibroadenoma of the breast. However, a malignant process such as for instance a mucinous carcinoma of the breast should always be excluded by differential diagnosis, especially if there are concomitant general symptoms of disease.

Aged↗
PubMed1993

Inter-rater reliability of a refined index of melancholia: the CORE system.

We report an inter-rater reliability study of the modified 18-item, sign-based CORE index of melancholia, undertaken on 205 ratings of 35 patients by five clinical research psychiatrists. Inter-rater agreement about the presence or absence of individual items was slight to moderate when examined by the kappa coefficient, but moderate to high when examined by the intraclass correlation statistic. For total CORE scores, perhaps the most important application of the index of melancholia, high levels of intraclass correlation coefficients (ranging 0.79 to 0.90 across the varying rater dyads) were established. When a single cut-off score (of 7/8) was used to allocate patients to either a 'melancholic' or 'non-melancholic' class, only moderate agreement was established between raters in such 'class' assignments--a limitation which can be redressed by imposing a 'probable/possible melancholia' band of scores.

Depressive Disorder↗
PubMed1993

Psychomotor disturbance in depression: defining the constructs.

Four hundred and thirteen depressed patients were rated on eighteen signs of psychomotor disturbance, and the data examined by factor analyses. A three-factor solution was favoured. In addition to 'retardation' and 'agitation' dimensions (whose derived factor scores suggested independence of those two dimensions), a third 'non-interactive' dimension was evident--with derived factor scores correlating significantly with both the retardation and agitation dimensions. Thus, a 'trunk and branch' analogy was suggested for construing psychomotor disturbance, with a truncal 'psychic' component arborising into retardation and agitation 'motoric' expressions. Higher scores on all three factors were significantly linked with features weighted more to the melancholic 'type' of depression.

Adjustment Disorders↗
PubMed1993

Specificity of interpersonal sensitivity to non-melancholic depression.

Scores of 69 remitted depressed patients were compared to control subjects on the Interpersonal Sensitivity Measure (IPSM). The patients were categorised into melancholic and non-melancholic sub-groups according to DSM-III criteria. Differences between the depressives and controls were detected but were principally the result of high IPSM scores being returned by the non-melancholic depressives. Melancholic depressives did not differ from the controls in their IPSM scores, supporting the proposition that this depressive sub-type is not associated with a vulnerable personality style.

Adult↗