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Biomedical subjects

M Sharpe

Publications and source records attributed to M Sharpe.

119 records · Page 7Linked to original sources
PubMed1985

Noninvasive clinical investigation of the cardiovascular system in the critically ill.

An understanding of fundamental principles of various modes of noninvasive cardiovascular monitoring is important in the investigation and management of acute cardiac illnesses found in the critically ill. The clinical application of electrocardiography, radiology, echocardiography, and nuclear medicine will be discussed as it applies to investigation and management of the cardiovascular system in these patients.

Cardiovascular System↗
PubMed1978

Steroid induction of gonadotropin surges in the immature rat. I. Priming effects of androgens.

Sexually immature female rats were either primed with estradiol benzoate on day 23 or given daily injections of various androgens on days 23--25. Plasma for LH and FSH determinations was collected on day 26, 5 h after an injection of progesterone. Massive gonadotropin surges were found after priming with estradiol benzoate or treatment with dehydroepiandrosterone (DHEA), delta 4-androstenedione, and testosterone, but not with ring A-reduced androgens (5 alpha-dihydrotestosterone, 5 alpha-androstane-3 alpha,17 beta-diol, its 3 beta-epimer, and androsterone) or the nonaromatizable 11 beta-hydroxy- and 11-ketoderivatives of delta 4-androstenedione. Rats bearing DHEA-containing Silastic implants also produced LH surges in response to progesterone. A single injection of an antiestrogen antiserum abolished gonadotropin surges in rats primed with estradiol benzoate or DHEA and greatly reduced the accompanying uterine hypertrophy. DHEA and delta 4-androstenedione were barely uterotrophic in ovariectomized rats but sustained progesterone-induced gonadotropin surges. The results indicate that certain (adrenal?) androgens are able to induce maturation of the steroid-sensitive surge system via extragonadal aromatization, whereas their uterotrophic effect is largely mediated by the ovaries. Coordinated increased conversion of androgens at central and peripheral sites may be of physiological importance for the triggering of puberty.

Androgens↗
PubMedDate not supplied

Cognitive behavior therapy for functional somatic complaints. The example of chronic fatigue syndrome.

Somatic complaints such as pain and fatigue that are unexplained by conventional disease are common in medical practice and are referred to as functional, somatoform, or somatization symptoms. Despite frequent chronicity, disability, and high associated medical costs, patients with these complaints are rarely offered either constructive explanations or effective treatment. In this perspective, a cognitive-behavioral approach to the problem is described, using chronic fatigue syndrome as an example. It is concluded that the utility of the cognitive-behavioral theory and the proven effectiveness cognitive behavior therapy provide the basis for a new evidence-based approach to psychosomatics.

Cognitive Behavioral Therapy↗
PubMedDate not supplied

Frequent attenders without organic disease in a gastroenterology clinic. Patient characteristics and health care use.

We used a hospital computer to identify 50 patients (35 women, 15 men) satisfying research criteria for "frequent attenders" at a gastroenterology outpatient clinic (four or more visits to a general hospital clinic in the previous 12 months). Their mean duration of symptoms was 5 years, and 80% reported fatigue as a significant complaint. Thirteen (37%) of the women were also consulting a gynecologist, and in nine of these their status was normal. Seven (21%) of the 35 women who were interviewed had a history of childhood sexual abuse, and these patients reported significantly more lifetime somatic symptoms (9.7, SD = 3.8) than those without such a history (5.4, SD = 3.5, p = < 0.01). The 50 patients reported high levels of disability and psychological distress, and were more likely to rate the probability of their symptoms as being due to "bowel disease" than to "stress" or "other problems." Forty-five patients had at least one current psychiatric diagnosis and 24 at least two, with somatoform disorders being the most common. Nineteen (38%) reported infrequent panic attacks, but only three had somatization disorder. The mean number of lifetime somatic symptoms was 5.9 (SD = 3.6; range 1-14). Seventeen patients (35%) also satisfied criteria for frequent attending in primary care (> 12 visits over the previous 12 months), and the patients reported a mean number of 5.7 (SD = 2.1) specialist appointments in the previous year. There may be a case for using the hospital computer to identify frequent attenders proactively at an earlier stage of their hospital visits so that appropriate management can be instituted. If such patients can be identified in this way, their assessment and management might be more appropriately supervised in designated clinics by more experienced gastroenterology staff.

Adult↗
PubMedDate not supplied

Neonatal exposure to potent and environmental oestrogens and abnormalities of the male reproductive system in the rat: evidence for importance of the androgen-oestrogen balance and assessment of the relevance to man.

The effects on reproductive tract development in male rats, of neonatal exposure to potent (reference) oestrogens, diethylstilboestrol (DES) and ethinyl oestradiol (EE), with those of two environmental oestrogens, octylphenol and hisphenol A were systematically compared. Other treatments, such as administration of a gonadotrophin-releasing hormone antagonist (GnRHa) or the anti-oestrogen tamoxifen or the anti-androgen flutamide, were used to aid interpretation of the pathways involved. All treatments were administered in the neonatal period before onset of puberty. The cellular sites of expression of androgen receptors (AR) and of oestrogen receptor-alpha (ERalpha) and ERbeta were also established throughout development of the reproductive system. The main findings were as follows: (i) all cell types that express AR also express one or both ERs at all stages of development; (ii) Sertoli cell expression of ERbeta occurs considerably earlier in development than does expression of AR; (iii) most germ cells, including fetal gonocytes, express ERbeta but not AR; (iv) treatment with high, but not low, doses of potent oestrogens such as DES and EE, induces widespread structural and cellular abnormalities of the testis and reproductive tract before puberty; (v) the latter changes are associated with loss of immunoexpression of AR in all affected tissues and a reduction in Leydig cell volume per testis; (vi) none of the effects in (iv) and (v) can be duplicated by treating with high-dose octylphenol or bisphenol A; (vi) none of the reproductive tract changes in (iv) and (v) can be induced by simply suppressing androgen production (GnRHa treatment) or action (flutamide treatment); and (vii) the adverse changes induced by high-dose DES (iv and v) can be largely prevented by co-administration of testosterone. Thus, it is suggested that many of the adverse changes to the testis and reproductive tract induced by exposure to oestrogens result from a combination of high oestrogen and low androgen action. High oestrogen action or low androgen action on their own are unable to induce the same changes.

Abnormalities, Drug-Induced↗
PubMedDate not supplied

Do patients with "pure" chronic fatigue syndrome (neurasthenia) have abnormal sleep?

OBJECTIVE: To determine whether patients with "pure" chronic fatigue syndrome (neurasthenia) have sleep abnormalities which may contribute to subjective measures of daytime fatigue. METHOD: Sleep characteristics of 20 patients meeting research criteria for chronic fatigue syndrome (CFS) but not depression, anxiety, or sleep disorder were compared with sleep characteristics of 20 healthy subjects matched for age and sex. Measures of sleep included a) subjective interview reports and sleep diaries and b) home-based polysomnography. RESULTS: Patients with CFS complained of poor quality unrefreshing sleep. They also napped during the day. Polysomnograph data showed no difference in actual nocturnal sleep time between the two groups although patients with CFS spent significantly longer in bed (p < .01), slept less efficiently (p < .03), and spent longer awake after sleep onset (p < .05). The polysomnographs of seven patients with CFS and one healthy subject were regarded as significantly abnormal. Five patients and one healthy subject had difficulty maintaining sleep. One patient had a disorder of both initiating and maintaining sleep and one patient woke early. CONCLUSIONS: Patients with "pure" CFS complain of unrefreshing sleep but only a minority have a clearly abnormal polysomnograph. The most common abnormality is of long periods spent awake after initial sleep onset. Although sleep abnormalities may play a role in the etiology of CFS, they seem to be unlikely to be an important cause of daytime fatigue in the majority of patients. However, pharmacological and behavioral methods that improve sleep quality may be an important component of a pragmatically based treatment package for patients who do have abnormal sleep.

Activities of Daily Living↗
PubMedDate not supplied

The psychological care of medical patients: a challenge for undergraduate medical education.

A recent joint report by the Royal College of Physicians and the Royal College of Psychiatrists has argued the case for improving the psychological and psychiatric care of medical patients. It makes a number of suggestions about staff education and training but does not specifically address undergraduate medical teaching. Following recommendations by the General Medical Council, UK medical schools are reorganising their undergraduate curricula with a new emphasis on equipping students for the preregistration year. These two important sets of recommendations present a challenge to medical education. In this article we report on a meeting which considered what the newly qualified doctor needs to know about psychological and psychiatric aspects of general patient care, how far the current psychiatric curriculum meets those needs, and how it could be improved.

Curriculum↗