Biomedical subjects
Publications and source records attributed to M Swartz.
The histology of macular photocoagulation is reviewed. This information may be helpful in selecting the best available laser for retinal vascular and choroidal disorders in the macular region, as providing an experimental method to better understand the effects of photocoagulation on retinal disease processes.
The authors examine somatization disorder in a community population, using grade of membership analysis, a new multivariate analytical technique for the analysis of medical classification. The technique is used to examine whether somatic symptoms will cluster into a clinical syndrome resembling somatization disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), if no a priori assumptions are made about the interrelationship of somatic symptoms or their clustering into clinical syndromes. Grade of membership analysis is applied to all respondents in the US National Institute of Mental Health Epidemiological Catchment Area Project of the Piedmont region of North Carolina reporting three or more somatic symptoms from the somatization disorder section of the Diagnostic Interview Schedule. The analysis indicates that seven 'pure' types, roughly analogous to clusters in cluster analysis, best describe the interrelationship of the symptoms included in the analysis. One 'pure' type in the analysis is nearly identical to DSM-III somatization disorder and is associated with demographic characteristics consistently found among patients with DSM-III somatization disorder. The present results demonstrate that symptoms associated with this disorder do cluster in a highly predictable fashion and represent a strong validation of the natural occurrence of an entity resembling somatization disorder.
The data recently collected in the Piedmont region of North Carolina as part of the National Institute of Mental Health Epidemiologic Catchment Area Program were used to examine somatization disorder in a community population. The authors found an adjusted prevalence of 0.38% for somatization disorder diagnosed according to the Diagnostic Interview Schedule and DSM-III. Respondents with somatization disorder demonstrated demographic characteristics (female, unmarried, nonwhite, from a rural area, less educated) that are consistent with findings from past clinical and epidemiologic studies of somatization disorder. The adjusted prevalence is higher than that of other Epidemiologic Catchment Area sites, and possible explanations for this findings are discussed.
Macular degeneration associated with age and drusen, an important cause of visual loss, is associated clinically with alterations in the retinal pigmented epithelium. Because the pigmented epithelium is a copper-rich tissue with antioxidant properties, the copper economy in patients and controls were studied by measuring ceruloplasmin. Ceruloplasmin, a multifunctional, copper-binding alpha-globulin, was significantly elevated in non-related patients as compared with controls (691 +/- 153 mg/L vs 312 +/- 64; P less than .001), both by the p-phenylenediamine oxidation technique and radial immunodiffusion assay. When 53 members of a large family were divided clinically into persons with and without macular degeneration, the ceruloplasmin concentrations were not significantly different from each other, but were elevated as compared with non-related controls (P less than .001). These differences were not due to an intragroup age mismatch. A group of patients with retinitis pigmentosa had normal serum ceruloplasmin concentrations. This study suggests a relationship between serum ceruloplasmin, trace metals, and the tissue alterations associated with macular degeneration that deserves further investigation.
Positron tomography has been used to measure blood flow, oxygen utilization, and glucose metabolism in soft-tissue tumors in rabbits and in human tumors in extremities. Both blood flow and oxygen utilization were increased in tumor in contrast to normal muscle tissue. Oxygen extraction fraction was, however, decreased in tumor. The most sensitive indicator of tumor growth was the glucose metabolic rate. The effect of irradiation was observed by blood flow measurements in human tumors and by blood flow and oxygen utilization in tumors in rabbits. Blood flow increased both in tumor and normal muscle tissue during irradiation and decreased afterwards. Oxygen utilization decreased in tumor and increased in normal tissue during irradiation.
A family history study of 36 patients with chronic posttraumatic stress disorder revealed a positive history of familial psychopathology in 66% of the patients. Alcoholism, depression, and anxiety disorders were the disorders most commonly found. The patients also had a higher prevalence of alcoholic siblings than did a retrospectively derived control group of depressed and anxious male patients. With respect to the proportion of familial anxiety to familial depression, the probands with posttraumatic stress disorder more closely resembled probands with generalized anxiety than probands with depression. Every patient had experienced at least one significant psychiatric illness during his lifetime, most commonly alcohol abuse or depression.
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This article reviews recent case and statutory law concerning patients who refuse medical treatment. Among the special cases considered are: the competent adult patient who refuses treatment on religious or privacy grounds; the incompetent patient whose own wishes were never expressed, but whose family refuses treatment; the incompetent patient who expressed the wish not to be treated before becoming incompetent; and parents who refuse treatment on behalf of their child. It is pointed out that recent court decisions have blurred the distinctions between "extraordinary" care and "ordinary" care and between withholding and withdrawing life-sustaining treatment. Reference is made to the recent trend toward allowing the family of an incompetent patient to assert the patient's rights without court intervention either in the form of direct court order or through guardianship proceedings. Finally, the implications of these legal developments for health care institutions are discussed. A protocol pertaining to incompetent patients is proposed. Health care institutions are encouraged to develop formal policies for dealing with patients who refuse treatment, and to work with their professional associations in lobbying for legislation which will clarify the law in this area.
Twenty-three members of a 96-member family exhibited an autosomal dominant disorder which has not previously been described. This disorder involves progressive optic atrophy, abnormal electroretinography without retinal pigment changes, and progressive sensorineural hearing loss usually evident in the first or second decade of life. In midlife, ptosis, ophthalmoplegia, dystaxia, and a nonspecific myopathy occur.
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A case of a posteriorly dislocated anterior chamber intraocular lens (IOL) is reported.
A 31-year-old woman lost central visual acuity in her left eye during scatter argon laser photocoagulation when her ophthalmologist treated the temporal peripapillary region. There was no evidence for a vascular explanation. Previous experimental work showed that the lateral spread of thermal energy into the optic nerve parenchyma from the peripapillary pigment epithelium and choroid can destroy adjacent nerve fibres. There is a risk of thermal optic neuropathy caused by peripapillary photocoagulation.
The incidence of progression of diabetic retinopathy during pregnancy is unknown and its proper management uncertain. In this study, 55 insulin-dependent diabetic patients under strict glucose control were followed throughout pregnancy with serial retinal examinations by ophthalmoscopy and photographs. Nineteen patients had minimal or background retinopathy and 7 had untreated proliferative changes. Six patients had been treated before pregnancy with photocoagulation for proliferative retinopathy. A positive correlation was found between progressive proliferative diabetic retinopathy and the duration of diabetes mellitus independent of glucose control. During gestation 3 of 19 patients (16%) with minimal or background retinopathy and 6 of 7 patients (86%) with untreated proliferative retinopathy experienced deterioration of their eye disease. In 4 patients with proliferative retinopathy, progression of retinal disease was arrested with photocoagulation during pregnancy. Only 1 of 6 who had received laser treatment prior to pregnancy experienced progression of her retinopathy. These results suggest that photocoagulation prior to pregnancy may protect against rapidly progressive proliferative retinopathy and that aggressive treatment during pregnancy can prevent progression of proliferative retinopathy and visual impairment.
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A 63-year-old female on long-term, high-dose tamoxifen treatment for metastatic breast cancer developed bilateral intraretinal refractile opacities, lesions at the level of the retinal pigment epithelium, and cystoid macular oedema.
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