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Biomedical subjects

O S Surman

Publications and source records attributed to O S Surman.

At least 19 recordsLinked to original sources
PubMed1992

Reevaluation of organ transplantation criteria. Allocation of scarce resources to borderline candidates.

Organ transplantation in the 1960s proceeded according to a "lifeboat" ethics formula with physicians acting as "gatekeepers." Selection of transplant recipients is now based on medical urgency and waiting time. Some candidates continue to be given low priority by virtue of psychological impairment. The three As--advanced age, acquired immune deficiency syndrome (or positive human immunodeficiency virus status), and alcoholism--also stand out as characteristics that tend to exclude candidates. Cancer is another relative or absolute contraindication to transplantation. This article focuses retrospectively on the psychosocial and medical aspects of the decision to include six patients at Massachusetts General Hospital who were selected for organ transplantation despite their borderline candidacy. The authors introduce four lines of thinking that decision-makers might use to either include or exclude marginal candidates (e.g., the physician's interpretation of what duty requires, the patient's or surrogate's wishes, cost-benefit considerations, or the need for research to improve our scientific understanding of transplantation issues) and discuss an ethical approach that supports each line of thinking. The authors conclude that not all of the ethical approaches lead practitioners and policymakers to the same conclusions regarding the optimum size of or who should be a part of the recipient pool. The future of who receives transplants and why depends at least in part on the underlying ethical considerations that are deemed appropriate as determinants of practice and policy.

Adult↗
PubMed1990

A double-blind, placebo-controlled study of oral acyclovir in postherpetic neuralgia.

Twenty-one patients with postherpetic neuralgia of two- to 84-months duration participated in a double-blind, placebo-controlled study of oral acyclovir. Pain perception was assessed with the Melzack Pain Questionnaire at baseline and at two-to six-week intervals during the ensuing six months. Clinically significant pain reduction occurred in eight patients: four received acyclovir, and four received a placebo. Several treatment strategies have been advocated for relief of postherpetic neuralgia. Results of the present study demonstrate the need for a double-blind, placebo-controlled paradigm to substantiate the efficacy of new clinical approaches. The same caveat applies to the more common syndromes encountered in psychiatric practice.

Acyclovir↗
PubMed1990

Unusual lymphocyte subset distribution in some depressed patients.

Depression has been previously associated with immunologic dysfunction. The lymphocyte subsets of 10 patients with major depression were found to show a mean T4-T8 (helper-suppressor) ratio lower than that of controls, a difference attributable to increased numbers of suppressor cells in the depressed group. One possible cause of increased suppressor cells is prior or current viral infection.

Adult↗
PubMed1989

Psychiatric aspects of organ transplantation.

Technical advances in surgery and the new antirejection agents cyclosporine and muromonab-CD3 have led to improved outcome for organ transplantation. Allograft rejection and complications of immunosuppressant therapy are often associated with considerable stress, so availability of psychiatric consultation is a necessity. As a transplant team consultant, the psychiatrist treats perioperative anxiety, depression, and organic brain dysfunction and addresses medical and ethical aspects of patient selection. Studies indicate that many patients with psychopathological conditions have good postoperative results and that most living kidney donors participate spontaneously and consider donation a positive experience.

Humans↗
PubMed1987

Psychosomatic aspects of liver transplantation.

Forty patients received orthotopic liver transplants at Massachusetts General Hospital between May 21, 1983 and July 21, 1987 (mean follow-up: 64 weeks, range: 2-186 weeks). Twenty-seven patients (68%) were living as of July 21. Among survivors, 15 (56%) returned to full activity; and 7 (26%) were partially rehabilitated. Five patients were rehospitalized or recently transplanted. Successful outcome occurred most often among those who came to transplant early in the course of illness. All adults experienced preoperative anxiety and 17 (50%) of adults had some degree of hepatic encephalopathy. Following operation, 8 adults (24%) were referred for treatment of depressive disorder typically associated with deterioration of hepatic status, infectious complication or recurrence of cancer. Medical noncompliance required psychiatric intervention in 3 cases. Other psychiatric events an increasingly successful intervention of major scope and affords meaningful survival to many patients whose liver disease allow less than a year of life. Psychiatric consultation is an essential support to the transplant program.

Adjustment Disorders↗
PubMed1986

Immunological response to stress in agoraphobia and panic attacks.

The authors studied in vitro immune function as measured by lymphocytic proliferative response to mitogen stimulation in 36 patients with agoraphobia and panic attacks who were participating in a double-blind placebo-controlled psychopharmacological study of anxiety disorder. No significant difference in immune status was observed between panic patients and healthy controls.

Adult↗
PubMed1986

Neuroendocrine correlates of lactate-induced anxiety and their response to chronic alprazolam therapy.

Lactate infusions are anxiogenic in patients with panic disorder or agoraphobia with panic attacks, but few neuroendocrine profiles of this effect have appeared. The authors measured the number and intensity of panic symptoms and blood hormone levels during double-blind lactate infusions in 25 patients and 10 normal subjects and during placebo infusions in another five patients. Each patient was rechallenged with an identical infusate after chronic double-blind outpatient treatment with alprazolam or placebo. The results confirm the effectiveness of lactate infusions in evoking anxiety, extend previous hormone profiles of this maneuver, and indicate that chronic alprazolam treatment minimizes the neuroendocrine response to lactate challenges in patients with panic disorder or agoraphobia with panic attacks.

Adolescent↗
PubMed1985

Microcomputer-assisted relaxation.

The present pilot study was designed to test the effectiveness of a microcomputer program developed by the authors to induce relaxation and focused attention, which are common to most clinical stress-reduction and hypnotic procedures. A nonclinical sample of 20 adults used the program on an APPLE IIc computer in two 30-min. sessions in a within-subjects design. Repeated measures analyses of variance showed significant decreases in the Spielberger State Anxiety Scale and on a visual analog anxiety scale. Limitations and implications of the study are discussed.

Adolescent↗