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Biomedical subjects

P Fink

Publications and source records attributed to P Fink.

At least 37 records · Page 2Linked to original sources
PubMed1992

Surgery and medical treatment in persistent somatizing patients.

This study describes the utilization of surgical operations, frequency and outcome of medical and surgical treatment in a group of persistent somatizers compared with a control group of non-somatizers. The study was carried out using the Danish national medical register to identify persons in the general population (age range 17-49 yr) with at least 10 general admissions during an 8-yr period. Persistent somatizers were defined as persons with more than six medically unexplained general hospital admissions in their lifetimes before 1985. Conversely, non-somatizers were patients whose admissions could mainly be ascribed to well-defined somatic disorders. The findings show that persistent somatizers had been exposed to extensive surgery, outnumbering the non-somatizers. Surgical operations were of several categories, with gastrointestinal and gynaecological operations being the most frequent. The physicians used medical and surgical treatment nearly as often for treating persistent somatizers as in the treatment of the non-somatizers. Surgical or medical treatment was used in nearly half of the medically unexplained admissions. The outcome of the surgical treatment of the persistent somatizers was, however, generally unsuccessful in that the effect was unsatisfactory in three quarters of cases. Similarly, two thirds of the medical treatments were judged to be unsuccessful in persistent somatizers. The findings suggest that the costs of somatic diagnostic procedures and fruitless surgical and medical treatment attempts on persistent somatizers are enormous, and only exceeded by the risk of iatrogenic harm. This emphasizes the need for an early diagnosis of somatization and of treating it properly.

Adolescent↗
PubMed1992

Physical complaints and symptoms of somatizing patients.

The purpose of the study was to describe the physical complaints and symptoms of persistent somatization patients. Individuals in the general population (age 17-49 yr) with at least 10 general admissions during an 8-yr period were studied. Persistent somatizers (i.e. patients with more than six medically unexplained general admissions) were compared with patients whose admissions could be ascribed to well-defined somatic disorders. Somatizers were characterized by multiple symptoms from many organ systems, and their physical complaints simulated most types of somatic disorder. Although some symptoms were more common than others, none were infrequent, so neither 'classic' conversion symptoms nor pain symptoms were found to be especially characteristic of the persistent somatizer. Gender had no influence on number of registered symptoms, whereas the number increases with age. The finding question the use of a predefined symptom checklist in the diagnostic criteria for somatizing disorder. The major part of the somatizers present a different illness picture when admitted with medically unexplained disorders compared with admission for which no adequate medical explanation could be found. However, one fifth had, when admitted with a medically explained diagnosis, also been admitted with the diagnosis medically unexplained at another admission. One fifth of the persistent somatizers had been admitted at least once for factitious illness, but apart from the fact that they had more symptoms and admissions, they did not differ from the other persistent somatizers.

Adolescent↗
PubMed1992

The use of hospitalizations by persistent somatizing patients.

Medical records were selected from the Danish National Patient Register in order to study individuals between the ages of 17 and 49 years in the general population who, during an 8-year period, were admitted at least 10 times to a general hospital (N = 282). Fifty-six subjects (19%) were found to be persistent somatizers, i.e. they were admitted repeatedly to general hospitals for physical symptoms without an organic basis. This corresponded to a frequency of persistent somatization in the population 0.6 per 1000 men and 3.2 per 1000 women. Seventy-five per cent of the subjects were under 25 years old at the onset of their disorder, and all were under 35. Their illnesses were long-lasting, with one-third having a hospital 'career' of more than 20 years. They had a lifetime median of 22 medical admissions, and had utilized 3% of the general population's admissions to non-psychiatric departments. This investigation shows that persistent somatization is not a rare phenomenon, and that taking the heavy utilization of health-care resources into account it constitutes a considerable problem for the health-care system. The long hospital career and the relatively early start of somatization in some subjects emphasize the importance of an early identification of the condition, and of efforts to try to prevent its persistence.

Adolescent↗
PubMed1990

Invariant chain distinguishes between the exogenous and endogenous antigen presentation pathways.

Class I MHC molecules acquire peptides from endogenously synthesized proteins, whereas class II antigens present peptides derived from extracellular compartment molecules. This dichotomy is due to the fact that the invariant chain associates with class II molecules in the endoplasmic reticulum, preventing binding of endogenous peptides. The mutually exclusive binding of peptide and invariant chain to class II molecules suggests that the invariant chain might play a part in autoimmune disease.

Amino Acid Sequence↗
PubMed1990

Adult expression of the Drosophila Lsp-2 gene.

Previous work has demonstrated expression of the larval serum protein-2 gene, Lsp-2, uniquely during the late larval and pupal stages of development in Drosophila melanogaster. Here we report that the LSP-2 polypeptide accumulates in the hemolymph throughout adult life as well. Western blot analysis using an LSP-2 antiserum reveals notable differences in the molecular weight of the larval and adult polypeptides. Lsp-2 transcription results in a unique mRNA of 2.3 kb, exhibiting the same 5' end in both larvae and adults. However, adult Lsp-2 mRNa is only expressed at 1% of the high level detectable in late third-instar larvae. Whereas Lsp-2 mRNA accumulates uniformly in all fat body cells of third-instar larvae, over 80% of the adult Lsp-2 transcript is expressed in the adipose tissue of the head. These results suggest a differential regulation for expression of the Drosophila Lsp-2 gene in adults and larvae.

Animals↗
PubMed1990

Physical disorders associated with mental illness. A register investigation.

On the basis of nationwide patient register data the diagnostic pattern of the medical admissions of a general population (17-49 year-olds; N = 30427) during an 8-year period was studied by comparing those individuals who had been admitted to the psychiatric department (i.e. psychiatric patients) with those individuals who had not. The results suggest that the high utilization of medical admissions by psychiatric patients could not be explained simply by coincident chronic physical illness or particular types of physical disease including the somatic complications of mental disorders. It is more likely to be attributable to other factors such as an increased general susceptibility to physical illness, different forms of illness behaviour, and the process of somatization.

Adolescent↗
PubMed1990

Mental illness and admission to general hospitals: a register investigation.

Admissions to psychiatric departments and general hospitals in an 8-year period were studied for the 17- to 49-year-old population in 2 Danish municipalities. Information was extracted from the National Patient Register and the Danish Psychiatric Register, registers containing information on all admissions to nonpsychiatric and psychiatric departments, respectively, in Denmark. Fourteen percent of the patients who had been admitted at least once to a general hospital (or 7.5% of the background population) had an indication of a mental disorder. They comprised one fourth of all general admissions of the population during the 8-year period. Patients who had been admitted to a general hospital had a 4 times greater risk of having been admitted to a psychiatric department than the rest of the population and the risk increased markedly with number of general admissions. A pronounced association was found between the number of admissions to general hospitals and psychiatric departments; i.e., both types of admissions clustered in some individuals. The excessive general admissions of psychiatric patients were found to be correlated to all types of psychiatric diagnoses, but was less prominent in nonorganic psychoses. The implication is that there is a very close association between somatic and psychiatric morbidity and that the mentally disturbed use a great part of the nonpsychiatric health services.

Adolescent↗
PubMed1989

[Admissions of persons aged 17-49 years to non-psychiatric departments].

Based upon data from the Danish National Patient Register, the number of somatic admissions during the period 1977-1984 was summed up in two municipalities with an average annual population of 30,426 persons in the age group 17-49 years. 38% of the male population and 48% of the female population in this age group had been admitted at least once during the period (excl. pregnancy conditions). 1% of the population had more than nine admissions which was 18% of all admissions. 4.5% had more than four admissions which was 38% of all admissions. No difference was observed as regards sex, and age was of minor importance for the frequency of admissions. A significant statistical association was found between the number of admissions and abuse, suicidal attempts, and psychiatric illness. About half of the patients (males 56%, females 43%) with more than nine admissions were discharged with one of the "non-organic" diagnoses on at least one occasion. Patients with "non-organic" diseases had an average of 5.2 admissions during the period compared with the other diagnoses with an average of 2.7 which was 20% of all admissions. There were more males with abuse diagnoses and a majority of 30-49 year-olds among the cases of psychiatric illnesses. Apart from this, no significant differences as regards sex and age were found among these diagnostic groups.

Adolescent↗
PubMed1989

Clinical characteristics of the Munchausen syndrome. A review and 3 new case histories.

The term Munchausen syndrome was introduced by Asher in 1951 for the description of patients who tell fantastic stories and deliberately seek repeated hospitalizations at different hospitals for simulated or self-induced acute illnesses. The syndrome has been repeatedly criticized and several other eponyms have been suggested. In DSM-III-R the designation chronic factitious disorder is used synonymously with Munchausen syndrome. On the basis of 3 new case reports and a statistic processing of literature case histories, this paper suggests that when using the original criteria by Asher, the syndrome constitutes a subtype of chronic factitious disorders, specially characterized by factitious illness, peregrination, pseudologia fantastica and dramatic admission circumstances. Further, most of the criticism of the syndrome may be a result of the great variability in definitions and diagnostic criteria used by different authors. Other clinical characteristics of the patients as well as psychopathologic and psychodynamic considerations are briefly discussed.

Adult↗
PubMed1985

Rearrangement and transcription of a T-cell receptor beta-chain gene in different T-cell subsets.

The functionally defined sets of T lymphocytes--helper T cells, cytotoxic T cells, and suppressor T cells--were examined for the possible involvement of a recently identified T-cell receptor beta gene locus in receptor formation. Since gene rearrangements are required for functional gene expression, cloned T-cell lines from each of the groups were surveyed for the expression of unique gene rearrangements. In addition, cell lines that showed gene rearrangements were further tested for the expression of the mature 1.2- to 1.3-kilobase mRNA transcribed from a productive gene rearrangement. The results of such experiments show that helper and cytotoxic T cells may use a common beta chain of the receptor, whereas suppressor cells do so rarely, if at all.

Animals↗
PubMed1984

A single-blind study of naproxen sodium and mefenamic acid in minor trauma.

In a single-blind, parallel, randomised trial the efficacies of naproxen sodium and mefenamic acid were compared in the treatment of musculo-skeletal injuries. The daily dosages used were 1100 mg naproxen sodium and 1500 mg mefenamic acid. Patients were assessed before, during and after four days' treatment, with respect to pain, tenderness, swelling and limitation of function of the injured part. Two hundred and eighty-one patients entered the study and 217 were included in the analysis, 106 in the mefenamic acid group and 111 given naproxen sodium. Both groups showed an improvement in symptoms under treatment but there was no significant difference between the two groups in terms of any of the measurements of efficacy. There was no significant difference between the numbers of side-effects reported in each group, although more were seen in the naproxen sodium patients. In this study, both drugs were equally effective in relieving the symptoms of musculo-skeletal injuries.

Adolescent↗
PubMed1979

Properties and applications of monoclonal antibodies directed against determinants of the Thy-1 locus.

Fusion of cells of the mouse myeloma line, P3/X63-Ag8 with spleen cells from AKR/J mice immunized against C3H thymocytes or from (BALB/c x BALB.K)F1 mice immunized against AKR/J thymocytes gave rise to hybrid cell lines that continuously secrete antibodies specific for the Thy-1.2 and Thy-1.1 antigens, respectively. Monoclonal antibodies from four such cell lines were analyzed in detail. All were 19S IgM, and, in the presence of complement (C), had high lytic titers on T cells of the appropriate antigenicity. Their specificity was shown by lysis of thymocytes from Thy-1 congenic mouse strains, A/J(Thy-1.2) and A. Thy 1.1. Furthermore, they lyse only 60 to 70% of lymph node cells, suggesting cytotoxicity for mature T cells and not B cells. Treatment of peripheral lymphocyte populations with monoclonal antibody plus C eliminated effector cytotoxic T lymphocytes, their precursors, and the mitogenic response to Con A, but did not affect the response to LPS. Purified, fluorescein-labeled monoclonal anti-Thy-1 antibody could be used to distinguish T and B cells. Purified antibody coupled to Sepharose 6MB was used to separate viable T and B cells. Two independently isolated anti-Thy-1.2 hybridomas are indistinguishable and bind the same determinant whereas a third is unique and may bind a separate site.

Animals↗