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Biomedical subjects

R C Young

Publications and source records attributed to R C Young.

At least 55 records · Page 3Linked to original sources
PubMed1998

Assessment and treatment of bipolar disorder in the elderly.

The aetiology of late-onset bipolar disorder is heterogeneous because the disease is more likely to have a secondary (i.e. a medical disorder or medication-induced) cause in older than in younger patients. Elderly patients with bipolar disorder typically require lithium dosages that are 25 to 50% lower than those used in younger individuals. Information on the use of valproic acid (sodium valproate) in elderly patients with bipolar disorder is limited but encouraging. In contrast, there is virtually no information regarding the use of carbamazepine or other drugs in this patient group. Electroconvulsive therapy is well tolerated by older people and can be useful for these patients.

Aged↗
PubMed1998

Management of early ovarian cancer.

About one third of the women diagnosed with ovarian cancer present with localized disease. Accurate surgical staging is required to properly evaluate these patients, define appropriate treatment, and establish prognosis. A series of recent studies have clarified which patients can be managed with comprehensive surgical staging and disease removal alone, and which may benefit from adjuvant therapy. A series of national and international prospective randomized trials are evaluating a variety of adjuvant treatments that may enhance long-term survival in those patients with early ovarian cancer who do require additional therapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

'Vascular depression' hypothesis.

We propose that cerebrovascular disease may predispose, precipitate, or perpetuate some geriatric depressive syndromes. The "vascular depression" hypothesis is supported by the comorbidity of depression, vascular disease, and vascular risk factors and the association of ischemic lesions to distinctive behavioral symptoms. Disruption of prefrontal systems or their modulating pathways by single lesions or by an accumulation of lesions exceeding a threshold are hypothesized to be central mechanisms in vascular depression. The vascular depression concept can generate studies of clinical and heuristic value. Drugs used for the prevention and treatment of cerebrovascular disease may be shown to reduce the risk for vascular depression or improve its outcomes. The choice of antidepressants in vascular depression may depend on their effect on neurologic recovery from ischemic lesions. Research can clarify the pathways to vascular depression by focusing on the site of the lesion, the resultant brain dysfunction, the presentation of depression and time of onset, and the contribution of nonbiological factors.

Aged↗
PubMed1997

Age and psychosis in degenerative dementia.

Among psychiatric inpatients with primary degenerative dementia, those with psychotic symptoms (N = 20) were older than those without (N = 20) (t = 3.48; p < 0.001). Persecutory delusions were the most frequent psychotic phenomena. Duration of dementia overlapped, but scores on the Global Deterioration Scale and the Cornell Scale for Depression in Dementia were lower in the psychotic group after correcting for age. The limited literature concerning demographic and clinical correlates of psychosis in dementia is reviewed; the age difference noted is consistent with two other reports.

Age Distribution↗
PubMed1997

A computer model of uterine contractions based on action potential propagation and intercellular calcium waves.

OBJECTIVE: To simulate a uterine contraction using a novel computer model for uterine communication and to validate the assumptions of the computer model by comparing the simulated contraction with a real uterine contraction. METHODS: The computer model assumed two known mechanisms of intercellular communication: action potential propagation and calcium wave propagation. Simulations were performed on a desktop computer using available programming language. Model validity was assessed by fitting the computer-simulated contraction to a real contraction and comparing the fit values with values measured independently. RESULTS: The simulated contraction demonstrated five characteristics that are also observed in human labor: 1) gradual onset, 2) a linear rising segment, 3) a plateau region, 4) a symmetrical fall, and 5) gradual offset. The fit values agreed well with values determined experimentally and supported the model. CONCLUSIONS: Our results support the model, strongly suggesting that intercellular communication occurs throughout the uterus by action potentials and locally within the tissue by calcium waves.

Action Potentials↗
PubMed1997

Paracrine and intracellular signaling mechanisms of calcium waves in cultured human uterine myocytes.

OBJECTIVE: To establish mechanisms of intercellular communication in human myometrium other than action potential propagation. METHODS: Monolayer cultured human myometrium was used as a model system. The calcium-sensitive fluorescent dye, calcium green-1, was used as a probe for the concentration of intracellular free calcium. Intercellular calcium waves were initiated by mechanical stimulation and observed with video spectrofluorimetry. This technique allowed initiation of calcium waves from a known location at a known time while simultaneously controlling the flow rate of the bathing solution across the surface of the cells. Intercellular calcium waves were observed at bath flow rates between 0 and 5.1 mL/minute through a 0.4 mL chamber. Experiments were performed using low calcium, high potassium bathing solutions to eliminate the possibility of action potential signaling. RESULTS: In still bathing solution, calcium waves radiated symmetrically from the site of initiation. With the bathing solution flowing, two mechanisms of intercellular calcium wave propagation were observed-one dependent on and one independent of the direction of bath flow. The calcium waves that were independent of bath flow used an intracellular mechanism for intercellular communication, were only observed within 100 microns of the site of wave initiation, and demonstrated mean (+/- standard deviation [SD]) wave speeds of 14.1 +/- 2.6 microns/second. The waves dependent on bath flow used an extracellular signaling mechanism, were observed at distances much greater than 100 microns, and exhibited downstream biasing. Mean (+/- SD) wave speeds of flow-dependent calcium waves were faster under flow conditions than still bath conditions (36.0 +/- 4.7 versus 6.2 +/- 1.3 microns/second; P < .001). By exposing the cells to flurbiprofen, a water soluble prostaglandin synthetase inhibitor, both types of calcium waves were inhibited. CONCLUSION: Human myocytes demonstrate paracrine and intracellular signaling mechanisms for intercellular communication that are distinctly different from action potential propagation.

Calcium↗
PubMed1997

Bipolar mood disorders in the elderly.

Age effects on early-onset bipolar illness may include changes in affective features and recovery. Age effects on the pharmacokinetics of lithium are clinically relevant. Average age at onset is relatively late among geriatric bipolars. Late-onset bipolar disorder is associated with lower rate of familial illness than early-onset cases and greater medical and neurologic comorbidity. The limited literature available points to the need for further studies of geriatric bipolar disorder. In such investigation, the distinction between age and age at onset effects provides a framework within which to enhance knowledge of psychopathology, to expand understanding of natural history and the impact of therapeutic interventions, and to study mechanisms.

Adult↗
PubMed1997

Clinically defined vascular depression.

OBJECTIVE: The authors' goal was to examine the clinical presentation of a group of depressed elderly patients with clinically defined risk factors for vascular depression compared with a group of elderly depressed patients without such risk factors. METHOD: Cognitive deficits, disability, and depressive symptoms were examined in 33 consecutively recruited elderly patients defined as having vascular depression and 32 patients defined as having nonvascular depression according to their scores on the Cumulative Illness Rating Scale-Geriatrics. RESULTS: The patients with vascular depression had greater overall cognitive impairment and disability than those with nonvascular depression. Fluency and naming were more impaired in patients with vascular depression, and they had more retardation and less agitation as well as less guilt feelings and greater lack of insight. CONCLUSIONS: The symptoms of vascular depression are consistent with lesions that may damage striato-pallido-thalamo-cortical pathways and other areas. The concept of vascular depression can provide the impetus for investigations of prevention and treatment of cerebrovascular disease and for studies of the course of vascular depression and selection of antidepressants.

Age of Onset↗
PubMed1997

Brainstem evoked response abnormalities in late-life depression with vascular disease.

OBJECTIVE: The purpose of this study was to examine whether the brainstem evoked responses of geriatric depressed patients with vascular disease show greater changes in wave V latency after increased stimulation than do responses of geriatric depressed patients without vascular disease and elderly comparison subjects with and without vascular disease. METHOD: Geriatric patients with unipolar depression (N = 53) were recruited from a university psychiatric hospital. Elderly comparison subjects (N = 23) were recruited through advertisements. All subjects were assessed for depressive symptoms, cognitive performance, overall medical burden, vascular disease, and disability. Brainstem evoked response was elicited at stimulation rates of 11.4 and 80.0 clicks/sec. RESULTS: The interaction between depression and vascular disease had a significant effect on change in wave V latency. This effect was synergistic, more than an additive effect. Post hoc comparisons showed that the depressed patients with vascular disease had greater changes in wave V latency that did the depressed patients without vascular disease, comparison subjects with vascular disease, and comparison subjects without vascular disease. Linear discriminant function analysis showed that 82% of the subjects with abnormal changes in wave V latency (sensitivity: 75%, specificity: 81%) could be identified on the basis of ratings for depression and vascular disease. CONCLUSIONS: Demyelination afflicting the pons and mesencephalon may explain the greater change in wave V latency for the brainstem evoked response in depressed patients with vascular disease. Further studies combining brainstem evoked response with brain imaging may determine whether depression develops only after vascular disease leads to demyelination.

Aged↗
PubMed1997

Alternating MOPP and ABVD chemotherapy plus mantle-field radiation therapy in patients with massive mediastinal Hodgkin's disease.

PURPOSE: To evaluate the efficacy and toxicity of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP)/doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy plus mantle-field radiation therapy in the treatment of patients with massive mediastinal Hodgkin's disease of any stage. PATIENTS AND METHODS: Eighty patients presented with Hodgkin's disease and a mediastinal mass greater than one third the greatest chest diameter on chest radiograph. Patients were staged and treated with MOPP alternated with ABVD chemotherapy for a total of six cycles. Patients then received 10 Gy mantle-field radiation therapy delivered to the original extent of disease followed by 25 to 35 Gy to the residual abnormalities. RESULTS: The complete response (CR) rate was 89%. With a median follow-up duration of 10 years, disease-free survival of the complete responders is 78% at 15 years and overall survival is 75% at 15 years. For patients with stage I or II disease, disease-free survival was 76% at 15 years and overall survival was 79%; for those with stage III or IV disease, disease-free survival was 82% at 15 years and overall survival was 64%. Age, stage, sex, B symptoms, number of extranodal sites, lactate dehydrogenase (LDH) levels, erythrocyte sedimentation rate, and platelet count did not influence treatment outcome. Treatment-related pneumonitis was noted in 16% of patients (fatal in one), mainly in those older than age 35 years who received total doses of radiation therapy greater than 42 Gy. Fertility is more often preserved with MOPP/ABVD therapy than with MOPP chemotherapy and there appears to be less pulmonary and cardiac disease than with ABVD chemotherapy. Two patients have developed second solid tumors within radiation ports and one relapsed patient developed acute leukemia after MOPP salvage therapy. CONCLUSION: MOPP/ABVD followed by mantle-field radiation therapy is an effective treatment for all stages of Hodgkin's disease that present with a large mediastinal mass. Our data suggest that the large mediastinal mass is a more dominant determinant of prognosis than Ann Arbor stage or other clinical prognostic factors.

Adolescent↗
PubMed1997

Strategies for suppression, containment, and eradication of resurgent tuberculosis.

This review provides strategies for the suppression, containment, and eventual eradication of resurgent tuberculosis. Some ethnic minority communities are at greatest risk because of the prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome, poverty and malnutrition, congregate living situations, aberrant lifestyles, illegal immigration, and underemployment among these populations. Proposed strategies include the education of the population at risk as well as health care providers to permit the optimization of preventive, diagnostic, and therapeutic technologies. Also necessary is the development of effective, safe, newer medications to enhance patient compliance and decrease drug resistance. Strategic planning embraces national socioeconomic policy to permit adequate resources to combat poverty and malnutrition, to rebuild the infrastructure of the public health system, and to improve access to health care among rural and urban dwellers. It is concluded that these efforts must continue to ensure the eradication of tuberculosis.

Adult↗
PubMed1997

Primary care paradigm for management of sarcoidosis, Part 1.

Sarcoidosis is a systemic granulomatous disease of undetermined etiology in which the immune system is overstimulated. Management of the patient with sarcoidosis entails continuity of patient care far beyond disease, even into remission. Care is comprehensive, including all involved organ systems, coordination of specialty consultations and services, and diagnostic tests. Therapeutic decisions are the responsibility of the primary care practitioner. Prognosis of sarcoidosis is not uniformly good. Patients can die. Subacute sarcoidosis patients usually do not require pharmacologic therapy. Chronic sarcoidosis may require long-term treatment for years to indefinitely. Corticosteroids are still the drugs of choice and other therapy is now available. Health organizations and private nonprofit support groups are available for patient education and assistance. Close support must still come from the family unit. Sarcoidosis may occur in family members in different cohorts at all ages in life and in any racial or ethnic group. This article is the first in a two-part series on management of the patient with sarcoidosis in the 21 st century by the primary are provider. Applications of principles of family medicine are emphasized. Part 1 considers continuity, comprehensiveness, and coordination of care. Part 2 will complete coordination of care, and consider community, prevention, and family aspects of this disease.

Adrenal Cortex Hormones↗
PubMed1997

Hormone replacement therapy and late-life mania.

The authors report a case of mania occurring in a woman in late life who had begun receiving hormone replacement therapy for osteoporosis. They discuss related literature reports of mania or rapid cycling after adjunctive estrogen administration for refractory depression.

Aged↗
PubMed1997

Primary care paradigm for management of sarcoidosis, Part 2.

Sarcoidosis is a systemic granulomatous disease of undetermined etiology in which the immune system is overstimulated. Management of the patient with sarcoidosis entails continuity of patient care far beyond disease, even into remission. Care is comprehensive, including all involved organ systems, coordination of specialty consultations and services, and includes diagnostic tests. Therapeutic decisions are the responsibility of the primary care practitioner. Prognosis of sarcoidosis is not uniformly good. Patients can die. Subacute sarcoidosis patients usually do not require pharmacologic therapy. Chronic sarcoidosis may require long-term treatment for years to indefinitely. Corticosteroids are still the drugs of choice and other therapy is now available. Health organizations and private nonprofit support groups are available for patient education and assistance. Close support must still come from the family unit. Sarcoidosis may occur in family members in different cohorts at all ages in life and in any racial or ethnic group. The second in a two-part series on management of the patient with sarcoidosis, this article describes coordination of care and considers community, prevention, and family aspects of the disease.

Adolescent↗
PubMed1996

TB testing.

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Animals↗