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Biomedical subjects

S Perry

Publications and source records attributed to S Perry.

At least 37 records · Page 2Linked to original sources

Effectiveness of psychoeducational interventions in reducing emotional distress after human immunodeficiency virus antibody testing.

To examine the effectiveness of three psychoeducational interventions in reducing emotional distress after voluntary serologic testing for human immunodeficiency virus-1,307 physically asymptomatic adults were randomly assigned to standard counseling, counseling plus a three-session interactive video program, or counseling plus six individual sessions of stress prevention training. Subjects were evaluated using five standardized distress measures at entry and 3 months later. Among the 204 human immunodeficiency virus-seronegative subjects, mean distress measures decreased significantly after all three interventions without differential treatment effects. Among the 103 human immunodeficiency virus-seropositive subjects, mean distress measures decreased significantly after the stress prevention training and did not significantly increase in the other two interventions. We conclude that stress prevention training is particularly helpful after notification of human immunodeficiency virus seropositivity.

Adult

Eicosanoid production by brain tumours in vivo--evidence for intracranial compartmentation.

Brain tumours produce prostaglandins in vitro; their in vivo production has been studied by determining the levels of prostaglandin F2 alpha, prostaglandin E2, 6-ketoprostaglandin F1 alpha and thromboxane B2 in tumour cyst fluid and ventricular CSF taken from 21 patients with a variety of intracranial tumours. The levels were high in tumour cyst fluid but there was no overall increase in ventricular CSF. Hence, brain tumours do not produce a consistent pattern of abnormality of eicosanoid concentrations in the ventricular CSF that would be useful for diagnosis. If brain tumours produce excess quantities of these prostaglandins in vivo as they do in vitro, these prostaglandins may be rapidly cleared by the cerebral microvasculature unless compartmentalized within a tumour cyst.

6-Ketoprostaglandin F1 alpha

The effects of hyponatraemia and subarachnoid haemorrhage on the cerebral vasomotor responses of the rabbit.

Impairment of cerebral autoregulation and development of hyponatraemia are both implicated in the pathogenesis of delayed cerebral ischaemia and infarction following subarachnoid haemorrhage (SAH) but the pathophysiology and interactions involved are not fully understood. We have studied the effects of hyponatraemia and SAH on the cerebral vasomotor responses of the rabbit. Cerebrovascular reactivity to hypercapnia and cerebral autoregulation to trimetaphan-induced hypotension were determined in normal and hyponatraemic rabbits before and 6 days after experimental SAH produced by two intracisternal injections of autologous blood. Hyponatraemia (mean plasma sodium of 119 mM) was induced gradually over 48 h by administration of Desmopressin and intraperitoneal 5% dextrose. Sham animals received normal saline. The cerebrovascular reactivity (% change +/- SD in cortical CBF/mm Hg PaCO2, measured by hydrogen clearance) of hyponatraemic (4.8 +/- 3.0%) and SAH (1.3 +/- 2.0%) animals was significantly less (p less than 0.05) than control (11.6 +/- 4.0%) and sham (8 +/- 2.0%) animals, whereas the reactivity of hyponatraemic-SAH animals was preserved (9.8 +/- 6.0%). Hyponatraemia and SAH alone each significantly impaired CBF autoregulation but their combined effects were not additive. Systemic hyponatraemia impairs normal cerebral vasomotor responses but does not augment the effects of experimental SAH in the rabbit.

Animals

The diffusion of medical technology: free enterprise and regulatory models in the USA.

The diffusion of technology in the US has taken place in an environment of both regulation and free enterprise. Each has been subject to manipulation by doctors and medical administrators that has fostered unprecedented ethical dilemmas and legal challenges. Understanding these developments and historical precedents may allow a more rational diffusion policy for medical technology in the future.

Certificate of Need

A survey of color discrimination in German ophthalmologists. Changes associated with the use of lasers and operating microscopes.

Color vision tests were performed on 211 German ophthalmologists during their annual meeting at Essen. The subjects also answered detailed questionnaires about their use of lasers and operating microscopes, and their ocular and general health. It was found that 33% of doctors who use lasers or operating microscopes have decreased color discrimination for colors in a tritan color-confusion axis (greater than 2 standard deviations above normal). There is a relationship between number of patients treated and the degree of threshold elevation. Thirty hours of using the operating microscope produces an increase in tritan threshold equivalent to one panretinal photocoagulation.

Adult

Balloon angioplasty for congenital mitral stenosis.

We attempted balloon angioplasty in 9 children (ages 0.1 to 10 years) with congenital mitral stenosis. All were symptomatic with severe congestive heart failure and failure to thrive. Effective reduction in mitral gradient was initially achieved in 7 patients. For the entire group, mean valve gradient decreased from 14.8 +/- 5.0 to 8.1 +/- 6.7 mm (p = 0.0007) and mean valve area increased from 1.1 +/- 0.5 to 1.8 +/- 0.9 cm2/m2 (p = 0.003). More than mild mitral regurgitation developed in 2 patients but none required surgery for mitral regurgitation. Poor gradient relief followed dilation of valves with unbalanced chordal attachments, with restriction to the valve apparatus as in mitral arcade, and where the obstruction was not purely valvar as it is with a supramitral ring. No strokes, infection or deaths were due to the procedure. Based on these data, balloon angioplasty of congenital mitral stenosis should be considered before mitral valve replacement in younger patients and in those in whom mitral valve replacement would be problematic.

Angioplasty, Balloon

Suicidal ideation and HIV testing.

To examine the effect of human immunodeficiency virus antibody testing on suicidal ideation among physically asymptomatic subjects at perceived risk for infection, 244 men and 57 women completed the Beck Depression Inventory 2 weeks before and 1 week and 2 months after notification. All subjects received extensive pretest and posttest counseling. Among the 49 seropositive subjects, rates of suicidal ideation on item 9 of the Beck Depression Inventory were 28.6% at entry and 27.1% and 16.3% at the two follow-up assessments; none reported increased suicidal ideation at 2 months. Among the 252 seronegative subjects, suicidal ideation decreased from 30.6% at entry to 17.1% and 15.9% at 1 week and 2 months after notification, respectively. Suicidal ideation correlated with modified Beck Depression Inventory scores (r = .50 to .55). Among the 4.7% of seropositives and seronegatives with suicidal wishes or intent at any assessment, average modified Beck Depression Inventory scores (mean, 17.1) suggested a clinical depression.

AIDS Serodiagnosis

The appropriate use of high-cost, high-risk technologies: the case of total parenteral nutrition.

An assessment of total parenteral nutrition (TPN), a high-cost, high-risk technology, is used to illustrate the importance of technology assessment to quality assessment. A review of the literature suggests that TPN is only sometimes effective and that it actually produces measurable harm by increasing complication rates in certain groups of patients. However, there are strong advocates for its use. The economic and ethical implications of TPN for the quality of care are also discussed at the levels both of the individual and of society. Continuous assessment of health care technologies, particularly those that are high-cost and high-risk, is critical to the overall quality of health care.

Cost-Benefit Analysis

Aerobics enhances cardiovascular fitness and agility in preschoolers.

Investigated effects of aerobic exercise on a sample of 24 preschoolers. Thirty minutes of aerobic exercises were provided daily for a period of 8 weeks for a group of 12 children while the remaining 12 children engaged in freeplay on the school playground. The children were given pretests and posttests on the following measures: a submaximal exercise test on a pediatric bicycle (baseline and three workloads), an agility test, a health knowledge test, a self-esteem scale, and an observational measure of their gross-motor activity. Despite comparability on pretests, significant group X repeated measures effects suggested that the aerobic exercise group showed decreases in heart rate at all three workloads as well as increases in agility and self-esteem following the exercise program. These findings suggest that cardiovascular fitness, agility, and self-esteem can be facilitated in preschoolers by an aerobic exercise program.

Arousal

Cataract surgery with intraocular lens implantation in Fuchs' heterochromic cyclitis.

The results of cataract extraction with posterior chamber lens implantation in twenty eyes with Fuchs' Heterochromic Cyclitis are reported. No serious operative complications were experienced. The visual outcome has been excellent in all but those eyes with coexistent glaucoma. The postoperative complications seem no more frequent than would be expected for the underlying condition.

Adult

Effect of hydrocephalus on prostaglandins and thromboxane B2 in ventricular cerebrospinal fluid.

The concentrations of prostaglandin F2 alpha, prostaglandin E2, 6-ketoprostaglandin F1 alpha (prostacyclin metabolite), and thromboxane B2 were assayed in ventricular cerebrospinal fluid obtained from 28 patients with hydrocephalus (17 obstructive, 11 communicating). Seven patients received dexamethasone or hydrocortisone on the day of sampling. No patient received nonsteroidal anti-inflammatory compounds for 48 hours before sampling. The median values did not differ significantly between the two types of hydrocephalus or from the concentrations in lumbar cerebrospinal fluid obtained from patients without intracranial pathology during lumbar myelography for possible lumbar disc disease. Hence, there is no evidence that eicosanoids accumulate in the ventricles in hydrocephalus, and it is unlikely that they have a significant role in its symptomatology.

6-Ketoprostaglandin F1 alpha

Equine infectious anemia virus derived from a molecular clone persistently infects horses.

A full-length molecular clone of equine infectious anemia virus (EIAV) was isolated from a persistently infected canine fetal thymus cell line (Cf2Th). Upon transfection of equine dermis cells, the clone, designated CL22, yielded infectious EIAV particles (CL22-V) that replicated in vitro in both Cf2Th cells and an equine dermis cell strain. Horses infected with CL22-V developed an antibody response to viral proteins and possessed viral DNA in peripheral blood mononuclear cells, as determined by polymerase chain reaction assays. In addition, horses infected with CL22-V became persistently infected and were capable of transmitting the infection by transfer of whole blood to uninfected horses. However, CL22-V, like the parental canine cell-adapted virus, did not cause clinical signs in infected horses. Reverse transcriptase assays of CL22-V- and virulent EIAV-infected equine mononuclear cell cultures indicated that the lack of virulence of CL22-V was not due to an inability to infect and replicate in equine mononuclear cells in vitro.

Animals

Psychiatric diagnosis before serological testing for the human immunodeficiency virus.

To identify the diagnostic characteristics and counseling needs of individuals at risk for acquired immune deficiency syndrome (AIDS), standardized DSM-III-R diagnoses were given to 207 physically asymptomatic adults when they sought serological testing for the human immunodeficiency virus (HIV). The subjects had high lifetime rates of mood disorders. Even after the 20 subjects with intravenous drug use as a risk factor were eliminated, lifetime rates of nonalcohol substance dependence were also high. These findings suggest that even before they are notified of HIV test results, many individuals at perceived risk for AIDS may be vulnerable to future depression and nonintravenous drug abuse.

AIDS Serodiagnosis

Voluntarily informing others of positive HIV test results: patterns of notification by infected gay men.

Forty gay men who had recently learned that they were infected with human immunodeficiency virus (HIV) were interviewed to determine the frequency with which they voluntarily informed physicians, dentists, friends, family members, and current and past sexual partners of their positive test results. Ninety percent of the subjects informed a personal physician, and 48 percent of the subjects who sought dental care informed the dentist. Sixty-six percent of subjects with at least one current sexual partner notified every current sexual partner, although notification was not associated with a greater likelihood of safer sex practices. Ninety percent of the subjects who had past sexual partners made no attempt to inform them. Sixty-eight percent confided in at least one friend, but only 35 percent told a family member.

AIDS Serodiagnosis