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Biomedical subjects

B Raphael

Publications and source records attributed to B Raphael.

At least 19 recordsLinked to original sources
PubMed2005

Submandibular gland endoscopic resection: a cadaveric study.

Recent advancement of head and neck surgery has been marked by the development of endoscopic and video-assisted minimally invasive surgery. This study reports the feasibility of endoscopic submandibular gland resection in human cadavers. Twelve submandibular gland resections were performed in six human cadavers. A 30 degrees angle endoscope and conventional surgical instruments were inserted through two 15 mm submandibular incisions. Dissection was carried out bluntly with scissors in an avascular plane superficial to the gland. No insufflation was needed since transcutaneous sutures lead to effective retraction. Facial vessels, the lingual nerve and Wharton's duct were identified and protected. Vascular ligatures were performed using surgical miniclips. After the procedure, an open submandibular dissection was performed to control the integrity of the anatomical structures. In all cases, the resection of the submandibular gland was successful without the need for an additional incision. Injuries of the facial artery and lingual nerve occurred when the procedure was carried out initially. The operative time decreased with training, from 120 min for the first cases to 35 min for the later ones. In conclusion, endoscopic submandibular gland resection is possible without major difficulty. Training and experience reduce the operative time and the complication rate.

Aged↗
PubMed2002

[Congenital nasal pyriform aperture stenosis: a case report].

Congenital nasal pyriform aperture stenosis is a rare and poorly understood pathology. It's etiology is unknown. In cases with severe nasal airway obstruction, this anomaly may produce newborn respiratory destress similar to those seen in bilateral posterior choanal atresia. It can occur as an isolated anomaly or it can be associated with a dental anomaly, craniofacial, ophthalmological or central nervous system malformation. The diagnosis is made by physical examination. Computed tomography confirms the diagnosis. Magnetic resonance imaging of the brain and pituitary endocrine axis must be performed. In patients with severe obstruction, surgical correction is necessary. We describe the case of a 1-month-old child who needed surgical treatment with a sublabial approach for a congenital nasal pyriform aperture stenosis associated with a solitary maxillary central incisor. The follow-up (4 years) reveals normal nasal airway and facial growth.

Constriction, Pathologic↗
PubMed2001

Gorillas with spondyloarthropathies express an MHC class I molecule with only limited sequence similarity to HLA-B27 that binds peptides with arginine at P2.

The human MHC class I gene, HLA-B27, is a strong risk factor for susceptibility to a group of disorders termed spondyloarthropathies (SpAs). HLA-B27-transgenic rodents develop SpAs, implicating HLA-B27 in the etiology of these disorders. Several nonhuman primates, including gorillas, develop signs of SpAs indistinguishable from clinical signs of humans with SpAs. To determine whether SpAs in gorillas have a similar HLA-B27-related etiology, we analyzed the MHC class I molecules expressed in four affected gorillas. Gogo-B01, isolated from three of the animals, has only limited similarity to HLA-B27 at the end of the alpha1 domain. It differs by several residues in the B pocket, including differences at positions 45 and 67. However, the molecular model of Gogo-B*0101 is consistent with a requirement for positively charged residues at the second amino acid of peptides bound by the MHC class I molecule. Indeed, the peptide binding motif and sequence of individual ligands eluted from Gogo-B*0101 demonstrate that, like HLA-B27, this gorilla MHC class I molecule binds peptides with arginine at the second amino acid position of peptides bound by the MHC class I molecule. Furthermore, live cell binding assays show that Gogo-B*0101 can bind HLA-B27 ligands. Therefore, although most gorillas that develop SpAs express an MHC class I molecule with striking differences to HLA-B27, this molecule binds peptides similar to those bound by HLA-B27.

Amino Acid Motifs↗
PubMed2001

The mental health of young people in Australia: key findings from the child and adolescent component of the national survey of mental health and well-being.

OBJECTIVE: To identify the prevalence of three mental disorders (Depressive Disorder, Conduct Disorder and Attention-Deficit/Hyperactivity Disorder), the prevalence of mental health problems, the health-related quality of life of those with problems, and patterns of service utilisation of those with and without mental health problems, among 4-17-year-olds in Australia. To identify rates of health-risk behaviours among adolescents with mental health problems. METHOD: The mental disorders were assessed using the parent-version of the Diagnostic Interview Schedule for Children Version IV. Parents completed the Child Behaviour Checklist to identify mental health problems and standard questionnaires to assess health-related quality of life and service use. The Youth Risk Behaviour Questionnaire completed by adolescents was employed to identify health-risk behaviours. RESULTS: Fourteen percent of children and adolescents were identified as having mental health problems. Many of those with mental health problems had problems in other areas of their lives and were at increased risk for suicidal behaviour. Only 25% of those with mental health problems had attended a professional service during the six months prior to the survey. CONCLUSION: Child and adolescent mental health problems are an important public health problem in Australia. The appropriate balance between funding provided for clinical interventions focusing on individual children and families and funding for interventions that focus on populations, requires careful study. The latter are an essential component of any strategy to reduce mental health problems as the high prevalence of problems makes it unlikely that individual care will ever be available for all those needing help. Clinical and population health interventions must take into account the comorbid problems experienced by children with mental disorders.

Adolescent↗
PubMed2001

Prevalence of adverse life events, depression and suicidal thoughts and behaviour among a community sample of young people aged 15-24 years.

OBJECTIVE: To provide prevalence data on several key mental health indicators for young people aged 15 to 24 years. METHODS: A cross-sectional household survey, using telephone recruitment followed by a postal pencil-and-paper questionnaire. The overall response rate was 67.3%. RESULTS: Difficulties with interpersonal relationships are common causes of distress for young people, in particular problems with parents, problems with friends and relationship break-ups. Depressive symptomatology is common among young people with approximately one in eight males and one in four females reporting current depressive symptomatology. One in three young people reported that they had had suicidal thoughts at some time in the past, 1.2% of young people reported that they had made a plan on how to kill themselves in the four-week period prior to completing the survey and 6.9% of young people reported that they had tried to kill themselves at some time during their life time (4.2% of males and 9.0% of females). CONCLUSIONS AND IMPLICATIONS: The prevalence figures for the various mental health indicators presented in this paper represent good baseline information upon which to examine the progress over time of interventions designed to improve the mental health of young people.

Adolescent↗
PubMed2000

Prevention in psychiatry: Australian contributions.

OBJECTIVE: To provide a historic context for developing a framework for preventive mental health research in Australia. METHOD: A literature review was undertaken and references were selected for their relevance to describing the contributions of Australian researchers and clinicians to an epidemiological approach to mental health disorders, particularly schizophrenia. RESULTS: Australian researchers and clinicians have made major innovative contributions to preventive mental health research. CONCLUSIONS: Australian mental health services, in collaboration with academic departments, are in a highly favourable position to expand preventive research activities into schizophrenia.

Australia↗
PubMed2000

Measuring psychological adjustment to HIV infection.

AIMS: A modified version of the Mental Adjustment to Cancer Scale (The Mental Adjustment to HIV Scale--MAHIVS) was used to evaluate patterns of psychological adjustment in response to HIV infection. METHODS: A sample of 164 HIV positive homosexual/bisexual men were recruited across three Australian centers (79 asymptomatic (CDC II/III) and 85 symptomatic HIV infection (CDC IV)). Factor analysis of the MAHIVS was conducted and the predictive validity of the MAHIVS was investigated using the General Health Questionnaire, while The Diagnostic Interview Schedule was used to assess current and lifetime psychiatric disorder. Other measures of adjustment/coping were used to investigate the construct validity of the MAHIVS (neuroticism, locus of control, defense style). RESULTS: Factor analysis of the MAHIVS detected four factors: Hopelessness, Fighting Spirit/Self Efficacy, Personal Control, and Minimization. Hopelessness and Fighting Spirit factors exhibited acceptable levels of internal consistency and validity, with significant correlations detected with psychological symptoms and significant association with other measures of psychological adjustment and personality. Fighting Spirit emerged as a potential indicator of psychological resilience, whereas Hopelessness was significantly associated with psychological symptoms and current major depression (but not past depression). CONCLUSIONS: The findings indicate the validity of the MAHIVS and support the presence of common themes in the psychological adaptation to life-threatening illness that can be detected across disease categories and groups.

Adaptation, Psychological↗
PubMed2000

Preventing PTSD in trauma survivors.

This article highlights some of the core issues in the prevention of PTSD in trauma survivors. A review of some of the noteworthy research is presented along with new directions for research, training, education, and social planning efforts.

Crisis Intervention↗
PubMed1999

Depressive symptoms and depressive episodes in recently widowed older men.

Older widowers have high rates of completed suicide but have rarely been the subject of systematic inquiry. We investigated the prevalence of depressive symptoms and major depressive episodes (MDEs) in recently widowed older men over the first 13 months after bereavement. We employed a matched-pair longitudinal design and recruited subjects from a suburban community population. Fifty-seven recently widowed older men were identified from official death records and 57 matched married men were identified from the electoral roll. Subjects were assessed for the presence of current DSM-III-R MDEs using the Composite International Diagnostic Interview (CIDI), a fully structured psychiatric interview. Widowers were assessed at 6 weeks after bereavement (T1) and 13 months after bereavement (T2). Married men were assessed at similar intervals. At T1, seven widowers (12.3%) and no married men were found to have CIDI cases of current MDE. At T2, one widower (1.9%) and no married men were found to have CIDI cases of current MDE. Current MDE was not predicted by a past history of dysphoria. At T1, 14.0% (8/57) of widowers reported specific suicidal thoughts or actions. At T2, 15.4% (8/52) of widowers reported suicidal thoughts or actions. We conclude that health workers should monitor closely the clinical course of MDEs in recently widowed older men. Routine inquiry about suicidal ideation should be an essential component of the clinical assessment of recently widowed older men.

Aged↗
PubMed1999

Alcohol consumption and psychological distress in recently widowed older men.

OBJECTIVE: The relationship between severe adverse life events and subsequent health-related behaviour is not well established for older people. To address this issue, we studied self-reported alcohol consumption in recently widowed older men and matched married men. METHOD: We carried out a double cohort study in community-residing men aged 65 years and over. Recently widowed men (n = 57; mean age = 74.5 years) were identified from the death records of their wives and assessed at 6 weeks, 6 months and 13 months post-bereavement. Matched married men (n = 57; mean age = 75.4 years) were identified from the electoral roll and assessed at similar intervals. Self-report measures of alcohol consumption, grief and state anxiety were employed. RESULTS: Similar proportions of older widowers and married men reported that they consumed some alcohol, although recently widowed older men reported significantly greater frequency (chi2 = 4.64, df = 1, p = 0.031) and quantity (chi2 = 7.75, df = 1, p = 0.005) of alcohol consumption than matched married men. A significant minority of subjects reported hazardous levels of alcohol consumption with 18.9% of widowers and 8.3% of married men reporting that they drank five or more standard drinks per drinking day. However, among widowers, self-reported alcohol consumption was not significantly correlated with levels of either self-reported grief or state anxiety. CONCLUSIONS: Hazardous alcohol consumption occurs commonly among recently widowed older men, but is not related to their levels of self-reported grief or psychological distress. Loss of spousal care and control may be an alternative explanation for this drinking behaviour. Older widowers should be regarded as a high-risk group for hazardous alcohol consumption and would be a suitable target group for preventive interventions.

Aged↗
PubMed1998

Oncocytoma of the eyelid: an aggressive benign tumor.

OBJECTIVE: The authors report the case of an 83-year-old patient with a benign oncocytoma of the inferior eyelid. DESIGN: INTERVENTIONal case report. INTERVENTION: Treatment consisted of a large orbital exenteration followed by reconstruction with a pedicled temporalis muscle flap. MAIN OUTCOME MEASURES: Histologic evaluation and clinical follow-up were measured. RESULTS: After a year of follow-up, there was no sign of local recurrence. CONCLUSIONS: Oncocytomas, even if benign, must be considered as very aggressive tumors and treated accordingly.

Adenoma, Oxyphilic↗
PubMed1998

Posttraumatic stress disorder in response to HIV infection.

This study investigated the psychological impact of HIV infection through assessment of posttraumatic stress disorder in response to HIV infection. Sixty-one HIV-positive homosexual/bisexual men were assessed for posttraumatic stress disorder in response to HIV infection (PTSD-HIV) using a modified PTSD module of the DIS-III-R. Thirty percent met criteria for a syndrome of posttraumatic stress disorder in response to HIV diagnosis (PTSD-HIV). In over one-third of the PTSD cases, the disorder had an onset greater than 6 months after initial HIV infection diagnosis. PTSD-HIV was associated with other psychiatric diagnoses, particularly the development of first episodes of major depression after HIV infection diagnosis. PTSD-HIV was significantly associated with a pre-HIV history of PTSD from other causes, and other pre-HIV psychiatric disorders and neuroticism scores, indicating a similarity with findings in studies of PTSD from other causes. The findings from this preliminary study suggest that a PTSD response to HIV diagnosis has clinical validity and requires further investigation in this population and other medically ill groups. The results support the inclusion of the diagnosis of life-threatening illness as a traumatic incident that may lead to a posttraumatic stress disorder, which is consistent with the DSM-IV criteria.

Adult↗
PubMed1998

The impact of domestic violence on women's mental health.

This longitudinal study aimed to establish a firmer scientific basis for recognition and treatment of post-traumatic psychiatric morbidity associated with domestic violence. The study used a sample of 335 women (mean age 45.5 years) recruited from the Royal Brisbane Hospital Emergency Department. This paper reports baseline data. The outcome measures of lifetime psychiatric diagnoses (DSM-111-R classification), showed that women who reported lifetime adult intimate abuse (n = 162) received significantly more diagnoses of generalised anxiety, dysthymia, depression, phobias, current harmful alcohol consumption and psychoactive drug dependence than those who reported no abuse ever (n = 173). Of the 191 women tested for lifetime post-traumatic stress disorder, those who reported lifetime abuse (n = 115) received significantly more diagnoses than those who reported no abuse (n = 76). Crude prevalence rates of psychiatric diagnoses for women who reported double abuse as child and adult were significantly higher than for women who reported adult intimate abuse only. Adjusted rates showed that doubly abused women had significantly greater risk of current harmful alcohol consumption and lifetime drug dependence than women who reported adult abuse only. A significant independent factor for lifetime psychiatric diagnoses was reporting abuse between a woman's parents. Measurement of the population attributable risk found that one-third of the psychiatric diagnoses were attributable to domestic violence.

Adult↗
PubMed1998

How does domestic violence affect women's mental health?

In this paper we compare the mental health of women who reported domestic violence and women who reported no abuse in their lifetime. A longitudinal study was conducted with women, 16 to 74 years (n = 358), who attended the emergency department of a major public hospital in Australia. Our aim was to investigate the nature of symptoms and pattern of mental illness associated with domestic violence. The results of the baseline data reported in this paper showed that women who experienced abuse as adults suffered more ill-effects to their mental health than women who did not experience such abuse; also that women who experienced both adult and child abuse suffered more ill-effects than women who experienced abuse either as an adult or child.

Adolescent↗
PubMed1998

A longitudinal study comparing bereavement phenomena in recently bereaved spouses, adult children and parents.

OBJECTIVE: The study investigated previous research findings and clinical impressions which indicated that the intensity of grief for parents who had lost a child was likely to be higher than that for widows/widowers, who in turn were likely to have more intense reactions than adult children losing a parent. METHOD: In order to compare the intensities of the bereavement reactions among representative community samples of bereaved spouses (n = 44), adult children (n = 40) and parents (n = 36), and to follow the course of such phenomena, a detailed Bereavement Questionnaire was administered at four time points over a 13-month period following the loss. RESULTS: Measures based on items central to the construct of bereavement showed significant time and group differences in accordance with the proposed hypothesis. More global items associated with the construct of resolution showed a significant time effect, but without significant group differences. CONCLUSIONS: Evidence from this study supports the hypothesis that in non-clinical, community-based populations the frequency with which core bereavement phenomena are experienced is in the order: bereaved parents > bereaved spouses > bereaved adult children.

Adaptation, Psychological↗
PubMed1998

Psychiatric disorder in HIV infection.

OBJECTIVE: This study aimed to investigate rates of psychiatric disorder in human immunodeficiency virus (HIV) infection, in an Australian sample of homosexual and bisexual men. METHOD: A cross-sectional study of a total of 65 HIV sero-negative (HIV-) and 164 HIV sero-positive men (HIV+) (79 CDC stage II/III and 85 CDC stage IV) was conducted in three centres. Lifetime and current prevalence rates of psychiatric disorder were evaluated using the Diagnostic Interview Schedule Version IIIR (DIS-IIIR). RESULTS: Elevated current and lifetime rates of major depression were detected in both HIV negative and HIV positive homosexual/bisexual men. Lifetime rates of alcohol abuse/dependence were significantly elevated in HIV positive men (CDC group IV) when compared with HIV negative men. Among the HIV positive group the majority of psychiatric disorders detected were preceded by a pre-HIV diagnosis of psychiatric disorder. Major depression represented the disorder most likely to have first onset after HIV infection diagnosis. CONCLUSIONS: Lifetime rates of major depression were elevated in this sample of HIV-negative and HIV-positive men. In the HIV-positive men, psychiatric disorder was significantly associated with the presence of lifetime psychiatric disorder prior to HIV infection diagnosis. The findings indicate the importance of evaluation of psychiatric history prior to HIV infection and the clinical significance of depressive syndromes in this population.

AIDS Dementia Complex↗