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Biomedical subjects

B T Walsh

Publications and source records attributed to B T Walsh.

At least 109 records · Page 6Linked to original sources
PubMed1982

Reversible loss of nocturnal penile tumescence during depression: a preliminary report.

Depressed patients regularly report a loss of interest in sex, but whether this represents only a lack of psychological motivation or is a reflection of an underlying physiological abnormality is unknown. We have studied 2 men suffering from severe depression and have observed that nocturnal penile tumescence was virtually absent while the men were depressed but returned to normal on recovery.

Aged↗
PubMed1982

Factors related to orthostatic hypotension associated with tricyclic antidepressants.

A group of 45 depressed patients treated with imipramine hydrochloride were examined in an attempt to identify factors that might influence the risk of developing orthostatic hypotension. Although the literature suggests that age and/or heart disease influences the occurrence of orthostatic hypotension, these conclusions are controversial. To pursue this issue, a sample of older depressed patients, many with severe cardiovascular disease, was chosen. The incidence of orthostatic hypotension rose dramatically among those with severe heart disease. There was a significant association between symptomatic orthostatic hypotension and cardiac medication (p less than .01), and trends between orthostatic hypotension and both ejection fraction (p = .11) and baseline forearm resistance (p = .16). The sample is too small to permit determination of the relative independent importance of these variables or the contribution of specific cardiovascular drugs among these sicker cardiac patients.

Aged↗
PubMed1981

The production rate of cortisol declines during recovery from anorexia nervosa.

The plasma concentration of cortisol is elevated in many patients with anorexia nervosa. It has remained unclear whether this elevation of plasma cortisol level is due only to a slowing of the rate of cortisol metabolism or whether there is, as well, an increase in adrenal secretory activity in anorexia nervosa. We studied adrenocortical activity in 9 female patients and one male patient with anorexia nervosa before and during recovery. The 24-h mean level of plasma cortisol and the rate of urinary free cortisol excretion decreased during recovery, from 11.4 to 7.4 micrograms/dl and from 225 to 116 micrograms/day, respectively (P less than 0.005 and P less than 0.10, paired t test). These changes were associated with a significant decline in the rate of cortisol production from 24.3 to 17.9 mg/day as measured by radioisotope dilution (P less than 0.005). These results suggest that adrenal secretory activity is increased in anorexia nervosa and that the elevation of plasma cortisol level observed in this syndrome reflects not only a slowing of cortisol metabolism but also a rise in cortisol production.

Adolescent↗
PubMed1981

Anorexia nervosa and salivary gland enlargement.

Enlargement of the salivary glands can occur in patients with anorexia nervosa (AN). This enlargement appears to be related to both the nutritional deficiencies and the bizarre eating habits (particularly the bulimia and vomiting) characteristic of these patients. In some patients, the salivary gland enlargement persists despite return to normal weight. Three patients illustrating this finding are described and the implications of this association between AN and salivary gland enlargement are discussed.

Adult↗
PubMed1978

Adrenal activity in anorexia nervosa.

Adrenocortical activity was studied in 19 emaciated women with anorexia nervosa. Relative to body size the patients' mean cortisol production rates of 0.591 mg/kg/day and 16.4 mg m2/day were significantly elevated compared to those of 0.322 mg/kg/day and 11.4 mg/m2/day for age and sex matched normal controls (p less than 0.001 and 0.02, respectively). The 24-hr mean plasma cortisol concentration in 18 patients was 10.6 microgram/dl and was significantly higher than that of the controls (6.8 microgram/dl, p less than 0.001). The average excretion of urinary free cortisol in nine patients was 205 microgram/day, significantly greater than that of 65 microgram/day in the controls (less than 0.01). Three patients underwent overnight suppression with 1 mg of dexamethasone and had inadequate responses. These data suggest that cortisol production is excessive in emaciated patients with anorexia nervosa due to a disturbance of the hypothalamic-pituitary mechanisms regulating adrenocortical function. The excessive adrenal activity may reflect certain psychobiological disturbances as well as the effects of malnutrition.

Adolescent↗
PubMed1977

The effectiveness and cost of acute respiratory illness medical care provided by physicians and algorithm-assisted physicians' assistants.

The medical management of patients with acute respiratory illnesses was analyzed at two different clinics during a 14- to 21-month period. Patients received care from either physicians or physician-supervised physician's assistants (PA). The PAs used respiratory illness clinical algorithms to guide their choice of diagnostic tests and treatment. Illness outcome, patient satisfaction, and medical care cost data were obtained for all patients approximately two weeks after the index illness. Despite significant differences in patient population characteristics, illness outcomes were similar, regardless of the provider's educational background. Medical care costs, however, were highest for the physician's patients. For all patients, diagnostic tests contributed about one-third of the total direct costs, mainly because of chest x-ray and throat culture use. Sixty to eighty per cent of medication costs were due to nonprescription drugs used principally for symptom relief. The data demonstrate that the medical care delivered by these physician's assistants was as effective and less costly than the care provided by physicians. Reducing chest x-ray and throat culture use would have a significant economic impact, without adversely affecting medical care effectiveness.

Acute Disease↗
PubMed1975

The nuchocephalic reflex.

The nuchocephalic reflex, previously undescribed, was investigated in a controlled study of 146 subjects ranging in age from 11 hours to 94 years. In 110 subjects over 16 years of age, the presence of the reflex was correlated directly with evidence of diffuse cerebral dysfunction as measured by a shortened form of the Wechsler Adult Intelligence Scale. Thirty-six children were studied from the newborn period to the age of 16 years. The reflex was found to be uninhibited in infants and to become inhibited by the age of 4 years. Among the adult subjects, the nuchocephalic reflex was found to be sensitive indicator of the status of higher cortical function. The presence or absence of the reflex appears to have somewhat different predictive value at different points in the adult age spectrum.

Adolescent↗
PubMed1975

Recognition of streptococcal pharyngitis in adults.

In order to devise a strategy for the management of acute pharyngitis, the clinical features of 418 adults with sore throat were noted and throat cultures were obtained. Patients with cultures positive for group A beta-hemolytic streptococci had a significantly higher (P less than or equal to .01) frequency of recent exposure to streptococcal infection, pharyngeal exudate, enlarged or tender cervical nodes, and high fever (greater than or equal to 38.3 C [101 F]. Patients with negative cultures complained more frequently of cough. On the basis of these symptoms and signs, a clinical algorithm was developed and discriminant function scores were computed that identify patient populations with different probabilities of having streptococcal pharyngitis. The patients with moderate and high probabilities included 91% of patients with positive cultures but only 67% of the total patient population. These methods could be the basis for more efficient evaluation of adults with sore throat.

Adolescent↗
PubMedDate not supplied

Pharmacotherapy of bulimia nervosa and binge eating disorder.

This paper reviews the use of medication in the treatment of bulimia nervosa and of binge eating disorder. There is now compelling evidence from double blind, placebo-controlled studies that antidepressant medication is useful in the treatment of bulimia nervosa. What is less clear is which patients are most likely to benefit from antidepressant medications and how to best sequence the various therapeutic interventions available. The utility of antidepressant medications in bulimia nervosa has led to their evaluation in binge eating disorder. The limited information currently available suggests that antidepressant treatment may be associated with a reduction in binge frequency in obese patients with binge eating disorder, but does not lead to weight reduction. Additional studies of the use of medication in the treatment of binge eating disorder and of the role of pharmacotherapy in the treatment of bulimia nervosa are needed.

Antidepressive Agents, Tricyclic↗