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Biomedical subjects

D L Elliot

Publications and source records attributed to D L Elliot.

18 recordsLinked to original sources
PubMed1991

Exercise training reduces intraocular pressure among subjects suspected of having glaucoma.

The effect of exercise conditioning on elevated intraocular pressure has not been previously described among sedentary individuals. We prospectively observed intraocular pressure for nine sedentary subjects suspected of having glaucoma before and after 3 months of aerobic exercise training. Mean (+/- SEM) aerobic capacity, as assessed by maximal oxygen uptake, increased 6.3 +/- 1.6 mL.kg-1.min-1 (30%) (P less than .02). Mean intraocular pressure decreased 4.6 +/- 0.4 mmHg (20%) (P less than .001) at the end of the conditioning period. With cessation of exercise and subsequent detraining, intraocular pressure returned to elevated preconditioning levels by 3 weeks. Regular aerobic exercise is associated with a reduction in elevated intraocular pressure and may represent an effective nonpharmacologic intervention for patients suspected of having glaucoma.

Adult↗
PubMed1991

Preceptors for an introduction to clinical medicine course: needs of volunteer and full-time faculty.

Recruiting clinicians to teach bedside skills is often a challenge for Introduction to Clinical Medicine (ICM) course co-ordinations. Little data is available concerning what motivates a faculty to participate in these programmes. Better understanding of these factors might allow enhanced faculty involvement. We surveyed full-time and volunteer faculty as to what forces promote and hinder participation as preceptors for an ICM course. Results documented that both faculty groups found student interactions and teacher fulfillment their major reward, with little perceived academic or patient recognition. Personal time limitations was the greatest deterrent to participation. Assessing faculty needs has allowed focused course changes and new activities to facilitate involvement.

Analysis of Variance↗
PubMed1991

Management of suspected iron deficiency: a cost-effectiveness model.

Iron deficiency is frequent among physically active women. Several diagnostic and therapeutic strategies have been advocated. We determined how women's preferences for care varied with their risk of iron deficiency and/or anemia. The women's strength of feelings (utilities) and management costs were used to assess: 1) no evaluation or therapy; treatment based on a 2) complete blood count (CBC) or 3) ferritin level; and 4) empiric iron therapy. The analysis was applied to groups with differing iron deficiency prevalence. Women (N = 22) were adverse to the risk of both anemia and iron deficiency without anemia, and their preferences did not correlate with age, running mileage, years of running, or vitamin supplement use. Because of women's desire to avoid undiagnosed deficiency, the benefits of no evaluation, complete blood count assessment, and, to a less extent, serum ferritin decreased as the prevalence of iron deficiency increased. Ferritin level was more effective per cost than a CBC. However, empiric therapy had the highest effectiveness per cost. These results suggest a strategy that combines both patient concerns and the clinical suspicion of disease in choosing management for physically active women at risk for iron deficiency.

Adult↗
PubMed1991

Hematuria in a young recreational runner.

A 27-year-old recreational jogger developed gross hematuria following a 2-mile run. Evaluation revealed a transitional cell carcinoma of the bladder. Etiologies for pigmenturia and the pathogenesis of exertional hematuria are reviewed. The need to exclude other causes of hematuria before attributing the finding to exercise is emphasized.

Carcinoma, Transitional Cell↗
PubMed1991

Anabolic steroid education and adolescents: do scare tactics work?

The opinions (level of agreement) of high school varsity football players with regard to reported effects of anabolic steroids were assessed before and after two different education interventions. Lectures and handouts of a balanced education program (potential risks and benefits) were compared with a risks-only (negative or "scare tactics") presentation, in a controlled manner. Those receiving the balanced review significantly increased their agreement with 5 of 10 targeted adverse effects, while no change occurred for any risks among those taught by the negative intervention. A teaching model that only emphasizes the untoward consequences of anabolic steroids is ineffective, even in the short-term. A balanced education approach can improve understanding of the potential adverse effects of these drugs. Additional strategies may be required to change young athletes' attitudes toward anabolic androgenic steroid use.

Adolescent↗
PubMed1991

Malnutrition in a compulsive runner: a case conference.

A 28-yr-old, female marathon and "fitness" runner presented with leg swelling, fatigue, and loss of endurance. She was running an hour or more daily in addition to regular biking and swimming. She was an instructor in a fitness center. For 2 months prior to her leg swelling, she had increased fatigue and decreased exercise tolerance. She had been seen previously for a slow healing hamstring strain. She had not had a menstrual period for over 2 yr and had refused evaluation. She admitted to very low dietary intake, which she had always denied. She was worried about her body fat. She denied recent blood loss, diuretic or cathartic use, and induced vomiting. She appeared malnourished, pale, and older than her stated age. Her weight was 41.4 kg. Her blood pressure was 90/60, and her pulse was 100 per minute. She had pitting edema of the lower extremities to the knees. The diagnosis of anorexia nervosa was made and will be discussed.

Adult↗
PubMed1989

Metabolic evaluation of obese and nonobese siblings.

OBJECTIVE: To test the hypotheses that obese adolescents have a lower resting metabolic rate and less aerobic endurance than their nonobese siblings. DESIGN: Case-referent study of obese and nonobese siblings from the same kindred. SETTING: Tertiary referral center. PARTICIPANTS: Telephone screening of community volunteers resulted in a consecutive sample of 16 kindreds. Obese and nonobese siblings were similar in age, height, and pubertal status. Significantly more female subjects were in the obese group (p less than 0.01). MEASUREMENTS AND MAIN RESULTS: Body composition studies revealed that the obese siblings had higher body fat (p less than 0.001) but that fat-free mass was similar to that of the lean siblings. Resting metabolic rates determined by indirect calorimetry for the obese and nonobese pairs did not differ. Although the obese siblings appeared less fit when maximal oxygen consumption was measured in relation to total weight, maximal oxygen consumption did not differ when values were standardized for fat-free mass. CONCLUSIONS: The obese adolescents did not have a reduced resting metabolic rate. As in adults, the relationship between resting metabolic rate and fat-free mass was similar for obese and nonobese children and adolescents. Any decreased sport participation by the obese siblings was not due to inherent reductions in aerobic capacity.

Adipose Tissue↗
PubMed1989

Sustained depression of the resting metabolic rate after massive weight loss.

To assess potential long-term effects of weight loss on resting metabolic rate (RMR), the RMRs of seven obese women were measured by indirect calorimetry before weight loss, during a protein-sparing modified fast, and for 2 mo while at a stable reduced weight. Body composition was also determined at each interval. RMR significantly decreased 22% (p less than 0.01) with initiation of the modified fast. RMR values during the modified fast and during the maintenance diet at stable reduced weight were not different and all were significantly lower than the prediet RMR. Loss of lean tissue could not account for the decrease because changes in RMR per fat-free mass paralleled the total RMR reduction. A sustained decrement in RMR accompanied weight loss and persisted for greater than or equal to 8 wk despite increased caloric consumption and body weight stabilization.

Adult↗
PubMed1989

Metabolic myopathies: evaluation by graded exercise testing.

Exertional muscle pain and fatigue are common complaints; some patients with these symptoms have a metabolic myopathy. We have performed graded exercise testing with analysis of expired ventilation on 13 individuals with various kinds of metabolic myopathies. Their results differed from normal and reflected the underlying biochemical abnormality. Patients with disorders of the mitochondrial electron transport chain demonstrated marked limitations in aerobic metabolism and a greatly reduced maximum oxygen consumption. During intense exertion, normal individuals increase carbon dioxide generation due to buffering of lactic acid. This did not occur in patients with McArdle disease, in whom the respiratory exchange ratio (carbon dioxide production/oxygen consumption) did not rise above 1.0 at maximum exercise. These results indicated a deficit in anaerobic metabolism. Pyruvate dehydrogenase complex allows pyruvate produced from carbohydrate metabolism to enter the citric acid cycle. Patients with this enzyme deficiency showed an initially normal pattern followed by an abrupt cessation in carbohydrate dependent aerobic metabolism at higher work loads. During high-intensity exercise, progressive anaerobic metabolism was not accompanied by additional oxygen consumption. Finally, results from a patient with carnitine palmitoyl transferase deficiency revealed an early dependence on carbohydrate metabolism. The ventilatory threshold occurred at a low percentage of maximal oxygen consumption, reflecting the limited availability of lipid substrates for aerobic metabolism. Detection of some muscle metabolic abnormalities can be made on small biopsy specimens. However, definitive diagnosis of the defect nearly always requires studies on fresh or frozen muscle tissue obtained by an open biopsy. The decision on how the tissue should be processed and which metabolic studies should be performed frequently needs to be made before the biopsy is obtained. Thus, a noninvasive method to initially characterize patients with potential metabolic disorders is useful. Exercise testing with expired gas analysis can indicate the presence of a metabolic myopathy and results can then be used to direct the appropriate biochemical evaluations.

Adolescent↗
PubMed1985

Catamenial hemoptysis. New methods of diagnosis and therapy.

Bronchopulmonary endometriosis is a rare cause of hemoptysis. We describe a woman with catamenial hemoptysis which was localized with chest CAT scanning and treated successfully with danazol. The proposed pathogenesis and manifestations of thoracic endometriosis are reviewed, and the use of new diagnostic and therapeutic modalities in its management are discussed.

Adult↗
PubMedDate not supplied

Internal medicine training in ambulatory gynecology.

OBJECTIVE: To assess internists' perceptions of their training in the management of common problems in ambulatory gynecology and to compare these perceptions with their clinical practice experiences. METHODS: We surveyed 325 internists in the Portland, Oregon, metropolitan area about their residency training and practice experiences in the diagnosis and management of 25 clinical problems in ambulatory gynecology and five nongynecologic problems. RESULTS: Responses were received from 159 internists (48.5%). Overall, the internists reported relatively little residency training in the management of many common gynecologic disorders. Women internists managed gynecologic problems more than did their male counterparts, independent of the number of women patients in their practices. CONCLUSIONS: Internal medicine residency programs need to expand training in ambulatory gynecology to better prepare graduates for clinical practice.

Clinical Competence↗