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Biomedical subjects

D S Bell

Publications and source records attributed to D S Bell.

17 recordsLinked to original sources
PubMed1992

Chronic fatigue syndrome. Recent advances in diagnosis and treatment.

Chronic fatigue syndrome is a chronic debilitating illness that is marked in the majority of cases by sudden onset of fatigue and flulike symptoms. Symptoms subsequently relapse and remit and may persist for years. Physical examination typically reveals relatively minor, nonspecific abnormalities in an apparently well patient. Although immunologic abnormalities are associated with chronic fatigue syndrome, tests for these features are expensive, nonspecific, and generally reserved for research purposes. The diagnosis is made on the basis of new onset of severe fatigue, a characteristic pattern of symptoms, and exclusion of other illnesses. Treatment is aimed at alleviating symptoms and helping patients adjust to the debilitating and chronic nature of the illness.

Diagnosis, Differential↗
PubMed1992

Factors predicting efficacy of phentolamine-papaverine intracorporeal injection for treatment of erectile dysfunction in diabetic male.

Thirty-three diabetic men were instructed in the use of phentolamine-papaverine injections for the treatment of erectile dysfunction over a two-year period. Of these, 12 reported a satisfactory response and 21 reported a nonsatisfactory response. The responders and the nonresponders were retrospectively studied to identify characteristics that would predict a satisfactory response. No difference was found between the two groups in the duration of diabetes, the presence of retinopathy, neuropathy, nephropathy, peripheral vascular disease, or ischemic heart disease. The utilization of insulin, the prevalence of type II diabetes, or the use of drugs which would cause impotence, did not differ between the two groups. There was no difference in the serum testosterone levels between the two groups. Age was the only predictive factor. Only 1 of 14 patients over age sixty had a satisfactory response to treatment while 11 of 19 patients under age sixty had a satisfactory response. Five of the responders and 2 of the nonresponders proceeded to penile implant surgery and reported satisfactory results. While older diabetic men may choose a trial of intracorporeal injections, they should be counselled regarding the high failure rate and alternative forms of therapy.

Age Factors↗
PubMed1992

Daily stress variability, learned resourcefulness, regimen adherence, and metabolic control in type I diabetes mellitus: evaluation of a path model.

A model of daily stress and metabolic control in Type I diabetes was tested in which stress has dual effects upon glycemic level: (a) direct, through psychophysiological mechanisms, and (b) mediated, through regimen adherence. Learned resourcefulness was postulated to moderate both effects. Two approaches to measuring daily stress were also compared: stress mean and variability. Daily stress and adherence were measured in 62 adult diabetics on six occasions over 2 months, after which glycosylated hemoglobin levels were obtained. Stress had a direct association with metabolic control that was not mediated by adherence. Although learned resourcefulness failed to moderate this relationship, it did relate directly to metabolic control, in the unexpected direction. The variables combined to explain 37% of the variance in metabolic control. The utility of the intraindividual approach to daily stress measurement was supported.

Adaptation, Psychological↗
PubMed1992

Exercise for patients with diabetes. Benefits, risks, precautions.

Exercise is beneficial in both prevention and control of non-insulin-dependent (type II) diabetes. Whether a patient has insulin-dependent or type II diabetes, a regular exercise program can produce positive changes in the lipid profile, reduce blood pressure and weight, and improve other cardiovascular risk factors. The risks of an exercise program include precipitation of cardiovascular events, damage to the soft tissue and joints of the feet, visual loss, early and delayed hypoglycemia, and hyperglycemia and ketosis. Consequently, a comprehensive clinical assessment to identify potentially harmful diabetic complications and to determine the patient's fitness level is needed before a suitable exercise program can be prescribed. With careful manipulation of insulin doses and home monitoring of blood glucose levels, exercise need not adversely affect glycemic control. Moreover, the metabolic and cardiovascular benefits that result from a sensible exercise program can greatly improve the quality of life for most diabetic patients.

Diabetes Complications↗
PubMed1992

Visual impact of adaptive speckle reduction on US B-mode images.

Adaptive speckle reduction, which is designed to improve image contrast, dramatically alters the familiar appearance of the ultrasonographic B-mode scan. The acceptability to radiologists of this alternative method of display was assessed. Four experienced radiologists selected B-mode scans from 83 liver and 71 breast examinations and graded the change in diagnostically important features after adaptive speckle reduction. There was no loss of important anatomic detail in the smoothed images and a net reduction in image artifacts. Removal of speckle noise improved definition of lesion margins in 38.3% of cases and enhanced visibility of metastases in 35.4% of liver studies and 7.7% of breast lesions. In 42.1% of cases, the textural information in the image was judged to be enhanced. Image information in general was said to be better seen in 49.5% of cases. The preliminary radiologic experience with speckle-reduced B-mode echograms is favorable and does not indicate generation of any substantial image artifacts.

Breast Neoplasms↗
PubMed1992

Microalbuminuria associated with diabetic neuropathy.

OBJECTIVE: To test the hypothesis that microalbuminuria may show an independent statistical association with diabetic neuropathy. RESEARCH DESIGN AND METHODS: An observational study of a prospectively identified cohort was conducted at the University Medical Center. The cohort consisted of 78 consecutive diabetic patients who fulfilled the criteria of having diabetes for greater than 10 yr, a normal serum creatinine, urine negative for macroalbuminuria by a commonly used dipstick method, a blood glucose less than 13.8 mM (less than 250 mg/dl), and an HbA1 less than 11% (normal range 5.5-8.5%). Medical record review established the presence of chronic complications of diabetes. Urine albumin level was measured by radioimmunoassay. Albumin concn greater than or equal to 15 mg/L was used as a cutoff value for microalbuminuria. RESULTS: Twenty-five of 78 patients (32%) showed microalbuminuria. Of these, 51% had neuropathy, 39% had retinopathy, 35% arterial hypertension, 17% peripheral vascular disease, and 15% ischemic heart disease. After adjusting for age, sex, and type and duration of diabetes, diabetic neuropathy and hypertension showed a significant association with microalbuminuria. After adjusting for other diabetic complications, diabetic neuropathy showed a significant association with microalbuminuria. CONCLUSIONS: Microalbuminuria is independently associated with diabetic neuropathy. This association lends support to the theory of a vascular etiology for diabetic distal symmetrical neuropathy.

Albuminuria↗
PubMed1992

Form-based clinical input from a structured vocabulary: initial application in ultrasound reporting.

Ultra-STAR (Ultrasound Structured Attribute Reporting) allows a sonographer to record reports using a hierarchic standardized vocabulary. Reports are constructed interactively by using checkboxes and radio buttons in a graphical user interface to select concepts from the vocabulary. Concepts are presented in small windows that open when needed to record further detail. Preliminary reports are printed for the referring physician. Reports are later finalized by an attending radiologist and uploaded to the hospital's information system. Clinicians involved so far prefer an outline report to a natural language format.

Medical Records Systems, Computerized↗
PubMed1991

Retroviral sequences related to human T-lymphotropic virus type II in patients with chronic fatigue immune dysfunction syndrome.

Chronic fatigue immune dysfunction syndrome (CFIDS) is a recently recognized illness characterized by debilitating fatigue as well as immunological and neurological abnormalities [Straus, S.E. (1988) J. Inf. Dis. 157, 405-412]. Once thought to be caused by Epstein-Barr virus, it is now thought to have a different but unknown etiology. We evaluated 30 adult and pediatric CFIDS patients from six eastern states for the presence of human T-lymphotropic virus (HTLV) types I and II by Western immunoblotting, polymearse chain reaction, and in situ hybridization of blood samples. The majority of patients were positive for HTLV antibodies by Western blotting and for HTLV-II gag sequences by polymerase chain reaction and in situ hybridization. Twenty nonexposure healthy controls were negative in all assays. These data support an association between an HTLV-II-like virus and CFIDS.

Adolescent↗
PubMed1979

Deviancy, delinquency and drug use.

A system for monitoring drug use was based on the data from annual surveys of two contrasting population groups, a general cross-section of young people and a cross-section of antisocial deviants. Correlation of deviancy and drug use established that drug use, both licit and illicit, was more extensive among those who suffered parental deprivation, whose parents were divorced or separated, who had psychiatric illness and particularly those who had committed antisocial acts. The degree of antisocial deviancy correlated with the extent of drug use.

Adolescent↗
PubMed1978

Methadone.

Explore the source record for details and available documents.

Female↗
PubMed1975

Psychotherapy in a large open family group.

A technique of psychotherapy is reported, using a large open group of theoretically unlimited lifetime. Family and friends are encouraged to attend and new members are added independently of those leaving the group. Various features of such a group are comparable to small group analysis. The group may be used for the exploration and treatment of family psychopathology. Meetings containing 20 or more members, with several families being represented, are not uncommon. Observers likewise are not limited in number and the group serves a useful teaching and training function as a consequence. A wide range of patients, including those regarded as unsuitable or too difficult for conventional psychotherapeutic management, may be treated by this technique. Illustrative cases are described. The purpose of this paper is to describe a technique of group psychotherapy which has been practised over a period of several years and which differs in some important respects from established methods. This technique, the large open family group, has proven itself to be useful in treating a wide range of patients.

Adolescent↗
PubMedDate not supplied

The dynamics of trends in drug use in Australia.

Drug use tends to follow cycles. Monitoring may be used to establish the trends over time and to analyse their dynamics. An approach is described which establishes the stage of adoption or discontinuance of drug use in the community and a method for the prediction of future trends. Monitoring in New South Wales from 1971 to 1973 provided data which are analysed to show that alcohol was in the phase of majority adoption and tobacco had reached a plateau, but with the worrying anomaly that heavy use among young people continued to rise. Sedatives and analgesics had also reached a plateau stage of use. The data on marijuana are subject to more than one interpretation, but in any case point to a continuing rapid increase in use; predictions are made about future trends. Hallucinogens seemed to be in the phase of late adoption and stimulants to have entered a phase that is of particular interest, discontinuance. Narcotics seemed to be in the phase of late majority adoption.

Adolescent↗