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Biomedical subjects

D Spiegel

Publications and source records attributed to D Spiegel.

At least 19 recordsLinked to original sources
PubMed1995

When disaster strikes, acute stress disorder may follow.

During and immediately following a traumatic event, people may manifest a pattern of dissociative and anxiety symptoms and other reactions, referred to as Acute Stress Disorder. A review of the empirical literature on psychological reactions to trauma suggest that this pattern of symptoms has often been identified across different kinds of traumatic events. It is likely to constitute a psychological adaptation to a stressful event, limiting painful thoughts and feelings associated with the event and allowing the person to function at least minimally. Continuation of these symptoms, however, may impair the person's quality of life and disrupt social and other functioning. If symptoms last beyond a month following the traumatic event, Post Traumatic Stress Disorder (PTSD) may ensue, continuing for months or even years after the precipitating event. Hence, it is important to be able to identify this pattern of reactions that may be manifested in reaction to trauma, so that appropriate intervention can be provided. Although it was not officially recognized in the 3rd edition Diagnostic and Statistical Manual (DSM-III-R), Acute Stress Disorder is included as a separate diagnosis in the DSM-IV.

Adaptation, Psychological↗
PubMed1995

Sonographic estimation of umbilical coiling index and correlation with Doppler flow characteristics.

OBJECTIVE: To quantitate umbilical vascular coiling antenatally, and to correlate the coiling index with Doppler flow characteristics in umbilical vessels. METHODS: We studied 45 normal term fetuses within 24 hours before delivery. The umbilical coiling index was calculated using sonographic longitudinal views of cord vessels from several segments antenatally, and by dividing the total number of helices by the cord length (in centimeters) postnatally. Doppler flow velocities were obtained from umbilical arteries and vein in each cord. Flow characteristics were correlated with the umbilical coiling index. RESULTS: The mean (+/- standard deviation) umbilical coiling index was 0.44 +/- 0.11 in the antepartum period and 0.28 +/- 0.08 after birth. Regression analysis showed a significant linear trend (r = 0.71, P < .001). The correlations between sonographic coiling index and umbilical arterial Doppler flow characteristics (mean velocity, pulsatility index, resistance index, and systolic-diastolic ratio) were not significant. The sonographic coiling index was related to time-averaged velocity and flow in the umbilical vein. A good correlation was found between umbilical vein flow and the coiling index, with a significant linear trend (r = 0.59, P < .001). CONCLUSION: An intrauterine umbilical coiling index can be determined by ultrasound and correlates well with the actual index at birth. The sonographic umbilical coiling index is related to Doppler flow characteristics in the umbilical vein.

Female↗
PubMed1995

[Lens astigmatism in connection with implantation of a foldable one-piece silicone lens in a patient].

BACKGROUND: The use of one-piece plate-haptic Silicon lenses has become more frequent especially in combination with small incision cataract surgery. Different complications as before are to be expected. CASE REPORT: Six weeks after cataract surgery and implantation of a one-piece plate-haptic Silicon lens a lens astigmatism of 3.5 dpt was noted. The astigmatism occurred after successfully performed retinal detachment surgery in this eye. The development of the astigmatism was considered to be due to a capsular shrinkage of the anterior capsular ring. The retinal detachment surgery was performed with the use of SF6 gas, which is known as a factor for increasing inflammation. After a Nd: YAG incision of the anterior capsule the astigmatism disappeared immediately. CONCLUSION: Capsular shrinkage can induce a significant lens astigmatism in combination with soft one-piece plate-haptic Silicon lenses. Intraocular inflammation seems to play an important role. Astigmatism after implantation of one-piece plate-haptic Silicon lenses in combination with signs of capsular shrinkage can be explained by lens astigmatism only.

Aged↗
PubMed1995

[Etiology of secondary glaucoma at university clinics in Munich and Nairobi].

Glaucoma is one of the most common blinding diseases worldwide. For early detection and treatment of this insidious ailment investigations of risk factors are necessary, most of which require extensive technically demanding and time consuming procedures. Basic information on risk factors for the development of glaucomatous damage is essential for diagnosis of glaucoma, for the identification of groups at risk, and for the planning of prevention and intervention programs. Epidemiological data on secondary glaucomas is especially scarce, while at the same time the strict distinction between primary and secondary glaucomas has been abandoned with changing pathophysiological rationale. We compared the distribution of the main causes of secondary glaucomas in the university eye clinics in Munich and Nairobi, with the aim of finding possible risk factors and obtaining basic information that might be used in preventive programs. We examined 150 patients in Munich and 132 in Nairobi in 1991 and 1992. In addition to tests of visual acuity and intraocular pressure, gonioscopy, ophthalmoscopic assessment of the optic disc and perimetry were performed. Eyes with intraocular pressures above 22 mmHg and a detectable causative condition were selected for the study. The average age of the patients in Munich was 65 years, and most of them presented with glaucoma caused by iris neovascularization (42%), followed by exfoliation syndrome (14%), intraocular inflammation (11%), trauma (10%) and preceding ocular surgery (9%). In Kenya patients were significantly younger, with an average age of 41 years. Here most glaucomas were posttraumatic (40%); 70% of these patients were aged under 30. Other causes were earlier operations (17%), inflammation (16%), lentogenous changes (10%) and neovascularizations (10%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Essentials of psychotherapeutic intervention for cancer patients.

Psychosocial treatments, including group, individual and family psychotherapies, are of proven efficacy, and deserve inclusion as standard components of biomedical treatment for cancer patients. Anxiety and depression are very common (and treatable) problems among cancer patients, most of whom can benefit from intervention. Psychotherapy, both group and individual, employs three fundamental approaches: emotional expression, social support, and cognitive symptom-management skills. Psychotherapy has been shown to be effective in improving quality of life. Results of studies of various psychotherapies include reduction in depression, anxiety, and pain, and improved coping skills, and, in some cases, there is evidence of extended survival time.

Adaptation, Psychological↗
PubMed1995

Calcium pyrophosphate dihydrate crystal deposition disease in the elderly.

Calcium pyrophosphate dihydrate deposition disease can mimic a large number of joint diseases. We report on three patients with predominantly systemic symptoms. Diagnostic pitfalls and treatment delays in these patients are discussed. Once the diagnosis is considered, confirmation is readily obtained by examination of the joint fluid and treatment promptly relieves symptoms.

Aged↗
PubMed1992

Hypnosis and related techniques in pain management.

Hypnosis has been used successfully in treating cancer patients at all stages of disease and for degrees of pain. The experience of pain is influenced not only by physiological factors stemming from disease progression and oncological treatment, but also from psychosocial factors including social support and mood. Each of these influences must be considered in the successful treatment of pain. The successful use of hypnosis also depends upon the hypnotizability of patients, their particular cognitive style, their specific motivation, and level of cognitive functioning. While most patients can benefit from the use of hypnosis, less hypnotizable patients or patients with low cognitive functioning need to receive special consideration. The exercises described in this chapter can be successfully used in groups, individual sessions, and for hospice patients confined to bed. Both self-hypnosis and therapist guided hypnosis exercises are offered.

Humans↗
PubMed1992

[Glaucoma parameters of the papilla. Comparison of clinical and stereophotography methods with laser scanning tomography].

The observations recorded by laser tomographic scanner (LTS) and with clinical and stereophotographic evaluation of 40 optic discs in the same glaucomatous patients were compared. Quantitative parameters (vertical and horizontal cup-to-disc ratio) and qualitative parameters (nasal excavation, notch, pseudo-pit, overpass, bayonetting) were evaluated. The correlation coefficients for the quantitative parameter ranged from 0.59 to 0.73. The definition of excavation used meant that the values found with the LTS were consistently higher. The qualitative parameter did not differ significantly with the method. Therefore, the LTS can be considered equivalent to the standard methods.

Adult↗
PubMed1992

A case of probable dissociative disorder.

The case of a patient with symptoms suggestive of a dissociative disorder is presented. The consultant reviews the diagnosis of multiple personality disorder (MPD) as defined in DSM-III-R and DSM-IV in relation to the patient's dissociative states, hallucinations, memory loss, and other symptoms. He then highlights the distinctions among MPD, schizophrenia, borderline personality disorder, major depression, and complex partial seizures. After presenting the conceptualization of MPD as a chronic posttraumatic stress disorder, he concludes with a review of treatment approaches that address the traumatic history and that involve hypnosis to gain access to and control dissociative states.

Adult↗
PubMed1992

Argon laser trabeculoplasty: long-term follow-up of at least 5 years.

This retrospective study evaluates the long-term follow-up of 331 eyes of 219 patients treated with argon laser trabeculoplasty (ALT). A total of 258 eyes were included with a follow-up of at least 5 years. Success was defined as an intraocular pressure of under 22 mm Hg with a stable visual field and optic nerve head. Overall, 22% (58/258) were regulated after 5 years (glaucoma chronicum simplex 26%, pigment dispersion glaucoma 31%, pseudoexfoliation glaucoma 19%, angle-closure glaucoma 14%, secondary glaucoma 7%). Filtration surgery was performed in 13% (33/258) mainly (73%) in the first 3 years after ALT. Repeat ALT was done in 43% of the eyes, and 60% of these eyes with repeat ALT underwent filtration surgery in the first year. With repeat ALT the overall success rate increased to 38%. High initial intraocular pressure and the stage of glaucoma documented by the visual field loss correlated with the failure of ALT. These results indicate that ALT and re-ALT were effective in glaucomatous eyes, yet there was a substantial diminishing effect as time progressed. Therefore, close follow-up on ALT-treated patients is necessary.

Adolescent↗
PubMed1992

Anterior chamber tube shunt to an encircling band (Schocket procedure) in the treatment of refractory glaucoma.

We reviewed a series of 42 eyes in patients with refractory glaucoma who had undergone a Schocket procedure. The mean follow up was 17.5 months; the minimal follow up, 8 months. The success rate was 81%, with "success" defined as either (1) an intraocular pressure less than 21 and greater than 5 mm Hg, with a pressure reduction of at least 10%, and less or no medication; or (2) a pressure reduction of at least 30%, with no change of medication. When eyes with a loss of more then one Snellen line of visual acuity were interpreted as failures, the success rate dropped to 61%. Forty percent of all cases required revision. In four cases, the shunt had to be removed (three cases due to hypotony and one secondary to conjunctival erosion). These results are in the range of those obtained by other investigators using this technique or other tube-shunt procedures.

Adolescent↗
PubMed1991

Disintegrated experience: the dissociative disorders revisited.

We present proposed changes to the dissociative disorders section of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and review the concept of pathological and nonpathological dissociation, including empirical findings on the relations between trauma and dissociative phenomenology and between dissociation and hypnosis. The most important proposals include the creation of two new diagnostic entities, brief reactive dissociative disorder and transient dissociative disturbance, and the readoption of the criterion of amnesia for a multiple personality disorder diagnosis. We conclude that further work on dissociative processes will provide an important link between clinical and experimental approaches to human cognition, emotion, and personality.

Depersonalization↗