Biomedical subjects

J Marengo

Publications and source records attributed to J Marengo.

11 recordsLinked to original sources

PubMed2001

Glaucomatous optic nerve head changes with scanning laser ophthalmoscopy.

PURPOSE: To determine whether there are angiographic differences among normal, preperimetric and advanced glaucoma eyes using indocyanine green angiography with SLO. This method was chosen because of its sensibility to detect peripapillary capillary vessels. METHODS: Scanning laser opthalmoscopy was preformed on normal eyes, preperimetric glaucomas and advanced glaucomas. MATERIAL: The authors used a confocal SLO (Heidelberg Retina Angiograph-HRA) CONCLUSION: Several changes may be seen on peripapillary capillary vessels at the different glaucomatous stages. DISCUSSION: In normal subjects HRT shows preservation of the disc/cup area ratio; indocyanine green angiography shows normal prepapillary plexus pattern on the neuroretinal rim and cup. Subjects on glaucomatous preperimetric stage reveal a decrease in the disc/cup area ratio as a result of an increase of the cup area secondary to a reduction of the neuroretinal rim area. ICG at this hipertensive stage shows an increase in prepapillary plexus visualization, which may be a consequence of increased blood flow while autoregulation is still operative. Subjects with advanced glaucoma show prominent decrease in the disc/cup area ratio as well as marked capillary droupout in ICG angiography.

Coloring Agents↗

PubMed2001

Antiglaucomatous drugs effects on optic nerve head flow: design, baseline and preliminary report.

PURPOSE: To determine the effect of the most frequent used antiglaucomatous drugs on the optic nerve head flow. To see the response of the autoregulation system in hypertensive, preperimetric and advanced perimetric glaucomas. MATERIALS: In this preliminary report, optic nerve head parameters and retinal perfusion values were measured in 25 healthy controls as well as in 72 glaucomatous optic nerve heads. The glaucomatous sample was divided into three groups: 24 eyes treated with Betaxolol, 24 with Brinzolamide and 24 treated with Brimonidine (each of these groups was conformed by 8 hypertensive glaucomas, 8 preperimetric glaucomas, and 8 perimetric glaucomas). METHODS: Patients were examined with scanning laser Doppler flowmetry (wave length 638 nm), and flow, volume and velocity indices were assessed in each report. Perfusion maps were analyzed with the new SLDF software, version 3.2 (automatic full field perfusion image analizer). Examinations were also performed with the Heidelberg Retina Tomograph (wave length 638 nm), using the new standard reference plane. Visual fields were performed with the Octopus 123 or 101 perimeters, programs Glx and G2, with 3 phases completed. Diurnal pressure curve with applanation tonometry and gonioscopy (for classification) were also performed. RESULTS: In this preliminary report, it was found that eyes in Hypertensive or preperimetric stages of glaucoma, seem to use their regulation systems in order to preserve their optic nerve head circulation, while advanced perimetric glaucomas seem not be able to preserve their optic nerve head flow. And that antiglaucomatous drugs were not able to increase optic nerve head flow neither. DISCUSSION: Optic nerve head blood supplies is regulated by an autoregulation system. This phenomenon may act in normals, hypertensive and preperimetric glaucomas, but it seems not be able to preserve blood flow in advanced glaucomas. Optic nerve head flow returns to normal values with treatment in glaucoma first stages, while it seems that it could not be restored in advanced glaucomas.

Adult↗

PubMed2000

A prospective longitudinal 10-year study of schizophrenia's three major factors and depression.

This study investigated the nature, independence, and stability of schizophrenia's syndrome factors and depression at 2, 4.5, 7.5 and 10 years post-index hospitalization. At the four follow-ups, 71 patients (48 with schizophrenia and 23 with schizoaffective disorder) were assessed for symptoms hypothesized to constitute the reality distortion, disorganized, and negative factors of schizophrenia. At the last three follow-ups, the patients were also assessed for symptoms of depression. Factor analyses of schizophrenia symptoms revealed more than three syndrome factors at each follow-up. Longitudinally, reality distortion was a stable and relatively independent factor. The negative syndrome was independent but was bifurcated into two dimensions, interpreted as social/emotional withdrawal and diminished movement/expressiveness. Although signs of disorganization were not unified or independent early in schizophrenia's course, speech/thought disorder, disorganized affect, and poverty of speech content coalesced to form a disorganization factor by the 7.5-year follow-up. When depressive symptoms were added to the analyses, depression constituted an independent and stable dimension of schizophrenia over time. Each schizophrenia factor demonstrated a unique longitudinal course. Courses included stable symptom consistency (reality distortion), evolving symptom convergence (disorganization), and recurrent bifurcation and symptom instability (the negative syndrome).

Adult↗

PubMed2000

Operative management and outcome of 302 abdominal vascular injuries.

BACKGROUND: Abdominal vascular injuries incur high mortality rates. The purposes of this study are (1) review institutional experience, (2) determine additive effect on mortality of multiple vessel injuries, (3) determine mortality of combined arterial and venous injuries, and (4) correlate mortality with American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) for abdominal vascular injury. METHODS: A retrospective 6-year study was made at an urban level I trauma center of patients with abdominal vascular injuries. Main outcome measure was survival. RESULTS: (1) There was a total of 302 patients, mean age 28, mean Injury Severity Score (ISS) 25 (range 4 to 75). Mechanism of injury was penetrating in 266 (88%), blunt in 36 (12%). Emergency Department thoracotomy was done in 43 of 302 (14%), 504 vessels were injured: arteries 238(47%), veins 266(53%). Surgical management was ligation 245, primary repair 141, prosthetic interposition grafts 24, autogenous 2. Overall mortality was 162 of 302 (54%). (2) Mortality multiple vessels injured: 1 vessel 160 (45%), 2 vessels 102 (60%), 3 vessels 33 (73%), >4 vessels 5 (100%). Mortality arterial injuries: aorta isolated (I) 78% versus combined with other arterial injuries (C) 82.4%, superior mesenteric artery (SMA) I 47.6% versus C 71.4%, iliac I 53% versus C 72.7%, renal I 37.5% versus C 66.7%. Venous injuries: inferior vena cava (IVC) isolated (I) 70% versus combined with other venous injuries (C) 77.7%, superior mesenteric vein (SMV) I 52.7% versus C 65%, IMV I 16% versus C 50%. (3) Specific mortality combined arterial and venous injuries: aorta plus IVC 93%, SMA plus SMV 43%, iliac artery plus vein 45.5%. (4) Mortality versus AAST-OIS: grade II 25%, grade III 32%, grade IV 65%, grade V 88%. CONCLUSION: Abdominal vascular injuries are highly lethal. Multiple arterial and venous injuries increase mortality. Mortality correlates with AAST-OIS for abdominal vascular injury.

Abdominal Injuries↗

PubMed1999

Traumatic injury to the superior mesenteric artery.

BACKGROUND: Superior mesenteric artery (SMA) injuries are rare and devastating injuries incurring very high mortality rates. It is the purpose of this study to review our experience with these injuries, to analyze Fullen's classification based on anatomical zone and injury grade for its predictive value, and to correlate the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) for abdominal vascular injury with mortality. METHODS: Retrospective study was made over a 65-month period of all patients sustaining SMA injuries in an urban level I trauma center. RESULTS: Thirty-five patients, mean age 31, had a mean Revised Trauma Score of 5.86 and a mean Injurity Severity Score of 23. Mechanisms of injury were penetrating 27 (77%) and blunt 8 (23%). Mean admission systolic blood pressure was 85 mm Hg. Mean estimated blood loss was 8,500 mL and mean total fluid replacement 17,000 mL. Operating room findings were retroperitoneal hematoma in 34 (97%) and "black bowel" in 2 (6%). Number of associated injuries was nonvascular, mean 4.2, and vascular, mean 1.5. Surgical management consisted of ligation in 18 (51%), primary repair in 14 (40%), and interposition graft in 2 (6%). Overall mortality was 19 of 35 (54%). Mortality versus Fullen's zones was zone I, 100%, zone II, 43%, and zones III and IV, 25%. Mortality versus Fullen's ischemia grade was grade 1, 89%, grade 2, 58%, grade 3, 100%, and grade 4, 19%. Mortality versus AAST-OIS: was grade 1, 0%, grade II, 20%, grade III, 0%, grade IV, 59%, and grade V, 88%. CONCLUSIONS: SMA injuries are highly lethal. Most deaths are due to exsanguination. A higher number of associated vascular injuries increases mortality. "Black bowel" is an uncommon finding. Both Fullen's anatomical zones and the AAST-OIS for abdominal vascular injuries correlate with mortality. Fullen's ischemia grade does not.

Adult↗

PubMed1994

Depression in schizophrenia: are neuroleptics, akinesia, or anhedonia involved?

To investigate the presence of a full depressive syndrome in schizophrenia years after the acute phase and factors linked to these depressive syndromes, 75 schizophrenia and schizoaffective patients and 32 patients with bipolar affective disorders were studied prospectively at index hospitalization and followed up 4.5 years later as part of the Chicago Followup Study. Over 30 percent of the schizophrenia patients showed full depressive syndromes during the followup year. Schizophrenia patients on neuroleptics were significantly more likely to show full depressive syndromes than those not on neuroleptics during the followup year. This relationship held after the level of posthospital psychosis was controlled. The data suggest that neuroleptic use is one factor linked to the depressive-like syndromes found in the posthospital phase in non-chronic schizophrenia samples. The results did not support the view that these depressive-like syndromes are only a function of akinesia, although they suggest that akinesia is probably one factor involved. The data indicate a strong link between neuroleptic use and anhedonia. These data suggest that one factor involved in the depressive-like symptoms found in schizophrenia patients could be interference by neuroleptics with the mesolimbic dopamine reinforcement system or the dopamine reward system.

Affective Symptoms↗

PubMed1994

Classifying the courses of schizophrenia.

The purpose of this review was to examine current strategies for classifying the courses of schizophrenia. Although a number of course classifications have evolved over the past two decades, the field has not addressed fully the complex issue of course description. This review compared previously published prototypes for describing the long-term courses of schizophrenia to identify variations and consistencies in course descriptions. Across investigations, differences were found in the number of courses described, in the structure of course categories, in the relative emphasis on syndrome symptoms versus syndrome change, and in documenting specific course features (i.e., illness onset, illness outcome, and types of symptoms). Interstudy comparisons of long-term illness patterns therefore are limited and cumulative statements on prognosis will remain problematic until some standardization is introduced. A minimal set of course parameters that should be documented in future studies include (1) the rate of syndrome onset; (2) postonset patterns of psychotic and residual symptoms; (3) postonset patterns of social, work, and self-care activities; and (4) outcome. Descriptive domains for assessing these parameters are offered. Future research should be directed toward (1) developing a standard schizophrenia course classification that is more representative than the current DSM and Research Diagnostic Criteria classifications; (2) using a broadened domain of symptom patterns to characterize short- and long-term courses of schizophrenia; (3) increasing course reports with a focus on patients who demonstrate intermediate illness courses; and (4) exploring factors that converge with particular course types.

Activities of Daily Living↗

PubMed1991

European versus U.S. data on the course of schizophrenia.

OBJECTIVE: The present research attempts to add to the existing body of data on the course of schizophrenia by comparing the findings of a prospective study of a group of U.S. schizophrenic patients with data from two European studies. METHOD: Seventy-four U.S. patients given the diagnosis of schizophrenia according to Research Diagnostic Criteria were longitudinally assessed at hospitalization and at three intervals up to 10 years after illness onset. The longitudinal criteria for type of onset, course of illness, and outcome were derived from the European studies of Manfred Bleuler and Luc Ciompi. The type of onset, course of illness, and outcome of the U.S. patients were compared with those of the patients in the two European studies. RESULTS: A lower rate of acute onset and of episodic illness was found in the U.S. patients, but the relative frequency of a number of major overall course patterns was similar across studies. CONCLUSIONS: Despite many potential threats to comparability, the results of the European and U.S. longitudinal studies of the course of schizophrenia were fairly congruent in terms of the relative rate with which patients fell into the categories established by Bleuler and Ciompi. These results are encouraging in that they point to the possibility of estimating the rate of occurrence of particular expressions of the overall course of schizophrenia.

Cross-Cultural Comparison↗

PubMed1986

The early course of schizophrenic thought disorder.

The current investigation studied the early course of positive thought disorder and its relationship to other aspects of schizophrenic outcome. Forty-eight schizophrenics diagnosed using the Research Diagnostic Criteria (RDC), 51 psychotic nonschizophrenics, and 67 nonpsychotic patients were studied at index hospitalization and at a 1.5-year followup. Most thought-disordered schizophrenics and other psychotic patients showed some reduction in thought pathology between index hospitalization and followup (p less than .02). A larger percentage of schizophrenics than other psychotic and nonpsychotic showed thought disorder at the acute phase and at followup assessment (p less than .05), although only a subgroup of 27 percent of the schizophrenics showed severe thought disorder at followup. At followup, severely thought-disordered schizophrenics showed residual signs of psychosis and poor functioning in other areas. Positive thought disorder in schizophrenics at followup most often occurred within the context of an unremitted illness and was less frequently due to a new, acute episode of disturbance. Continuously thought-disordered schizophrenics exhibited more severe impairments in life adjustment at 1.5-year followup than did episodic or nonthought-disordered schizophrenics (p less than .02). The results suggest that severe thought disorder is a persistent characteristic in a subgroup of early schizophrenics.

Acute Disease↗

PubMed1985

Thought disorder. A function of schizophrenia, mania, or psychosis?

Does thought disorder emerge solely as a function of psychosis, or is it a function of diagnosis? The present research investigated whether thought disorder is more frequent in specific diagnostic groups, such as schizophrenia and mania, than in other types of psychotic disorders. The frequency and severity of positive thought disorder was assessed in 324 Research Diagnostic Criteria and DSM-III schizophrenics, manics, other psychotic patients, and nonpsychotic patients, and a normal comparison group. Fifty-seven percent of the sample were first hospital admissions. Patients were tested at the acute phase of their disorder, within the first 2 weeks of hospitalization, with three cognitive tests. Scores from these three tests were scaled to obtain a composite index of the severity of positive thought disorder. Diagnostic factors were more salient to the severity of disordered thinking than was psychosis. Thought disorder was significantly more frequent in schizophrenia and mania than in other psychotic disorders (p less than .05). The frequency of patients with severe thought disorder was reduced as one moved down the hierarchy of manic, schizophrenic, schizoaffective, and depressed psychotic disturbances (p less than .001). Rather surprisingly, the current research suggests that nonpsychotic manic patients may be as thought disordered as psychotic manic patients at acute phases of disturbance. This would indicate that the presence of positive thought disorder in mania is not primarily a function of most of these patients' being psychotic at the acute phase of disturbance. Thought disorder was not simply a function of psychosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMed1983

Disordered thinking.

To evaluate formulations that thought disorder at the posthospital phase identifies a subgroup of nuclear schizophrenics with poor outcomes, 77 patients from a longitudinal project were followed up on major dimensions of psychopathology linked to nuclear schizophrenia. The data indicate that (1) schizophrenics were more thought disordered than were nonschizophrenics at the posthospital phase; (2) thought-disordered schizophrenics had only slightly poorer scores on classic prognostic indicators associated with poor outcomes; (3) a subgroup of early chronic schizophrenics were not severely thought disordered; (4) almost all severely thought-disordered schizophrenics demonstrated clear evidence of delusional activity at follow-up; and (5) thought-disordered schizophrenics had poorer outcomes. The overall results fit in with formulations that a severe thought disorder is one of several major features of schizophrenia. The data suggest that posthospital thought disorder identifies a subgroup of poor-outcome schizophrenics, although some non-thought-disordered schizophrenics also show poor outcomes.

Adult↗