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Biomedical subjects

L Sands

Publications and source records attributed to L Sands.

At least 19 recordsLinked to original sources
PubMed2004

Effects of colonoscopy on intracranial pressure: observation in a large animal model.

BACKGROUND AND STUDY AIMS: Increased intra-abdominal pressure has been associated with increased intracranial pressure. Bowel insufflation during colonoscopy may increase the intra-abdominal pressure. It was hypothesized that colonoscopy may be associated with intracranial pressure elevation subsequent to an elevation in intra-abdominal pressure. MATERIALS AND METHODS: Colonoscopy was carried out in seven anesthetized pigs, and the colonoscope was advanced up to 60 cm from the anal verge. Insufflation was used to allow safe advancement of the colonoscope and to allow visualization of the colon, in the same way as in the procedure performed in humans. Intra-abdominal pressure was measured by determining the hydrostatic pressure in the urinary bladder. A subarachnoid screw was used to monitor intracranial pressure. The mean arterial blood pressure and intra-abdominal venous pressure were directly monitored via the femoral vessel access; all parameters were recorded before and during colonoscopy. RESULTS: A statistically significant elevation in intracranial pressure was demonstrated during colonoscopy. The average increase in intracranial pressure was 3.1 mm Hg. The intra-abdominal pressure and intra-abdominal venous pressure were also significantly elevated during the procedure. CONCLUSIONS: Colonoscopy may increase intracranial pressure due to an increase in intra-abdominal pressure. This may have clinical implications when colonoscopy is conducted in patients with brain pathology associated with high intracranial pressure.

Anesthesia, General↗
PubMed2001

Validating the diagnosis of delirium and evaluating its association with deterioration over a one-year period.

The authors probed the associations between clinical diagnoses and independent research measures of cognitive, behavioral, and electroencephalographic (EEG) changes in hospitalized older patients and investigated the contribution of medical illness to deterioration. Patients (N=96; 47 of whom were hospitalized during the course of 1 year; 12 diagnosed with delirium) received tests of cognitive and physical functioning and the Cumulative Illness Rating Scale, specific neuropsychological tests, and a two-channel EEG. Delirium was associated with independent measures of cognitive decline and EEG slowing. Hospitalization was associated with deterioration in functional status during the year, whether or not patients showed delirium. Results suggest that medical illness leading to hospitalization can contribute significantly to deterioration in self-care, and, when it is associated with delirium, to deterioration in cognitive performance and cerebral activity over a period of 1 year.

Activities of Daily Living↗
PubMed2001

Management of perianal sepsis in immunosuppressed patients.

Despite improvements in the supportive care of immunosuppressed patients controversy still surrounds the surgical management and outcome of anorectal sepsis in these patients. We reviewed 83 immunocompromised patients with diagnosis of perianal sepsis from 1995 to 1997. Sixty-six patients (80%) were followed for a mean of 15 months. Mean age was 44 years and 76 per cent were males. Twenty-eight per cent were HIV+, 34 per cent had inflammatory bowel disease on steroids, 20 per cent had malignancies, and 18 per cent had diabetes. Twenty-eight per cent had anal fistula, 2 per cent had perianal abscess, and 40 per cent had both. Primary sites of fistula were: transsphincteric (38%), intersphincteric (33%), superficial (20%), and suprasphincteric (3%), and multiple tracks (6%). Horseshoeing was present in 14 per cent of cases. The most commonly practiced surgical procedures were primary fistulotomy (n = 23) and fistulotomy plus drainage (n = 28). Seven patients underwent fistulotomy and ostomy and eight patients were treated with fistulectomy plus drainage. Most wounds (91%) healed within 8 weeks. Incontinence (6%) and recurrence (7%) were the most commonly observed complications. These results are similar to those seen in the general population. Perianal sepsis can be safely managed in immunocompromised patients, with high rates of healing and low complication rates. An aggressive sphincter-preserving approach in the management of these patients may be undertaken.

Adult↗
PubMed1999

Depressive symptoms and cognitive decline in nondemented elderly women: a prospective study.

BACKGROUND: The association between depressive disorders and subsequent cognitive decline is controversial. We tested the hypothesis that elderly women (aged 65 years and older) without dementia but with depressive symptoms have worse cognitive function and greater cognitive decline than women with few or no symptoms. METHODS: As part of an ongoing prospective study, we evaluated 5781 elderly, mostly white, community-dwelling women. Women completed the Geriatric Depression Scale short form. Three cognitive tests--Trails B, Digit Symbol, and a modified Mini-Mental State Examination--were administered at baseline and approximately 4 years later. Baseline, follow-up, and change scores for the cognitive tests were analyzed by analysis of covariance and Kruskal-Wallis analysis; the odds of cognitive deterioration (> or =3-point decline on the modified Mini-Mental State Examination) were determined by logistic regression. RESULTS: At baseline, 211 (3.6%) of the women had 6 or more depressive symptoms. Only 16 (7.6%) of these women were receiving antidepressant medication. Increasing symptoms of depression were associated with worse performance at baseline and follow-up on all 3 tests of cognitive function (P<.001 for all comparisons). For example, the baseline Digit Symbol score (mean +/- SD) was 45.5 +/- 10.7 among women with 0 to 2 symptoms of depression, 40.3 +/- 10.7 for women with 3 to 5 symptoms, and 39.0 +/- 11.3 for women with 6 or more symptoms. After adjusting for the baseline score, cognitive change scores were also inversely associated with the number of depressive symptoms (P<.001 for all comparisons). Odds ratios for cognitive deterioration using 0 to 2 symptoms as the reference were 1.6 (95% confidence interval, 1.3-2.1) for 3 to 5 symptoms and 2.3 (95% confidence interval, 1.6-3.3) for 6 or more symptoms. Results were similar after being adjusted for education, age, health status, exercise, alcohol use, functional status, and clinic site. CONCLUSIONS: Depressive symptoms in older women are associated with both poor cognitive function and subsequent cognitive decline. Mechanisms underlying the association between these 2 common conditions need further exploration.

Age Factors↗
PubMed1999

Impaired spelling in Alzheimer's disease: a linguistic deficit?

Different kinds of real words and pronounceable pseudowords (PWs) were presented for writing to dictation to patients with the diagnosis of probable Alzheimer's disease (AD) and to age- and education-matched healthy controls. Though spelling less accurately on all tasks, AD patients responded in a manner generally qualitatively similar to controls. Except for a slightly enhanced effect of spelling regularity in real word writing accuracy, AD patients showed the same sensitivity to various lexical, orthographic and phonological variables as controls. Both groups showed no difference in spelling accuracy for words and PWs with regular vs ambiguous spelling patterns, and groups also showed similar orthographic preferences when spelling PWs having several different acceptable pronunciations. Finally, AD patients and controls produced similar types of errors when spelling real words. Dementia severity was related to the overall accuracy, but not to the pattern, of spelling responses. It is suggested that the decline in response accuracy in cognitively demanding writing tasks in patients with more advanced dementia is most likely due to semantic impairment and impairments of nonlinguistic functions of attention, executive control and praxis, rather than to a disturbance within language specific processes.

Aged↗
PubMed1999

Conceptualization and measurement of quality of life in dementia: the dementia quality of life instrument (DQoL).

Direct assessment of quality of life (QoL) of persons with dementia has largely been ignored due to logistical, conceptual and practical issues. This article presents a disease-specific conceptual framework of QoL for dementia. Based on this conceptualization, a 29-item instrument designed to assess QoL by direct interview with dementia patients was developed and tested on 99 participants. The data show that the instrument is reliable and shows evidence of validity. Nearly all participants (96%) were able to respond to questions appropriately. Thus, persons with mild to moderate dementia can be considered good informants of their own subjective states, paving the way to consider patient responses rather than proxy measures as the gold standard for assessing QoL for persons with dementia.

Aged↗
PubMed1998

Cognitive mechanisms for processing nonwords: evidence from Alzheimer's disease.

Repetition and reading of various types of pronounceable nonwords (pseudowords) was examined in patients with probable Alzheimer's disease (AD) and healthy elderly controls. Overall accuracy of performance was lower in AD patients compared to controls, but the two groups showed qualitatively similar response patterns when reading different kinds of pseudowords aloud and when repeating pseudowords composed of familiar phonological forms, analogous to those in real English words. AD patients diverged in performance from controls, however, when repeating pseudowords composed of phonologically unusual forms. These results support two conclusions: (1) Aspects of phonological processing may become disrupted in AD patients in association with increasing dementia severity, while orthographic processing remains comparatively less impaired. (2) The results are consistent with the view that the processing of pseudowords is achieved through the same system as real words, and further show that the influence of prior language experience on the processing of novel linguistic forms occurs primarily at the level of phonological, rather than orthographic processing.

Aged↗
PubMed1997

Apolipoprotein E phenotype and cognitive decline in a prospective study of elderly community women.

OBJECTIVE: To determine whether apolipoprotein E (Apo E) phenotype is associated with cognitive decline in community-dwelling nondemented elderly women. DESIGN: Prospective cohort study. SETTING: A university-affiliated clinic near Pittsburgh, Pa. PATIENTS: A total of 1750 nondemented community-dwelling women, aged 65 years and older, who were enrolled in the Study of Osteoporotic Fractures. MAIN OUTCOME MEASURES: The women completed a baseline interview and performed 3 cognitive tests: the modified Mini-Mental State Examination, Trials B, and Digit Symbol. Serum samples were obtained for Apo E typing. Baseline cognitive scores and repeated scores approximately 6 years after study enrollment were compared in women with and without Apo E epsilon 4. Cognitive decline, defined as the worst 10th percentile change scores, was assessed for each test and by phenotype group. RESULTS: After adjustment for age, education, presence of severe tremor, and depression, baseline scores did not differ by Apo E epsilon 4 status except for lower scores on Trails B in the homozygous epsilon 4 group (mean score, 159.7 compared with 127.7 for the heterozygous epsilon 4 group and 125.4 for the no epsilon 4 group; P = .01). However, repeated test performance on follow-up examination was worse on all tests in those women with 1 or more epsilon 4. Reduction on the modified Mini-Mental State Examination was 0% for no epsilon 4 allele, 1.9% for 1 epsilon 4 allele, and 3.7% for 2 epsilon 4 alleles (P < .001); reduction on Digit Symbol was 6.2% for no epsilon 4 allele, 9.0% for 1 epsilon 4 allele, and 17.5% for 2 epsilon 4 alleles (P = .04); and reduction on Trials B was 5.9% for no epsilon 4 allele, 25.0% for 1 epsilon 4 allele, and 10.9% for 2 epsilon 4 alleles (P = .002). Women with at least 1 epsilon 4 had an odds ratio of 1.6 (95% confidence interval, 1.1-2.3) of having cognitive decline during the study period. CONCLUSION: Apolipoprotein E epsilon 4 is associated with cognitive decline in community-dwelling nondemented women.

Aged↗
PubMed1997

Repetition of single words and nonwords in Alzheimer's disease.

Repetition of single words and pronounceable nonwords (pseudowords) was assessed in Alzheimer's Disease (AD) patients to evaluate how lexical phonological processing might be accomplished when semantic and conceptual knowledge is impaired. AD patients performed significantly worse than healthy elderly controls on all repetition tasks. However, repetition abilities and dementia severity were not correlated, and AD patients produced the same distribution of error types as controls. Furthermore, despite their semantic problems, AD patients, like controls, showed a significant advantage for repeating real words compared to pseudowords, even when repeating low frequency phonologically complex words whose meaning is not likely to have been retained. The results support the postulated existence of a lexical phonological system that is used to repeat both known and novel words and that processes linguistic information independent of its meaning.

Aged↗
PubMed1997

Identification of drug-related cognitive impairment in older individuals. Challenge studies with diphenhydramine.

The authors tested the use of repeated cognitive measures to identify those older individuals who experience cognitive decline after administration of a centrally acting medication. Subjects were 30 medically stable, older volunteers, mean age 71.4. Administration was a double-blind, placebo-controlled, crossover "challenge" from baseline to placebo, 50 mg, or 75 mg of diphenhydramine. More patients exhibited significant cognitive decrements after 75 mg of diphenhydramine than after placebo on the Buschke Selective Reminding Test Total Recall and the Trails B test. Data were consistent with models based on prediction intervals. Quantitative algorithms using prediction equations can characterize the normal limits of within-subject variability and define excessive cognitive change in elderly subjects, showing promise for use in monitoring patients to identify those who experience mild cognitive toxicity from prescribed medications.

Age Factors↗
PubMed1996

Epidemiologic linkage of rodent and human hantavirus genomic sequences in case investigations of hantavirus pulmonary syndrome.

Sin Nombre virus (SNV) causes the zoonotic disease hantavirus pulmonary syndrome (HPS). Its mechanisms of transmission from rodent to human are poorly understood. It is possible that specific genetic signature sequences could be used to determine the probable site of each case-patient's exposure. Environmental assessments suggested 12 possible sites of rodent exposure for 6 HPS patients. Rodents were captured at 11 of the 12 sites and screened for SNV infection within 2 weeks of the patient's diagnosis. Viral sequences amplified from tissues of rodents at each site were compared with those from case-patients' tissues. Rodents bearing viruses with genetic sequence identity to case-patients' viruses across 2 genomic segments were identified in 4 investigations but never at >1 site. Indoor exposures to rodents were especially common at implicated sites. By distinguishing among multiple possible sites of exposure, viral genotyping studies can enhance understanding of the conditions associated with infection by SNV.

Animals↗
PubMed1996

A passenger with pulmonary/laryngeal tuberculosis: no evidence of transmission on two short flights.

BACKGROUND: We investigated the likelihood of transmission of tuberculosis (TB) from a highly infectious passenger with pulmonary/laryngeal TB to other persons aboard two airline flights, each approximately 1.25 h in duration. METHODS: The 146 passengers with known U.S. residence and 15 flight crew were contacted and referred to their personal health care provider or local health department for a Mantoux tuberculin skin test (TST). Each person was asked to complete a risk factor questionnaire and return this form with TST information provided by the health care provider. RESULTS: Questionnaires and TST results were obtained for 110 passengers (75%) and 10 crew (67%). Twenty passenger TST's were excluded from the analysis: 10 were self-read; one was not read in millimeters of induration; 8 were read after 72 h of being placed; and 1 was performed on a person suspected of being anergic. A positive TST was defined as > or = 5 millimeters of induration. Five passengers were found to be TST positive. There were no positive TST's identified among flight crewmembers. Each of the TST positive individuals had a risk factor for a positive TST. The TST positive individuals were seated throughout the plane, and each was seated at least 5 rows away from the passenger with infectious TB. CONCLUSION: Although the possibility of transmission cannot be excluded, the findings of our investigation support a low likelihood of TB transmission during the study flights.

Adolescent↗
PubMed1994

Our experience with Roux-Y intestinal drainage in simultaneous kidney and pancreas transplantation.

Enteric drainage is a sound surgical technique in SKP, and it avoids the majority of urological as well as metabolic complications. We did not see an increase in intraabdominal complications or of graft loss due to rejection. Intestinal leak is rare and easily managed provided a Roux-Y loop of jejunum is used. Even though the number of patients was small and the follow-up short, the results of the RY group were at least comparable to the BD group. In view of our results, we plan to use this technique in all our future SKP patients.

Adult↗
PubMed1993

Hantavirus in the southwestern United States: epidemiology of an emerging pathogen.

In May of this year, an outbreak of sudden, unexplained, and highly fatal respiratory illness of unknown etiology was identified in the four-corners region of the southwestern United States. Within 3 weeks after the collaborative response launched by the state and local health agencies in the affected area, laboratory studies from the federal Centers for Disease Control and Prevention suggested that an acute infection with a previously unrecognized Hantavirus species was responsible for the reported cluster of cases. The hantavirus associated with this outbreak has since been isolated in tissue culture, and diagnostic test systems specific for the newly identified hantavirus have been developed. This article summarizes the history of the outbreak as experienced by investigators from the Arizona Department of Health Services and reviews the epidemiologic and clinical aspects of both the current epidemic and hantaviruses in general. The sudden occurrence of acute illnesses in the Southwest due to a previously unrecognized hantavirus reaffirms that the potential for the emergence of new infectious diseases exists at any place or time in the United States. The response to the outbreak also illustrates how community clinicians and federal, state, and local health agencies work together to promptly identify the emergence of new disease threats, rapidly determine new etiologic agents, and develop and swiftly implement appropriate disease prevention and control strategies.

Adult↗
PubMed1986

Concepts of nutrition in adolescent pregnancy.

The pregnant adolescent presents a special challenge to health care providers. Large nutrient and calorie requirements need to be met at a time when she is likely to have an intense concern about weight. Peer pressures, time constraints, her need to exert independence from parents and family, and the overwhelming pressures which may be associated with teenage pregnancy, may be more important determinants of her food behaviors than knowledge of what she should eat to have a healthy pregnancy. Health care providers need to be able to assess the nutritional status and specific determinants of eating behaviors for each young woman and make recommendations designed to fit into her life. These suggestions should be compatible, to the extent possible, with the norms of the young woman's primary reference group, be it family or peers. Also important is an assessment of her cognitive ability. If she has not developed the ability to think futuristically or abstractly, the provider will need to emphasize the short-term benefits to her of healthy eating as opposed to focusing on how she can eat to have a healthy baby in a number of months. Again, specific recommendations on types and quantities of foods as well as timing and location of eating may be necessary.

Adolescent↗