The efficacy and safety of maintenance ECT in geriatric patients.
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Biomedical subjects
Publications and source records attributed to L Siegel.
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Exposure to inorganic lead has been associated with impaired uptake of iodine by the thyroid as well as depressed estimated free thyroxine levels in occupationally exposed adults. Consideration of the serious consequences of impaired thyroid function in young children prompted investigation of the effects of lead on thyroid function in children. Blood lead determinations and thyroid function tests were performed on 68 children examined at a hospital outpatient pediatric clinic. Serum thyroxine (T4) and free thyroxine (FT4) levels were within the normal range for all patients. No statistically significant relationship was found between lead levels and T4 or FT4 levels. We conclude that lead is unlikely to have a clinically significant effect on thyroid function in children exposed in inner cities at prevailing levels.
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Effects of stimulant medication (methylphenidate) on levels (feature, name, semantic) of word processing by the left and right hemisphere were assessed in 31 attention-deficit-disordered children. In a double-blind procedure, same-different decisions were made to tachistoscopically presented word pairs under medication and placebo. Analysis of manual response times failed to show any negative effects of medication. Feature decisions were faster than name decisions, which were faster than semantic decisions. Methylphenidate induced a right visual field advantage (left hemisphere) for the name decision, which was interpreted as a normalization effect. The results suggest that (1) methylphenidate may selectively improve the phonological level of word processing and (2) methylphenidate's favorable therapeutic effect is produced through inhibition of excessive right hemisphere activity in response to task demands that engage the left hemisphere.
Review of insurance data indicates that approximately 1.5 claims are paid per 10,000 anesthetic procedures, a conservative estimate of the incidence of preventable serious injury associated with anesthesia. Insurance data permit estimation of the premium cost for the anesthesiologist and hospital, per operating room per year, of $69,429.00. We propose the use of an enhanced monitoring standard requiring a pulse oximeter, capnograph, spirometer, halometer, automatic sphygmomanometer, breathing circuit oxygen analyzer, stethoscope, electrocardiographic monitor, and temperature monitor. We suggest that this premium cost, together with the estimate that 50% of incidents would be avoided, predicts a resultant saving of over $27,000/operating room/year, a savings equal to the entire cost of the enhanced monitoring system in approximately 8 months, or a yearly savings of over five times the annualized expense of the monitoring system. Thus, in addition to the moral imperative to monitor a patient during anesthesia to avoid injury and death, there is an economic incentive to monitor effectively.
This report describes a mammalian model for exploring the role of virus in peripheral neuropathy. Schwann cells in culture were permissive for mouse cytomegalovirus (MCMV) replication. Intraperitoneal inoculation rarely led to sciatic nerve infection. Sciatic nerves infected by direct intraneural injection produced infectious virus and contained viral antigen at 4 days postinfection (pi). Nerves taken later, at 4 to 8 weeks pi, contained no infectious virus, but MCMV was present in a latent state because culture of nerve explants reactivated virus. The findings contrast the viral permissiveness of cultured Schwann cells to the latency observed in intact peripheral nerve.
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The mechanisms of persistence and of demyelination in Theiler's virus (TV)-induced chronic neurologic disease (a murine model for multiple sclerosis) are, as yet, disputed. We investigated the tropism and persistence of TV in brain cell culture to better understand the pathogenesis of this disease. Using anti-genic markers to identify specific cells in culture, we have demonstrated that TV infects, lytically, neurons and oligodendrocytes and persistently astrocytes and macrophages. These results suggest that host cell factors play a key role in the mechanism of demyelination and the persistence of TV in the nervous system.
Most people who are exposed to AIDS do not get the syndrome. It seems clear that there must be cofactors. Most people with AIDS have a history of alcohol or other drug use, and many of the drugs used have been shown to suppress the immune system. The correlation between drug use and development of AIDS in several populations is striking, and it is suggested that definitive research into this possible cofactor be urgently initiated. The elimination of cofactors may present an immediate way to control this epidemic. Suggestions are made as to how and why alcohol and drug treatment professionals should become a part of this effort.
Non-sustained ventricular tachycardia (VT) in the late post myocardial infarction (MI) period (7-21 days) has been reported to be a predictor of sudden death. We suspected that patients with 3 beat VT on Holter monitoring in the late infarction period would demonstrate electrical instability at electrophysiologic studies. Forty-seven patients were identified as having at least 3 beat VT on Holter monitoring. Eighteen patients refused electrophysiologic studies or were not referred by their attending physician. The mean ejection fraction of this group was 43 +/- 16%. Eight patients have died, 3 sudden deaths in 13 +/- 5 months, a 17% incidence of sudden death. Twenty-nine patients underwent invasive electrophysiologic studies. Their mean ejection fraction was 37 +/- 7%, and 28 had inducible, 18 sustained ventricular tachycardia and 10 non-sustained VT. No complications were noted with electrophysiological testing in the post infarction patients. Using programmed electrical stimulation studies an effective antiarrhythmic agent preventing VT induction (usually experimental) could be found for each patient. After a mean follow-up of 12.5 +/- 4 months, the patient without inducible VT is alive and 26 of the 28 "inducible" patients are alive and well. Two patients died, one of stroke and one due to pump failure following a second MI. No sudden deaths were observed in this group. Two patients had breakthrough arrhythmias and were treated by alternative antiarrhythmic therapy that was also effective at the initial electrophysiologic studies. Thus, PES studies post MI are safe and may be an effective way to assess therapy for patients in the early post MI period, identified at high risk for sudden death.
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The drastic reduction of State Hospital population in New York over the past decade has led to a demographic relocation of the mentally ill, rather than any real decline in the rate or severity of mental disorders. Unable to function on their own in society and without adequate supportive facilities available, many discharged patients live in the streets and eventually end up on the Bowery, where they are cared for at The Men's Shelter. Studies have shown that over 50% of the current Bowery population has a history of mental illness and that alcoholism is often a secondary, rather than primary diagnosis. The most frequently encountered diagnostic syndromes are mentioned and commented upon. Possible alternative treatment interventions are suggested.
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In this new method for estimating free thyroxine concentration in serum by use of polyacrylamide gel filtration, the prolonged incubation that is characteristic of equilibrium dialysis is obviated. Although the values so obtained for the percentage of free thyroxine are severalfold higher than those obtained by dialysis, the results of the two procedures correlate well over a wide range of thyroid states. In addition, the precision of the polyacrylamide method compares well with that for equilibrium dialysis. The method is convenient for use in clinical laboratories and values for free thyroxine in serum of patients with metabolic thyroid disorders are diagnostically discriminatory.
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We describe a method for estimating free triiodothyronine in serum by polyacrylamide gel filtration. Precise and easy to perform, it avoids the lengthy incubation required for equilibrium dialysis. Results of this procedure correlate well with those by the dialysis method over a wide range of thyroid states. The role of free triiodothyronine as part of a protocol for the evaluation of thyroid status is discussed.