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Biomedical subjects

M L Elks

Publications and source records attributed to M L Elks.

At least 19 recordsLinked to original sources
PubMed1996

Popular press diagnoses and psychiatric diagnoses.

The symptom spectra of several 'popular press' diagnoses are examined and compared to Diagnostic and Statistical Manual of Mental Disorders-IIIR criteria for somatization disorder, depression, and generalized anxiety disorder. While there is much overlap, there are clear distinctions, and these psychiatric terms do not adequately coincide with the symptom spectra of these disorders. These conditions may represent 'neuroendocrine dysrhythmias' - abnormal/normal physiological dysfunctions with psychodynamic roots and/or influences. They currently often fall between the established domains claimed by Medicine and Psychiatry, with resultant poor evaluation and management with this spectrum of problems.

Female↗
PubMed1996

Appetite suppressants as adjuncts in the treatment of obesity.

Obesity is a common and challenging problem that often leads to other medical problems, including type II diabetes, hyperlipidemia, hypertension, coronary artery disease, and degenerative joint disease. Weight loss, which is central to the dietary treatments for obesity, is often of limited success. Recent studies have documented the safety and efficacy of certain appetite suppressants for assisting in long-term weight loss and maintenance of weight loss. Since appetite suppressants, alone or in combination, have been documented to be safe and effective adjuncts for treating obesity and complicated obesity, physicians should consider using these agents in the pharmacotherapy for obese patients.

Appetite Depressants↗
PubMed1995

Neuroendocrine dysrhythmias.

Neuroendocrine rhythms play a major role in the regulation of physiological function. Stress can disrupt these rhythms and produce neuroendocrine dysrhythmias. A paradigm of classification of these dysrhythmias is presented and includes diurnal (phase and amplitude), autonomic (adrenergic or cholinergic excess or imbalance), and muscle tension (skeletal or smooth). By placing common psychosomatic conditions in this paradigm, one can model these conditions as exaggerations of normal responses producing disruption in normal neuroendocrine rhythms. This can also lead to a focus of therapy on restoring neuroendocrine balance and rhythm.

Circadian Rhythm↗
PubMed1995

Conflict of interest and the physician-researcher.

Conflicts of interest for the physician-researcher are not limited to direct financial support by a pharmaceutical or device manufacturer but rather include subtler indirect financial and research support. In addition, a physician's role as investigator may conflict with the role of patient advocate in ways that are not always recognized. Efforts to increase awareness of subtle conflicts of interest should help prevent and address patient harm and damage to data integrity.

Conflict of Interest↗
PubMed1994

On the genesis of anorexia nervosa--a feminist perspective.

Anorexia nervosa may occur, in part, in an effort not to delay an adult role but rather to delay the encumbered female adult role of being wife and mother. By weight loss, the patient assumes an androgenous form and role, in an assertion of desire for independence and self-actualization, rather than a reversion to the role of dependent child. The incidence of anorexia is increased by the inappropriately thin female ideal in Western society. A focus on self-actualization and independence should be an important aspect of therapy, and continued efforts need to be made to a societal atmosphere of judgement of women predominantly in the context of appearance and domestic duties.

Adolescent↗
PubMed1994

On the genesis of somatization disorder: the role of the medical profession.

The development of somatization disorder is supported by the way physicians focus on somatic complaints but fail to effectively diagnose and relieve them if a specific anatomic or biochemical lesion is not found. This inadequate treatment of somatizing patients may related to the focus of medical teaching as well as male skills, styles and vulnerabilities.

Delivery of Health Care↗
PubMed1994

Divergent effects of arachidonate and other free fatty acids on glucose-stimulated insulin release from rat islets.

Long-term perifusion of isolated rat islets with 1 mM palmitate with 3 gm/dl albumin for 2 to 4 hrs. before an increase in glucose from 3 mM to 17 mM has been shown to suppress the stimulated release of insulin. In these studies, similar concentrations of myristate, stearate, oleate, palmitoleate, linoleate, linolenate, and gamma-linolenate had similar effects. Arachidonate, under similar conditions, enhanced rather than suppressed the release of insulin. This effect occurred at concentrations as low as 10 microM (lower than that needed for the suppressive effects of palmitate). This was not prevented by ibuprofen and was not associated with alteration of glucose oxidation. In prior work with palmitate, the fatty acid effects may have been due to suppressive effects of fat oxidation on glucose oxidation and signaling, but the arachidonate effects seen here may be due to metabolites or direct ionic effects.

Animals↗
PubMed1994

Malaise in medicine: we don't teach what we do.

I tested the hypothesis that the most frequently used textbooks of internal medicine are inadequate in their coverage of the evaluation and management of common complaints and management problems of primary care. Fourteen common complaints (symptoms) and nine common management problems (diseases) representing 20% to 40% of primary care patient visits were identified, and seven major textbooks of internal medicine were reviewed to assess the amount and extent of coverage of these topics. The average number of pages devoted to all 14 major problems was about 30, or 1.5% of the total. About 40 (2%) of the pages addressed the nine management problems. The minimal amount of coverage devoted to these topics could be taken as evidence of the lack of respect, importance, and emphasis ascribed to them. The lack of instruction in these areas may enhance malaise in primary car medicine due to inadequate instruction in the needed data base and skills and the resultant patient dissatisfaction.

Education, Medical↗
PubMed1993

Open trial of fluoxetine therapy for premenstrual syndrome.

To assess the possible efficacy of fluoxetine hydrochloride in severe PMS (premenstrual syndrome, luteal phase dysphoric disorder), an open trial of this medication was undertaken on women with severe PMS. Of 38 patients seeking evaluation of PMS, 35 met the criteria for diagnosis, and 21 had mild symptoms and were treated symptomatically. Fourteen had more severe symptoms persisting for more than 5 to 6 days of the month, and 11 elected to participate in an open trial of low-dose (20 mg) fluoxetine, an antidepressant. Ten continued treatment for 3 to 20 months, with moderate to marked relief of symptoms during treatment and without problematic side effects (one patient was given 40 mg daily; the remainder received 20 mg daily). On discontinuing therapy, seven have had persisting remissions, and two have returned for another cycle of fluoxetine therapy, with relief. It is unclear whether such a strong positive response to fluoxetine, an antidepressant with particularly good effects in "atypical depression," indicates that the women affected by severe PMS have a cyclic, hormonally induced change in brain chemistry causing a depressive type of condition, or whether they have a true (atypical) mild depression with brief remission due to "perifollicular euphoria" in the estrogenic follicular phase.

Adult↗
PubMed1993

A format for scripted clinical oral examinations.

A format for scripted clinical oral examination in general medicine is presented. Using this format, untutored pairs of teachers were consistent in grading third-year clerkship students. This measure of performance appeared to evaluate an aspect of clinical skills not assessed by the National Board Medical Examination or clinical performance assessments. Acceptance by teachers was good.

Clinical Competence↗
PubMed1993

Chronic perifusion of rat islets with palmitate suppresses glucose-stimulated insulin release.

To test the hypothesis that the high circulating FFA levels in the diabetes of obesity could contribute to the altered dynamics of insulin secretion seen in that condition, insulin release was measured in isolated perifused rat islet cells, without or with added palmitate. Acutely, as in other systems, palmitate (1 mM) stimulated insulin release. Palmitate (1 mM) suppressed both first and second phase insulin release after 2, 3, or 4 h of perifusion, but not after 1 h. No significant effect was noted with 0.3 mM palmitate, and the effect was maximal at 1 mM. The stimulatory effects of arginine were essentially unaffected. Tolbutamide (1 mM) reversed or counteracted the effect. Glucose oxidation was suppressed in islets incubated with 1 mM palmitate for 4 h. Inhibitors of fat oxidation, alpha-bromostearate (1 mM) and methyl-3-tetradecylglycidate (100 microM) reversed the effects of palmitate on glucose-stimulated insulin release and glucose oxidation. Thus, prolonged incubation of rat islet cells with 1 mM palmitate could suppress the glucose-stimulated release of insulin from perifused rat islets. This suppression could be reversed by inhibitors of fat oxidation. This supports the hypothesis that elevated FFA levels and/or increased fat oxidation could contribute to the altered dynamics of insulin secretion in obese diabetics by fuel antagonism as well as the previously documented suppression of peripheral glucose uptake and stimulation of hepatic gluconeogenesis and may be a key link between obesity and the development of diabetes.

Animals↗
PubMed1993

The right to participate in research studies.

Institutional review boards for the use of human subjects in scientific studies were initially established to focus on protection of human subjects from the risks of research. It has become evident in recent years, however, that it is also important to protect the rights of individuals to have access to the benefits of research participation. These include, but are not limited to, certain experimental drugs or treatments, closer monitoring, free care or direct remuneration, and societal benefits of results of studies on specific populations. Researchers, so long sensitized by their respective institutional review boards to the need for protection of the subjects, now must also focus on the added burden of efforts to include individuals and the increased efforts it may take to protect the safety and rights of certain populations, including patients with AIDS, women, minorities, children, and the elderly. Additional care must be taken to design appropriate studies, recruit an appropriate spectrum of the population, craft a complete yet understandable and nondeterent informed consent form, and make efforts to assure that participants are informed.

Beneficence↗
PubMed1993

Misunderstanding in the classification of diabetes mellitus. What's in a name?

To assess whether physicians, residents, medical students, hospital diagnosis coders, and patients properly use the designations insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) that were established by criteria of the National Diabetes Data Group, we reviewed clinic and hospital records and administered questionnaires. Although essentially all cases of true IDDM were identified as such and most cases of NIDDM not requiring insulin therapy were correctly identified by all groups, patients with NIDDM on insulin therapy were misidentified as having IDDM by 38% of residents in internal medicine clinics and 68% of primary care and surgical subspecialty residents. On a survey, of 22 patients with NIDDM on insulin therapy, 17 (77%) considered themselves to have IDDM. Thus, patients who have NIDDM by the established criteria who are on insulin therapy are commonly mislabeled as having IDDM. We present an approach for dealing with this problem by adapting nomenclature focusing on insulin deficiency and resistance. It would probably also be helpful to separately identify the subset of patients with "insulin-deficient diabetes" who are ketosis-prone. It is important to use immunologic profiling (islet cell antibody testing) and insulin sensitivity or deficiency testing (C-peptide levels).

Adult↗