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Biomedical subjects

P S Mueller

Publications and source records attributed to P S Mueller.

At least 19 recordsLinked to original sources
PubMed2006

Black esophagus: report of six cases and review of the literature, 1963-2003.

Black esophagus is the uncommon endoscopic finding of extensive black discoloration of the esophageal mucosa, usually from acute esophageal necrosis. Six cases of black esophagus were seen at Mayo Clinic (Rochester, Minnesota, USA) from 1997 through 2003, and 46 cases were reported in the English-language literature from 1963 through 2003. We studied the demographics, clinical features, and outcomes of these 52 cases of black esophagus. Age and sex were known for 50 patients: the mean (SD) age was 65 years (19), and 42 patients (84%) were men. Symptoms were known for 51 patients: the most common symptom was upper gastrointestinal tract bleeding, occurring in 40 patients (78%). All 52 patients had at least one comorbid condition (with most having two or more), including duodenal ulcer in 17 (33%), cancer in 15 (29%), renal insufficiency in 15 (29%), and diabetes mellitus in 14 (28%). The suspected cause of black esophagus was reported for 40 patients: ischemia in 22 (55%); massive gastroesophageal reflux in seven (18%); and esophageal infection (Lactobacillus acidophilus, herpes simplex, Candida albicans) in four (10%). Most patients received supportive therapy, particularly acid suppression therapy. Of the 47 patients for whom outcomes were known, 17 (36%) died. There were no statistically significant differences between survivors and non-survivors. Black esophagus typically occurs in older men with at least one comorbid condition; a substantial number of patients die. Although the underlying mechanism leading to black esophagus is unknown, clinicians caring for patients with black esophagus should focus on optimizing perfusion, minimizing acid reflux, and treating esophageal infection if present.

Acute Disease↗
PubMed2006

The effect of online status on the impact factors of general internal medicine journals.

BACKGROUND: We sought to determine the effects of becoming available online on impact factors of general medicine journals. METHODS: Through MEDLI NE with an institutional subscription, the 2004 online status of "Medicine, General and Internal" journals listed in the Institute for Scientific Information (ISI ) Journal Citation Reports (JCR) was classified as full text on the Net (FU TON), abstract only, or no abstract available (NAA)/unavailable in MEDLI NE. Similarly, through use of a home computer without an institutional subscription, the 2004 online status of the same journals was determined. For each journal, impact factors for 1992 to 2003 were obtained. RESULTS: Of the 102 "Medicine, General and Internal" journals listed in the ISI JCR, 71 (70%) existed in both pre-Internet (1992) and Internet (2003) eras. Of these 71 journals, those available as FU TON in 2004 had higher median impact factors than non-FU TON journals in 1992 (p < 0.0001> and 2003 (p < 0.0001). Journals that became available online, at least partially, had significant increases in median impact factors from 1992 to 2003 (p< 0.0001 for journals that became available as FUTON and for journals that provided an abstract only. However, journals that became available as FUTON had a greater increase in median impact from 1992 to 2003 than other journals (p = 0.002). Similar results were obtained using impact factor data according to journal online status through use of a home computer without an institutional subscription and for English-language journals only. CONCLUSION: Becoming available online as FUTON is associated with a significant increase in journal impact factor.

Bibliometrics↗
PubMed2006

Safety of electroconvulsive therapy in patients with asthma.

BACKGROUND: Patients with depression and other psychiatric disorders being considered for electroconvulsive therapy (ECT) may also have asthma. Since ECT requires the administration of general anaesthesia, it is assumed that extra care should be taken with asthmatic patients before and during ECT. We sought to investigate the safety of ECT in asthmatic patients. METHODS: A retrospective review was conducted of the medical records of all of the patients with currently active and managed asthma who underwent ECT for severe depressive syndromes at Mayo Clinic, Rochester, Minnesota, between 1 January 1998, and 30 June 2006. RESULTS: Thirty-four patients with asthma who also underwent ECT were identified. Of these, 27 (79%) were women. The median age was 45 years (range 23-84 years). All 34 patients were using asthma medications daily at the time of ECT. The 34 patients underwent a total of 459 ECT sessions. Four (12%) patients experienced exacerbation of their asthma on a total of five occasions. Each exacerbation was successfully treated with standard asthma medications, and all four patients completed their courses of ECT. CONCLUSION: ECT in patients with asthma appears to be safe. Although exacerbation of asthma after ECT was rare in our series, a prospective study would be needed to determine the precise risk of pulmonary complications of ECT in asthmatic patients.

Adult↗
PubMed2001

Disseminated Mycobacterium abscessus infection manifesting as fever of unknown origin and intra-abdominal lymphadenitis: case report and literature review.

Mycobacterium abscessus is a rapidly growing mycobacterium found in soil and water throughout the world. Disease in immunocompetent patients usually consists of localized skin and soft tissue infections. In contrast, disseminated disease is uncommon, usually presents with rash, and almost always occurs in an immunocompromised host. We describe an unusual case of disseminated M. abscessus infection manifesting as fever of unknown origin and intra-abdominal lymphadenitis, but without rash. Our patient responded well to amikacin and clarithromycin therapy. We also review the literature related to the diagnosis and management of this uncommon disease.

Aged↗
PubMed2001

Successful electroconvulsive therapy in an elderly man with severe thrombocytopenia: case report and literature review.

Electroconvulsive therapy (ECT) is a safe and effective treatment for depression. Furthermore, modifications to ECT have made it a safe procedure for patients who were previously thought to be too ill or old to undergo the stress of convulsions. Little is known, however, of the safety of performing ECT on patients with severe thrombocytopenia. Such patients may be at increased risk for hemorrhagic complications due to the procedure. In this article, we describe the case of a 74-year-old man with major depression and myelodysplastic syndrome with associated severe thrombocytopenia, who underwent successful administration of a full course (nine treatments) of ECT. The physiologic changes caused by modified ECT and the potential risk of hemorrhage (including intracranial hemorrhage) in thrombocytopenic patients undergoing ECT are also discussed.

Aged↗
PubMed2001

Religious involvement, spirituality, and medicine: implications for clinical practice.

Surveys suggest that most patients have a spiritual life and regard their spiritual health and physical health as equally important. Furthermore, people may have greater spiritual needs during illness. We reviewed published studies, meta-analyses, systematic reviews, and subject reviews that examined the association between religious involvement and spirituality and physical health, mental health, health-related quality of life, and other health outcomes. We also reviewed articles that provided suggestions on how clinicians might assess and support the spiritual needs of patients. Most studies have shown that religious involvement and spirituality are associated with better health outcomes, including greater longevity, coping skills, and health-related quality of life (even during terminal illness) and less anxiety, depression, and suicide. Several studies have shown that addressing the spiritual needs of the patient may enhance recovery from illness. Discerning, acknowledging, and supporting the spiritual needs of patients can be done in a straightforward and noncontroversial manner. Furthermore, many sources of spiritual care (e.g., chaplains) are available to clinicians to address the spiritual needs of patients.

Adaptation, Psychological↗
PubMed2000

Symptomatic ischemic heart disease resulting from obstructive intramural coronary amyloidosis.

PURPOSE: Obstructive intramural coronary amyloidosis is an unusual complication of systemic amyloidosis. SUBJECTS AND METHODS: We review the characteristics of 11 patients seen at the Mayo Clinic (Rochester, Minnesota) from January 1, 1960, to June 1, 1999, with intramural cardiac amyloidosis diagnosed at autopsy or after examination of an explanted heart. RESULTS: Symptomatic ischemic heart disease resulting from obstructive intramural coronary amyloidosis was found in 11 patients (8 men, 3 women). The mean (+/-SD) age at the diagnosis of primary amyloidosis was 62 +/- 12 years. All patients had angina pectoris; angina was the presenting symptom of primary amyloidosis in 6 patients. Unstable coronary syndromes occurred in 7 patients and congestive heart failure in 8. New electrocardiographic abnormalities after the development of angina were common and included ischemic changes, bundle branch block, and dysrhythmias. Low voltage was seen in only 2 patients. All 7 patients who underwent coronary angiography had normal or clinically insignificant findings. Endomyocardial biopsy was performed on 4 patients; amyloid was found in 3 patients, none of whom had obstructive intramural coronary amyloidosis. The diagnosis of obstructive intramural coronary amyloidosis with associated myocardial injury was established only at autopsy or after examination of the explanted heart after cardiac transplantation. The mean time to death or cardiac transplantation after symptoms of cardiac ischemia developed was 18 +/- 20 months. CONCLUSIONS: The diagnosis of ischemic heart disease resulting from obstructive intramural coronary amyloidosis is difficult to establish before death or cardiac transplantation. Although the condition has a poor prognosis, its accurate recognition may have therapeutic implications, because some patients may benefit from treatment, including systemic chemotherapy or cardiac transplantation.

Adult↗
PubMed1987

Cocaine abuse and adult attention deficit disorder.

Cocaine increases dopaminergic tone in the central nervous system, and hyperprolactinemia has been found in chronic cocaine abusers. Dopamine depletion is believed to result from chronic cocaine abuse. Dopamine deficiency has also been associated with attention deficit disorder (ADD) in adults, and dopamine agonists have been effective in the treatment of ADD. Four case reports of cocaine addiction and ADD are presented. ADD was assumed to play an etiologic role in cocaine abuse, and it was postulated that the patients might in part have been self-medicating a dopamine-deficient state. In addition, cocaine addicts without a premorbid history of ADD may experience a temporary cocaine-induced ADD state. In both cases, the dopamine agonist bromocriptine was highly effective for treating ADD and promoting cocaine abstinence. Restoration of the presumed dopamine deficit may permit an easier course of rehabilitation by improving the patient's ability to participate in therapeutic programs.

Adult↗
PubMed1984

Seasonal affective disorder. A description of the syndrome and preliminary findings with light therapy.

Seasonal affective disorder (SAD) is a syndrome characterized by recurrent depressions that occur annually at the same time each year. We describe 29 patients with SAD; most of them had a bipolar affective disorder, especially bipolar II, and their depressions were generally characterized by hypersomnia, overeating, and carbohydrate craving and seemed to respond to changes in climate and latitude. Sleep recordings in nine depressed patients confirmed the presence of hypersomnia and showed increased sleep latency and reduced slow-wave (delta) sleep. Preliminary studies in 11 patients suggest that extending the photoperiod with bright artificial light has an antidepressant effect.

Adult↗
PubMed1984

Differential response of plasma glucose, amino acids and nonesterified fatty acids to insulin in depressed patients.

Levels of plasma glucose, nonesterified fatty acids and total amino acids at various times after insulin administration were determined in patients with either major depressive disorder or dysthymic disorder and in normal control subjects. For the first 30 min following insulin administration, the rate of change in glucose levels was significantly less among the patients with major depressive disorder than among either the patients with dysthymic disorder or the normal control subjects. However, during the same time period, the rates of decline in nonesterified fatty acids and total amino acids were indistinguishable among the three subject groups. Therefore, the insulin resistance in terms of glucose levels that is observed in patients with major depressive disorder is not generalized to other substances affected by insulin.

Adult↗
PubMed1984

Platelet secretion defect in patients with the attention deficit disorder and easy bruising.

Platelet function was evaluated in 12 patients with the attention deficit disorder and lifelong history of easy bruising. Aggregation and 14C-serotonin secretion studies in platelet-rich plasma in response to adenosine diphosphate (ADP), epinephrine, and arachidonic acid did not reveal striking abnormalities. Secretion of adenosine triphosphate (ATP), ADP, beta-hexosaminidase, and beta-glucuronidase by gel-filtered platelets in response to the divalent cation ionophore A23187 and low concentrations of thrombin (less than or equal to 0.1 U/ml) was impaired in patients as compared to normals. The aggregation response to A23187 (4 microM) was absent in 8 of the 12 patients. The total stores of the secretable constituents, the retention of incorporated 14C-serotonin, and the arachidonate metabolism of the platelets were normal. Our findings suggest a new platelet disorder with impaired secretion mechanism, without storage pool deficiency or impaired arachidonate metabolism. The secretion defect in platelets represents a tissue disorder in a functional psychiatric disease. We refocus attention on the role of platelets as a model for neurons in functional disorders, with emphasis on secretion mechanisms rather than amine uptake, storage, and metabolism.

Adolescent↗