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Biomedical subjects

R A Stern

Publications and source records attributed to R A Stern.

At least 37 records · Page 2Linked to original sources
PubMed1996

A survey study of neuropsychiatric complaints in patients with Graves' disease.

One hundred thirty-seven patients with treated Graves' disease completed a questionnaire pertaining to neuropsychiatric complaints. Psychiatric symptoms, especially anxiety and irritability, were common prior to treatment of hyperthyroidism. These complaints appeared to result in delays in seeking treatment as well as delays in receiving appropriate diagnosis. Subjects reported significantly worse memory, attention, planning, and productivity while hyperthyroid than prior to becoming hyperthyroid, and, although somewhat improved once euthyroid, they reported residual cognitive deficits. These results suggest that neuropsychiatric impairments are highly prevalent in Graves' disease, may lead to initial misdiagnosis or delays in diagnosis of the endocrine disorder, and may continue even once patients are believed to be euthyroid.

Adult↗
PubMed1996

Assessment of mood state in patients undergoing electroconvulsive therapy: the utility of visual analog mood scales developed for cognitively impaired patients.

Reliable, valid, and brief measures of mood state are essential to the evaluation of electroconvulsive therapy (ECT) efficacy. However, existing measures of mood state may be inappropriate for patients with transient cognitive impairment. Stern and colleagues have recently developed a set of Visual Analog Mood Scales (VAMS) for use in neurologically impaired patients. These brief scales (including measures of sad, confused, afraid, happy, tired, angry, and energetic states) are easily administered and have documented reliability and validity in neurologically impaired patients and in healthy adult and geriatric samples. In the present study, we assessed the validity and sensitivity of the VAMS to detect ECT-related mood change. Twenty-five inpatients who were diagnosed with major depressive episode and referred for ECT were administered the VAMS and the Hamilton Depression Rating Scale (HDRS) both pre- and post-ECT. Results indicate that the VAMS are as sensitive to the therapeutic effects of ECT as is the more lengthy and verbally demanding HDRS. In addition, the VAMS were highly correlated with the clinician's Clinical Global Improvement rating and the patient's self-report using a modified Center for Epidemiological Studies-Depression scale. The VAMS are brief, reliable scales that are sensitive to the treatment effects of ECT and that are appropriate for patients with transient cognitive impairment.

Adult↗
PubMed1995

Somatic symptoms and HIV infection: relationship to depressive symptoms and indicators of HIV disease.

OBJECTIVE: This study examined the relationship of the somatic symptoms fatigue and insomnia with indicators of both psychiatric disturbance and HIV disease severity. METHOD: Study participants were 98 asymptomatic HIV-infected and 71 uninfected homosexual men; 82 HIV-infected and 64 uninfected men had 6-month follow-up examinations. Scales from the self-reported Profile of Mood States measured fatigue and dysphoric mood. Major depression diagnosis was determined by the Structured Clinical Interview for DSM-III-R. Selected items from the Hamilton depression and anxiety scales measured insomnia and other symptoms of depression. Performance on a battery of standardized tests determined neuropsychological function ratings. RESULTS: At study entry, complaints of fatigue and insomnia were associated with dysphoric mood, major depression, and other non-HIV-related symptoms of major depression but not with CD4 cell counts or neuropsychological functioning. Increases in levels of fatigue and insomnia over the 6-month follow-up period were associated with increases in non-HIV-related symptoms of depression and in severity of dysphoric mood. Increases in fatigue were also associated with decrements in motor functioning. Otherwise, fatigue or insomnia were not associated with HIV disease progression. CONCLUSIONS: These findings suggest that complaints of fatigue and insomnia in otherwise asymptomatic HIV-infected patients are likely to be related to psychological disturbances and possibly major depression, which can be treated. HIV-infected patients who complain of fatigue or insomnia should routinely be assessed for major depression.

Adult↗
PubMed1995

Stress-associated reductions of cytotoxic T lymphocytes and natural killer cells in asymptomatic HIV infection.

OBJECTIVE: Previous research has documented a possible relation of stress and depression to cell-mediated immunity. The authors examined how stressful events and depression may affect key parameters of cellular immunity in subjects with and without HIV infection. METHOD: Data were collected on 99 asymptomatic HIV-positive and 65 HIV-negative homosexual men as part of an ongoing, longitudinal study. Criticisms of previous studies of psychoimmunity were addressed by 1) using a comprehensive, semistructured interview to measure the objective context of stressful events, 2) double labeling of lymphocytes with monoclonal antibodies to measure subsets of cytotoxic/suppressor T lymphocytes and natural killer (NK) cells, and 3) controlling for circadian effects and methodological factors. RESULTS: In the HIV-positive men, severe stress was significantly associated with reductions in NK cell populations and a subset of T cells thought to represent cytotoxic T effector cells, particularly the CD8+ T cells expressing the CD57 antigen. In the HIV-negative men, no clear and consistent relation between stress and immune system measures was found. Depression was not correlated with any variables in either of the groups, perhaps due to the low levels of depressive symptoms. CONCLUSIONS: The findings suggest that stress is associated with reductions in killer lymphocytes (decreased NK cell and cytotoxic T lymphocyte phenotypes). The data provide evidence that stress may alter cell populations that provide cytotoxic defense against infection in HIV-positive men and indicate that the clinical significance of stress-related changes in cytotoxic T lymphocytes and NK cells in HIV infection warrants further study.

Adaptation, Psychological↗
PubMed1995

Variability of contact transscleral neodymium:YAG cyclophotocoagulation.

PURPOSE: To study the variability of ciliary body lesions created by contact Nd:YAG cyclophotocoagulation and to evaluate modifications in probe design to reduce this variability. METHODS: Contact transscleral Nd:YAG cyclophotocoagulation was performed on fresh, enucleated porcine eyes in three ways: using a standard, handheld fiber-optic probe (98 eyes); using the same probe with an adjunctive contact lens guide to control for probe pressure, angle, and position (69 eyes); and using a spring-loaded handpiece to control for probe pressure (148 eyes). Four laser lesions were created in each eye and were rated for size and severity of tissue response. RESULTS: For the three groups of eyes, the mean for size differences (largest lesion minus smallest lesion in millimeters for each eye) was 2.53, 1.65, and 2.36, respectively. The mean for severity differences (most severe lesions minus least severe lesion for each eye, based on a four-part subjective rating) was 1.9, 1.1, and 1.7, respectively. These measures of size difference and severity difference were significantly lower with the lens guide than with the other two systems (P = 0.022 and P = 0.020, respectively). CONCLUSIONS: These findings indicate that contact transscleral cyclophotocoagulation can be associated with considerable variation in the size and severity of the ciliary body reaction. This variation has a significant dependence on probe pressure and orientation against the eye and can be reduced by modification in probe design.

Animals↗
PubMed1994

The health status of women following cosmetic surgery.

A retrospective study was performed to determine the frequency of new symptoms and diseases after silicone breast implantation. Questionnaires were mailed to 826 women who made up a breast implant group (n = 516) and a control group who had undergone blepharoplasty (n = 124), liposuction (n = 111), or rhinoplasty (n = 75). Responses were obtained from 370 women (45 percent); however, 68 of these patients (18 percent) were considered ineligible. The overall response rate was 59 percent for the breast implant group and 46 percent for controls. The 302 eligible women included patients with silicone breast implants (n = 222) and controls (n = 80). Women with implants were significantly younger than controls, the median age of women with breast implants being 37 years compared with 46.5 years for controls (p < 0.0001). We compared the incidence of 23 symptoms and 4 connective-tissue diseases after cosmetic surgery in the two groups. The symptoms of swollen glands under arms (p < 0.05) and tender glands under arms (p < 0.01) were statistically more frequent in the breast implant group. The symptom change in skin color was more common in the controls (p < 0.001). The Bonferroni correction for multiple (27) endpoints adjusts the 5 and 1 percent significance cutoff points to 0.00185 and 0.00037, respectively, leaving only change of skin color significant at the 5 percent level on the adjusted data. No cases of scleroderma or lupus were found, and the incidence of arthritis was not significantly different between the implant and control groups.

Adult↗
PubMed1994

Mood disorders in HIV infection: prevalence and risk factors in a nonepicenter of the AIDS epidemic.

OBJECTIVE: The authors studied the lifetime, initial cross-sectional, and 6-month follow-up prevalence of mood disorders in asymptomatic HIV-infected and uninfected homosexual men who lived in an area with a low prevalence of HIV. They also determined the relationship between current major depression and potential depression risk factors. METHOD: Subjects included 98 asymptomatic HIV-infected and 71 uninfected homosexual men. Subjects underwent extensive clinical, psychiatric, neuropsychological, and laboratory evaluations. RESULTS: Similar proportions of HIV-infected and uninfected subjects reported a lifetime (29% and 45%, respectively), an initial current (8% and 3%), and a 6-month follow-up (9% and 11%) history of major depressive disorder. Anxiety disorders were less common, with similar proportions of HIV-infected and uninfected subjects reporting a lifetime (7% and 13%, respectively), an initial current (3% and 7%), and a 6-month follow-up (2% and 5%) history of anxiety disorders. There were no differences in the severity of mood symptoms between HIV-infected and uninfected subjects. Current major depression at initial visit was significantly associated with lifetime history of major depression but not with neuropsychological function or vitamin B12 level. CONCLUSIONS: These findings are in agreement with previous studies of areas with a high prevalence of HIV. However, the proportion of subjects with mood disorders is high compared with general population studies. Both HIV-infected and uninfected homosexual men may be at high risk for major depression, especially if they have a past history of depression. Moreover, in the asymptomatic stage of HIV infection, major depression does not appear to be secondary to HIV central nervous system effects or low vitamin B12 levels.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Vitamin B12 deficiency and nervous system disease in HIV infection.

BACKGROUND: Vitamin B12 deficiency may result in a number of neurological and neuropsychiatric disorders. Patients with human immunodeficiency virus type 1 (HIV-1) infection may have a high rate of vitamin B12 deficiency and nervous system disease. Vitamin B12 deficiency may contribute to neurological disease in HIV-1-infected individuals. OBJECTIVE: To evaluate the possible contribution of vitamin B12 deficiency to neurological disease in HIV-1-infected individuals. MAIN OUTCOME MEASURES: Comparison of serum vitamin B12 levels with neurological, neuropsychological, and mood state abnormalities in 153 HIV-1-positive subjects and 57 high-risk seronegative controls. A subgroup of 67 subjects underwent additional extensive clinical neurophysiological, cerebrospinal fluid, and magnetic resonance imaging evaluations. RESULTS: No statistically significant relationships were noted between vitamin B12 levels and abnormalities on any of the measures examined. CONCLUSIONS: This study does not indicate an important role for vitamin B12 deficiency in the neurological disease of HIV-1 infection.

Adult↗
PubMed1993

Menstrual cycle and premenstrual syndrome: modifiers of cardiovascular reactivity in women.

Fifteen women prospectively diagnosed with PMS and 15 non-PMS women were each tested twice for cardiovascular stress reactivity and behavioral performance, once during the follicular phase and once during the luteal phase of their cycle. Although blood pressure and heart rate responses to stress did not differ across the menstrual cycle in either group of women, for the non-PMS women, differences in hemodynamic responses were observed across the 2 phases. The luteal phase was associated with greater stroke volume responses and lesser vascular tone. For the PMS women, none of their cardiovascular measures differed across their cycle. Instead, these women showed significantly attenuated blood pressure and heart rate responses compared with non-PMS women, irrespective of cycle phase.

Adult↗
PubMed1993

Subclinical hypothyroidism: a modifiable risk factor for depression?

The authors assessed the lifetime history of major depression in 16 subjects with subclinical hypothyroidism and 15 subjects whose thyroid function was completely normal. The lifetime frequency of depression was significantly higher in the subjects who met the criteria for subclinical hypothyroidism (56%) than in those who did not (20%), suggesting that subclinical hypothyroidism may lower the threshold for the occurrence of depression.

Adult↗
PubMed1993

Prospects for ultrasonic spectroscopy and spectral imaging of abdominal tissues.

A system for the digitization and frequency spectral analysis of radiofrequency data for ultrasonic waveforms backscattered from abdominal tissues is described. Studies of phantoms meant to simulate abdominal tissues of differing scattering characteristics indicated that frequency spectral differences due to differences in the frequency dependence of backscattering were seen with 5 MHz probes, but not with a 3.5 MHz probe. Studies of a phantom with a simulated lesion of altered scattering characteristics indicated potential for improved lesion detection and characterization, using custom circuitry developed for variable bandwidth filtering of received ultrasonic beams. The techniques discussed have potential for improved diagnosis of diffuse and focal abdominal abnormalities over that obtained with conventional ultrasonic imaging.

Abdomen↗
PubMed1992

Neurobehavioral functioning in a nonconfounded group of asymptomatic HIV-seropositive homosexual men.

Neurobehavioral functioning was tested in 34 asymptomatic HIV-seropositive and 43 HIV-seronegative male homosexual subjects without substance abuse and CNS disorders. The HIV-positive subjects exhibited mild motor slowing compared to the seronegative subjects. These differences remained after controlling for potential cofactors. Early neurobehavioral impairment in HIV infection seems limited to subclinical motor deficits and attributable to HIV rather than possible confounding factors.

Adolescent↗
PubMed1991

Transscleral Nd:YAG laser cyclophotocoagulation with a contact lens.

Transscleral Nd:YAG laser cyclophotocoagulation was performed on 100 consecutive patients. A contact lens designed specifically for this operation was used, and the results were compared to those of a previously reported series of 100 patients in which the same procedure was performed without the lens. The lens provided intraoperative advantages of eyelid separation, compression and blanching of the conjunctiva at the treatment site, and precise measurements for placement of the laser applications. Early postoperative advantages were reduced conjunctival burns and less hyperemia. However, the long-term results were comparable between the two series, with the exception of a higher incidence of phthisis when the lens was used. The thinning and blanching of the conjunctiva may increase the percentage of laser energy reaching the ciliary processes, which suggests a need for reduced energy levels when using the lens.

Adult↗