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Biomedical subjects

Richard B Birrer

Publications and source records attributed to Richard B Birrer.

9 recordsLinked to original sources
PubMed2004

Depression in later life: a diagnostic and therapeutic challenge.

Depression in elderly persons is widespread, often undiagnosed, and usually untreated. The current system of care is fragmented and inadequate, and staff at residential and other facilities often are ill-equipped to recognize and treat patients with depression. Because there is no reliable diagnostic test, a careful clinical evaluation is essential. Depressive illness in later life should be treated with antidepressants that are appropriate for use in geriatric patients. A comprehensive, multidisciplinary approach, including consideration of electroconvulsive treatment in some cases, is important. The overall long-term prognosis for elderly depressed patients is good.

Aged↗
PubMed2003

Hepatocellular carcinoma and hepatitis virus.

Integrated hepatitis B virus (HBV) DNA is present in many hepatocellular carcinomas (HCC), suggesting that HBV has a direct oncogenic effect through interaction with transformation-associated genes. Many genes involved in cell cycle regulation (cyclins, kinases, negative regulators, Wnt-beta-catenin) and the transcriptome profile are deregulated or altered in most HCC patients. The HBx protein, potentially oncogenic via multistep carcinogenesis, modifies apoptosis, inhibits nucleotide excision and repair of damaged cellular DNA, and modulates transcriptional activation of cellular growth regulating genes. Hepatocyte transformation may be indirectly influenced by HBV DNA integration, by the generation of mutagenic oxygen reactive species, or by acquisition of mutations in association with necroinflammatory disease. HBV replication, which may occur in HCC, affects the long-term survival of patients. Prevention of HBV infection is expected to decrease the incidence of endemic HCC.

Carcinoma, Hepatocellular↗
PubMed2002

Digital foot trauma: emergency diagnosis and treatment.

Trauma to the foot is commonly seen in the emergency setting. An accurate diagnosis and step-wise management is appropriate. Although most injuries respond to aggressive non-surgical treatment, surgical intervention may be required for an unstable or a displaced fracture, particularly of the first metatarsophalangeal joint.

Fractures, Bone↗
PubMed2002

Hypermagnesemia-induced fatality following epsom salt gargles(1).

Hypermagnesemia is a rare cause of coma in a patient with normal renal function. When present, it is often because of iatrogenic medication overdose. We report a fatal case of chronic Epsom salt gargles for halitosis that produced a serum magnesium of 23.6 mg/dL (9.8 mmol/L) and resulted in coma. We review the wide presentation of hypermagnesemia from subtle neurologic and cardiovascular signs to the major life-threatening clinical manifestations of shock, dysrhythmias, coma, and cardiopulmonary arrest despite emergency dialysis.

Adult↗
PubMed2002

Irritable bowel syndrome.

Irritable bowel syndrome is a biopsychosocial disorder characterized by dysregulation of intestinal motor, sensory, and central nervous system functions. It is associated with significant disability and health-care costs. The traditional diagnostic approach leads to excessive investigation for many patients. A reductionist approach of focusing on evaluation and treatment of a single mechanism is unlikely to prove effective. Identification of the characteristic symptom pattern is the key to cost-effective management. A strong patient-physician relationship is essential for a successful outcome. Optimal outcome is predicated on an individualized treatment plan that integrates pharmacologic and behavioral modalities.

Adult↗
PubMedDate not supplied

The Special Olympics athlete: evaluation and clearance for participation.

Evaluating and clearing the Special Olympics athlete for participation in sports and recreational activities can be a challenging task for a primary care physician. Radiographic clearance of the cervical spine is mandatory for all athletes with Down syndrome. Regular physical activity for this special population has measurable physiologic and psychosocial benefits.

Athletic Injuries↗