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Biomedical subjects

S M Gold

Publications and source records attributed to S M Gold.

14 recordsLinked to original sources
PubMed2006

Fatigue in multiple sclerosis: an example of cytokine mediated sickness behaviour?

BACKGROUND: Fatigue is a major complaint of multiple sclerosis (MS) patients. However, little is known about its pathophysiological mechanisms. Evidence from chronic fatigue syndrome and studies on sickness behaviour suggest that immune and neuroendocrine factors may play a causative role in the development of fatigue. METHODS: We compared whole blood stimulatory capacity for pro- (TNFalpha, IFNgamma) and anti-inflammatory cytokines (IL-10) as well as hypothalamo-pituitary-adrenal (HPA) axis function in 15 MS patients with marked fatigue and 15 patients without fatigue as determined by the Fatigue Severity Scale (FSS). RESULTS: Proinflammatory cytokines were significantly higher (TNFalpha: 478.9 v 228.2 pg/ml, p = 0.01; IFNgamma: 57.6 v 27.8 pg/ml; p = 0.01) in MS patients with fatigue. Furthermore, TNFalpha values significantly correlated with daytime sleepiness as measured by the Epworth Sleepiness Scale (r = 0.64, p = 0.001). Controlling for disease activity (as measured by the Cambridge Multiple Sclerosis Basic Score), disease duration, Expanded Disability Status Scale, and depression further increased the correlation of cytokine production and fatigue. HPA axis activity was not related to fatigue but was modestly correlated with cognitive impairment. CONCLUSION: Our data suggest that fatigue in MS is at least partially mediated through activation of proinflammatory cytokines. In line with earlier findings, HPA axis dysfunction seems not to be relevant in MS fatigue pathogenesis but appears to be linked to cognitive impairment. Our findings suggest that increased levels of inflammatory cytokines may be involved in MS fatigue. Investigation of cytokine profiles may increase the understanding of fatigue pathogenesis in MS.

Adrenocorticotropic Hormone↗
PubMed2004

Characterization of basal and re-inflammation-associated long-term alteration in pain responsivity following short-lasting neonatal local inflammatory insult.

Recently, several studies have suggested that neonatal noxious insult could alter future responses to painful stimuli. However, the manifestations, mechanisms, and even developmental nature of these alterations remain a matter of controversy. In part, this is due to the lack of detailed information on the neonatal sensitive period(s) during which noxious stimulation influences future nociception, and the time-course and distribution of the resultant abnormalities. The present paper describes these parameters in a rat model of short-lasting ( approximately 24 h) neonatal local inflammation of a hindpaw produced by injection of 0.25% carrageenan (1 microl/g). Examinations of paw withdrawal responses to thermal and mechanical stimulations in adult animals, which as neonates were subjected to this insult, showed that the previously-reported long-term hypoalgesia and hyperalgesia are not mutually exclusive outcomes of early noxious experience. Long-term hypoalgesia was apparent at the basal conditions and was equally strong in the previously injured and uninjured paws, which suggests a globally-driven deficit. In contrast, long-term excessive hyperalgesia had the strongest manifestation in the neonatally-injured paw after re-inflammation, indicating significant segmental involvement in its generation. The differences between mechanisms underlying the observed hypoalgesia and hyperalgesia are further underscored by the finding that, while the former is detectable only after animals reach the second month of life, the latter is elicitable immediately upon cessation of the initial neonatal inflammation. Nevertheless, we detected a significant overlap in the neonatal sensitive periods for generation of these effects (both occurring within the first postnatal week). Also, neither the basal hypoalgesia nor excessive re-inflammation-associated hyperalgesia subsided with age and were detectable in 120-125-day-old rats. These finding provide a framework within which the entire complex of long-term effects of early noxious experience can be understood and examined.

Animals↗
PubMed2003

Stronger endocrine responses after brief psychological stress in women at familial risk of breast cancer.

Recent research has linked exposure to chronic stress to altered acute stress responses and suggests a sensitizing effect of chronic stress leading to a stronger endocrine and cardiovascular response to acute stressors. Substantial evidence indicates that familial breast cancer risk is a chronic life stressor with higher levels of self reported distress. In this study, we investigated whether the endocrine response to a brief psychological stressor was stronger for women at familial risk for breast cancer. Thirty-six women at normal risk of breast cancer (FR- Stress Group) and 17 women at familial risk (FR+ Stress Group) underwent a brief psychological laboratory stress test (speech task and mental arithmetic) over a 15 min period. Thirty women at normal risk not subjected to the stressful task served as controls (FR- Control Group). Plasma epinephrine, norepinephrine and cortisol were measured at baseline, directly after the stress test (15 min) and at 30 min and 45 min post baseline. Heart rate data confirmed the effectiveness of the stress regimen. While there were no significant baseline group differences in the endocrine parameters, the response curves for the familial risk group revealed stronger epinephrine and cortisol reactivity to the stress test, as confirmed by significant group by time interactions. Norepinephrine levels showed a similar pattern, but results did not reach significance. These findings are in line with previous research documenting the facilitating effects of chronic stressors on acute stress response in animals and humans and provide the first evidence in the literature of a heightened endocrine reactivity to acute psychological stress in women at familial risk of breast cancer. The heightened endocrine reactivity to the experimental tasks seen here suggests that these women may experience stronger responses to stressors in their daily lives. According to the recently proposed concept of allostatic load, repeated overly strong stress responses may cumulatively have negative health implications.

Adult↗
PubMed2003

Delivering the diagnosis of MS--results of a survey among patients and neurologists.

OBJECTIVES: The need for an early disclosure of the diagnosis of multiple sclerosis (MS) has become more pressing with the publication of two recent randomized trials which have indicated that very early treatment may favourably alter the disease course. We assessed the current status of diagnostic and therapeutic information on MS from the point of view of patients and neurologists. METHODS: A standardized questionnaire was sent out through the patients' self-help organization in Hamburg, Germany and to all neurologists. RESULTS: A total of 434 of 1300 patients and 80 of 250 neurologists replied. Neurologists gave 90% of the diagnoses but only 50% of patients reported them as the major aid helping to understand the disease. Fifty per cent of patients were not informed about any form of therapy at the time of diagnosis regardless of whether their MS diagnosis was disclosed within the last 5 years or earlier. In contrast to physicians, patients voted for information about a possible MS even if the diagnosis may not yet be clear. CONCLUSION: From the patients' perspective, information about the diagnosis of MS should be more straightforward, and more information about therapies should be provided.

Adolescent↗
PubMed2001

Disease specific quality of life instruments in multiple sclerosis: validation of the Hamburg Quality of Life Questionnaire in Multiple Sclerosis (HAQUAMS).

Quality of life (QoL) is discussed as an additional outcome measure in multiple sclerosis (MS). However, few questionnaires assessing disease specific QoL in MS have been published. On the basis of the literature and interviews with clinicians and MS patients, we have developed a disease specific QoL instrument and validated it in a broad range of patients with MS. In this study, a heterogeneous sample of n = 237 MS patients completed the newly developed Hamburg Quality of Life Questionnaire in Multiple Sclerosis (HAQUAMS, in German language) and a battery of already validated questionnaires. They further underwent neurological scoring and objective tests. By these means, we investigated its validity, appropriateness, internal consistency, and retest reliability. Internal consistency and retest coefficients were high and satisfied psychometric standards. Convergent and discriminant validity was supported by direction, magnitude and pattern of correlations with other health measures. HAQUAMS subscales and its total score distinguished between patient groups of varied disease severity, cognitive impairment, and affective symptomatology. No floor or ceiling effects were found in either of the HAQUAMS subscales. The HAQUAMS is a reliable, valid and appropriate instrument for QoL assessment in multiple sclerosis. Data of responsiveness are currently being obtained.

Adult↗
PubMed1999

Cerebral blood flow and personality: a positron emission tomography study.

OBJECTIVE: This study sought to describe brain regions associated with the personality dimension of introversion/extraversion. METHOD: Measures of cerebral blood flow (CBF) were obtained from 18 healthy subjects by means of [150]H20 positron emission tomography. Correlations of regional CBF with introversion/extraversion were calculated, and a three-dimensional map of those correlations was generated. RESULTS: Overall, introversion was associated with increased blood flow in the frontal lobes and in the anterior thalamus. Regions in the anterior cingulate gyrus, the temporal lobes, and the posterior thalamus were found to be correlated with extraversion. CONCLUSIONS: The findings of the study lend support to the notion that introversion is associated with increased activity in frontal lobe regions. Moreover, the study suggests that individual differences in introversion and extraversion are related to differences in a fronto-striato-thalamic circuit.

Adult↗
PubMed1998

Small wire external fixation of high energy tibial plateau fractures.

Open plate osteosynthesis for high energy tibial plateau fractures with dissociation between the metaphysis and diaphysis has been plagued with frequent soft tissue complications. The Harbor-University of California at Los Angeles Medical Center's experience with small wire external fixation supplemented by limited internal fixation is examined. This alternative method of adequate stable fixation offers the advantage of minimal soft tissue compromise. Twenty-four patients with Schatzker Type VI tibial fractures were treated with small wire external fixation. Supplementary limited internal fixation was used with percutaneous screws in 10 patients and with open reduction in one patient. Sixteen patients had isolated fractures, and eight others suffered multiple injuries. Minimum followup was 12 months. All fractures healed. Complications included one septic knee, two infections at screw sites, and one 10 degrees knee flexion contracture. One knee had Grade 3 radiographic arthrosis, five had Grade 2, 10 had Grade 1, and eight showed no arthrosis. The outcomes (Knee Society clinical rating system) of this study compare favorably with outcomes described in reports published previously for this type of fracture, despite inclusion of eight multiply injured patients. This technique preserves the goals of early range of motion and stable fixation for these devastating injuries, while decreasing the observed major wound complications and nonunion rates. However, longer followup may reveal higher arthrosis rates, specifically in those fractures that were not anatomically reduced.

Adolescent↗
PubMed1997

Blunt laryngotracheal trauma in children.

OBJECTIVES: To demonstrate the diverse causes and manifestations of blunt laryngotracheal trauma in children, and to recommend an appropriate treatment protocol for these patients. DESIGN: A retrospective review of the medical records of patients treated at a tertiary care children's hospital for blunt laryngotracheal trauma during the 12 years before March 1, 1995 was performed. Clinical signs and symptoms, mechanisms of injury, and the results of laryngoscopy were included. PATIENTS: The study included 23 patients ranging from 2 1/2 to 18 1/2 years of age. The medical records of patients who had sustained an injury as a result of penetrating trauma, intubation, or foreign body were excluded. RESULTS: Four patients urgently required tracheotomies; 2 of these patients required subsequent reconstructive airway procedures. One child required a microlaryngoscopy with relocation of the arytenoid cartilage. The remaining 18 patients were treated conservatively with continuous pulse oximetry, cool mist room air, and serial flexible fiberoptic laryngoscopy. The 18 patients were discharged from the hospital after 24 to 48 hours of observation without sequelae. CONCLUSIONS: The signs and symptoms of blunt laryngotracheal trauma in children are not always specific to the extent or type of injury. A prompt diagnosis and treatment plan are needed to prevent potentially catastrophic complications. Patients with obvious airway compromise require immediate intervention. Those without acute airway symptoms often can be treated conservatively, provided that flexible fiberoptic laryngoscopy confirms a safe airway.

Adolescent↗
PubMed1997

Role of middle meatus aspiration culture in the diagnosis of chronic sinusitis.

Although empiric antibiotic therapy is often used for sinusitis, the emergence of antibiotic resistance has increased the failure rate of this approach. Culture-directed therapy usually increases treatment success, but traditional antral puncture is often accompanied by poor patient and physician acceptance. Endoscopically directed middle meatal aspiration culture is increasingly used in this setting, but studies have not convincingly demonstrated the validity of this technique. Both endoscopic middle meatal and direct antral cultures were performed during endoscopic sinus surgery. Cytologic examination was performed to confirm the presence of inflammatory cells. When culture results were compared in 21 specimen pairs, exact correlation was found in 18 (85.7%). Based on this study, endoscopically directed middle meatus aspiration culture appears to be a valuable alternative to antral puncture for guiding organism-specific antibiotic therapy in sinusitis.

Adult↗
PubMed1996

A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears.

A prospective and retrospective study was undertaken to compare the accuracy of magnetic resonance imaging (MRI) with clinical examination in diagnosing meniscal and anterior cruciate ligament (ACL) tears. Pathological findings were then confirmed during arthroscopy. One hundred fifty-four patients clinically diagnosed with a meniscal or ACL tear who ultimately had arthroscopic knee surgery were evaluated; 100 patients underwent clinical examination followed by MRI, and 54 underwent clinical examination alone. The presence or absence of meniscal and ACL tears was confirmed during arthroscopy. The accuracies of clinical examination and MRI were compared for the 100 patients who underwent both clinical examination and MRI. The accuracy of MRI was 75% for medial meniscal tears, 69% for lateral meniscal tears and 98% for ACL tears. The accuracy of clinical examination was 82% for medial meniscal tears, 76% for lateral meniscal tears and 99% for complete tears of the ACL. Furthermore, the accuracy of clinical examination for the 54 patients who underwent clinical examination alone was not significantly different from the accuracy of clinical examination in the 100 patients who also underwent MRI. There was no significant difference between the accuracy of clinical examination and MRI in the diagnosis of meniscal and ACL tears and, overall, MRI contributed to treatment in only 16 of 100 cases. Based on these findings, we feel that MRI, except in certain circumstances, is an expensive and unnecessary diagnostic test in patients with suspected meniscal and ACL pathology.

Adult↗
PubMed1993

Comparison of QEEG and response accuracy in good vs poorer performers during a vigilance task.

Subjects performed an auditory continuous performance test requiring them to detect targets in a series of letters presented at a rate of 2/s. 2-min samples of EEG were obtained from eight bipolar sites during a resting condition and during early and late (7-10 min) test performance. EEG power spectra from 27 subjects whose performance accuracy decreased between these latter periods (LoVig group) were compared with those from 27 subjects who maintained a constant level of performance (HiVig group). In both groups EEG power changed significantly between resting and test conditions for all frequency bands: beta power increased, especially in fronto-temporal and temporal left-hemisphere sites; alpha and posterior theta decreased; anterior theta and delta increased. Significant changes also were found between early and late test performance: anterior theta and delta power decreased in both groups; temporal beta power decreased in the LoVig group only, and is thus considered the best indicator of performance changes. Other differences found between groups were across conditions. The HiVig group had more anterior beta and less posterior alpha and theta than the LoVig group. EEG results are discussed in relation to an explanation of vigilance errors based on signal detection theory.

Arousal↗
PubMed1988

Eustachian tube function associated with histamine-induced and ragweed-induced rhinitis.

Nasal allergies may contribute to Eustachian tube dysfunction and chronic middle ear problems. In exploring this association further, Eustachian tube function was measured in ten ragweed-allergic and eight non-allergic patients undergoing repetitive nasal provocation. Anterior nasal provocation was done using paper disks impregnated with either histamine or aqueous ragweed allergen. Increasing concentrations of the provocative agent were placed on both inferior nasal turbinates until moderate symptoms of rhinitis developed. Eustachian tube function was evaluated using the 9-step inflation-deflation tympanometric test before and immediately after each nasal challenge. Eustachian obstruction developed in 4 of 38 non-allergic ears during histamine nasal provocation. With ragweed nasal challenge, 9 of 42 allergic ears developed Eustachian tube obstruction. Four allergic ears gained Eustachian tube function despite being obstructed before the challenge. The observed changes in ear function for both groups were not significant due to variability in Eustachian response. At the concentrations which initiated symptoms of rhinitis, nasal provocation with histamine or ragweed did not consistently obstruct the Eustachian tube. We conclude that mild symptoms of allergic rhinitis may not cause significant Eustachian tube obstruction.

Airway Resistance↗
PubMedDate not supplied

A guide for applying principal-components analysis and confirmatory factor analysis to quantitative electroencephalogram data.

Principal-components analysis (PCA) has been used in quantitative electroencephalogram (qEEG) research to statistically reduce the dimensionality of the original qEEG measures to a smaller set of theoretically meaningful component variables. However, PCAs involving qEEG have frequently been performed with small sample sizes, producing solutions that are highly unstable. Moreover, solutions have not been independently confirmed using an independent sample and the more rigorous confirmatory factor analysis (CFA) procedure. This paper was intended to illustrate, by way of example, the process of applying PCA and CFA to qEEG data. Explicit decision rules pertaining to the application of PCA and CFA to qEEG are discussed. In the first of two experiments, PCAs were performed on qEEG measures collected from 102 healthy individuals as they performed an auditory continuous performance task. Component solutions were then validated in an independent sample of 106 healthy individuals using the CFA procedure. The results of this experiment confirmed the validity of an oblique, seven component solution. Measures of internal consistency and test-retest reliability for the seven component solution were high. These results support the use of qEEG data as a stable and valid measure of neurophysiological functioning. As measures of these neurophysiological processes are easily derived, they may prove useful in discriminating between and among clinical (neurological) and control populations. Future research directions are highlighted.

Adolescent↗