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Biomedical subjects

T J Silber

Publications and source records attributed to T J Silber.

At least 19 recordsLinked to original sources
PubMed1999

Eating disorders in adolescents and young women with spina bifida.

This is the first report of the association of spina bifida and eating disorders. Five patients were diagnosed rather late in the course of their illness. They all had been overweight premorbidly and had been urged to lose weight for years in order to improve their mobility. As they dieted, they experienced their weight loss as a source of power that could somehow compensate for their losses and neurologic limitations. They responded to a multidisciplinary intervention. Clinicians taking care of patients with spina bifida need to be cognizant that they may be at risk of developing an eating disorder. Such awareness should influence the quality of nutritional counseling (prevention aspect) and the clinical assessment of sudden weight loss (early intervention).

Adolescent↗
PubMed1997

Eating disorders and reflex sympathetic dystrophy syndrome: is there a common pathway?

The comorbidity of eating disorders and reflex sympathetic dystrophy syndrome in the same patients raises the possibility of a common pathway for both conditions. Reflex sympathetic dystrophy syndrome may be manifesting itself in those individuals who have sympathetic overdrive. Microtrauma, often induced by compulsive exercise, and depression may be contributory factors. It is recommended that: patients with eating disorders who develop pain in an extremity should be investigated for possible reflex sympathetic dystrophy syndrome; patients with reflex sympathetic dystrophy syndrome should be discouraged from dieting, and eating disorders should be suspected if they begin to lose weight or are already malnourished.

Comorbidity↗
PubMed1996

Immunologic cytofluorometric studies in adolescents with anorexia nervosa.

OBJECTIVE: To assess lymphocyte stimulation and lymphocyte phenotype evaluation in adolescent patients with anorexia nervosa (AN). METHOD: In vitro lymphocyte stimulation and flow cytometric phenotype studies were done on 26 hospitalized patients with AN receiving nutritional rehabilitation. The laboratory assessment consisted of lymphocyte subset analysis and in vitro lymphoproliferative responses to mitogens and antigens. RESULTS: Flow cytometric phenotype analysis showed that only a minority of the patients had abnormal phenotype and immune responses, moreover their immune systems were not significantly impaired. DISCUSSION: The cytofluorometric study of immune function does not show significant alterations in adolescents hospitalized for anorexia nervosa.

Adolescent↗
PubMed1994

Eating disorders and health insurance.

Eating disorders are being diagnosed and managed by an increasing number of pediatricians and practitioners of adolescent medicine. These physicians are increasingly discovering the power and importance of their patients' health insurance status in the management of these conditions because the lack of appropriate insurance may often pose obstacles and barriers to care. This article provides an analysis of this situation through brief case presentations followed by a discussion and recommendations.

Adolescent↗
PubMed1993

Mineral balance and bone turnover in adolescents with anorexia nervosa.

We evaluated seven female adolescents with anorexia nervosa to determine whether calcium metabolism was affected by their disorder. We measured calcium absorption, urinary calcium excretion, and calcium kinetics, using a dual-tracer, stable-isotope technique during the first weeks of an inpatient nutritional rehabilitation program. Results were compared with those from a control group of seven healthy adolescent girls of similar ages. The percentage of absorption of calcium was lower in subjects with anorexia nervosa than in control subjects (16.2% +/- 6.3% vs 24.6% +/- 7.2%; p < 0.05). Urinary calcium excretion was greater in subjects with anorexia nervosa than in control subjects (6.4 +/- 2.5 vs 1.6 +/- 0.7 mg.kg-1 x day-1; p < 0.01) and was associated with bone resorption rather than calcium hyper-absorption. Calcium kinetic studies demonstrated a decreased rate of bone formation and an increased rate of bone resorption. These results suggest marked abnormalities in mineral metabolism in patients with anorexia nervosa. From these results, we hypothesize that improvement in bone mineralization during recovery from anorexia nervosa will require resolution of hormonal abnormalities, including hypercortisolism, in addition to increased calcium intake.

Absorption↗
PubMed1993

Clinical spectrum of anorexia nervosa in children.

A retrospective review of 21 patients ages 12 years and younger (age of onset range 7 to 12 years) with anorexia nervosa showed diagnostic delay in the youngest ones, high incidence of family psychiatric history, a remarkable severity of illness, and positive response to intensive treatment. Additional findings included significant comorbidity, a distinct subgroup with personality disorder and another with features of the "vulnerable child syndrome." This broad clinical spectrum of anorexia nervosa in children may explain the great variability in outcome. The development of anorexia nervosa in children relates to a complex combination of etiological and trigger factors. Precipitants identified in this study were physical maturation, entry into junior high, loss, or some combination thereof.

Anorexia Nervosa↗
PubMed1992

Substance abuse and syphilis in urban adolescents: a new risk factor for an old disease.

The incidence of syphilis is increasing. To identify the epidemiologic characteristics of adolescents with syphilis in an urban adolescent clinic, we performed a retrospective review and case-control study of 59 patients with syphilis and 111 sex-matched controls seen at our institution between 1985 and 1988. Only 24% of cases occurred in males, in contrast with 61% in a 1977-1981 study. Almost one-half (46%) of cases occurred in asymptomatic individuals, and only 24% were diagnosed at the initial visit. Patients with syphilis were more likely to have a history of substance abuse (odds ratio, 4.94; 95% confidence interval, 1.83, 13.3). This study suggests that the epidemiology of syphilis in adolescents may be changing. The high percentage of asymptomatic syphilis cases underscores the need for a high index of suspicion, particularly in sexually active adolescents who abuse drugs.

Adolescent↗
PubMed1989

Justified paternalism in adolescent health care. Cases of anorexia nervosa and substance abuse.

This essay on the limits of adolescent autonomy espouses justified paternalism in adolescent medicine as a 1980s alternative to the "antipaternalistic" rights position of the 1970s. Thus, it proposes that the harm principle be a basis for justified limitations of liberty. In turn, justified paternalism should be both testable and severely limited because by definition it always involves treating someone in a way that violates a moral rule (e.g., coercive deprivation of freedom, invasion of privacy). Therefore, paternalism can only be justified when the evil prevented from occurring to the person is greater than the wrong caused by the violation of the moral rule and, more importantly, if it can be universally justified under relevantly similar circumstances always to treat persons in this way.

Adolescent↗