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Biomedical subjects

W Meller

Publications and source records attributed to W Meller.

At least 19 recordsLinked to original sources
PubMed2002

Major depression in unexplained infertility.

Although a potential relationship between depression and infertility has been described throughout history, only recently has this topic been subjected to systematic investigation, and the literature is often confusing. The present study uses well-established structured psychiatric interviews--Structured Clinical Interview for DSM-III-R (SCID), Beck and Family History-Research Diagnostic Criteria (Fh-RDC)--to investigate the prevalence of major depression in a small group of women with infertility of unknown origin, and a community control sample. There were significantly more women with current depression or a history of depression in the infertile group, and of these women the majority experienced their first depressive episode prior to their diagnosis of infertility.

Adolescent↗
PubMed1998

Failure of clonidine to stimulate feeding in healthy humans.

The alpha2-adrenergic system is involved in the regulation of food intake in animals but its effects on feeding in humans are unknown. We hypothesized that clonidine administration would stimulate food intake in healthy human subjects. Ten men and 4 women, all physically and psychiatrically healthy, received clonidine 3 microg/kg or placebo, orally, in blinded, balanced, randomized order. Consumption of a liquid test meal was measured; also, serum growth hormone levels were used as a secondary measure of clonidine effects. Visual analog scale ratings of hunger, satiety, and sedation were obtained before, during, and after the test meal. A subset of five subjects also received 1.5 microg/kg clonidine, in addition to the two trials described above. Test meal consumption was greater following placebo than following clonidine. Sedation ratings were substantially higher at all time points after clonidine and correlated with meal consumption (correlation coefficient r = -0.584; p = 0.028). Hunger and satiety ratings did not differ. The 1.5 microg/kg dose did not provide different effects on feeding from that seen with placebo. Contrary to our hypothesis, clonidine did not stimulate food intake in humans. Sedation associated with clonidine administration may have suppressed any effects on feeding.

Administration, Oral↗
PubMed1996

Use of ECT after brain injury.

Electroconvulsive therapy (ECT) was administered to a man with a history of a gunshot wound to the head with persisting skull defect and intracranial metallic foreign bodies. It appears that ECT is a safe and effective treatment for depression in this setting. Electrode placement is selected to avoid the skull defect and anticonvulsant therapy may be continued if the patient was previously receiving it.

Adult↗
PubMed1990

Simulated acute hemorrhage through lower body negative pressure as an activator of the hypothalamic-pituitary-adrenal axis.

While insulin induced hypoglycemia is the principle method of producing hypothalamic-pituitary-adrenal stress response, the mechanism by which this occurs may be different from that produced by other stressors. In a pilot study, we explored ways to standardize lower body negative pressure (LBNP), as a simulator of hemorrhage, to determine its utility for future studies of hypothalamic-pituitary-adrenal (HPA) axis function. Reduced atmospheric pressure of -40 mmHg applied at the level of the iliac crests during LBNP rapidly lowers blood pressure in most subjects, simulating acute hemorrhage. In 6 normal subjects, ACTH and cortisol values were measured before, during and after the application LBNP at 0800, 1600 and 2300 hours in the baseline state and at 1600 hours on the day following 1 mg of dexamethasone. Peak ACTH values of 60-250 pg/ml occurred 2 to 10 minutes after the cessation of the stimulus in subjects experiencing presyncope or having a systolic or diastolic blood pressure decrease of greater than 20 mmHg with a rise in pulse of 30 beats per minute or more. There was no significant difference between ACTH responses at different times of day. Peak cortisol values of 25-30 micrograms/dl occurred 15-20 minutes after cessation of the stimulus. In all subjects, administration of dexamethasone greatly attenuated the ACTH response and decreased but did not ablate the cortisol response. In conclusion, these data indicate that LBNP may be used to simulate hemorrhage as a stimulus of the HPA axis. HPA axis changes occur only when physiologic evidence of hypovolemic stress is present. Dexamethasone may be used to modulate the response to this stress paradigm.

Acute Disease↗
PubMed1989

Assessing the cost of albuterol inhalers in the Michigan and California Medicaid Programs: a total cost-of-care approach.

A study was conducted to determine whether the addition of albuterol inhalers to the Medicaid formulary of California would increase patient costs. Data on the treatment of asthma in 1,463 patients were obtained from the Michigan Medicaid formulary files for the period from July 1983 to December 1984. Annual inhalant costs for albuterol users were higher (+60.47) than for metaproterenol users (+47.66). However, the costs of additional asthma drugs and the total asthma drug costs were lower for the albuterol than metaproterenol users. Other asthma-related medical costs, including emergency-room and physician or clinic visits and days in hospital, were lower for the albuterol than metaproterenol users (+765 vs +1,135 per patient per year, P less than 0.05). These Michigan data were used to determine the costs in California. It was estimated that the addition of albuterol to the California Medicaid formulary would result in an annual per-patient saving of +3.46 in asthma medication and +521.33 in asthma-related medical costs.

Adult↗
PubMed1988

Reproducibility of post-exercise lactate and anaerobic threshold.

To test the effect of previous strenuous training on lactate (LA) formation and on changes of lactate threshold (AT) values, a group of seven male athletes aged 26.3 +/- 9.2 years, height 184 +/- 6.2 cm, body weight 79.3 +/- 8.1 kg, percentage of body fat 8.8 +/- 3.7 and VO2 max 56.2 +/- 5.4 ml/kg were examined on a treadmill to the maximum in the morning after 2 days of rest, and after 2 consecutive days of strenuous training. The subjectively perceived rate of fatigue (SPF) in the morning prior to the exercise test was assessed by means of a 5-grade score. The values of LA max, AT, and SPF on day 1 were 11.06 +/- 2.4 mmol/l, 3.5 +/- 0.4 m/s, and 0.6 +/- 0.4, respectively. The corresponding values on day 2 were 8.8 +/- 1.7 mmol/l, 4.0 +/- 0.3 m/s, and 2.0 +/- 0.5, respectively. The values on day 3 were 8.6 +/- 1.1 mmol/l, 4.1 +/- 0.4 m/s, and 2.1 +/- 0.7, respectively. Statistically significant differences on the 1st day were found in LA max, AT, and SPF compared with days 2 and 3. No significant differences were found between the values for the 2nd and 3rd days. AT values for day 1 were significantly lower than those for days 2 and 3. A significantly higher level of SPF in the morning prior to the test procedure was observed on days 2 and 3 compared with day 1. The AT and SPF values for days 2 and 3 showed no significant difference.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

HPA axis abnormalities in depressed patients with normal response to the DST.

In order to identify depressed patients with hypothalamic-pituitary-adrenal (HPA) axis abnormalities who have a normal response to the dexamethasone suppression test (DST), the authors administered a series of neuroendocrine tests including insulin-induced hypoglycemia, arginine vasopressin challenge, and a DST. Using standard sensitivity measures, as well as logistic regression, they concluded that many patients with HPA abnormalities are not identified by the DST. These findings suggest that other neuroendocrine tests, which are sensitive to HPA axis abnormalities, may be helpful in subtyping depression on the basis of HPA axis functioning.

Adrenocorticotropic Hormone↗
PubMed1987

Stable adrenocorticotropin-stimulated 11-beta-hydroxylase activity but loss of age-related changes in patients with hypercortisolemia.

Eleven-beta-hydroxylase activity was measured before and after acute adrenocorticotrophic hormone (ACTH) stimulation in 28 controls, 25 depressed Dexamethasone Suppression Test (DST) suppressors, 13 DST nonsuppressor patients, and 8 patients with Cushing's syndrome to investigate changes in states of cortisol hypersecretion. Eleven-beta-hydroxylase activity was equivalent among groups both before and after stimulation. Such 11-beta-hydroxylase stability, however, resulted in higher cortisol and 11-deoxycortisol poststimulation levels in both depressed DST nonsuppressors and Cushing's patients than in controls. Basal 11-beta-hydroxylase activity is positively correlated and 11-deoxycortisol is negatively correlated with age in controls and DST suppressors, but not in the patients tested with evidence of cortisol hypersecretion. These findings suggest that in vivo basal 11-beta-hydroxylase activity rises gradually with age, but does not rise after acute administration of exogenous ACTH. The age relationship is lost in states of cortisol hypersecretion, but the lack of response to acute exogenous ACTH is not affected.

Adrenocorticotropic Hormone↗
PubMed1987

The HPA axis response to insulin hypoglycemia in depression.

Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, demonstrated by failure to suppress cortisol secretion after dexamethasone, is found in approximately 50% of patients with major depression (MD). In this study, we examined the response of adrenocorticotrophic hormone (ACTH) and cortisol to insulin-induced hypoglycemia in 20 healthy controls and 18 inpatients with MD [12 dexamethasone suppressors (S) and 5 dexamethasone nonsuppressors (NS)]. After the administration of 0.15 U/kg of regular insulin, both controls and patients with MD showed an increase in plasma ACTH and cortisol levels. Controls had a significantly higher ACTH peak (p less than 0.01) and ACTH increment (p less than 0.01) than MD patients. There were no statistically significant differences between patients who were S and NS. Although baseline plasma cortisol levels were significantly higher in MD patients, there were no significant differences in the peak cortisol or increment in plasma cortisol after hypoglycemia between patients with MD and controls or between patients who were S and those who were NS. These findings suggest that a defect exists in the regulation of the HPA axis at the pituitary level in MD and that this defect is not necessarily reflected in the dexamethasone suppression status of the patient.

Adrenocorticotropic Hormone↗
PubMed1987

Attention deficit disorder in childhood.

Attention deficit disorder refers to a syndrome of pervasive inattention, impulsivity, and hyperactivity that is found in between 3 and 6 per cent of the population. It is commonly associated with conduct disorders and learning disabilities. The etiology of ADD is unknown, but family and adoption studies demonstrate an important role for genetic transmission. Pre- or postnatal central nervous system damage is suggested in only a few cases. Animal models as well as pharmacologic and clinical studies point to abnormalities in the catecholamine system, particularly dopamine function. Although certain psychometric tests are suggestive, no single laboratory marker is specific to ADD, and information from several sources is usually necessary before reaching the diagnosis. These sources may include parents, teachers, and pediatric psychology consultation, as well as clinical interview and physical examination. Children with ADD often suffer ridicule or rejection from family members, teachers, and peers. Treatment may interrupt the cycle of negative reinforcement that can have devastating effects on the self and public image of the child. Educational and behavioral management are the first line of intervention. Pharmacotherapy is also often helpful with stimulants considered the drugs of choice. Methylphenidate may be administered at a dose of 0.3 to 0.6 mg/kg in the morning. This dose may be repeated at noon. D-amphetamine at approximately half this dose is usually equally effective. Other medications such as the antidepressants and clonidine have proven to be effective in the treatment of ADD and may play a role in the management of some children.

Attention↗
PubMed1987

Behavioral complications of alcoholism.

Behavioral complications of alcoholism are frequently found in young alcoholics before medical complications develop. The antisocial alcoholic is at high risk of behavioral complications, including aggressive, violent behavior and accidental injury. Because of the markedly increased risk of trauma in alcoholism, the family physician should investigate the possible role of alcohol or other drug use in any patient with an injury.

Accidents, Traffic↗