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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a prospective open study, 61 consecutive patients with advanced cancer admitted to a Palliative Care Unit underwent survival estimation by two independent physicians after a complete medical exam performed during the first day of admission. An independent research nurse also assessed each patient during the first day of admission. The assessment included activity, pain, nausea, depression, anxiety, anorexia, dry mouth, dyspnea, dysphagia, weight loss, and cognitive status. After the assessment was completed, patients were followed until discharge or death. In 47 evaluable patients, logistic regression showed a significant correlation between survival and dysphagia, cognitive failure, and weight loss. Accordingly, an "indicator of poor prognosis" was considered to exist in any patient who demonstrated weight loss of 10 kg or more plus cognitive failure (Mini-Mental State Questionnaire less than 24) plus dysphagia to solids or liquids. This indicator had a similar level of sensitivity, specificity, and overall accuracy, and a higher level of significance as compared with the assessment by physician #1 and physician #2, respectively. Our data suggest that three simple determinations, which may be performed by a nurse, can predict survival more or less than 4 wk as well as the assessments of two skilled physicians. These results need to be confirmed in other trials with large numbers of patients. Perhaps confirmation of these results and identification of other prognostic factors will result in staging systems for survival estimation of terminally ill cancer patients.
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PMID:Estimate of survival of patients admitted to a palliative care unit: a prospective study. 157 89

Thyroid disease in the elderly can be easily overlooked. Symptoms too often are explained away as normal processes of aging. Development of unstable illness, especially cardiac disease, is a frequent mode of presentation. One symptom or one clinical feature of thyroid disease in the elderly may be overwhelming in its presentation, as in apathetic hyperthyroidism, thyroid myopathy, depression and dementia. Physical examination of the thyroid gland can be helpful but in a high percentage of older patients the gland is normal to palpation. The treatment of hypothyroidism is straightforward. Only myxedema coma requires large doses of levothyroxine parenterally; all other forms of hypothyroidism are treated with oral levothyroxine. The dose is started very low and increased gradually over months. The euthyroid state is achieved gradually and safely. Hyperthyroidism can be treated by several modalities. In the unstable elderly patient, antithyroid medication can quickly produce a euthyroid state. When the patient is stable, further decisions can be made regarding definitive therapy. Radioactive iodine therapy is well-tolerated and effective. On occasion, a second course of therapy is needed to suppress hyperthyroidism. Close follow-up of all patients ever having received this therapy is needed to identify the development of hypothyroidism. Surgical thyroid ablation may be necessary in patients who fail to respond to radioactive iodine therapy. Abnormalities associated with unresolved thyromegaly, dysphagia, or tracheal compression may require surgical intervention. If suspicion exists that the gland is cancerous, surgical intervention is warranted.
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PMID:Hypothyroidism and hyperthyroidism in the elderly. 158 94

A complete search of the literature concerning Lyme borreliosis as it relates to horses and cattle was done. The epidemiology, pathogenesis, immunological response to the disease, diagnosis and treatment are discussed. A review of clinical cases in horses and cattle is presented. Clinical signs of Lyme borreliosis in horses include: chronic weight loss, sporadic lameness, laminitis, low grade fever, swollen joints, muscle tenderness, and anterior uveitis. In addition to those clinical signs, neurological signs such as depression, behavioral changes, dysphagia, head tilt and encephalitis can be seen in chronic cases. Borreliosis occurs in cattle, usually as a herd problem. In acute Lyme borreliosis, cattle often will show a fever, stiffness, swollen joints, and decreased milk production. Chronic weight loss, laminitis and abortion are also possible outcomes of borreliosis in cattle. Diagnosis of clinical Lyme borreliosis is difficult and depends upon recognition of clinical signs, a history of possible exposure, and identification of the spirochete in the affected animal. Since the spirochete is very difficult to culture, confirmation of B. burgdorferi infection often relies on serologic testing. Subclinical seropositive animals do occur, thus confusing the diagnosis. An approach to treatment of cattle and horses with Lyme borreliosis is outlined.
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PMID:Lyme borreliosis in cattle and horses: a review of the literature. 164 76

We assessed the therapeutical efficacy of various antidepressants (amineptine, minaprine and clomipramine) in patients affected by retarded depression. All patients exhibited symptoms of retardation, including hypokinesia, anergia, reduction of speech, increased salivation, hypersomnia, Parinaud's syndrome, reduced sexual activity, slowness, hypomimia, orthostatic hypotension, dysphagia and drowsiness. Antidepressant drugs were administered for a 6-week period in a randomized double-blind vs placebo design. The rank order of clinical effectiveness (amineptine much greater than minaprine greater than clomipramine greater than placebo) paralleled the specificity of antidepressants as dopaminomimetic agents. These results support the view that a reduced dopaminergic transmission contributes to the pathophysiology of retarded depression.
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PMID:Dopaminergic hypothesis for retarded depression: a symptom profile for predicting therapeutical responses. 179 29

Patients at various stages of human immunodeficiency virus (HIV) infection require rehabilitation services. These patients present problems for each of the disciplines in a rehabilitation team, and all team members must confront the psychosocial and ethical issues involved with the disease. Patients with HIV infection may have polyneuropathy with multisystem involvement, including dysphagia, autonomic dysfunction, respiratory failure, bowel and bladder dysfunction, generalized weakness, a painful sensory neuropathy, and depression. Guidelines are presented for determining if inpatient rehabilitation or other settings are appropriate. Case management is a valuable strategy for the rehabilitation of patients with this complicated disorder.
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PMID:Human immunodeficiency virus infection and diffuse polyneuropathy. Implications for rehabilitation medicine. 186 48

Thirty consecutive patients with globus sensation who were referred to a psychosomatic clinic prospectively underwent otolaryngological, videokinematographic, and manometric examinations of pharynx and esophagus to evaluate whether morphological abnormalities or motility disorders underlay their symptom. When indicated by findings, 24-hour pH-metry, scintigraphy of bolus transport, and esophagogastroscopy were performed. Seven patients were shown to have achalasia, 10 had "hypochalasia" (lower esophageal sphincter relaxation less than 75% with esophageal contraction abnormalities but no complete distal aperistalsis), and 1 had diffuse esophageal spasms; 2 patients had also hyperplastic lingual tonsils, 1 had tonsillitis, and 1 had a cervical spondylophyte. Nutcracker esophagus and nonspecific contraction abnormalities were found in 7 patients, and gastroesophageal reflux with esophagitis and a low lower esophageal sphincter resting pressure was found in 1; only 3 patients had normal esophageal motility. None had volunteered dysphagic symptoms at primary evaluation. Psychometric investigations in consenting patients showed no higher mean scores for state and trait anxiety, depression, hysteria, and hypochondriasis than in general medical outpatients. Esophageal motor disorders may, before giving rise to dysphagia, be sensed more vaguely and induce the globus sensation. However, only disappearance of the sensation after treatment allows inferring an etiological significance of such a disorder.
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PMID:High incidence of esophageal motor disorders in consecutive patients with globus sensation. 195 17

Nineteen cases are described, including 12 cases from three different families and 7 nonfamilial cases, in which multisystem neurological disease was associated with acanthocytosis in peripheral blood and normal plasma lipoproteins. Mild acanthocytosis can easily be overlooked, and scanning electron microscopy may be helpful. Some neurologically asymptomatic relatives with significant acanthocytosis were identified during family screening, including some who were clinically affected. The mean age of onset was 32 (range 8-62) yrs and the clinical course was usually progressive but there was marked phenotypic variation. Cognitive impairment, psychiatric features and organic personality change occurred in over half the cases, and more than one-third had seizures. Orofaciolingual involuntary movements and pseudobulbar disturbance commonly caused dysphagia and dysarthria that was sometimes severe, but biting of the lips or tongue was rarely seen. Chorea was seen in almost all symptomatic cases but dystonia, tics, involuntary vocalizations and akinetic-rigid features also occurred. Two cases had no movement disorder at all. Computerized tomography often demonstrated cerebral atrophy. Caudate atrophy was seen less commonly, and nonspecific focal and symmetric signal abnormalities from the caudate or lentiform nuclei were seen by magnetic resonance imaging in 3 out of 4 cases. Depression or absence of tendon reflexes was noted in 13 cases and neurophysiological abnormalities often indicated an axonal neuropathy. Sural nerve biopsies from 3 cases showed evidence of a chronic axonal neuropathy with prominent regenerative activity, predominantly affecting the large diameter myelinated fibres. Serum creatine kinase activity was increased in 11 cases but without clinical evidence of a myopathy. Postmortem neuropathological examination in 1 case revealed extensive neuronal loss and gliosis affecting the corpus striatum, pallidum, and the substantia nigra, especially the pars reticulata. The cerebral cortex appeared spared and the spinal cord showed no evidence of anterior horn cell loss. Two examples of the McLeod phenotype, an X-linked abnormality of expression of Kell blood group antigens, were identified in a single family and included 1 female. The genetics of neuroacanthocytosis are unclear and probably heterogeneous, but the available pedigree data and the association with the McLeod phenotype suggest that there may be a locus for this disorder on the short arm of the X chromosome.
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PMID:Neuroacanthocytosis. A clinical, haematological and pathological study of 19 cases. 199 79

Relapsing polychondritis (RP) is an uncommon systemic disorder with a highly variable course. A 17-year-old woman recently presented with a 1-month history of depression, weight loss, chest wall tenderness, hoarseness, and dysphagia. Physical examination revealed cachexia, low-grade fever, pharyngeal erythema, and tenderness of the right auricle, anterior chest, cricothyroid cartilage, and both knees. Laboratory studies included a hematocrit of 34% and a sedimentation rate of 50 mm/hr. Initial improvement on oral corticosteroids was followed by respiratory distress. At that time calcified tracheal cartilage, subglottic stricture, and a saddle nose deformity were present. Despite therapy with steroids, dapsone, and pulse cyclophosphamide, the respiratory distress reoccurred, eventually necessitating tracheostomy. Tracheal cartilage biopsy confirmed the presumptive diagnosis of RP. Bilateral auricular chondritis developed after initial presentation, as did acute vertigo. Although seen in all age groups, less than 10% of cases of RP are seen in children and adolescents. Auricular chondritis (89% of all cases), inflammatory asymetric arthritis (81% of all cases), nasal chondritis (72% of all cases), respiratory tract chondritis (56% of all cases), and audiovestibular abnormalities (46% of all cases) were present in our patient. Relapsing polychondritis may follow a slowly evolving or rapidly progressive course. Appropriate diagnosis and aggressive therapy are recommended to lessen the morbidity and mortality.
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PMID:Relapsing polychondritis in an adolescent. 260 58

Symptoms of masked depression are often localised in the otorhinolaryngeal field. Headache, facial pain, dysphagia, burning sensations in the tongue, tinnitus, vertigo and voice and respiratory disorders were frequent complaints of 48 patients at our out-patient clinic between 1980 and 1985. After careful exclusion of organic disease, they proved to be due to endogenous depressive disorder. An increase in the number of such cases has been noted. One patient is described as an example of the problems of diagnosis.
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PMID:[Otorhinolaryngologic manifestations of masked mono- or oligosymptomatic depressions]. 317 Feb 84

We performed endoscopic sclerotherapy of esophageal varices (ESEV) as an outpatient procedure in a private setting in patients with portal hypertension and a least one previous episode of variceal hemorrhage. Twenty-six stable cirrhotic patients (child's class A, 11 patients; class B, 10 patients; class C, 5 patients) underwent 103 outpatient sessions of ESEV. There were two episodes of post-sclerotherapy bleeding (1.9% of total sessions) requiring hospitalisation. Fever (2.9%), dysphagia (6.8%), chest pains (14.6%) and one episode (1%) of respiratory depression due to sedation were also noted, but were managed with simple measures. One of 26 patients developed esophageal stricture. These preliminary results suggest that ESEV can be performed as a relatively safe ambulatory procedure.
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PMID:[Outpatient sclerotherapy of esophageal varices: preliminary results]. 322 99


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