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

Medical audit is vital to ensure continuous quality assurance and quality improvements. We did a retrospective study to ascertain the adequacy of clinical documentation and the factors hindering early discharge after an acute stroke in a restructured hospital. The medical records of all patients with acute stroke who died or were discharged from a restructured hospital in Singapore in January and February 1999 were reviewed retrospectively. Demographic data and the presence or absence of clinical documentation were noted. Factors hindering the discharge of patients at Day 5, Day 10 of stroke and at final discharge were noted and classified into: stroke-related, complications of stroke, medical-related and social factors. There were 101 patients in the study cohort, 55 males (54.5%) and 46 females (45.5%). The mean age was 67.9 years (SD 12.3). Documentation in Barthel scores (0%), presence of depression (0%), mental scores (1.0%), visual problems (10.0%), bladder continence (39.6%), admission functional status (37.6%) and dysphagia (52.5%) were deficient. The mean length of stay (LOS) was 13.0 (SD 14.2) days. The main factor hindering discharge at Day 5 (90.4%), Day 10 (95.2%) and at final discharge (82.1%) was stroke-related problems. Poor function (60.3%) and dysphagia (15.8%) were the 2 most common stroke-related problems hindering final discharge. Complications of stroke, medical-related problems and social reasons hindered final discharge in 10.8%, 17.8% and 2.9% of patients respectively. This audit revealed inadequacy in clinical documentation in patients with acute stroke. The main hindrance to final discharge of patients was stroke-related problems. The 2 most important stroke-related problems were poor function and dysphagia.
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PMID:Stroke audit. 1475 Mar 71

When no organic cause for dyspepsia is found, the condition generally is considered to be functional, or idiopathic. Nonulcer dyspepsia can cause a variety of symptoms, including abdominal pain, bloating, nausea, and vomiting. Many patients with nonulcer dyspepsia have multiple somatic complaints, as well as symptoms of anxiety and depression. Extensive diagnostic testing is not recommended, except in patients with serious risk factors such as dysphagia, protracted vomiting, anorexia, melena, anemia, or a palpable mass. In these patients, endoscopy should be considered to exclude gastroesophageal reflux disease, peptic or duodenal ulcer, and gastric cancer. In patients without risk factors, consideration should be given to empiric therapy with a prokinetic agent (e.g., metoclopramide), an acid suppressant (histamine-H2 receptor antagonist), or an antimicrobial agent with activity against Helicobacter pylori. Treatment of patients with H. pylori infection and nonulcer dyspepsia (rather than peptic ulcer) is controversial and should be undertaken only when the pathogen has been identified. Psychotropic agents should be used in patients with comorbid anxiety or depression. Treatment of nonulcer dyspepsia can be challenging because of the need to balance medical management strategies with treatments for psychologic or functional disease.
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PMID:Evaluation and management of nonulcer dyspepsia. 1525 26

A 68-year-old woman had felt a chest and back pain for 3 months. Gradually her symptom became aggravated, and she felt severe dyspnea in supine position and dysphagia combined with superior vena cava syndrome. A huge posterior mediastinal tumor was revealed and her esophagus was severely narrowed on the chest MRI. Therefore, emergency tumor resection was scheduled under general anesthesia. Anesthesia was induced by midazolam (2 mg) with the patient in the right lateral position. After gas exchange and oxygenation were comfirmed by pulse oximetry reading and clinical signs, she was slowly turned to supine position. But, suddenly, ST-segment depression and low amplitude developed in electrocardiogram and systolic blood pressure was depressed to below 60 mmHg. Therefore, she was rapidly retuned to right lateral position, and ST-segment and systolic blood pressure recoverd. On the next time, although she was slowly turned to the right semi-lateral position, there was almost no circulatory failure. A bronchial tube was intubated in her left bronchia under bronchoscope. We should remember that the preparation of percutaneous cardiopulmonary support (PCPS) should be considered as a means of protection against cardiovascular collapse or airway obstruction perioperatively.
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PMID:[A patient with a huge posterior mediastinal tumor and ST-segment depression in electrocardiogram]. 1544 83

Age-related remodeling of the hypopharyngeal constrictor muscle was studied by comparing the morphological features of the subneural apparatus (SNA) of the thyropharyngeal (TP) and cricopha ryngeal (CP) muscles in young and old rats. Scanning electron microscopy revealed that the TP and CP muscles had both gutter- and depression-type SNAs, although different proportions of the two types of apparatus were found in each muscle. In young-adult rats, the gutter-type SNA was predominant in the TP muscle, whereas in the CP muscle the depression type was predominant. By contrast, in old rats, the depression-type SNA was predominant in the TP muscle, while no such transformation of the dominant SNA was noted in the CP muscle. In addition, the number of type IIb and type I muscle fibers was lower and greater, respectively, in older animals compared with those of younger animals. Furthermore, there were more type IIc fibers in the TP muscle of old rats, but no difference in the CP muscle between young and old animals. These findings suggest that the transformation of SNAs and the muscle fibers of the hypopharyngeal constrictor muscle takes place during aging and that their remodeling processes differ in the TP and CP muscles.
Dysphagia 2004
PMID:Age-related remodeling of the hypopharyngeal constrictor muscle and its subneural apparatuses: a scanning electron microscopical study in rats. 1566 58

When alkalinized lidocaine instead of air is used to fill the endotracheal tube (ETT) cuff, coughing, and bucking are decreased during extubation when ventilation is controlled with N2O. However, sodium bicarbonate (NaHCO3) used to transform lidocaine hydrochloride (L-HCl) to lidocaine base induces a pH increase that could be irritating for mucosa in the case of cuff rupture. Therefore, we determined, in a randomized controlled study with controlled patient ventilation without N2O, whether the smallest concentrations of NaHCO3 (1.4% versus 8.4%) reduced diffusion (in vitro evaluation) and other secondary clinical benefits. After pH determination of different solutions (2 mL of 2% L-HCl and 2 to 6 mL of 8.4%, or 1.4% NaHCO3), an in vitro lidocaine diffusion through the ETT cuffs was evaluated (2 mL of 2% L-HCl and 3 mL of 8.4% or 1.4% NaHCO3). Then, adult patients scheduled for total thyroidectomy surgery were consecutively enrolled (n = 20 for each group). The ETT cuff was filled with air (group air) or with alkalinized lidocaine (2 mL of 2% L-HCl) using 8.4% (group large dose) or 1.4% (group small dose) of NaHCO3. After tracheal extubation, sore throat was evaluated by visual analog scale as the main end-point of the study. Hoarseness, bucking, dysphonia, dysphagia, cough, restlessness, and postoperative nausea and vomiting were also evaluated. There was a slight tendency toward a slower release when a small concentration of NaHCO3 was used (i.e., 1.4%). Compared with group air, the alkalinized-lidocaine groups had a significant reduction in sore throat during the 24-h postoperative period (P < 0.0001). The difference was not significant between the two alkalinized lidocaine groups. This increase in ETT tolerance was confirmed by the analysis of secondary end-points. No laryngospasm, rupture of ETT cuff, or depression of the swallowing reflex were recorded. A decrease in sore throat during the postoperative period was recorded when the cuff was inflated with a small dose of alkalinized lidocaine (i.e., 40 mg of L-HCl and 1.4% of NaHCO3) rather than with air when ventilation was controlled without N2O.
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PMID:Alkalinization of intracuff lidocaine: efficacy and safety. 1624 28

A 22-year-old man presented with fever and ulceration of the oral mucosa. The patient had pharyngeal and esophageal candidiasis. For the 3 weeks prior to presentation, he had been taking approximately 1000 mg/day of flowering herbs (Hypericum perforatum L, known as St. John's wort) for treatment of depression. A complete blood count on the first day of hospitalization showed agranulocytosis and normocytic anemia. His condition worsened, and he developed progressive dysphagia. A bone marrow biopsy on day 3 revealed bone marrow necrosis. After the diagnosis was established (day 3 of hospitalization), treatment with granulocyte colony-stimulating factor 48 U/day, intravenous immunoglobulin 400 mg/kg, and amphotericin B 100 mg/day was initiated. The patient did not respond, and died within one week of the diagnosis. This cases suggests that Hypericum species may lead to severe hematologic toxicity, with conditions involving bone marrow necrosis.
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PMID:Bone marrow necrosis: a rare complication of herbal treatment with Hypericum perforatum (St. John's wort). 1625 19

We report the case of a 52-year old woman who presented with a 4-year history of depression associated with intermittent dysphagia and globus sensation for which she was admitted to a nursing home. Physical examination revealed a murmur on the right carotid artery, while the routine biochemical tests were normal. Chest computer tomography (CT) demonstrated the presence of an anomalous vessel departing from the aortic arch; angiography showed an aberrant right subclavian artery of large lumen and a severe stenosis at the origin of the right internal carotid artery. Surgical intervention was performed and dysphagia disappeared.
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PMID:Successful surgical treatment of ''globus hystericus''. 1649 15

Hyperlipemia in horses is a disorder of lipid metabolism peculiar to ponies. This study reports changes of blood biochemical values from the acute to the postconvalescent phases in 3 Shetland ponies with hyperlipemia in Japan. Diseased ponies (all 7 to 9 years old, in late pregnancy, and obese) were fed in the same farm. The periods of their hospitalizations ranged from 30 to 45 days. Twelve well-conditioned ponies (3 to 13 years old) around parturition were used to establish baseline values for blood test results. Main clinical findings in the affected ponies were depression, dysphagia, anorexia, ventral edema and milky-appearing plasma. Hypertriglyceridemia (40- to 70-fold rise of controls) was found in the acute phase of the disease in the affected ponies, and was derived from increased very-low density lipoproteins. Aspartate transaminase and gamma-glutamyl transpeptidase activities, blood urea nitrogen, and creatinin concentrations were increased in acute ponies compared to controls, suggesting impairment of liver and kidney functions. However, these values gradually recovered until the end of postconvalescent phase. Hyperinsulinemia was observed in the acute phase of the hyperlipemia of all affected ponies. And an exaggerated insulin response to intravenous glucose was observed in the 2 ponies given intravenous glucose tolerance tests. These findings suggest decreased insulin sensitivity in hyperlipemic ponies.
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PMID:Changes of blood biochemical values in ponies recovering from hyperlipemia in Japan. 1667 26

We tested two hypotheses using surface electrical stimulation in chronic pharyngeal dysphagia: that stimulation (1) lowered the hyoid bone and/or larynx when applied at rest, and (2) increased aspiration, penetration, or pharyngeal pooling during swallowing. Bipolar surface electrodes were placed on the skin overlying the submandibular and laryngeal regions. Maximum tolerated levels of stimulation were applied while patients held their mouth closed at rest. Videofluoroscopic recordings were used to measure hyoid movements in the superior-inferior and anterior-posterior dimensions and the subglottic air column position while stimulation was on or off. Patients swallowed 5 ml liquid when stimulation was off, at low sensory stimulation levels, and at maximum tolerated levels (motor). Speech pathologists, blinded to condition, tallied the frequency of aspiration, penetration, pooling, and esophageal entry from videofluorographic recordings of swallows. Only significant (p = 0.0175) hyoid depression occurred during stimulation at rest. Aspiration and pooling were significantly reduced only with low sensory threshold levels of stimulation (p = 0.025) and not during maximum levels of surface electrical stimulation. Those patients who had reduced aspiration and penetration during swallowing with stimulation had greater hyoid depression during stimulation at rest (p = 0.006). Stimulation may have acted to resist patients' hyoid elevation during swallowing.
Dysphagia 2007 Jan
PMID:Effects of surface electrical stimulation both at rest and during swallowing in chronic pharyngeal Dysphagia. 1671 20

Energy intake is reduced in older individuals, with several lines of evidence suggesting that both physiological impairment of food intake regulation and non-physiological mechanisms are important. Non-physiological causes of the anorexia of aging include social (e.g. poverty, isolation), psychological (e.g. depression, dementia), medical (e.g. edentulism, dysphagia), and pharmacological factors. Physiological factors include changes in taste and smell, diminished sensory-specific satiety, delayed gastric emptying, altered digestion-related hormone secretion and hormonal responsiveness, as well as food intake-related regulatory impairments for which specific mechanisms remain largely unknown. Studies in healthy elderly individuals have shown that men who consume diets over several weeks providing either too few or too many calories relative to dietary energy needs subsequently do not compensate for the resulting energy deficit or surplus when provided an ad libitum diet. Healthy elders have also been shown to be less hungry at meal initiation and to become more rapidly satiated during a standard meal compared to younger adults. Studies in animal models are required to investigate potential mechanisms underlying these observations, while human studies should focus on examining the potential consequences of this phenomenon and practical therapeutic strategies for the maintenance of appropriate energy intake with increasing age. In light of this need, we have recently demonstrated that low reported hunger assessed using a simple questionnaire predicts unintentional weight loss in a sample of healthy older women, and thus may provide a clinically useful tool for identifying older individuals at risk for undesirable weight change and therefore at high priority for intervention.
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PMID:The anorexia of aging in humans. 1676 94


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