Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound

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

The SECCA (Curon Medical, Freemont, CA USA) device delivers temperature-controlled radiofrequency (RF) energy to the anorectal junction to treat fecal incontinence. The procedure is performed as an outpatient either in the endoscopy suite or ambulatory surgery center. After appropriate local block, the SECCA device is then inserted into the anal canal and submucosal RF energy is delivered circumferentially to the anorectal junction. A pilot trial in Mexico on 10 patients demonstrated a significant improvement in Cleveland Clinic Florida Fecal Incontinence Scores (CCF-FIS) from a pre-treatment score of 13.5 to 12-month post-treatment score of 3.8. These patients continued to have significantly improved continence with an average CCF-FIS of 7.3 at 24-month follow up. A multi-center, institutional review board-approved, open label, prospective trial that evaluates the efficacy and safety of the SECCA procedure has been completed in the United States (U.S.). Five centers prospectively enrolled 50 patients with greater than or equal to 3 months of weekly fecal incontinence who also had failed either medical or surgical interventions. Patients underwent anoscopy, anorectal manometry (ARM), endoanal ultrasound (EAUS), and pudendal nerve terminal motor latency (PNTML) at 0 and 6 months. The CCF-FIS scale, fecal incontinence-related quality of life score (FIQL), and SF-36 were administered at 0, 3, and 6 months. After conscious sedation and local perianal block, RF energy was delivered by way of the SECCA device. At 6 months, the mean CCF-FI score improved significantly (14.5 to 11.1, p<0.0001). All FIQL parameters improved: lifestyle (2.5 to 3.1, p=0.0001), coping (1.9 to 2.3, p=0.005), depression (2.8 to 3.1, p=0.0008), embarrassment (1.9 to 2.5, p<0.0001). Sixty-percent (n=30) of the patients improved after therapy, with 70% resolution of their symptoms. The SF-36 mental composite score (45.3 to 48.3, p=0.06) and social function sub-score (64.0 to 77.3, p=0.003) improved. No changes occurred in ARM, EAUS, or PNTML. Two major complications included two mucosal ulcerations. From these data, the authors concluded that RF energy delivered for treatment of FI safely improves CCF-FIS, FIQL, and quality of life.
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PMID:The SECCA procedure: a new therapy for treatment of fecal incontinence. 1574 81

Saimiriine herpesvirus 1 (SaHV-1), an alphaherpesvirus enzootic in squirrel monkeys, is genetically related to monkey B virus and human herpes simplex virus (HSV). To study the temporal progression of viral spread and associated lesions, Balb/c mice were inoculated epidermally by scarification with a green fluorescent protein (GFP)-expressing recombinant strain of SaHV-1 and killed sequentially. Pinpoint ulcerative lesions in the inoculated epidermis progressed over a few days to unilateral or bilateral hindlimb paresis or paralysis, urinary and faecal incontinence, abdominal distension, hunched posture and eventual depression warranting euthanasia. Viral replication was present within epidermal keratinocytes, neurons of the dorsal root ganglia and thoracolumbar spinal cord, regional autonomic ganglia, lower urinary tract epithelium and colonic myenteric plexuses, as indicated by histological lesions and GFP expression. Almost all mice inoculated with 10(5) or 10(6) plaque-forming units (PFU) of SaHV-1 developed rapidly progressive disease. Two of eight mice given 10(4)PFU developed disease, but no mice receiving less than 10(4)PFU gave evidence of infection. Mice that showed no clinical signs also failed to develop an antiviral IgG response, indicating absence of active viral infection. For SaHV-1 inoculated epidermally, the ID(50), CNSD(50) and LD(50) values were identical (10(4.38)), indicating that successful infection by this route invariably resulted in lethal CNS (central nervous system) disease. Consistently severe disease in all infected animals, with regionally extensive distribution of viral replication, constituted a marked difference from the disease produced by intramuscular inoculation.
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PMID:Temporal progression of viral replication and gross and histological lesions in Balb/c mice inoculated epidermally with Saimiriine herpesvirus 1 (SaHV-1). 1596 89

A total of 208 women were assessed 2 years' post-delivery to record the prevalence of subjective urinary and faecal incontinence, incontinence of flatus, dyspareunia, subjective depression and sexual satisfaction. This was correlated with mode of delivery. A sample population was selected from the Cardiff Birth Survey Database, in accordance with strict inclusion and exclusion criteria. Each woman was invited to complete and return a postal questionnaire addressing symptoms of pelvic floor dysfunction. There was a significant decrease in sexual satisfaction scores in women who underwent vaginal delivery in comparison with those who underwent elective caesarean section at 2 years follow-up. There was also a significant increase in the prevalence of urinary incontinence, incontinence of flatus, dyspareunia and subjective depression in women who underwent vaginal delivery.
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PMID:Female genital tract morbidity and sexual function following vaginal delivery or lower segment caesarean section. 1707 32

Fecal incontinence (FI) has a prevalence of 2-7% in the general community and increases substantially in hospitalized patients and nursing home residents. Incontinent patients often isolate themselves from society for fear of having an incontinent episode in public. Few of these patients ever discuss this ailment with their doctor, despite a significant increase in depression and anxiety. Women have gender-specific medical and surgical conditions that predispose them to FI such as pregnancy, scleroderma, MS, IBS, childbirth, and pelvic surgeries. This article will address multiple facets of FI, but will focus specifically on issues related to women.
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PMID:Fecal Incontinence: a woman's view. 1717 64

Anorectal disorders which often lead to fecal incontinence are a frequent problem especially in elderly patients. Direct risk factors for fecal incontinence are higher age, female sex and co-morbidity with reduced health status. Anorectal disorders cause significant socio-economic burden. Impairment of the structural and functional integrity of the anorectum are mostly multifactorial (integrity of the muscles, sensory function, stool consistency) leading to depression and fear with reduction in quality of life. A basic diagnostic work up is sufficient to characterize the different manifestations of anorectal disorders in most of the cases. This includes patient history with daily stool protocol, clinical and endoscopic investigation. Follow-up investigations include anorectal manometry, anal sphincter-EMG, conduction velocity of the pudendal nerve, needle-EMG, barostat investigation, defecography and the dynamic MRT. Therapeutic interventions are focussed on the individual symptoms and should be provided in close cooperation with gastroenterologists, surgeons, gynecologists, urologists, physiotherapeutics and psychologists (nutritional-training, food fibre content, pharmacological treatment of diarrhea/constipation, toilet-training, pelvic floor-gymnastic, anal sphincter training, biofeedback). Indication for surgical therapy is rarely seen and should be decided only after complete diagnostic work-up and only when all conservative treatment options have failed. Surgical treatment should be provided only in experienced clinical centres.
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PMID:[Diagnostic in anorectal disorders]. 1736 10

As the adults age, the risk of both urinary and fecal incontinence increases, the result of natural degenerative changes in concert with concomitant issues of aging such as infection, polypharmacy, and decreased cognitive function. Most adults past the age of 65 suffer incontinence on some level, with significant and often devastating impact on the physical and emotional health of the patient. Incontinence in the older adult is a humiliating and disabling disorder, which causes substantial stress, depression, and limitation. It can impede interpersonal relationships, decrease sexual function, and increase the risk of debilitating falls, institutionalization, and even increase mortality. Incontinence also represents a substantial economic burden to the general population. Nonetheless, incontinence is often undiagnosed, and when diagnosed, often left untreated. Although common in older adults, incontinence is not an inevitable consequence of aging but a disorder that can and should be treated. Appropriate clinical management of incontinence can help seniors continue to lead vital, active lives as well as avoid the cutaneous sequelae of this disorder.
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PMID:Psychosocial and societal burden of incontinence in the aged population: a review. 1802 73

Oxidative stress is associated with skeletal muscle fatigue. This study tests the hypotheses that N-acetylcysteine (NAC) reduces fatigue and accelerates recovery of the rat external anal sphincter (EAS). Fifteen female Wistar rats were killed humanely. The EAS was mounted as a ring preparation and electrically stimulated with 50 Hz trains of 200 ms in duration every 4 s for three and a half minutes. Three groups were analysed: a control group (n = 5), a group pretreated with NAC (10(-4) mol L(-1); n = 5) and a group pretreated with NAC (10(-3) mol L(-1); n = 5). A novel fatigue index was formulated and was compared to a conventional method of expressing fatigue. There was no significant difference at concentrations of NAC (10(-4) mol L(-1); P > 0.05). At high concentrations of NAC (10(-3) mol L(-1)) there was a significant depression in peak twitch amplitude before fatigue (P = 0.04). N-acetylcysteine in both concentrations used, did not alter fatigue or recovery of the rat EAS. There was a significant positive correlation between the two methods of expressing fatigue but the conventional method produced a higher fatigue index (22.4% on average). N-acetylcysteine does not ameliorate fatigue or accelerate recovery of the EAS and may not be a useful medical therapy for faecal incontinence.
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PMID:External anal sphincter fatigue is not improved by N-acetylcysteine in an animal model. 1836 38

Sacral neuromodulation is a new treatment for urinary and fecal incontinence that has demonstrated good therapeutic results. This treatment modality has shown not only to reduce urinary dysfunction symptoms and urinary and fecal incontinence but improve quality of life scores as well. We present a 73 years old female patient with severe fecal and urinary incontinence with major quality of life impact. She was referred after failure of different surgical and conservative therapeutic approaches. Her evaluation met inclusion criteria for sacral neuromodulation treatment. Acute sacral nerve evaluation (PNE) proved to be therapeutic in the patient as measured by at least a 50 percent improvement in her symptoms so a permanent implant (Medtronic InterStim System) was placed. After the implant there was a significant improvement in urinary and fecal functional scores. Fecal Incontinence Severity Index improved from 34 to 8 and Urinary Sandvik's Severity Index from very severe urinary incontinence to minor urinary incontinence after the placement of the implant. Using standard quality of life questionnaires, she improved in the areas of lifestyle,coping and behavior and her experience with depression and self-perception.
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PMID:[First case of sacral neuromodulation for treatment of urinary and fecal incontinence in Mexico. Case report.]. 1966 95

Because falls are highly prevalent, harmful events for older adults, identification of patients at risk is a high priority for home health care agencies. Using routine administrative data, we demonstrated that patients with depressive symptoms on the Outcome and Assessment Information Set are at risk for falls. A prospective case-control study that matched 54 patients who experienced an adverse fall with 854 controls showed that patients who fell had twice the odds of being depressed (odds ratio = 1.90, 95% confidence interval = 1.01 to 3.59). Bowel incontinence, high medical comorbidity, stair use, injury and poisoning, memory deficit, and antipsychotic medication use were also predictors, but no association was found for antidepressant medications. These data suggest the potential benefit of including depression screening for multifactorial fall prevention interventions.
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PMID:Depression and risk for adverse falls in older home health care patients. 2007 99

SEXUAL FUNCTION IN AGING WOMEN: Sexuality is an integral part of human expressions. Mental health plays a major role in sexuality. Several psychological interventions are proposed to increase the sexual quality of life in older women with diverse gynecologic pathology. A biopsychosocial approach utilizing brief strategies can be easily implemented in clinics to help women of all ages increase their sexual quality of life. THE IMPACT OF FEMALE PELVIC FLOOR DISORDERS ON SEXUAL FUNCTION IN OLDER WOMEN: Female pelvic floor disorders include urinary incontinence, pelvic organ prolapse, and fecal incontinence. These disorders increase dramatically with increasing age. Urinary incontinence has been demonstrated to have a negative impact on a woman's sexual function. Among sexually active older women with urinary incontinence, 22% report being moderately or extremely worried that sexual activity would cause urine loss. An increased prevalence of sexual distress [9% (6/76) vs. 1.3% (2/216), p=0.005] has been reported in sexually active women over 40 years old with urinary incontinence. Treatment of urinary incontinence can improve sexual function in older women. Among sexually active women (N=53) who underwent midurethral slings procedures for the correction of urinary incontinence, increased coital frequency, decrease fear of incontinence with coitus, decreased embarrassment due to incontinence was reported six months after surgery. Pelvic organ prolapse, a hernia of the vagina resulting in a visible vaginal bulge, has also been associated with a negative impact on sexual function. Women with advanced pelvic organ prolapse (POP-Q stage III or IV) have been demonstrated to have decreased body image reporting that they are more self-conscious about their appearance [adjusted odds ratio (AOR) 4.7; 95% confidence interval (CI) 2.9, 51], feel less feminine (AOR 4.0; 95% CI 1.2, 15) and less sexually attractive (AOR 4.6; 95% CI 1.4, 17) compared with women who have normal pelvic support. Both vaginal and abdominal approaches to surgical correction of pelvic organ prolapse have been demonstrated to improve sexual function. MENTAL HEALTH: Mental health plays a major role in older woman's sexuality. Sexual interest and satisfaction is tied to emotional expressivity, women's self-worth, feelings of depression and loneliness as well as cognitive function. Research has shown that both general practitioners and specialists lack training in sexual assessments. Behavioral health specialists, such as a psychologist, can play an integral role in helping to facilitate communication between the patient and the provider. A main focus of communication training is to facilitate open and genuine conversation between the provider and the patient. Providers are encouraged to ask open ended questions while patients are encouraged to discuss symptoms while coping with an internal state of anxiety. Despite the known prevalence of sexual dysfunction among older women, few studied empirically based interventions have been published with these women. This speaks to the general assumption among medical professionals that having the "sex talk" in older women with gynecological pathology is not important or relevant. A biopsychosocial approach utilizing some of the aforementioned brief strategies can be easily implemented in comprehensive gynecology clinics in order to help women of all ages increase their sexual quality of life.
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PMID:Sexual satisfaction in the elderly female population: A special focus on women with gynecologic pathology. 2249 48


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