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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Eysenck Personality Inventory and Hospital Anxiety and Depression scale were administered to 80 patients undergoing medical treatment for long standing inflammatory bowel disease: 22 patients were studied before the diagnosis was established and 40 patients with diabetes mellitus served as controls. High neuroticism and introversion scores were more prevalent in the patients with inflammatory bowel disease than controls (p less than 0.05) and these characteristics were as prominent in patients before diagnosis as in established cases. Introversion scores increased with the duration of disease (r = 0.51). Depression was uncommon, occurring only in patients with active chronic disease. Patients believed there was a close link between personality, stress and disease activity. Fifty six of the patients recognised factors that initiated the disease and in 42 this was thought to be a stressful life event or a 'nervous personality'.
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PMID:Personality profile and affective state of patients with inflammatory bowel disease. 273 54

The experience with CAPD using the Tenckhoff catheter in 115 patients over a 7 year period has been reviewed. The general indications for CAPD in the patient with chronic renal failure are the mental and physical ability of the patient or his relatives to perform CAPD. In our series, diabetes mellitus has been a relative indication for CAPD, because diabetic patients often have vascular disease severe enough to make long-term hemodialysis difficult. The general contraindications are abdominal problems such as hernias, abdominal wall infections, inflammatory bowel disease, adhesions, and gastrointestinal stomas. Other contraindications are lumbar disk disease and respiratory insufficiency. The surgical principles of catheter insertion have been described. Complications associated with the Tenckhoff catheter were either mechanical (intraabdominal organ injury, incisional hernia, catheter leakage, catheter occlusion, or catheter dislodgement), or infectious (peritonitis or abdominal wall infection). The single most common organism isolated from effluent dialysate in 65 patients with peritonitis was Staphylococcus epidermidis in six patients (9.2 percent), and in 20 patients (30.8 percent), no organism could be isolated. For those patients who had peritonitis, the average frequency was at 8.9 months of CAPD. There were only three deaths (3 percent) directly related to the Tenckhoff catheter and these were due to peritonitis and sepsis. Only 22 (19 percent) of the 115 patients in this series had to discontinue CAPD because of its ineffectiveness or the patient's or relative's inability to perform CAPD.
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PMID:Surgical aspects of the Tenckhoff peritoneal dialysis catheter. A 7 year experience. 315 18

We retrospectively reviewed the charts of 55 patients with ischiorectal abscesses treated from 1980 to 1983 at the Cleveland Clinic Foundation. The patients were treated by placement of a 10F to 16F soft latex mushroom catheter into the abscess cavity under local anesthesia as an office procedure. The end of the catheter was shortened to leave 2 to 3 cm exiting the skin, and a bandage was applied. No sutures or irrigations were used, and the drains were removed an average of 12 days after placement. Antibiotics were not given. The patients ranged in age from 17 to 76 years (mean, 40 years) and 36% were female. Four patients had diabetes, and eight had a history of inflammatory bowel disease. Nine patients had been treated previously for anorectal abscesses. There were no complications. Adequate follow-up was obtainable in 31 patients (ten to 63 months; mean, 30 months). Eight of them (26%) were subsequently treated for fistulas found after resolution of the abscess, and an additional eight (26%) had a second abscess form during the follow-up period. The average time to this recurrence was 20 months. Catheter drainage of ischiorectal abscess in selected cases resulted in healing with low morbidity and significant cost savings.
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PMID:Catheter drainage of ischiorectal abscesses. 335 66

This article deals with the use of oral contraceptives and IUDs by chronically ill adolescent females. Results of controlled studies of contraceptive choices and problems are reviewed for teenagers with cardiac disease, epilepsy, multiple sclerosis, migraine headaches, asthma, cystic fibrosis, inflammatory bowel disease, hepatitis, diabetes mellitus, thyroid disease, oligomenorrhea and amenorrhea. If oral contraceptives (OC) are prescribed for use in teens with cardiac disease, a contraceptive with 35ug or less of estrogen and the equivalent of 1 mg or less of norethindrone should be used. The low-dose progestin only pill can be prescribed, but should be used in conjunction with a back-up barrier method. Reports to date have failed to reveal increased seizure activity in epileptic pattients on OCs, and there is no significant evidence to date that OCs alter the course of multiple sclerosis. Although the evidence is inconclusive, the physician should use extreme caution in prescribing OCs for teens with prior migraines. Regarding asthmatic patients, no problems have been reported with IUD use except in regard to steroid therapy and its possible effect on reducing IUD effectiveness. No adverse effects 2ndary to the use of OCs in asthmatic patients have been reported. OCs should be avoided or used with extreme caution in the cystic fibrosis patient. Teens with active inflammatory bowel disease should be advised that OCs may be ineffective or dangerous; there are no reports available on the effects of the IUD on the disease. The pill is contraindicated during active liver disease or cirrhosis. The IUD is not highly recommended for contraception in diabetic teenagers, whereas a low-dose combined OC can be used with extreme caution. However, OCs should be avoided in the diabetic patient with nephropathy, vascular complications or retinopathy. There is at present no contraindication for contraceptive use by women with thyroid disease. Finally, patients with prolonged post pill amenorrhea and infertility are generally females with amenorrhea or oligomenorrhea before pill use.
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PMID:Contraceptive use in the chronically ill adolescent female: Part I. 351 58

This article updates progress and results to date in the Oxford Family Planning Association contraceptive study. This study involves over 17,000 women recruited at clinics in England and Scotland in 1968-74 who have been followed since then. At entry to the study, 56.6% of subjects were oral contraceptive (OC) users, 24.8% were diaphragm users, and 18.6% were IUD users. By the end of 1983, 192,000 woman-years of observation had been collected. Over 4000 women currently have at least 8 years of OC use, providing opportunities for a study of longterm and delayed effects of this contraceptive method. The data suggest changing patterns of contraceptive use over time, with a decline in OC use and a rise in the use of sterilization as subjects have aged. Progestogen-only OCs are moderately popular across the age range, but combined OCs are rarely use past the age of 40 years. Although the study was originally concerned with the risks and benefits of OC use, it has contributed to knowledge about the effects of a wide variety of contraceptive methods. In addition, it has been possible to analyze the influence of factors such as age, parity, social class, and motivation on contraceptive efficacy. 33 individual publications (listed and annotated in the article) have emerged from the study. Work is currently underway on factors affecting fertility, psychiatric illness in users of different methods, patterns of cervical cytology in women with neoplasia of the cervix uteri, the effectiveness of IUDs in women with arthritis, and the realtionship between OC use and chronic inflammatory bowel disease. Future research will focus on the delayed effects of OCs on major chronic diseases such as cancer, coronary heart disease, and diabetes. The study is funded through mid-1989.
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PMID:The Oxford-Family Planning Association contraceptive study. 650 57

Phagedena is an old term for serious deep, necrotic and gangrenous skin ulcers. In the past these have been regarded as severe infections. A review of 31 cases revealed that except in cases of Streptococcus pyogenes or Clostridium welchii infection a bacterial of fungal infection was only one of several factors that led to the development of phagedenic ulcers. Initiating factors may be a bacterial infection, a debilitated state as a result of immunosuppressive therapy or of such conditions as alcoholism, severe diabetes, inflammatory bowel disease or severe arteriosclerosis, and various types of injury or trauma. Continuing factors include enzymatic mechanisms, the release of toxins from large areas of dead tissue and vascular disorders. In general, antibiotics are of limited value. systemic corticosteroid therapy may be useful in the subacute or chronic case. In acute, spreading, gangrenous phagedena with surrounding erythema, fever and systemic toxic effects, immediate excision of dead tissue may be lifesaving.
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PMID:Phagedena: gangrenous and necrotic ulcerations of skin and subcutaneous tissue. 706 92

Islet cell antigen (ICA) 69 is a newly-recognized islet cell antigen to which autoantibodies have been observed in prediabetic relatives of patients with insulin-dependent-diabetes mellitus (IDDM). Here we extend the earlier analysis of ICA69 antibodies to patients with recent-onset IDDM and to patients with other immune-mediated diseases. ICA69 antibodies were determined by Western blot using an affinity purified recombinant fusion protein of ICA69 and maltose binding protein. ICA69 antibody quantities were determined as titres using a titration curve of a standard serum as reference. Mean logarithmic ICA69 antibody titres were 3.4 (+/- 1.4) in 99 patients with acute IDDM compared to 2.8 (+/- 0.9) in 49 healthy blood donors (p < 0.001). A higher mean ICA69 antibody titre of 4.1 (+/- 0.8) was observed in 16 patients with rheumatoid arthritis in comparison to acute IDDM (p < 0.01) and healthy control subjects (p < 0.001). The percentage of sera with ICA69 antibody titres above the 2 SD level of normal subjects was 21% in IDDM, 31% in rheumatoid arthritis and 6% in healthy blood donors. None of the patients with autoimmune thyroid disease (n = 20), inflammatory bowel disease (n = 9) or multiple sclerosis (n = 7) had elevated ICA69 antibodies. In IDDM, presence of ICA69 antibodies persisted and the titre remained the same over 18 months of follow-up. The relationship of ICA69 antibodies to islet cell antibodies (ICA) or insulin autoantibodies (IAA) was tested. The production of ICA69 antibodies was not associated in diabetic patients with the presence of any of the two other autoantibodies.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Autoantibodies to the islet antigen ICA69 occur in IDDM and in rheumatoid arthritis. 878 74

The authors define pro-thrombotic states as conditions associated with a high frequency of thrombosis; this association is based on pathogenetic or simply clinical and epidemiological relationships. Thrombophilic states have well-defined, specific causes: antithrombin III, protein C and S and similar deficiencies for inherited thrombophilias, and lupus anticoagulant, antiphospholipid antibodies for the acquired forms. Another identifiable group is made up of several conditions predisposing to thrombosis (CPT) characterized by less specific and multiple mechanisms (e.g. malignancy, inflammatory bowel disease, nephrotic syndrome, diabetes, obesity, etc.). These conditions may induce thrombosis by themselves or contribute to its clinical onset in patients with true thrombophilic states. This is especially the case for patients who are taking contraceptive drugs, are pregnant, have undergone surgery or trauma. The term hypercoagulability states is by no means equivalent to either thrombophilia or CPT. In fact, hypercoagulability may be defined as "activation of blood coagulation" in the presence of specific markers such as fibrinopeptide A and prothrombin fragment F1 + 2. Hypercoagulability is therefore a laboratory rather than a clinical condition and can be a transient feature appearing during certain phases of thrombophilia or CPT. Lastly, conditions involving the presence of hemostatic risk factors for atherothrombosis are simply terms used to describe a statistical-epidemiological relationship between certain hemostatic variables (fibrinogen, factor VII, PAI, etc.) involving the risk of cardiovascular morbidity and mortality but not necessarily indicating a hypercoagulability state.
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PMID:Pro-thrombotic states and their diagnosis. 800 87

Children, like adults and parents, depend on primary care physicians to identify, treat, or refer those with mental disorders. Mental health concerns are also germane to the growing number of chronically ill children in pediatric care. This paper focuses on: 1) the level of agreement between children and parents about the presence of a mental disorder and the impact of informant on case identification; and 2) the extent to which pediatricians agree with reports by chronically ill children and/or their parents regarding such problems. The study sample includes 112 children, ages 9 to 18, with cancer, cystic fibrosis, inflammatory bowel disease, and insulin-dependent diabetes and a control group of 35 healthy subjects. Subject and a parent were interviewed separately using a highly standardized, structured interview that generates DSM-III-R diagnoses by computer algorithms. Pediatricians completed a questionnaire asking about the presence of any mental disorders. Agreement between parent and child was poor for both groups. In the medically ill group, more cases were identified by the parent interview than by child interview alone for all types of disorders. In contrast, children in the comparison group more often reported symptoms sufficient for a diagnosis than did their parents. The difference in prevalence between the two groups was significant only for the parent-identified cases, and physicians were more likely to recognize child-identified disorders. The choice of informant(s) has clear implications for case identification and case recognition in both clinical care and research in pediatric settings.
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PMID:Mental disorders in chronically ill children: case identification and parent-child discrepancy. 800 96

Therapeutic apheresis as applied to humans may encompass a single treatment or numerous treatments for disorders ranging from acute poisoning to severe chronic autoimmune disease. However, the mechanisms of beneficial effects of apheresis are not well characterized. Utilizing a miniaturized hollow-fiber membrane system, we have developed a reliable technique for long-term vascular access in the rat that permits repetitive plasmapheresis. We established vascular access in 14 animals, with 8 and 6 rats randomized to 3- and 7-wk experimental periods, respectively. Immunoglobulin levels of blood samples obtained immediately before and after each plasmapheresis were measured to examine membrane filtration characteristics. Overall, 100% of the animals survived and 93% successfully completed their assigned experimental periods. Mean decrease of immunoglobulin G and M levels for 28 plasmapheresis treatments in five rats was 66.9 +/- 8.1 and 61.0 +/- 7.3% (SD), respectively, indicating effective membrane filtration. This model of apheresis can be applied to several disorders in the rat, including, but not limited to, spontaneous insulin-dependent diabetes mellitus and experimental inflammatory bowel disease.
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PMID:A method for chronic membrane plasmapheresis in the rat. 812 6


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