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PubMed1993

Panic disorder: efficacy of current treatments.

As has been demonstrated in the numerous studies cited in this report, there are multiple effective treatments for panic disorder (PD), both pharmacological and psychosocial. Available evidence documents that at least 75 percent of patients will have a good response to three classes of medications (tricyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines) which are all approximately equal in efficacy and side effects. Medications may be even more effective when combined with cognitive and behavioral techniques. Several of the psychosocial treatments are also quite effective and appear to have certain advantages, including a low relapse rate. Currently a cognitive treatment specific for panic disorder is under active study and appears especially promising. It is clear that both pharmacological and cognitive-behavioral treatments for panic disorder are effective and can reduce or eliminate the multiple symptoms (panic attacks, phobic avoidance, depression, etc.) and the secondary disability in occupational and social and family roles associated with panic disorder. Untreated, panic disorder patients appear to generally remain chronically ill and worsen over time. What is less clear are issues of length of treatment, outcome after treatment is discontinued, relationship of pharmacological and nonpharmacological treatments, effect of comorbid disorders and presence of subclinical symptoms, and patient characteristics which predict a positive response. The relatively recent finding that panic disorder is a common condition, occurring in about 1-2 percent of the population within any 6-month period (Weissman 1990) has stimulated clinical interest in the development of effective interventions. Until the early 1980s available treatments were generally ineffective, leaving approximately 75 percent of patients unimproved (Doctor 1982). However, excellent pharmacological and nonpharmacological treatments are now available and provide significant improvement with complete resolution of symptoms and disability in the majority of patients. The advances in the knowledge base about panic disorder were underscored in the National Institutes of Health Consensus Development Conference held September 25-27, 1991 at the National Institutes of Health in Bethesda, MD. These conferences are convened periodically by the National Institutes of Health to evaluate available scientific evidence, resolve issues of both safety and treatment efficacy, and make these advances known to the public. One of the primary conclusions from this conference is that "Panic disorder is a distinct condition with a specific presentation, course, and positive family history and for which there are effective pharmacological and cognitive-behavioral treatments" (Panic Consensus Statement 1991).(ABSTRACT TRUNCATED AT 400 WORDS)

Combined Modality Therapy↗

PubMed2003

Efficacy and limitations of current methods of intraoperative spinal cord monitoring.

The purpose of this study was to evaluate the efficacy and reliability of intraoperative spinal monitoring using spinal cord-evoked and compound muscle action potentials. We reviewed 716 cases of spinal monitoring performed over 15 years. The series contained 672 patients with spinal functions that could be monitored intraoperatively; 44 (6.1%) were impossible to record. Based on the 21 impossible-to-record patients, it is evident that missing a serious case such as a Frankel B type spinal cord injury indicates the limitations of the current monitoring methods for stimulating and recording. The monitoring outcomes were true-negative in 652 patients, true-positive in 12, false-negative in four, and false-positive in four. In two of the patients with false-negative results, postoperative myelomere motor paralysis was observed temporarily even though it was possible to record the muscle-evoked potential after electrical stimulation to the brain [Br(E)-MsEP] at the end of the operation. In cases in which the spinal parenchyma or spinal nerve root might be selectively damaged, Br(E)-MsEPs may not diagnose the disorder accurately. By employing multimodal monitoring, it should be possible to eliminate patients with false-negative results and to detect spinal disorders during the early stages, as well as to examine whether the abnormality that had been recorded by a single method is false-positive.

Action Potentials↗

PubMedDate not supplied

Continuous arteriovenous hemofiltration in infants.

Renal replacement therapy is sometimes necessary in small infants with acute renal failure or severe metabolic disorders. Of the available methods hemodialysis and peritoneal dialysis are not always feasible in small infants. We used continuous arteriovenous hemofiltration as renal replacement therapy in five small infants. This report describes the technique and efficiency of this new extracorporal treatment modality. Azotemia and hypervolemia can be controlled easily by spontaneous or suction supported arteriovenous hemofiltration. Furthermore it allows adequate parenteral nutrition in anuric infants and eliminates toxic products in amino acid disorders. Arteriovenous hemofiltration is well tolerated by small infants and can be performed in every pediatric intensive care unit.

Acute Kidney Injury↗

PubMed1985

A Raman spectroscopic study on the effect of cholesterol on lipid packing in diether phosphatidylcholine bilayer dispersions.

For assessing lipid-sterol packing characteristics in model membrane systems, the vibrational Raman spectra of 1,2-di-O-hexadecyl-sn-glycero-3-phosphocholine (DHPC) multilamellar dispersions containing 18 mol% cholesterol were examined. The thermotropic behavior of the pure diether- and cholesterol-containing bilayers were studied in both the C-H stretching (2800-3100 cm-1) and C-C stretching (1000-1200 cm-1) mode regions, spectral intervals reflecting intermolecular and intramolecular order/disorder characteristics. Pure DHPC bilayers exhibit the pretransition and gel to liquid-crystalline phase transition temperatures at approx. 31 and 42.8 degrees C, respectively. In contrast to the temperature behavior of dipalmitoylphosphatidylcholine-cholesterol bilayers in which the primary phase transition Tm, is simply broadened, Tm is increased to approx. 49.6 degrees C in the DHPC (diether PC) liposomes containing 18 mol% cholesterol. As in the saturated chain diacyl-cholesterol bilayer systems, the sterol disorders the DHPC gel phase and eliminates the pretransition, while ordering the liquid-crystalline phase. Pure diether liposomes exhibit a headgroup dehydration effect as the multilamellar dispersions are cycled slowly over a temperature range including the gel and liquid-crystalline forms. That is, on multiple passages through the phase transitions, both the gel and liquid-crystalline bilayer forms assume an increased hydrocarbon chain order. In the cholesterol-containing diether bilayers, only the disordered intra- and interchain states are formed.

Chemical Phenomena↗

PubMed1988

Morphologic considerations in the interpretation of gastrointestinal disorders.

Misinterpretations of gastrointestinal alterations can be reduced or eliminated by avoiding sampling/labeling errors, reducing artifact, and gaining familiarity with normal variations for the species under study. The errant thrust of the gastroscopic biopsy forceps can yield mucosa resembling atrophic gastritis; ileal villi taken for jejunal erroneously lead to consideration of sprue-like disorder. Reduction of the postmortem delay prior to fixation is critical for avoiding artifact. Villous epithelial cells separate from basement membrane within 5 to 10 minutes. Flushing saline, water, or fixative through unopened intestine causes intolerable damage to epithelium and villi. The thin-walled intestines of small laboratory species may be fixed unopened, but without dissection gross lesions are overlooked. Osmolarity of the fixative is important for preserving normal shapes of villi. Smooth muscle of the muscularis and villi of the dog contracts vigorously after euthanasia and immediate fixation. Optimum preservation may be had by applying iso-osmolar neutral buffered fixatives to intestinal segments which have been opened, stretched slightly, and pinned to cardboard or styrofoam. The villous height:crypt depth ratios vary among species and among intestinal segments. Shapes vary as well, ileal villi of many species appearing short and Christmas-tree- or thumb-shaped. Dilated lacteals occur occasionally in normal villi. The goblet cell population increases aborally, while the lymphocytic-plasmacytic population of the core increases with age. Eosinophils are a normal component in several species; globule leukocytes are common in others. Mast cells of the villi will be overlooked unless tissues are fixed in Carnoy's solution and stained with Astra or Alcian blue.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1984

Selection against genetic defects in semen donors.

Artificial insemination donor selection requires predicting which men are likely to beget the healthiest offspring. Methods are developed for calculating the "offspring excess recurrence risk", delta R, for an anomaly in the offspring of an afflicted father. Mainly from published family survey and population data delta R is computed for 38 disorders. From a small survey a value for the with-treatment "affliction burden", Bt, is assigned to each anomaly. For each disorder the "offspring excess burden expectation" is delta RBt. Defects such as cataract, hereditary Parkinson disease, psoriasis, seropositive rheumatoid arthritis, and schizophrenia have such a high delta RBt that they are individually sufficient cause for rejecting a donor candidate. A candidate may be rejected because of a combination of lesser defects with sigma delta RBt exceeding an acceptable limit. A limit should also be placed on Bt, because the affliction burden for Tay-Sachs disease or cystic fibrosis is intolerable, however infrequent. Most of the important hereditary defects are late onset, and for the older donor the opportunity to select more directly against late-onset disorders offsets the added risk of newly-arising gene mutations. The most careful donor selection cannot completely eliminate the risk of a child inheriting some disorder, but selection can reduce the average total burden by as much as 17%.

Genetic Diseases, Inborn↗

PubMedDate not supplied

Two girls with necrobiosis lipoidica and type I diabetes mellitus with transfollicular elimination in one girl.

Necrobiosis lipoidica (NL) is a rare disorder that usually appears in the lower extremities and it is often related with diabetes mellitus (DM). There are few reported cases of NL in children. Transfollicular elimination of necrotic material has been described in adult patients with NL diabeticorum. Here we describe two new cases of NL in two girls with type I diabetes mellitus (DM). One of the cases is the first case, to our knowledge, of transfollicular elimination in a girl. The other case is the second case reported of lesions on the arms in a child with DM.

Administration, Topical↗

PubMed1990

Obstructive sleep apnea treated by independently adjusted inspiratory and expiratory positive airway pressures via nasal mask. Physiologic and clinical implications.

Treatment of obstructive sleep apnea with nasal continuous positive airway pressure mandates simultaneous increases of both inspiratory and expiratory positive airway pressures to eliminate apneas as well as nonapneic oxyhemoglobin desaturation events. We hypothesized that the forces acting to collapse the upper airway during inspiration and expiration are of different magnitudes and that obstructive sleep-disordered breathing events (including apneas, hypopneas and nonapneic desaturation events) could be eliminated at lower levels of EPAP than IPAP. To test these hypotheses, a device was built that allows the independent adjustment of EPAP and IPAP (nasal BiPAP). Our data support the hypotheses that expiratory phase events are important in the pathogenesis of OSA and that there are differences in the magnitudes of the forces destabilizing the upper airway during inspiration and expiration. Finally, applying these concepts, we have shown that by using a device that permits independent adjustment of EPAP and IPAP, obstructive sleep-disordered breathing can be eliminated at lower levels of expiratory airway pressure compared with conventional nasal CPAP therapy. This may reduce the adverse effects associated with nasal CPAP therapy and improve long-term therapeutic compliance.

Algorithms↗

PubMedDate not supplied

[Effect of disorders of thyroid function on phenazone pharmacokinetics].

Phenazone elimination test, as a marker of metabolic efficiency of the liver, was carried out in 11 hypothyroid patients. 20 hyperthyroid patients, 10 persons after hyperthyroidism treatment and in 20 healthy persons as a control group. In hyperthyroid patients the acceleration, and in hypothyroid patients the delay of phenazone elimination, in comparison with a control group was observed. Moreover, the impairment of phenazone gastrointestinal absorption was shown in hypothyroid patients and in persons after hyperthyroidism treatment. Similar alterations may be expected in persons with thyroid dysfunctions to whom the drugs with pharmacokinetic properties similar to phenazone are administered.

Adult↗

PubMed1994

[Genetic analysis and a new therapy for a hereditary disease: familial amyloid polyneuropathy].

Familial amyloid polyneuropathy (FAP) is a hereditary disorder with autosomal dominant trait and is characterized by the accumulation of transthyretin at the nervous systems. The disorder mostly becomes overt in the fourth decade of life among affected individuals. Treatment of FAP has been directed toward the relief of symptoms and not intended to eliminate the yet unknown cause of this disorder. Recently, Val30 to Met substitution in the transthyretin gene was found among the patients with typical FAP. This enabled us to genotype affected individuals by PCR-RFLP and paved the way to the treatments directed to lower the levels of abnormal transthyretin in patients. In 1990, a Swedish group successfully performed liver transplantation to patients with FAP. This report was followed by more than 60 cases of liver transplantation to FAP patients in the Western hemisphere. Herein, I describe the first case of living-related liver transplantation to an FAP patient at Shinshu University Hospital. The patient was a 31-year-old female, whose father and aunt died of typical FAP in their fifth decade. She was suffering from severe pains in her lower extremities and nausea and vomiting. PCR-RFLP of her transthyretin gene revealed that she was heterozygous for Val to Met substitution at codon 30. In 1993, she was transplanted the left lobe of liver from her elder sister, who was genetically free of the disorder. Two weeks after the transplantation, serum Met30-transthyretin levels fell below 5% of the initial level. Symptoms due to peripheral nervous system and gastrointestinal tract were relieved after the transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2006

Modulation of Hsp90 function in neurodegenerative disorders: a molecular-targeted therapy against disease-causing protein.

Abnormal accumulation of disease-causing protein is a commonly observed characteristic in chronic neurodegenerative disorders such as Alzheimer's disease, Parkinson's disease, and polyglutamine (polyQ) diseases. A therapeutic approach that could selectively eliminate would be a promising remedy for neurodegenerative disorders. Spinal and bulbar muscular atrophy (SBMA), one of the polyQ diseases, is a late-onset motor neuron disease characterized by proximal muscle atrophy, weakness, contraction fasciculations, and bulbar involvement. The pathogenic gene product is polyQ-expanded androgen receptor (AR), which belongs to the heat shock protein (Hsp) 90 client protein family. 17-Allylamino-17-demethoxygeldanamycin (17-AAG), a novel Hsp90 inhibitor, is a new derivative of geldanamycin that shares its important biological activities but shows less toxicity. 17-AAG is now in phase II clinical trials as a potential anti-cancer agent because of its ability to selectively degrade several oncoproteins. We have recently demonstrated the efficacy and safety of 17-AAG in a mouse model of SBMA. The administration of 17-AAG significantly ameliorated polyQ-mediated motor neuron degeneration by reducing the total amount of mutant AR. 17-AAG accomplished the preferential reduction of mutant AR mainly through Hsp90 chaperone complex formation and subsequent proteasome-dependent degradation. 17-AAG induced Hsp70 and Hsp40 in vivo as previously reported; however, its ability to induce HSPs was limited, suggesting that the HSP induction might support the degradation of mutant protein. The ability of 17-AAG to preferentially degrade mutant protein would be directly applicable to SBMA and other neurodegenerative diseases in which the disease-causing proteins also belong to the Hsp90 client protein family. Our proposed therapeutic approach, modulation of Hsp90 function by 17-AAG treatment, has emerged as a candidate for molecular-targeted therapies for neurodegenerative diseases. This review will consider our research findings and discuss the possibility of a clinical application of 17-AAG to SBMA and other neurodegenerative diseases.

Age Factors↗

PubMed2001

Family therapy for eating disorders.

It is a perpetual source of debate whether dysfunctional family communication and relationship patterns cause eating disorders or the stress associated with raising a child with an eating disorder elicits such problems. Regardless, family therapy is a necessary component of any comprehensive biopsychosocial approach to the treatment of eating disorders. A careful assessment of the entire family, including the identified patient; his or her parents and siblings; the parents' marriage and families of origin; the child's emotional, social, and physical development; parental regulation of developmental stages; and communication patterns is mandatory. Family therapy for eating-disordered patients attempts to facilitate the elimination of potentially life-threatening symptoms and begin a therapeutic process of change within the entire family. Research has shown significant support for the use of family therapy in this population, but well-controlled treatment outcome research remains somewhat limited.

Adolescent↗

PubMed1977

[Neurosis-like tics in children].

The author examined 115 children from 4-14 years who suffered from ticose hyperkinesis. The specific traits of the background (somatical diseases, organic brain diseases, mental disorders, the MBD syndrome permitted to eliminate 4 groups of patients. On the basis of the achieved results the author comes to the conclusion that in the pathogenesis of a pseudoneurotic tic an important role is being played by a premorbid insufficiency of the motor analyzer. Comprehensive treatment is being recommended, with a consideration of the background against which the hyperkinetical syndrome arises.

Adolescent↗

PubMed2005

Master equation approach to charge injection and transport in organic insulators.

We develop a master equation model of a disordered organic insulator sandwiched between metallic electrodes by treating as rate processes both the injection and the internal transport. We show how the master equation model allows for the inclusion of crucial correlation effects in the charge transport, particularly of the Pauli exclusion principle and of space-charge effects, besides, being dependent on just the microscopic form of the transfer rate between the localized electronic states, it allows for the investigation of different microscopic scenarios in the organic, such as polaronic hopping, correlated energy levels, interaction with image charge, etc. The model allows for a separate analysis of the injection and the recombination currents. We find that the disorder, besides increasing the injection current, eliminates the possibility of observation of a Fowler-Nordheim injection current at zero temperature, and that it does not alter the Schottky barrier size of the zero-field thermionic injection current from the value based on the energy difference between the electrode Fermi level and the highest occupied molecular orbital/lowest unoccupied molecular orbital levels in the organic, but it makes the Arrhenius temperature dependence appear at larger temperatures. We investigate how the I(V) characteristics of a device is affected by the presence of correlations in the site energy distribution and by the form of the internal hopping rate, specifically the Miller-Abrahams rate and the Marcus or small-polaron rate. We show that the disorder does not modify significantly the ebeta square root E field dependence of the net current due to the Schottky barrier lowering caused by the attraction between the charge and its image in the electrode.

Journal Article↗

PubMed1979

[Situational reactions manifesting themselves in behavior disorders as a form of psychogenic (reactive) disorders in children and adolescents].

The paper is related to the history, elimination, clinical expression, systematics and the clinico-nozological place of the group of situational reactions expressed in disordered behaviour of children and adolescents. These reactions are considered as associated pairs, including interconnected psychological and pathological forms. Some common criteria delineating the psychological and pathological situational reactions are presented. The paper also contains a description of the main traits of psychological and pathological reactions of protest, rejection, imitation, compensation-hypercompensation. All these reactions are considered as a special group of psychogenic (reactive) diseases.

Adolescent↗

PubMed1999

Once-weekly dosing of fluoxetine in the maintenance of remission in panic disorder.

BACKGROUND: Fluoxetine and its active metabolite norfluoxetine have long half-lives of 4-6 days and 4-16 days, respectively. We postulated that, owing to the long elimination half-life, patients diagnosed with panic disorder might be maintained on fluoxetine taken once a week, after being treated initially with daily doses of fluoxetine. METHOD: Ten patients with DSM-III-R panic disorder were treated openly with fluoxetine, 20-40 mg daily. Once panic free, these patients were switched to once-weekly dosing of fluoxetine, and dosage was titrated as needed. RESULTS: All 10 patients successfully switched to once-weekly dosing. One patient reported recurrence of panic attacks 18 months after the switch. After a brief treatment for 4 weeks with benzodiazepines and daily fluoxetine, the patient was once again maintained on once-weekly dosing when rechallenged. Patients have been maintained in a panic-free state for up to 26 months with a single weekly dose of fluoxetine ranging from 10 to 60 mg. The medication was well tolerated. CONCLUSION: Fluoxetine at doses ranging from 10 to 60 mg administered once weekly appears to be effective maintenance treatment for patients with panic disorder who were initially treated successfully with daily fluoxetine. A once-weekly regimen may allow for considerable cost savings and may serve as a convenient alternative method for treating panic disorder.

Adult↗

PubMed2003

Acquired mutations in GATA1 in neonates with Down's syndrome with transient myeloid disorder.

Transient myeloid disorder is a unique self-regressing neoplasia specific to Down's syndrome. The transcription factor GATA1 is needed for normal growth and maturation of erythroid cells and megakaryocytes. Mutations in GATA1 have been reported in acute megakaryoblastic leukaemia in Down's syndrome. We aimed to investigate changes in GATA1 in patients with Down's syndrome and either transient myeloid disorder (n=10) or acute megakaryoblastic leukaemia (n=6). We recorded mutations eliminating exon 2 from GATA1 in all patients with transient myeloid disorder (age 0-24 days) and in all with acute megakaryoblastic leukaemia (age 14-38 months). The range of mutations did not differ between patients with each disorder. Patients with transient myeloid disorder with mutations in GATA1 can regress spontaneously to complete remission, and mutations do not necessarily predict later acute megakaryoblastic leukaemia.

Child, Preschool↗

PubMed1980

The effect of lactation on methylmercury intoxication.

Four days after parturition 17 weeks old rats of Porton Wistar strain were given 8 mg/kg mercury as methylmercury chloride for 5 days. Virgin females or mothers separated from their offspring immediately after delivery received the same treatment and served as controls. Compared with these controls, lactation delayed the onset of weight loss, shortened the time between the end of treatment and the onset of weight gain, accelerated the elimination of mercury from the whole body and prevented the development of severe co-ordination disorders. However, lactation had no detectable effect on the elimination of mercury from the brain. Moreover control and lactating females had the same degree of histological abnormalities both in the granular layer of the cerebellum and in the dorsal root ganglion cells.

Animals↗