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PubMed2006

Prevalence of youth-reported DSM-IV psychiatric disorders among African, European, and Mexican American adolescents.

OBJECTIVE: The authors present prevalence data for adolescents in a large metropolitan area and examine the association of DSM-IV diagnoses with functional impairment and selected demographic correlates among European Americans (EA), African Americans (AA), and Mexican (MA) Americans. METHOD: The authors sampled 4,175 youths ages 11 to 17 years whose households were enrolled in large health maintenance organizations. Data were collected using questionnaires, the Diagnostic Interview Schedule for Children-IV and the Children's Global Assessment Scale. The data were collected in the Houston Metropolitan area in 1998-2000. Data on psychiatric disorders were derived from interviews with youths only. RESULTS: AA had a lower prevalence of mood disorders, substance use disorders, and any disorders adjusted for Diagnostic Interview Schedule for Children-IV impairment or Children's Global Assessment Scale score than did others. EA had greatest prevalence of substance use disorders, whereas AA were lowest. After adjusting for covariates, EA had a higher risk for some disorders than AA. Effects of gender, age, parent education, family income, and marital status were not consistent across groups. Family income was protective only for EA. CONCLUSIONS: There appear to be few systematic differences between majority and minority adolescents at risk for psychiatric disorders. MA are not at increased risk contrasted to EA. AA had lower risk for some disorders, but adjusting for impairment and covariates eliminated most differences. Thus, multivariate analyses support the hypothesis that initial ethnic differences appear to be a function of factors associated with disadvantaged minority status rather than to distinctive ethnic culture. A noteworthy finding was that disadvantaged social status did not appear to increase the risk for disorders among minority youths.

Adolescent↗
PubMed1998

Kinetics of beneficial effect of pentoxifylline on persistent forms of arterial hypertension.

In some hypertensive patients a high level of arterial pressure proved resistant to the effect of Ca-antagonists. However, the addition of therapeutic doses of Pentoxifylline caused a significant decrease of blood pressure. The arterial pressure changes were found to be correlated with the index of erythrocyte aggregability (investigated using a highly sensitive "Georgian technique") in these patients. Thus, a pathogenetic link between blood pressure and hemorheological disorders could be conjectured. For a better understanding of the mechanism of these events the direct effect of Pentoxifylline on erythrocyte aggregability was investigated in vitro by using the blood samples of hypertensive patients possessing hemorheological disorders. The obtained results showed that the effect of Pentoxifylline (in therapeutic doses) was direct and that the dose-effect dependence was linear. From the obtained results we concluded that the beneficial effect of Pentoxifylline in hypertensive patients resistant to Ca-blockers is attained by eliminating the immediate cause of blood rheological disorders, the enhanced erythrocyte aggregability.

Aged↗
PubMed1994

Rapid cycling in severely multidisabled children: a form of bipolar affective disorder?

A debilitating, regularly recurring, biphasic disorder is described in 6 severely multidisabled children. It was characterized by several days of lethargy, withdrawal, loss of abilities, irritability, and hypersomnolence followed or preceded by a high-energy state for several days during which the children slept very little, at times were euphoric, had improved mental ability, and were hyperactive. These cyclic episodes had been present for years but unexpectedly disappeared in one child. The etiology is unknown, in spite of detailed neurologic, metabolic, and endocrine investigations. All patients had family histories positive for affective disorder. Melatonin treatment helped to regulate the coexisting chronic sleep disorders of 3 children but failed to eliminate the cycles. Antiepileptic drug treatment, lithium, sedatives, stimulants, tranquilizers, and light therapy were largely ineffective. The children's symptoms and signs fit the diagnostic criteria of a bipolar affective illness, as it was modified for patients with associated neurologic disability; therefore, the patients appeared to have a unique disorder that closely resembles or is a variant of rapid cycling affective disorder.

Adolescent↗
PubMed2000

[Lower urinary tract function and its disorders].

The lower urinary tract provides two modes of operation--storage and elimination of urine. The normal function results in the coordination of contraction and relaxation of muscles of the urinary bladder and urethral sphincters. Disorders of these activities or their interaction lead to the development of lower urinary tract dysfunctions. The nervous system plays an essential role in the regulation of the functions. The control of micturition is coordinated by several regious of the central nervous system. Afferents and efferents of the peripheral nervous system carry signals from and to the lower urinary tract. The reflex circuitry controlling micturition consists of five components: spinal efferent neurons, peripheral efferent neurons, primary afferent neurons, spinal interneurons and neurons in the brain. Preganglionic neurons located in the sacral parasympathetic nucleus and lumbar sympathetic nucleus excite the peripheral efferent neurons innervating smooth muscles of the urinary bladder and urethra. Motoneurons of sacral Onuf's nucleus excite the striated muscle of the external urethral sphincter. Myelinated and unmyelinated afferent axons transmit information from the lower urinary tract to the lumbosacral spinal cord. Three receptor types of the lower urinary tract are present: tension receptors, volume receptors and "silent receptors", which become nociceptors following the sensitization. Afferent pathways terminate on spinal interneurons. Spinal interneurons relay information to the brain or to other regions of the spinal cord. Because micturition reflexes are mediated by disynaptic or polysynaptic pathways, interneuronal mechanisms are of crucial importance in the regulation of lower urinary tract. Central pathways involved in micturition reflexes are located in spinal and supraspinal areas. Micturition reflexes can be modulated at the level of the spinal cord by viscero--bladder and somato--bladder reflexes. Supraspinal areas have a more complicated organization: critical component of the micturition reflex is the pontine micturition center and the periaqueductal gray. Inhibitory and excitatory areas in the pontomedullary and hypothalamic systems and the brain play an important role in the regulation of micturition reflexes.

Humans↗
PubMed1998

Occlusal adjustment and the incidence of demand for temporomandibular disorder treatment.

STATEMENT OF PROBLEM: Contrary to clinical opinion, the structural risk from dental occlusion in temporomandibular disorders has been questioned or considered to be insignificant in clinical practice. PURPOSE: This study tested the effect of elimination of occlusal interference through occlusal adjustment, on the incidence of temporomandibular disorders. MATERIAL AND METHODS: In a controlled clinical trial of 146 healthy children and adolescents, half of the subjects underwent occlusal adjustment aimed at elimination of the presumed structural risk, and the other half underwent mock adjustment. Adjustments were repeated every 6 months over a period of 4 years. The outcome variable was the incidence of temporomandibular disorders, operatively defined as request for treatment of symptoms characteristic of the disorders with presence of clinical signs demonstrated in the muscles of mastication and/or jaw joint. RESULTS: The cumulative incidence rate was 9/67 in the mock adjustment group and 1/60 in the real adjustment group, for a relative risk of 8.06. The difference between groups was statistically significant (p = 0.019). CONCLUSIONS: Elimination of the presumed structural risk from the dental occlusion appeared to significantly reduce the incidence of temporomandibular disorders in a select group of young subjects.

Adolescent↗
PubMed2003

Rituximab induces remission in refractory HCV associated cryoglobulinaemic vasculitis.

OBJECTIVES: To report the successful induction of remission with the monoclonal anti-CD20 antibody rituximab in a patient with hepatitis C virus (HCV) associated cryoglobulinaemic vasculitis and a non-Hodgkin's lymphoma (NHL) resistant to previously advocated conventional treatments. CASE REPORT: The patient was a 45 year old woman with HCV associated cryoglobulinaemic vasculitis, with purpura, arthralgia, constitutional symptoms, and a polyneuropathy. A malignant NHL was found as underlying lymphoproliferative disease. At this stage the disease was refractory to interferon alpha2b and ribavirin and to subsequent immunosuppressive treatment with cyclophosphamide. Six rituximab infusions targeting the CD20 antigen on cells of the B cell lineage induced remission of the vasculitis. Bone marrow biopsy disclosed absence of the NHL. Remission has subsequently been maintained and HCV eliminated with the new pegylated interferon alpha2b and ribavirin for nearly one year. CONCLUSIONS: Transition of the underlying "benign" lymphoproliferative disease to a malignant lymphoma may result in difficult to treat HCV associated cryoglobulinaemic vasculitis. Rituximab offers a new possibility for inducing remission in refractory HCV associated cryoglobulinaemic vasculitis and the lymphoproliferative disorder. After remission, HCV may subsequently be eliminated with pegylated interferon alpha2b and ribavirin.

Antibodies, Monoclonal↗
PubMed1993

Bilateral basal ganglia lesions: pediatric differential considerations.

Computed tomography (CT) and magnetic resonance (MR) imaging have dramatically improved the ability to visualize the deep gray structures of the basal ganglia (primarily, the caudate nucleus, putamen, and globus pallidus). Any process that alters cerebral metabolism can lead to basal ganglia damage. This article presents the spectrum of disease that may be seen with bilateral basal ganglia abnormalities in the pediatric population. A simplified approach to the differential diagnosis of these entities is based on acute versus chronic conditions and radiologic manifestations. Acute processes include hypoxia, hypoglycemia, carbon monoxide poisoning, hemolytic-uremic syndrome, osmotic myelinolysis, and encephalitis. Chronic conditions include inherited ("inborn errors of metabolism," Huntington disease, and dysmyelinating diseases) or acquired (sequelae of acute disorders) conditions that represent abnormal biochemical or structural processes within the basal ganglia. Elimination of acute causes gives little hope for improvement. Recognition of chronic disorders is important for counseling purposes, since most of these conditions have specific patterns of inheritance.

Acute Disease↗
PubMed2001

Systemic lupus erythematosus and B-cell hematologic neoplasm.

The association of systemic lupus erythematosus (SLE) and B-cell malignancy is widely reported in the literature. Here we report nine cases of concurrent of SLE or discoid lupus erythematosus (DLE) and lymphoma or plasma cell disorder. A MEDLINE search was done using the keywords, 'SLE' and 'lymphoma' and the characteristics of all identified cases were summarized and analyzed, along with data from our own cases. Numerous variants of B-cell malignancies were encountered in these patients. B-cell malignancy occurs after the diagnosis and treatment of SLE in most reported cases, although it may precede SLE, or occur synchronously with it. The age at onset of the B-cell neoplasm in SLE patients is similar to that in the general population. Mortality in patients with both diseases is associated with progressive B-cell neoplasm, sepsis secondary to either disease, or both. B-cell malignancy and SLE seem to run independent clinical courses rather than being affected by each other. The use of immunosuppressive drugs is common in patients with SLE diagnosed prior to B-cell lymphoma, arguing that the effect of immunosuppression on the pathogenesis of lymphoma can not be excluded. Three areas worthy of study regarding the probable mechanisms for the occurrence of SLE and B-cell malignancies are discussed. A tumor suppressor gene PTEN may link the two disorders via a defective apoptosis pathway to eliminate hyperactive B and T cells in SLE. The accumulation of clonally expanded hyperactive B-cells that recognize self-antigens in the lymph nodes of SLE may predispose these B-cells to DNA breaks, facilitating tumorigenesis. Lastly, EBV infection, found to have a high prevalence in SLE patients, may serve as a common etiological factor in both disorders.

Adult↗
PubMed2003

[Conformational diseases].

Conformational diseases are diseases where cellular functions are compromised because of misfolded proteins. The conceptional framework of conformational diseases is found in the cellular protein quality control systems which in the normal and young cell eliminate misfolded proteins. Many inherited genetic defects result in the misfolding of proteins, which may lead to recessive disorders if the proteins in question are totally or partly eliminated or to dominant diseases if the proteins slip through the protein quality control and accumulate in the cell. These inherited diseases are all early onset. Misfolding may also occur in proteins with an intrinsic ability to aggregate and in oxidatively damaged proteins, which accumulate by ageing. If the protein quality control systems are not sufficiently efficient cell toxic protein complexes may accumulate. This pathogenesis is a major contributing factor in the development of late onset neurodegenerative disorders.

Cardiomyopathies↗
PubMed2006

Role of complement in neurodegeneration and neuroinflammation.

The complement system provides an innate defence mechanism against pathogenic microorganisms. Although viewed for many years as an immune-privileged organ, the central nervous system contains many components of the immune system, including components of the complement system that are synthesized by astrocytes, microglia, and neurons. During the past two decades, a wide range of inflammatory markers, typically absent in the normal elderly population, have been reported in Alzheimer's disease brains. It is becoming evident that sustained brain inflammation might be an essential cofactor in Alzheimer disease and other neurodegenerative disorders such as Parkinson disease, dementia with Lewy bodies, Huntington's and prion diseases. The complement system may be useful in eliminating aggregated and toxic proteins associated with these neurological disorders and thus have a protective effect. However, an exaggerated or insufficient activation of the complement system can have deleterious effect through the activation of microglia, secretion of many proinflammatory cytokines, and generation of oxidative products. The role of complement-mediated inflammation in Alzheimer disease has drawn greater attention recently in view of new therapeutic advances made in the management of the disease. This review is meant to update the role of complement in Alzheimer's disease and other neurodegenerative disorders in view of recent vaccination and immunotherapeutic approaches.

Animals↗
PubMed2003

Topiramate in the treatment of severe bulimia nervosa with comorbid mood disorders: a case series.

OBJECTIVE: To report observations on the efficacy and tolerability of topiramate in a sample of five patients with severe symptoms of bulimia nervosa and comorbid mood and/or anxiety disorders. METHOD: Topiramate was added to other psychotropic medication under open-label conditions up to the maximum tolerated dose or until remission of the eating disorder was achieved. RESULTS: Topiramate almost completely eliminated binging and purging behavior in three of the five patients. Improvement was maintained throughout the period of follow-up for up to 18 months. One patient showed a partial, temporary response, and the fifth was intolerant of the drug and unable to complete an adequate trial. DISCUSSION: These results suggest strongly that the efficacy of topiramate in patients with bulimia nervosa with and without comorbid mood and anxiety disorders should be investigated more fully.

Adult↗
PubMed1990

Problems in the treatment of premenstrual syndrome.

Three categories of treatments for premenstrual syndrome (PMS) have been proposed: those designed to correct the cause of the disorder; those designed for symptom relief; and those aimed at eliminating the menstrual cycle. Many of these recommendations are based on poor research with loose definitions of the disorder and uncontrolled open trials. This paper reviews the literature on treatment methods with emphasis on recent random, placebo controlled, double-blind studies. The most effective current management of PMS is a conservative one including accurate diagnosis, stress control, sensible levels of diet and exercise and perhaps the use of alprazolam in the premenstrual period. Other approaches such as the use of mefenamic acid and evening oil of primrose remain unproven. Progesterone has been proven uneffective. Further research is required into the value of antidepressant medication.

Alprazolam↗
PubMed1989

[The sleep apnea syndrome in children].

The authors give an account of the causes of the sleep apnea syndrome in children (SAS). SAS, unless eliminated in time, may cause serious functional and organic disorders in the cardiopulmonary and central nervous system due to repeatedly occurring hypoxia for prolonged periods. The authors discuss therapeutic methods used for elimination of airway obstruction from which the children suffer during sleep. The authors' solution of SAS is a simple apparatus (registered as an invention), inserted into the child's mouth through which the child breathes during sleep.

Child↗
PubMed2003

Cognitive-behavioral therapy for panic disorder: a review of treatment elements, strategies, and outcomes.

This article provides an overview of cognitive-behavioral therapy (CBT) for panic disorder. CBT is currently considered a first-line treatment for panic disorder. It offers benefit after short-term intervention, typically consisting of 12-15 sessions conducted in either an individual or a group format. The treatment focuses on the elimination of the patterns that underlie and perpetuate the disorder. Through CBT, patients learn about the nature of the disorder and acquire a set of strategies that counter the fears of panic attacks themselves, and break the recurring cycle of anticipatory anxiety, panic, and agoraphobic avoidance. The collaborative format of treatment, and a focus on elimination of core fears may be factors in enhancing longer-term outcome. In this article, we review the efficacy of CBT as a first-line treatment, a strategy for medication nonresponders, a replacement strategy for patients who wish to discontinue pharmacotherapy, and a potential preventive strategy for at-risk individuals. We also discuss some of the complex issues involved with combination-treatment strategies.

Cognitive Behavioral Therapy↗
PubMed1989

[Voice therapy according to Smith. Comments on the accent method of treating voice and speech disorders].

The accent method (A.M.) is based on the myoelastic and aerodynamic phonatory theory. The aim of the respiration exercises is to establish a predominantly abdominal respiration. Following the exercises of accentuated phonatory pulsations, patients work on reading special texts designed to enable them to become aware of the accentuated or unaccentuated sections. The AM is based on a holistic understanding of the voice and of speech. Whilst the exercise of AM is linked to a physiological phenomenon, such as phonatory aerodynamics and muscular function, the method is to be understood as a therapy aimed at producing an overall change in the behaviour related to oral communication disorders. The aim is not so much to eliminate a given particular defect, but rather to condition a subconscious automatism.

Humans↗
PubMed2004

Identifying and treating panic disorder in primary care.

Many individuals who experience a panic attack at some point in their lives will meet criteria for panic disorder. However, although most primary care physicians recognize broad-spectrum mood and anxiety disorders, they may not make a specific diagnosis such as major depressive disorder or panic disorder. Comorbid panic disorder and other anxiety conditions are a well-established phenomenon in depressive disorders and can have a negative impact on treatment and worsen prognosis. This negative impact underscores the importance of specifically identifying these disorders and their comorbidities. Although an analysis of other potential causes of presenting symptoms is at times indicated, diagnosis should be made positively by identifying the symptoms diagnostic of the anxiety conditions rather than negatively by eliminating other conditions. Treatment of patients with panic disorder can improve quality of life and productivity as well as reduce health care costs. Pharmacotherapy, cognitive-behavioral therapy, and collaborative relationships with patients and psychiatrists can all aid primary care physicians in providing acute and long-term treatment for patients with panic as well as other mood and anxiety disorders.

Humans↗
PubMed1982

[Changes in heart rhythm and conduction during surgical treatment of ischemic heart disease].

The effect of coronary flow recovery and/or aneurism resection on the pattern of conductivity disorders was examined in 76, and that of excitability disorders, in 35 patients. Aortal-coronary shunting eliminated ventricular extrasystole in 13 of 17 patients, normalized conductive function in all 12 patients with transitory block of the His bundle's anterior left branch, while their general clinical condition improved. Functional conductivity and excitability disorders due to scarry myocardial changes persisted in spite of revascularization procedure. Following aneurism resection, cardiac rhythm returned to normal in 5 of the 7 patients with ventricular extrasystole, while in 2 patients with paroxysmal atrial fibrillation paroxysms disappeared, a fact attributable to the removal of ectopic excitement focus and improved intracardiac hemodynamics. In all cases, conductivity and excitability improvement and normalization occurred during the early postoperative period and were maintained for long terms (up to ten years).

Adult↗