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PubMed2002

[Clinical randomized double-blinded study on treatment of vascular dementia by jiannao yizhi granule].

OBJECTIVE: To observe the effect of Chinese herbal medicine in treating vascular dementia (VD) and to explore the method for therapeutic effect evaluation. METHODS: Multi-center, double-blinded randomize-controlled method was adopted to observe the effect of treatment of 242 patients with VD of mild or middle degree, they were 89 cases in the TCM group, 106 cases in the western medicine group and 47 in the placebo group. Minimental state examination (MMSE), Blessed dementia scoring on TCM symptom classified evaluation were used to evaluate the therapeutic effect after 60 days treatment. RESULTS: The total effective rate of Jiannao Yizhi Granule was 58.4%, showing a better effect than that of the placebo group and the western medicine group respectively. The treatment was superior in holistic regulation and systemic functional state improvement, it could not only improve the mild middle key symptoms of VD and the mental disorder induced reduction of functional activities, but also alleviate or eliminate the peripheral symptoms of VD. CONCLUSION: The effect of treatment of vascular dementia by Jiannao Yizhi Granule is certain and is worth spreading.

Aged↗

PubMed2003

[Prophylaxis and treatment of serotonin insufficiency in surgical patients].

The authors demonstrate that appearance in blood of chemical substances (ligands) capable to bind with serotonin receptors of smooth muscles (SM) leads to serotonin insufficiency. Intravenous injection of serotonin adipinat corrects serotonin insufficiency (biochemical stage) which leads to restoration of disordered function of SM (pharmacological stage). Normal function of SM eliminates functional intestinal obstruction (from the first hours after surgery), vascular insufficiency, tissues hypoxia (clinical stage) in surgical patients with different diseases. Serotonin adipinat was used in more than 900 surgical patients. It is concluded that this drug is a necessary component of prophylaxis and treatment of functional intestinal obstruction, vascular insufficiency, local and regional tissues hypoxia.

Adipates↗

PubMed1990

Modification of thrombogenic factors in cardiac disease.

Thrombosis plays an important role in the development and course of most disorders affecting the heart. No effective methods are available to eliminate the thrombogenic stimulus for those conditions requiring the use of antithrombotic agents for prophylaxis or to arrest a thrombotic event. Available platelet and coagulation inhibitors are effective when properly selected and administered.

Coronary Disease↗

PubMed1989

Giant prosthetic reinforcement of the visceral sac.

One hundred and seventy-nine patients with 237 hernias of the groin who were at high risk for recurrence after classic hernioplasty were operated upon; the procedure of giant prosthetic reinforcement of the visceral sac (GPRVS) was used. The patients in this series had predominantly recurrent and re-recurrent hernias. However, a few were obese with bilateral primary direct hernias and some had associated connective tissue disorders, such as Marfan and Ehlers-Danlos syndromes. GPRVS eliminates hernias of the groin by rendering the peritoneum inextensible by placing, in the preperitoneal space, a large prosthesis that extends far beyond the borders of the myopectineal orifice. The myopectineal orifice is the weak spot at which all hernias of the groin begin and is bounded by the rectus, oblique abdominal and iliopsoas muscles and the pectin of the pubis. In bilateral GPRVS, the peritoneum of both groins is reinforced with a single prosthesis inserted in the preperitoneal space through the midline. In unilateral GPRVS, the mesh envelops the peritoneum of a single groin. This simplifies the operation and makes it suitable for surgical centers that perform outpatient operations. The prosthesis with the best physical characteristics for GPRVS is Mersilene (polyester fiber). Unsutured prostheses of polypropylene and Teflon (polytetrafluoroethylene) may not adhere at the far edges, leading to a failure and recurrence. The over-all recurrence rate in this series of problem hernias was 3.7 per cent, which is extremely good. However, the rate becomes outstanding if recurrences resulting from meshes unsuitable for GPRVS are excluded.

Hernia, Inguinal↗

PubMed1986

[Pulmonary hypertension from the viewpoint of the pediatric pulmonologist].

The main cause of secondary pulmonary hypertension in the view of a pulmonologist is alveolar hypoventilation - eventually potentiated by acidosis and hypercapnia - which leads to reflectory hypoxemic vasoconstriction of the small pulmonary arteries. Anatomic changes in the pulmonary vessels may be absent or may be limited to medial hypertrophy of the arterioles. If the underlying cause of the hypoxia can be corrected, this reflectory pulmonary hypertension is reversible. In diffuse progressive lung disease, interstitial fibrosis with destruction of the alveolar wall and capillaries may occur, leading to restriction of the pulmonary vascular bed. In such cases pulmonary hypertension may not be completely reversible. The most frequent causes of pulmonary hypertension in childhood are obstructive (e.g. Cystic Fibrosis) or restrictive lung diseases (e.g. interstitial fibrosis). Rare but important in the differential diagnosis are upper airway obstruction, thoracic cage deformity, neuromuscular disorders, high altitude and respiratory center dysfunction. The therapy is elimination of the underlying disease or optimal treatment. In addition prophylactic or therapeutic longterm application of oxygen is more efficient than treatment with pulmonary vasodilators or modern substances like Almitrine. Right heart decompensation should be treated by diuretics. The longterm prognosis is dependent of the underlying disease and is poor in a chronic progressive lung disease like cystic fibrosis and certain types of lung fibrosis.

Airway Resistance↗

PubMedDate not supplied

["Qualitative test of fecal fat" and "steatocrit", simple complementary methods for the evaluation of steatorrhea in childhood].

The evaluation of fecal fat elimination (steatorrhoea) is of primary importance for diagnosis of gastroenterological disorders. In childhood it is quite difficult to apply the ordinary methods of evaluation, on the other hand it is necessary to make use of them to screen and diagnose maldigestion and/or malabsorption syndromes. In this work "Steatocrit" method by Phuapradit and "Fecal fat qualitative test" (FFQT) on glass, by Jacobson, have been used in a parallel study on stool samples from subjects with suspected gastrointestinal disease. While Steatocrit was determined on 200 samples, FFQT was determined on 1574 samples. Our data show that steatocrit is fully able to detect quantitative steatorrhoea with high significance when compared to controls. Likewise FFQT shows a sensibility of 100% compared to controls and it is able to predict coeliac disease and cystic fibrosis in 85.5% of cases and in 89.9% of cases respectively. We conclude that these two tests are sure and auxiliary each other. They allow, when performed on the same sample, to go toward diagnosis of both malabsorption and maldigestion, furthermore they allow to monitor steatorrhoea under therapy.

Adolescent↗

PubMed1994

[What is the place of conventional radiology in the exploration of esophageal dyskinesia and hiatal hernia?].

Esophageal dyskinesias are due to various aetiologies and sometimes present with marked clinical symptoms. The barium swallow remains the preferred first-line examination. Upper GI endoscopy and manometry are useful to confirm the functional nature and eliminate any concomitant or secondary mucosal lesions of these motor disorders. The clinical signs of hiatus hernia are essentially due to complications related to gastro-esophageal reflux. They can be asymptomatic or may present in the form of atypical, sometimes extra-gastrointestinal, symptoms. Although conventional radiology allows the diagnosis of hiatus hernia by specifying the type, the morphology and the anatomical relations, it may fail to detect the consequences of gastro-esophageal reflux, especially ulcerated lesions. Upper gastrointestinal endoscopy appears to be the first-line examination of choice for the diagnosis of hiatus hernia. Barium swallow is useful in cases of failure of endoscopy and in the context of preoperative assessment, as these two investigations are often complementary.

Esophageal Achalasia↗

PubMedDate not supplied

[Systemic diseases and infections: current questions].

Infections are a major cause of morbidity and mortality in patients with connective tissue diseases. Infectious consequences are caused by systemic disorders by themselves and the immunosuppressive treatments. Systemic lupus erythematosus and Wegener's granulomatosis are associated with the higher risk of infection. Primary prophylaxis of Pneumocystis carinii pneumonia has to be systematically given in patients with Wegener's granulomatosis and in other patients with connective tissue diseases if their CD4-cell count is lower than 200/mm3. Intensitification of immunosuppression during the course of systemic disorders can not be performed before any infection has been eliminated.

Connective Tissue Diseases↗

PubMed1996

Psychiatric diagnoses in patients with fibromyalgia are related to health care-seeking behavior rather than to illness.

OBJECTIVE: To compare the frequency of lifetime psychiatric disorders among 3 groups of subjects: patients with fibromyalgia syndrome (FMS) from a tertiary care setting, community residents with FMS who had not sought medical care for their FMS symptoms ("FMS nonpatients"), and healthy controls. METHODS: We used the Computerized Diagnostic Interview Schedule to assess lifetime psychiatric diagnoses, as well as the Center for Epidemiological Studies Depression scale and the Trait Anxiety Inventory to assess current psychological distress, among 64 patients with FMS, 28 FMS nonpatients, and 23 healthy individuals. RESULTS: Patients with FMS, relative to FMS nonpatients and healthy controls, were characterized by a significantly greater number of lifetime psychiatric diagnoses (P = 0.002). Nonpatients did not differ from controls in psychiatric diagnoses. Patients also exhibited higher psychological distress levels than nonpatients, and nonpatients showed greater distress than controls. Differences in psychological distress between patients and nonpatients were eliminated after controlling for pain threshold and fatigue ratings. CONCLUSION: Psychiatric disorders are not intrinsically related to the FMS syndrome. Instead, multiple lifetime psychiatric diagnoses may contribute to the decision to seek medical care for FMS in tertiary care settings.

Adolescent↗

PubMed1994

Coverage of mental health and substance abuse services under a single-payer health care system.

Health care reform proposals based on a single-payer system of health care insurance were introduced in the U.S. Congress in 1992 and 1993 but were superseded by the Clinton Administration's health care reform proposal, which was based on managed competition. In a single-payer system, the government collects all health care funding and pays private- and public-sector providers; similar providers are paid the same rate. Other features include consumer choice of providers, distribution of risk of high utilization over the entire nation, and control of health care expenses via an annual national health care budget. Such proposals cover outpatient, inpatient, and long-term care and case management services for mental illness and substance abuse disorders, call for periodic utilization review of continuing mental health care, and eliminate the distinction between public and private services based on limits of coverage. The last provision particularly affects severely or chronically mentally ill persons who are likely to exhaust their private insurance coverage.

Health Care Reform↗

PubMed1986

The determination of essential clearance, volume, and residence time parameters of recirculating metabolic systems: the reversible metabolism of methylprednisolone and methylprednisone in rabbits.

Methods based on moment analysis are described which permit the calculation of the fundamental parameters of reversible drug/metabolite systems. These parameters include the four essential clearances of reversible and irreversible elimination, the central and steady-state distributional volumes, and the sojourn times or turnover rates of the metabolic pair. Additional parameters unique to interconversion systems are developed which describe the properties of metabolic entrapment ("recycled fraction"), conservation ("exposure enhancement"), and equilibrium resulting from reversible metabolism ("Percent parent drug at steady-state"). Parameters obtained by these methods are compared to those generated by conventional mammillary analysis. The influence of perturbation of essential parameters on the response of mammillary descriptors and the state of the interconversion system are simulated. The interconversion analysis is applied to disposition data for methylprednisolone and methylprednisone in the rabbit. Mammillary methods underestimate the metabolic clearance of these two steroids by 30%, while steroid turnover is underestimated by 100%. The steady-state volumes of distribution of the two steroids are overestimated by 10 and 61%. Additional literature data for disposition of several corticosteroids in various species and disease states are reanalyzed. Examination of cortisol/cortisone disposition in thyroid disorders reveals that mammillary methods detect the overall acceleration of steroid elimination in hyperthyroidism, but fail to reveal a 50% reduction in metabolite backconversion and decreased metabolic cycling. These moment analysis methods should facilitate characterization of the pharmacokinetics of the increasing array of reversible drug/metabolite systems.

Animals↗

PubMed1988

Necrobiotic xanthogranuloma: a case without paraproteinemia but with transepithelial elimination.

We report a female patient, now aged 60, followed for 20 years for lesions originally diagnosed as necrobiosis lipoidica diabeticorum. In fact, the anatomical and clinical features of her disorder correspond to the new entity described as necrobiotic xanthogranuloma. Two elements distinguish this from earlier cases: 1) two examinations failed to reveal paraproteinemia; 2) there was transepithelial elimination of cholesterol crystals and degenerated xanthomatous cell debris via hair follicles. This demonstrates the characteristic histology of the disorder and indicates that the diagnosis of necrobiotic xanthogranuloma should be considered even in the absence of paraproteinemia.

Cholesterol↗

PubMed2005

Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests.

BACKGROUND: Eosinophilic esophagitis (EE) is a recently described disorder identified in patients with symptoms suggestive of gastroesophageal reflux disease (GERD) but unresponsive to conventional reflux therapies. Therapies have included corticosteroids, elemental diet, and diet restriction. We report our experience with skin prick and atopy patch testing and food elimination diets in patients diagnosed as having EE. OBJECTIVE: To identify food antigens that cause EE and the characteristics of patients who respond to food elimination vs those who are unresponsive. METHODS: Patients diagnosed as having EE had restricted diets based on skin prick and atopy patch testing results. Additional biopsies were performed after 4 to 8 weeks of restricted diet. Demographics, atopic tendencies, and food antigens were identified retrospectively in our food allergy database. RESULTS: A total of 146 patients diagnosed as having EE were evaluated with skin prick and atopy patch testing. Thirty-nine patients had unequivocal demonstration of food causing EE, with normalization of biopsy results on elimination and reoccurrence on reintroduction. An additional 73 patients, for a total 112 (77%) of 146 patients, had resolution of their EE as demonstrated by biopsy results. Fifteen (10%) of 146 patients were nonresponders manifested by no significant reduction in esophageal eosinophils despite restricted diet based on skin prick and atopy patch testing. Egg, milk, and soy were identified most frequently with skin prick testing, whereas corn, soy, and wheat were identified most frequently with atopy patch testing. CONCLUSION: In more than 75% of patients with EE, both symptoms and esophageal inflammation can be significantly improved with dietary elimination of foods. Skin prick and atopy patch testing can help identify foods in most patients.

Adolescent↗

PubMedDate not supplied

[The rehabilitation of participants in the cleanup of the sequelae of the accident at the Chernobyl Atomic Electric Power Station with borderline mental disorders].

Among ecological disasters the aftermath of the accident at the Chernobyl NPP present an undoubted chronic anthropogenic stress situation. Psychological stress is manifested by somatic, predominantly vasovegetative disorders, as well as by pre-nosological and clinical forms of mental disorders. Phasing and reconstructive principle forms a basis for the organizational and structural activity of specialized psychoneurological institutions dealing with rehabilitation and readaptation of the participants in the elimination of the ChNPP accident aftereffects.

Borderline Personality Disorder↗

PubMed1990

A disorder of axonal development, necrotizing myopathy, cardiomyopathy, and cataracts: a new familial disease.

We report severe congenital encephalopathy and profound hypotonia associated with necrotizing myopathy, cardiomyopathy, and cataracts in 3 infants, including 2 sisters. Brain scans suggested agenesis of the corpus callosum. Neuropathological findings consisted of severe atrophy of the corpus callosum (not the usual agenesis with longitudinal callosal bundles), atrophy of the white matter, and absence of pyramidal tracts in the medulla. Multiple axonal swellings were present in the white matter and in Purkinje cells. Except for the corpus subthalamicum, gray matter structures were preserved. These findings are considered to be the expression of a primary disorder of axonal development leading to a reduction in interneuronal synaptic contacts. It is suggested that the anomaly may be due to an extension of the normal phenomenon of axonal elimination, related to a primary defect of the axonal cytoskeleton. The concept of a primary axonal disorder may also apply to other, mostly familial, conditions with progressive atrophy of the cerebral white matter and corpus callosum.

Atrophy↗

PubMed2001

Differences between adolescents and young adults at presentation to an eating disorders program.

OBJECTIVE: To describe differences between adolescents and adults in clinical presentation of eating disorders. METHODS: Data from the charts of 622 female patients treated for an eating disorder in a division of adolescent medicine between 1980 and 1994 were coded and computerized. General categories included demographic and family factors, weight loss and weight changes, eating-related behaviors, diagnosis and severity, and treatment issues. Differences between the 438 patients who were aged 9-19 years (adolescents) and 184 patients who were aged 20-46 years (adults) were analyzed. RESULTS: Adolescents were more likely than adults (p <.05) to have a diagnosis of "eating disorder not otherwise specified," lower global severity score, greater denial and less desire for help, weight loss > or = 3 lb/month, lower original and maximum weights, and history of fasting and elimination of junk food from their diets. Adults were more likely than adolescents (p <.05) to have >1 year of weight loss, greater total weight loss, history of binge eating and laxative use, history of diuretic and ipecac use, diagnosis of bulimia nervosa, and prior use of psychiatric medications. Adolescents and adults did not differ (p >.05) in parents' occupational level; height, weight, and percent ideal body weight at presentation; original percent ideal body weight; use of diet pills, elimination of meat and use of a low-fat diet; daily calorie intake; prior eating disorder hospitalizations; and hospitalization during the course of treatment. CONCLUSIONS: The findings in this study document and confirm that there are important differences between adolescents and adults that must be taken into account in the evaluation and treatment of patients with eating disorders.

Adolescent↗

PubMed2003

Serum tryptophan ratio and suicidal behavior in adolescents: a prospective study.

A lower ratio of tryptophan to other amino acids in serum (tryptophan ratio), established as an index of serotonin precursor available to the brain, has been shown to be associated with increased suicidal behavior in cross-sectional studies. The purpose of this study was to conduct the first prospective examination of the utility of the tryptophan ratio along with clinical variables in predicting suicidal behavior in high-risk and reference adolescents. Adolescents with alcohol use disorders (AUDs) and prior suicidal attempts (n=20), adolescents with AUDs without suicide attempts (n=20), and community controls with neither of these characteristics (n=20) were matched on demographic variables. These groups were not significantly different on the tryptophan ratio at baseline. Of 56 subjects who completed follow-up assessments, six had suicidal behavior in the follow-up period. The tryptophan ratio, along with demographic and clinical variables, was examined using Cox regression with a backward stepwise variable elimination procedure. In the final model, the tryptophan ratio and major depressive disorder both significantly contributed to the prediction of suicidal behavior. This finding suggests that the tryptophan ratio may improve the identification of adolescents at high risk for suicidal behavior.

Adolescent↗

PubMed1989

Athletic amenorrhoea. An update on aetiology, complications and management.

The enormous increase in participation by women in physical recreation and sport since the early 1970s, has seen a parallel increase in research into the effects of strenuous exercise on the female neuroendocrine and reproductive systems. Oligomenorrhoea, primary or secondary amenorrhoea, altered pubertal progression, defective luteal phase, anovulation, and infertility may result, most frequently in those aerobic type activities associated with the lower bodyweight and fat percentages such as running, aerobics, and gymnastics. As well as body composition and sport specificity, intensity of training, previous menstrual history (in particular delayed menarche) and diet/eating disorders are all important associated factors. The neuroendocrinological pathogenesis to this altered menstrual function is complex and controversial; however, the evidence for accelerated bone loss in these young women with chronic hypo-oestrogenaemia is substantial. Since the first studies released in 1982 when amenorrhoeic runners' bone mineral content was measured and found equivalent to that predicted normal for 52-year-old women, further studies have proposed an association between this hypo-oestrogenaemia, reduced bone density and stress fractures. Studies so far show that this bone loss continues to occur over time, but the most rapid rate of bone loss (approximately 4%/year) occurs early on cessation of menses, thus emphasising the importance of early management in preventing bone loss occurring in young amenorrhoeic athletes. The role of calcium and oestrogen supplementation in management of the hypo-oestrogenic exercising female are unclear. The results of longitudinal studies currently under way assessing their benefits are awaited. Meanwhile an increased calcium intake to 1500mg per day should be advised and consideration of oestrogen and/or progesterone supplementation given. It is important that other causes of amenorrhoea are not overlooked in this exercising population and the diagnosis of 'athletic amenorrhoea' should not be made until a full thorough history, physical examination and blood tests have eliminated other common causes. Full dietary history and assessment for eating disorders is an essential part of this assessment.

Amenorrhea↗