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PubMed2006

Psychiatric comorbidity in Korean children and adolescents with attention-deficit hyperactivity disorder: psychopathology according to subtype.

It is well-known that more than 50% of attention-deficit hyperactivity disorder (ADHD) cases also have comorbid psychiatric disorders. We evaluated the comorbid psychopathology of Korean children and adolescents with ADHD using a standardized diagnostic instrument. The Korean Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL-K) was administered and completed in 105 patients who had been referred to the outpatient and inpatient clinics at the Samsung Medical Center from March 2004 to May 2005. All of the cases were diagnosed as ADHD according to DSM-IV criteria. We analyzed their clinical characteristics and psychiatric comorbidities, and assessed the correlation of any comorbidity with gender, age and ADHD subtype. Among our 105 participants, 70 (66.7%) subjects were diagnosed with combined-type ADHD, 22 (21.0%) were the predominantly inattentive type, only 1 (1.0%) was determined to have the predominantly hyperactive-impulsive type of ADHD, and 12 (11.4%) were classified as not otherwise specified (NOS) ADHD. Eighty (76.2%) subjects had at least one comorbid disorder such as oppositional defiant disorder (n = 53, 50.5%), anxiety disorders (n = 35, 33.3%) and affective disorders (n = 15, 14.3%). Our patients ranged in age from five to 16 years. Among the factors including gender, age, and ADHD subtype, ADHD subtype was the only one significant to comorbidity in our study. The results of this study suggest that psychiatric comorbidity in Korean children with ADHD is similar to the results of previous studies in western countries. Out of all the ADHD subtypes, the combined-type group had a significantly higher ratio of comorbid disorders and psychopathologies.

Adolescent↗

PubMed2006

Diagnosing major depressive disorder III: can some symptoms be eliminated from the diagnostic criteria?

All criteria used to diagnose a psychiatric disorder should contribute to distinguishing cases from noncases. The principal of parsimony argues for defining a disorder with as few criteria as possible. Thus, criteria that do not contribute to the case-noncase distinction should be eliminated from the list of defining features because they unnecessarily increase the complexity of the definition of the disorder. In polythetically defined disorders such as major depressive disorder (MDD), diagnosis is based on the presence of a minimum number of features from a list. For a criterion to be retained on such a list, it should contribute to distinguishing between individuals with and without MDD. Simply demonstrating that a criterion is significantly more common in individuals with MDD than individuals without MDD is not a sufficient demonstration of its necessity. Rather, to demonstrate an impact on diagnosis, it should be shown that eliminating the criterion from the list results in individuals being reclassified from a case to a noncase. A criterion does not contribute to determining caseness if its elimination does not result in diagnostic reclassification. The goal of this report from the Rhode Island Hospital Methods to Improve Diagnostic Assessment and Services project was to determine if any of the criteria of MDD are candidates for elimination because of their lack of impact on diagnosis. The results indicated that the symptoms of increased weight, decreased weight, and indecisiveness rarely influenced diagnostic classification and thus are candidates for elimination.

Affective Symptoms↗

PubMed1999

[Correction of kyphosis in tuberculous spondylitis in children].

Various modifications of radical reparative surgery were made in 145 children with tuberculous spondylitis were comparatively analyzed. Greatest correction of kyphosis was achieved by combining anterior spinal repair with posterior plunged contractors, in additional resection of the apical vertebral arch in particular. There is a direct correlation between the degree of compression of the dural sac and the severity of neurological disorders. Anterior decompression of the spinal cord is an obligatory surgical component in tuberculous spondylitis, eliminates central stenosis of the spinal canal; however, it is insufficient to eliminate neurological disorders caused by myelic ischemia.

Adolescent↗

PubMed2002

[Systematic review of randomised controlled trial of iodised salt for preventing iodine deficiency disorders].

OBJECTIVE: To assess the effect of iodised salt for preventing iodine deficiency disorders. METHOD: Cochrane systematic review. RESULTS: Four randomised controlled trials were included. Subgroup analysis performed lay on different ages, interventions and controls. Prevalence of goitre was reduced close to 5% when using distributed iodised salt and market iodised salt plus iodine oil capsule which showed more effective than using market iodised salt alone (OR = 0.10, 95% CI: 0.02 - 0.17). The latter's prevalence of goitre was 14.7%. When using market iodised salt, the iodine urea excretion level showed different results in children group in different countries. Basically, the market iodised salt for preventing iodine deficiency of pregnancy women were effective, but a part of them did not achieve to the ideal status of iodine nutrition. CONCLUSIONS: The needs to be strictly controlled quality of iodised salt and market iodised salt plus iodised oil capsule thus can effectively reduce the prevalence of iodine deficiency disorders. However there was not enough evidence to support that market iodised salt can effectively eliminate these disorders, particularly in children. More eligibility trials are needed for providing more evidences.

Adult↗

PubMed1980

[Treatment of sleep disorders in the elderly].

The physiological and pathophysiological peculiarities of the aging organism require to be observed in the treatment of sleep disorders. After eliminating extracerebral causes one has to consider changes of cerebral blood flow as a reason for impaired sleep, for instance resulting from cardial insufficiency or pathological changes of blood pressure. In using sleeping drugs one should keep in mind type and severeness of the sleep disorders and prescribe with care, since the elimination potential in the aged is mostly reduced and the quote of side effects is increased.

Aged↗

PubMed1985

[Role of disorders of the hemostatic system in the pathogenesis of multiple sclerosis and ways of correcting them].

The changes in the hemostatic system were studied in 77 patients with different patterns of disseminated sclerosis (DS). The studies demonstrated activation of both vasculothrombocytic and coagulation components of hemostasis as well as of fibrinolytic blood properties. The latent course of the disseminated intravascular coagulation was revealed in 20.7% of cases. The role of hemostatic disorders in the pathogenetic mechanisms of DS is discussed. The patients with DS received pathogenetic treatment including drugs eliminating hemostatic disorders, which was beneficial for most patients.

Adult↗

PubMed2000

Neurofilaments in health and disease.

With dendritic neurofilaments (NFs) and NF reassembly experiments, the phosphorylation of NF-H was found related to development of crossbridges, resulting in alignment of core filaments. When treated with aluminum chloride, rabbits died acutely with tetanic spasm in which NFs were accumulated in neuronal perikarya and proximal axons. Compared with axonal NFs, the NFs accumulated in the perikarya were composed of less-developed cross-bridges and more irregularly aligned core filaments, and their NF-H, although it became phosphorylated, was less phosphorylated. Transgenic mice expressing NF-H-beta-galactosidase protein also showed NF accumulation in the perikarya, which was similar in organization and NF-H phosphorylation to that in aluminum-treated rabbits, but NFs were almost absent from the axonal compartment in these mice that did not show any overt phenotype. Jimpy mutant mice, with dysmyelinated axons and a short lifespan, showed a significant increase in NF density in the axonal compartment. NF-H and its mRNA were drastically enhanced in expression in these mice, whereas enhancement in expression of NF-L and its mRNA was slight. Most increased NF-H, and probably NF-M also, in the axons was of the nonphosphrylated form. NFs that increased in the axons were also constructed of irregularly organized core filaments linked with fewer crossbridges. Another dysmyelinating mutant type of mice, shiverer mice, also showed similar morphological, immunocytochemical, and behavioral characteristics. Taken together, axonal NF accumulation rather than that in the perikarya must be toxic for neurons to provoke axonal degeneration, possibly resulting in reduction of lifespan. In other transgenic mice, however, the elimination of NFs from the axonal compartment seems to make the neuron vulnerable. Nevertheless, because overexpression of NF-H displayed severe neurological disorder while elimination of this protein appeared to be more resistant to some neurotoxic agent, NF-H appears to function as an exacerbation factor when it exists in the neurologically disordered condition. However, as NF-H is provided with a unique carboxy-terminal tail domain that is highly phosphorylated in the axon and because disruption of its gene affected the survival of axons, which did not develop normal axonal caliber, NF-H should play an important role in healthy neurons.

Aluminum↗

PubMed1990

Anxiety and depression in a community sample: the influence of comorbidity on social functioning.

The main aim of the present study was to examine whether the well-established association between depression and social dysfunction still remains when effects of a coexistent anxiety disorder are eliminated from the data. As these effects strongly depend on the proportion of depressed subjects suffering simultaneously from an anxiety disorder, we first examined the frequency of mixed and pure depressive disorders and that of pure anxiety disorders (control subjects) in a community sample (n = 483). Using DIS/DSM-III criteria (reference period 6 months), pure anxiety disorders were most frequent (6%), followed by pure depressive disorders (3%) and the coexistence of anxiety and depression (2%). Cases suffering from both disorders were most severely afflicted in terms of psychopathology (persistence of symptoms, comorbidity regarding other mental disorders). At the diagnostic level, the association between depression and social dysfunction was only slightly influenced by effects resulting from comorbidity; at the level of actual symptoms, however, we found that cases suffering simultaneously from severe depression and severe anxiety were significantly more handicapped in their social lives than depressive subjects with only mild anxiety symptoms.

Adult↗

PubMed2004

Classification of primary headaches.

Given the range of disorders that produce headache, a systematic approach to classification and diagnosis is an essential prelude to clinical management. For the last 15 years, the diagnostic criteria of the International Headache Society (IHS) have been the accepted standard. The second edition of The International Classification of Headache Disorders (January 2004) reflects our improved understanding of some disorders and the identification of new disorders. Neurologists who treat headache should become familiar with the revised criteria. Like its predecessor, the second edition of the IHS classification separates headache into primary and secondary disorders. The four categories of primary headaches include migraine, tension-type headache, cluster headache and other trigeminal autonomic cephalalgias, and other primary headaches. There are eight categories of secondary headache. Important changes in the second edition include a restructuring of these criteria for migraine, a new subclassification of tension-type headache, introduction of the concept of trigeminal autonomic cephalalgias, and addition of previously unclassified primary headaches. Several disorders were eliminated or reclassified. In this article, the authors present an overview of the revised IHS classification, highlighting the primary headache disorders and their diagnostic criteria. They conclude by presenting an approach to headache diagnosis based upon these criteria.

Adult↗

PubMed1990

[Voice disorders in children with velopharyngeal valving problems].

The purpose of this study was to examine if velopharyngeal valving problem can affect voice production (phonation) to some extent. Seventeen cleft palate children, mean age 7.0 had developed hoarseness for years without any treatment. In this study, each subject received a complete voice evaluation and the velopharyngeal (VP) function assessment. Voice evaluation included vocal cords condition and four voice parameters (quality, intensity, fundamental frequency and phonation behaviors). V-P function, classified into 3 levels (adequate, marginal & inadequate), was based on speech evaluation and instrumentations. The results showed that 41% of the subject had had bilateral vocal nodules; phonation indicated various findings in four parameters. V-P function indicated 83% of the subjects had valving problems, among which 71% had marginal V-P level. The results lead to discussion that V-P valving problems may be related with phonation disorders, because subjects like to use "compensatory behaviors" to mask their speech disorders. Among the level of valving problems, a marginal V-P function may achieve an appropriate V-P valving under compensatory behaviors and results in phonation disorders. The authors further suggest that subjects with V-P valving problems should not be subjected to the stresses of speech therapy for hypernasality because of the chance that they would compensate laryngeally for V-P problems. Meanwhile, the treatment for nodules or voice disorders should eliminate compensatory behaviors, then secondary management such as pharyngeal flap surgery for V-P problem should be considered if voice disorders persist.

Child↗

PubMed2001

[Efficacy of application of colonic lavage for peritonitis of biliary genesis].

The species and quantitative composition of the bile microflora, peritoneal exudate, colonic cavity and mucosa was studied in 55 patients and in experiment on 17 mongrel dogs to estimate efficacy of application of colonosanation method in treatment of an acute peritonitis of biliary origin. It was established that in occurrence of peritonitis of biliary origin the essential role play disorders of intestinal microbic landscape and his colonizing resistance. Application of elaborated method of colonosanation had permitted to a considerable extent to eliminate these disorders and to improve result of treatment of the patients.

Acute Disease↗

PubMed2002

[Colonic sanation in peritonitis caused by acute destructive cholecystitis].

Specific and quantitative microorganisms composition of colon cavity in 53 patients with an acute biliary peritonitis was investigated. Pathogenetic substantiated method of colonic sanation for treatment of peritonitis, caused by an acute destructive cholecystitis was elaborated. There was established, that in occurrence of the biliary genesis peritonitis the disorders of microbic intestinal cenosis and its colonizational resistance play an important role. Application of proposed method of colonic sanation allowed to eliminate its disorders and to improve result of treatment of patients.

Acute Disease↗

PubMed2001

Will mixed chimerism cure autoimmune diseases after a nonmyeloablative stem cell transplant?

BACKGROUND: Mixed chimerism after allogeneic bone marrow transplantation has been shown to cure a number of genetic disorders in both the clinical and experimental settings. Although encouraging results have been reported from animal experiments, the role of mixed chimerism in eliminating autoimmune disorders is not clear. METHODS: A 50-year-old man with extensive psoriasis received an allogeneic transplant from his brother after nonmyeloablative conditioning with fludarabine, melphalan, and Campath-1H for relapsed non-Hodgkin's lymphoma. The chimerism status and the immunological recovery after the transplant were serially monitored. RESULTS: Twenty-one months after the transplant, the patient continues to be in complete remission from psoriasis and lymphoma with stable mixed chimerism (30% to 40% donor cells), despite significant recovery of T-cell subsets and antigen-specific response. CONCLUSIONS: If mixed chimerism can be achieved safely with novel low-intensity conditioning regimens and results in sustained remission of autoimmune diseases, allogeneic transplantation may become a realistic therapy in the management of some patients with autoimmune disease.

Alemtuzumab↗

PubMed1984

Phenobarbital-induced dyskinesia in a neurologically-impaired child.

A 2-year-old child with known neurologic impairment developed a dyskinesia soon after starting phenobarbital therapy for seizures. Known causes of movement disorders were eliminated after evaluation. On repeat challenge with phenobarbital, the dyskinesia recurred. Phenobarbital should be added to the list of anticonvulsant drugs that can cause movement disorders.

Child, Preschool↗

PubMed1996

Upper gastrointestinal motility disorders and respiratory symptoms.

The association between upper gastrointestinal (GI) motility disorders and respiratory problems is reviewed. Upper GI motility disorders, such as gastroesophageal reflux disease, gastroparesis, and achalasia, have been associated with respiratory problems, including aspiration, airway obstruction, asthma, bronchospasm, chronic cough, and laryngitis. These associations, which had been based solely on clinical observation, have recently been supported by physiologic studies and treatment trials. The association of reflux disease with asthma has the most support. Up to 80% of persons with asthma have evidence of pathologic gastroesophageal reflux, and in several studies antireflux therapy with prokinetic agents, antisecretory drugs, or fundoplication surgery has been found to reduce asthma symptoms and the need for medication in some patients. Reflux has also been associated with chronic cough and laryngitis, and antireflux therapy can reduce respiratory symptoms. Gastroesophageal reflux, gastroparesis, and achalasia are all associated with aspiration. In addition, in rare instances, the megaesophagus associated with achalasia can produce mechanical airway obstruction. Effective therapy for these GI motility disorders can eliminate complicating respiratory problems.

Adult↗

PubMed2001

Laparoscopic antireflux surgery in gastro-oesophageal reflux disease patients with concomitant anxiety disorders.

BACKGROUND: Several psychological factors are known to affect the subjective outcome, such as quality of life, after laparoscopic antireflux surgery. AIM: To evaluate: a. outcome of laparoscopic antireflux surgery in gastro-oesophageal reflux disease patients with concomitant anxiety disorders, b. potential effects of laparoscopic antireflux surgery on psychiatric comorbidities. PATIENTS AND METHODS: Out of more than 550 patients who underwent laparoscopic antireflux surgery, 21 suffered from additional anxiety disorders. Outcome assessments included traditional data, evaluation of symptoms and side-effects, and quality of life. These data were evaluated before laparoscopic antireflux surgery and 6 weeks, 3 months and 1 year after surgery, RESULTS: Post-operative lower oesophageal sphincter pressure and DeMeester score were normal in all patients. Subjective severity of anxiety disorders remained unchanged in 13 patients 1 year after surgery. One patient suffered from severe dysphagia and required single dilatation. In this patient, severity and frequency of panic attacks increased for approximately 6 months after laparoscopic antireflux surgery. In 7 patients, total relief of panic symptoms was reported within 3 months post-operatively. Severity of most gastro-oesophageal reflux disease-related symptoms decreased significantly after laparoscopic antireflux surgery, but severity of some symptoms remained stable in patients with continuing anxiety disorders. In all patients, Gastrointestinal Quality of Life Index increased significantly. This improvement was less marked in patients with continuing anxiety disorders. Patients presenting total relief of panic symptoms showed an outcome comparable to normal data. CONCLUSIONS: Data obtained suggest that patients with concomitant anxiety disorders should not generally be excluded from laparoscopic antireflux surgery but should be selected more carefully. In these patients, surgery significantly improves quality of life and eliminates gastro-oesophageal reflux disease-related symptoms. Some patients demonstrated less symptomatic relief. In contrast, laparoscopic antireflux surgery was able to eliminate panic disorders in one third of our patients.

Adult↗

PubMed2003

Ethics and genetic selection in purebred dogs.

There is an ongoing revolution in medicine that is changing the way that veterinarians will be counselling clients regarding inherited disorders. Clinical applications will emerge rapidly in veterinary medicine as we obtain new information from canine and comparative genome projects (Meyers-Wallen 2001: Relevance of the canine genome project to veterinary medical practice. International Veterinary Information Service, New York). The canine genome project is described by three events: mapping markers on canine chromosomes, mapping gene locations on canine chromosomes (Breen et al. 2001: Genome Res. 11, 1784-1795), and obtaining the nucleotide sequence of the entire canine genome. Information from such research has provided a few DNA tests for single gene mutations [Aguirre 2000: DNA testing for inherited canine diseases. In: Bonagura, J (ed), Current Veterinary Therapy XIII. Philadelphia WB Saunders Co, 909-913]. Eventually it will lead to testing of thousands of genes at a time and production of DNA profiles on individual animals. The DNA profile of each dog could be screened for all known genetic disease and will be useful in counselling breeders. As part of the pre-breeding examination, DNA profiles of prospective parents could be compared, and the probability of offspring being affected with genetic disorders or inheriting desirable traits could be calculated. Once we can examine thousands of genes of individuals easily, we have powerful tools to reduce the frequency of, or eliminate, deleterious genes from a population. When we understand polygenic inheritance, we can potentially eliminate whole groups of deleterious genes from populations. The effect of such selection on a widespread basis within a breed could rapidly improve health within a few generations. However, until we have enough information on gene interaction, we will not know whether some of these genes have other functions that we wish to retain. And, other population effects should not be ignored. At least initially it may be best to use this new genetic information to avoid mating combinations that we know will produce affected animals, rather than to eliminate whole groups of genes from a population. This is particularly important for breeds with small gene pools, where it is difficult to maintain genetic diversity. Finally, we will eventually have enough information about canine gene function to select for specific genes encoding desirable traits and increase their frequencies in a population. This is similar to breeding practices that have been applied to animals for hundreds of years. The difference is that we will have a large pool of objective data that we can use rapidly on many individuals at a time. This has great potential to improve the health of the dog population as a whole. However, if we or our breeder clients make an error, we can inadvertently cause harm through massive, rapid selection. Therefore, we should probably not be advising clients on polygenic traits or recommend large scale changes in gene frequencies in populations until much more knowledge of gene interaction is obtained. By then it is likely that computer modelling will be available to predict the effect of changing one or several gene frequencies in a dog population over time. And as new mutations are likely to arise in the future, these tools will be needed indefinitely to detect, treat and eliminate genetic disorders from dog populations. Information available from genetic research will only be useful in improving canine health if veterinarians have the knowledge and skills to use it ethically and responsibly. There is not only a great potential to improve overall canine health through genetic selection, but also the potential to do harm if we fail to maintain genetic diversity. Our profession must be in a position to correctly advise clients on the application of this information to individual dogs as well as to populations of dogs, and particularly purebred dogs.

Animals↗

PubMed1999

Transepidermal elimination of urate-like crystals: a new perforating disorder?

We report two men who developed a transient perforating disorder characterized by transepidermal elimination of negatively birefringent needle-shaped crystals similar to monosodium urate. This striking clinical presentation has not previously been described and we propose that it be added to the group of diseases known as the primary perforating disorders.

Aged↗