Dental management of patients with mental retardation and related developmental disorders.
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Recent advances in the human genome initiative have accelerated positional cloning efforts toward identification of a number of genes responsible for human developmental anomalies, particularly those involving the skeletal system. Genotype/phenotype comparison and functional analysis of these genes will further elucidate pathways of normal and abnormal human development of the skeletal and other organ systems.
The development of the anterior pituitary gland is dependent upon a cascade of signalling molecules and developmental genes that function as transcription factors. Many of these genes are homeobox genes which contain a DNA-binding region or homeobox. Animal models have given a valuable insight into human pituitary disease. For example, Pit-1 and Prop1 mutants are known to have deficiencies of growth hormone, prolactin and thyroid-stimulating hormone. Human phenotypes arising as a result of mutations in these genes are similar to the mouse mutants. Mutations in the novel homeobox gene Hesx1/HESX1 are associated with the highly variable phenotype of septo-optic dysplasia in mouse and man. The unravelling of this complex developmental cascade is just commencing.
A consecutive sample of 298 mainly non psychotic outpatients was classified according to DSM-III criteria. The differences in the reports from childhood and the precipitating events among the various subgroups of mood disorders (bipolar disorder, major depression, cyclothymic disorder, dysthymic disorder) and a residual group of patients with other mental disorders were examined. The patients in the non bipolar group reported more traumatic childhood experiences than the patients in the bipolar group. Precipitating events among patients in the group with major depression consisted more often of acute external stressors. Developmental factors and precipitating events in adulthood seem to be relevant in differentiating between the depressive disorders. The study supports the validity of the unipolar-bipolar distinction. The cyclothymic group seem to be a special variant of the major mood disorders.
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The impaired glucose tolerance in pregnancy (IGT) represents an important fact in aetiopathogenesis of insulin dependent diabetes mellitus (IDDM) and non insulin dependent diabetes (NIDDM) as well as obesitas and cardiovascular diseases in context with fetal hyperinsulinism. Prospective studies of diabetic mothers newborns are difficult by reason of health controls in different outpatient departments. The aim of this review is to claim a general glucose screening in pregnancy looking on the development of newborns in later life. In present preventive prospects were not used to decrease the morbidity in diabetes, obesitas and cardiovascular diseases without gestational diabetes screening in pregnancy. The neonatal onset and late morbidity is dependent on the quality of maternal glycemia in pregnancy measured by means of glycosylated hemoglobin and insulin the amniotic fluid.
Traumata to primary teeth occur very often in small children. The highest prevalence of developmental disturbances of permanent teeth after trauma to their predecessors has been recorded after intrusive injuries of primary teeth. In the present survey 47% of the recalled children had such developmental disturbances. The majority of developmental disturbances consisted of enamel hypoplasia (59%) which included discoloration, defects or a combination of both. In some cases the clinical feature of enamel defects could be diagnosed radiographically before tooth eruption. However, the total number of all enamel discolorations was to be detected after complete tooth eruption only. The so-called pre-eruptive calciotraumatic lines on radiographs corresponded clinically to circular enamel defects or crown dilacerations. Generally, a high correlation was found between the degree of intrusion (of the primary tooth) and the frequency and severity of developmental disturbance (of the permanent tooth). No correlation was found, however, concerning the treatment of intruded primary teeth and the occurrence of developmental disturbances. Whether intruded primary teeth were removed immediately or left to spontaneous re-eruption did not affect the incidence and type of developmental disturbances.
We report a case of a 35-year-old teacher, Louise, with a history of learning difficulties and current evidence of developmental phonological dyslexia and dysgraphia. Her reading, spelling, and remembering of novel stimuli written in conventional alphabetic script was poor, but she performed significantly better when the same items were written in the International Phonetic Alphabet, a system that she learned when studying linguistics. Her impaired performance in tasks of phonemic segmentation and short-term memory, which are generally associated with impaired reading and spelling of unfamiliar material, could not account for her specific difficulty with alphabetic stimuli. Instead, her problems appear to result from a lexical strategy, which we have called "lexical capture".
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