SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The authors studied the typology, clinical picture, dynamics and therapy of reactive (psychogenic) depressions in 46 children, aged 1.5-4.5 years. Clinical-psychopathological variants of depression and types of dynamics have been described, which is important for prognosis and choice of adequate therapy.
Temporomandibular joint dysfunction with myofascial pain, a well-known clinical disorder in adults, is reported in children. In a series of 400 patients, 40 children less than 16 years of age were seen. Of these pediatric patients, 35% had a reactive depression as primary psychopathology. The multifactorial nature of the disorder is described. The need to differentiate this syndrome from recurrent otitis media and other pain syndromes is emphasized. A combined medical, oral surgical, and psychiatric management program is outlined.
A complex pathogenetic approach to the prevention of postoperative complications in generalized fibrinopyogenic peritonitis is suggested. It includes a wide operative access, one-stage cleansing with antiseptics and detoxification solutions, ultrasonic cavitation of the abdominal cavity, creation of laparostomy, local infiltration of the wound edges with 0.01% thymalin solution, correction of hemostasis disorders, and increase of the organism's general reactivity. With the use of this complex the results of treatment were significantly improved in 21 children and the number of complications was much less than in the control group of patients subjected to operation.
Three instances of depigmentation occurring in children with congenital large nevocytic nevi are reported. Serologic studies for tumour-associated antigens to melanoma were performed by indirect immunofluorescence and complement fixation on these patients and others with benign melanocytic disorders. Positive reactivity in several children was observed. The small numbers studied and lack of uniformity of other testing methods leave open the question of relevance of such reactivity to malignant conversion or protection in congenital nevi.
BACKGROUND: Pseudoseizures may occur as a somatoform disorder in children and adolescents as well as adults. However, few data are available about psychiatric features or outcome in pediatric patients. PATIENTS AND METHODS: We studied 34 patients (25 girls [74%]) who were evaluated by a child psychiatrist at our institution immediately after diagnosis of pseudoseizures by ictal video electroencephalogram (EEG) at ages 9 to 18 years (mean age, 14 years). Each patient had at least 1 pseudoseizure recorded by video EEG that was judged by the patient and family as typical, characterized by unresponsiveness plus limb twitching or limpness and other features, with EEG showing persistence of normal cortical background rhythms. RESULTS: In addition to conversion disorder, 11 patients (32%) had mood disorders including major depression, bipolar disorder, or dysthymic disorder, usually with severe psychosocial stressors. Eight children (24%) had separation anxiety and school refusal with moderate psychosocial stressors. Two patients (6%) had brief reactive psychosis or schizophreniform disorder. A few (1-3) patients each had panic disorder, overanxious disorder, adjustment disorder, oppositional/defiant disorder, or impulse control disorder. Four patients (12%) also had personality disorders. Eleven patients (32%) had a history of sexual abuse. This was especially frequent in the subgroup with mood disorders (7 [64%] of 11 patients). Fifteen patients (44%) had severe family stressors including recent parental divorce, parental discord, or death of a close family member. Two patients (6%) had a history of physical abuse. Freedom from pseudoseizures for the preceding 9 to 55 months (mean, 30 months) was achieved for 15 (72%) of the 21 patients who could be reached for telephone follow-up. For 8 (53%) of these 15 patients, the last pseudoseizure was within 1 month of diagnosis by video EEG. CONCLUSIONS: Major mood disorders and severe environmental stress, especially sexual abuse, are common among children and adolescents with pseudoseizures and should be considered in every case. A subgroup of children with separation anxiety and school refusal had less severe psychiatric problems and moderate psychosocial stressors. Clear diagnosis by video EEG, together with prompt psychiatric evaluation and treatment, may result in freedom from pseudoseizures for most children and adolescents.
The present study compared the efficacy of ACTH 4-9 analog, methylphenidate, and placebo on attention deficit disorder with 30 (HK) children with attention deficit disorder and psychometric measurements. HK children were randomly placed into three groups, according to body weight, and treated with placebo, methylphenidate, and adrenocorticotropic hormone fractions (ACTH 4-9 analog). The results revealed that HK children on methylphenidate manifested a significantly greater vasomotor reactivity, behavioral improvement, and learning receptivity than HK children taking ACTH 4-9 analog and/or placebo. Future research implications with ACTH 4-9 and HK children are discussed.
OBJECTIVE: Opsoclonus-myoclonus (OM) is a rare neurologic syndrome affecting children and adults. In children it occurs as a parainfectious process or a paraneoplastic syndrome in association with neuroblastoma. Evidence for an immune mechanism includes the presence of serum autoantibodies to several neural antigens and improvement of symptoms with immunosuppressive therapy. We studied the neural antigenic targets of serum IgM and IgG autoantibodies from nine children with OM. DESIGN: We studied sera from nine children with OM, three with associated neuroblastoma and six with a prodromal viral illness. Control subjects (n = 77) included four children with neuroblastoma but not OM, 32 children with other neurologic disorders, and 41 with nonneurologic illnesses. We studied the neural antigenic targets of serum IgM and IgG autoantibodies by the following methods: (1) immunostaining of human cerebellar sections and peripheral nerve, and (2) Western blot analysis with human brain fractions including white matter, gray matter, and cerebellar Purkinje cells and nuclei. RESULTS: Sera from all nine children with OM had IgM and IgG binding to the cytoplasm of cerebellar Purkinje cells and to some axons in white matter. In peripheral nerve, IgM and IgG from all nine OM sera bound to large and small axons. Western blot analysis showed a distinctive pattern of binding to several neural proteins, including a 210 kd antigen identified as the high molecular weight subunit of neurofilament. No control serum showed a similar pattern of reactivity. CONCLUSION: Opsoclonus-myoclonus syndrome in childhood is associated with a distinctive pattern of serum IgM and IgG binding to neural tissues and antigens.
After the regaining of consciousness and awareness in the strange environment of an intensive care unit, an injured child is exposed to a situation of extreme psychological impact. This situation, in addition to a probably organically changed reactivity, is liable to provoke a particular, abnormal psychic response. The abnormal reaction can follow the pattern of a feigned-death response and thus mimic an organic coma vigile (apallic state). The resulting psychoreactive stuporous state ("Sleeping Beauty syndrome") may lead to a misjudgement of the recovery degree and may delay early rehabilitation. With the help of a representative case, the clinical manifestation, course, and treatment of this reactive juvenile syndrome are presented. The interaction of physiogenic and psychogenic factors responsible for some psychiatric sequelae during the early period after head injury is emphasized.
Intramuscular blood vessels were examined with succinate dehydrogenase stain in skeletal muscle biopsy specimens from 6 patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS). Almost all arteries had large granular deposits with high succinate dehydrogenase activity in their walls. Electron microscopic examination of serial frozen sections of these biopsies showed that the smooth muscle cells of the strongly succinate dehydrogenase-reactive blood vessels contained markedly proliferated mitochondria, characteristic of patients with MELAS. The presence of strongly succinate dehydrogenase-reactive blood vessels in muscle biopsy specimens provides an important clue toward understanding the underlying pathogenetic mechanism in patients with MELAS as well as another approach to the diagnosis of this disorder.
The morphology and distribution of NADPH diaphorase reactive neurons was studied in the normal human hypothalamus. Reactive neurons were divided into three categories on the basis of perikaryal size. Small neurons (8-20 microns) were oval or fusiform, and pale staining. Intermediate neurons (20-30 microns) were fusiform, triangular or pyramidal with a wide range of staining intensity. Large neurons (greater than 30 microns) were triangular or pyramidal with moderate to dark staining. Reactive neurons were found in four major regions: medial preoptic, ventromedial, lateral, and perifornical. Scattered positive neurons were found in several other hypothalamic areas. Reactive fibers were present in the supraoptic decussation, medial forebrain bundle, and stria medullaris thalami. The localization of NADPH diaphorase neurons in hypothalamic nuclei affected by Alzheimer's disease and other degenerative disorders suggests that further studies of this neuronal subset are warranted.
Using the phalloplethysmographic test, comprising 50 coloured slides of six categories, 50 men with impaired erectivity and a control group of 50 men free from disorders or complaints as regards sexual life were examined. On exposure of slides of heterosexual partner activities positive reactions were recorded in all examined men. Men with impaired erectivity, however, displayed in response to these optic erotic stimuli a lower vasomotor reactivity. These men reacted more frequently positively also to homosexual stimuli and to children. In two men with erectile dysfunction the phalloplethysmographic examination revealed a bisexual orientation, in one a preference of heterosexual child objects, in another eight a quite undefined age differentiation in heterosexual objects.
The present study examined the interaction between pubertal status and anxiety sensitivity (AS) in predicting anxious and fearful responding to a three-minute voluntary hyperventilation challenge among 124 (57 females) adolescents between the ages of 12 and 17 years (Mage = 15.04; SD = 1.49). As predicted, after controlling for baseline anxiety, age, and gender, there was a significant interaction between pubertal status and AS in predicting anxious responding to bodily sensations to the hyperventilation challenge. Specifically, adolescents reporting more advanced pubertal status and higher levels of AS reported the greatest post-challenge self-reported anxiety focused on bodily sensations, whereas pubertal status had relatively less of an effect on low AS adolescents. A test of specificity also was conducted; as expected, the interaction between AS and pubertal status was unrelated to generalized negative affectivity, suggesting the predictor variables interact to confer specific risk for anxious responding to bodily sensations. Finally, exploratory analyses of psychophysiological reactivity to the challenge indicated AS, but not pubertal status, moderated the relation between challenge-related change in heart-rate and post-challenge anxiety such that high AS youth who had experienced a relatively greater heart-rate change reported the most anxious reactivity to the challenge. Results are discussed in relation to theory regarding vulnerability to anxious responding to bodily sensations among adolescents.
Vasculitis associated anticytoplasmic autoantibodies (ANCA) are directed against enzymes in the granules of both neutrophils and monocytes. These autoantibodies can be detected by indirect immunofluorescence technique (IIFT) using ethanol-fixed cytospins. We here report the identification of a novel specificity of autoantibodies, present in the sera of eight patients, that reacted only with eosinophils in the IIFT. By immunoprecipitation and ELISA experiments it was shown that the autoantibodies in these sera were directed against eosinophil peroxidase (EPO). There was no apparent influence on initial substrate conversion rate, but reduced plateau levels suggested increased inactivation of the enzyme in the course of the peroxidase reaction. Flow cytometry studies demonstrated the presence of EPO on the surface of primed eosinophils. Anti-EPO sera and purified anti-EPO immunoglobulins significantly increased the release of reactive oxygen species from primed eosinophils. The patients with anti-EPO antibodies suffered from clinically diverse disorders, with more or less generalized manifestations involving the kidneys, blood vessels, lungs and/or joints.
Prolactin has been measured in unextracted human plasma by a sensitive and specific in vitro bioassay. Secretory activity of breast tissue fragments from mid-pregnant mice, incubated in organ culture with human plasma, serves as the histologic end point. Sensitivity is 5 ng/ml (0.14 mU/ml) or somewhat better for ovine prolactin, and approximately 0.42 mU/ml for prolactin activity of human plasma at the dilutions used in the assay. Human growth hormone as it circulates in blood, like the material extracted from pituitary glands, is strongly lactogenic. Antisera to human growth hormone are capable of completely neutralizing the prolactin effect of large amounts (600 ng/ml) of human growth hormone added to the system. Plasma prolactin activity is less than 0.42 mU/ml in normal men and women. Of 26 patients with nonpuerperal galactorrhea, 14 had elevated prolactin activities ranging from 0.42 to 3.5 mU/ml. Growth hormone levels by radioimmunoassay were far too low, in general, to account for the observed prolactin activity. All of 14 nursing mothers, 1-30 days post partum, had elevated prolactin activity with a mean of 2.29 and a total range of 0.56-4.5 mU/ml. Growth hormone was in the low normal range in all of these subjects. Seven patients on psychoactive drugs of the phenothiazine series similarly had elevated prolactin activity with low growth hormone. Antiserum to human growth hormone, when preincubated with plasma samples from each of these three groups of subjects, produced no significant inhibition of prolactin activity. In two acromegalic patients with markedly elevated growth hormone levels, antiserum to growth hormone produced complete inhibition of prolactin activity in one and partial inhibition in the other. These studies indicate that human growth hormone and human prolactin are separate molecules, with little if any immunologic cross-reactivity, at least as demonstrated by the antisera used in this study, and that their release is governed by different physiologic mechanisms.
This article summarizes the clinical and biochemical evidence for maximal treatment of atherosclerosis by a simultaneous 60% to 70% reduction of plasma low-density lipoprotein cholesterol (LDL cholesterol), fibrinogen, and lipoprotein a concentrations with heparin-mediated extracorporeal LDL/fibrinogen precipitation (HELP) apheresis and statins. Apheresis has proven efficient and safe in the treatment of more than 1,000 patients since 1984 and has been applied in children and adults for the treatment of homozygous and heterozygous familial hypercholesterolemia, coronary artery disease, ischemic cardiomyopathy, generalized atherosclerosis, or transplant-associated arteriosclerosis after cardiac transplantation. Simultaneous removal of the main atherogenic plasma compounds has an immediate impact on myocardial and peripheral vasomotion by increasing myocardial blood flow, coronary flow reserve, cerebral CO2-reactivity, and muscle oxygen tension. Removal of fibrinogen and cholesterol reduces plasma viscosity by 20% and erythrocyte aggregation by 60% which gives rise to applying the HELP apheresis in various microcirculatory disorders. Pilot studies on acute retinal ischemia, critical limb ischemia, and sudden hearing loss confirm this observation.
A study was made of burns patients who were referred for psychiatric problems. There were a total of 69 subjects, divided into three groups. The first group comprised thirty-four cases who attempted suicide by burning themselves--there were more women than men, the majority were less than forty years, and Indians were overrepresented. The majority of these were suffering from schizophrenia or a major depressive disorder. The second group of twenty-three patients were those who had a non-psychotic psychological reaction to their burns. The majority were also less than 40 years of age, and the main reactions were anxiety neurosis or reactive depression. The third group of twelve patients were suffering from delirium. All were pyrexic and in eleven, infective agents were cultured. Some of them also had electrolyte abnormalities and two had respiratory burns.
Cerebrospinal fluid lipoperoxides, measured as the malondialdehyde-thiobarbituric acid (MDA-TBA) adduct, were quantified by adapting the plasma liquid-chromatographic method of Wong et al. (Clin Chem 1987;33:214-20) to cerebrospinal fluid. Reference values for spinal fluid specimens from 91 adults, ages 17 to 95 y, and 37 children, ages 8 d to 8 y, were determined. Their concentrations were not significantly different (P = 0.222), adults having a mean (and SD) of 0.11 (0.06) mumol and children 0.10 (0.04) mumol of MDA per liter. Their ranges were 0.02-0.26 and 0.04-0.21 mumol of MDA per liter, respectively. We found concentrations in cerebrospinal fluid to be increased in several central nervous system disorders, including seizures, cerebral infarction, alcoholic encephalopathy, and, perhaps, prematurity. The presence of other thiobarbituric acid-reactive substances in cerebrospinal fluid stresses the importance of using highly specific techniques when lipoperoxides are measured in body fluids.
The present study compared the behavioral performance of 30 children with attention deficit disorder with hyperkinesis (HK) on electrophysiological, biochemical, behavioral, and psychometric measurements. HK children were partitioned into cells of 10 and were then treated with placebo, methylphenidate, and adrenocorticotropic hormone fractions (ACTH4-9 analog), respectively, in a double-blind randomized cell sequence according to body weight. The results revealed that HK children on methylphenidate manifested a significantly greater vasomotor reactivity, behavioral improvement, and learning receptivity than did HK children taking ACTH4-9 analog and/or placebo. Future research implications with ACTH4-9 and HK children are discussed.