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1.
Sleep disorders in children are very common and their impact on emotional and cognitive functions is considerable. Clinical work necessitates an interdisciplinary access to the subject because the scope of sleep medicine is related to various medical disciplines (e.g. paediatric neurology, pulmology and child psychiatry). Although many sleep problems are seen in both children and adults diagnoses, symptoms and pathogenetic factors are quite different in the two groups. In childhood especially parent-child interactional factors and developmental aspects of the sleep architecture and the sleep-wake cycle have to be taken into account leading to different diagnostic and therapeutic approaches. In this article we focus on important developmental aspects of childrens' sleep problems. Their relationship to neurologic, paediatric and psychiatric diseases is demonstrated and finally clear indications to diagnostic procedures, especially polysomnography, are given.  相似文献   

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OBJECTIVE: Primary insomnia and insomnia related to mental disorders are the two most common DSM-IV insomnia diagnoses, but distinguishing between them is difficult in clinical practice. This analysis was performed to identify clinical factors used by sleep specialists to distinguish primary insomnia from insomnia related to mental disorders. METHOD: Clinicians evaluated 216 patients referred for insomnia at five clinical sites, rated a list of clinical factors judged to contribute to each patient's presentation, and assigned diagnoses. Analysis of variance was performed, with contributing factors as the dependent variable and diagnostic group and clinic location as independent variables. RESULTS: Sleep specialists rated a psychiatric disorder as a stronger factor for insomnia related to mental disorders and rated negative conditioning and sleep hygiene as stronger factors for primary insomnia. However, a psychiatric disorder was rated as a contributing factor for 77% of patients who received a first diagnosis of primary insomnia. CONCLUSIONS: While neither sleep hygiene nor negative conditioning is a diagnostic criterion in DSM-IV, these results support the face validity of these clinical factors distinguishing between primary insomnia and insomnia related to mental disorders. The use of a psychiatric disorder as an inclusion criterion for insomnia related to mental disorders and an exclusion criterion for primary insomnia reinforces a categorical distinction between the two diagnoses, but the contribution of psychiatric symptoms in primary insomnia appears to be a clinically relevant one. These findings suggest the need for studies on the validity of negative conditioning and sleep hygiene in the etiology of primary insomnia, as well as on the significance of psychiatric disorders, especially depression, in primary insomnia.  相似文献   

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BACKGROUND: Oculomotor abnormalities have been reported in patients with degenerative ataxic disorders. OBJECTIVE: To assess the diagnostic sensitivity and specificity of oculomotor deficits in patients with Friedreich ataxia (FA), cerebellar atrophy (CA), and olivopontocerebellar atrophy (OPCA). SETTING: Neurology clinic at a university hospital in Lübeck, Germany. PATIENTS: Seven patients with FA, 9 with CA, and 10 with OPCA were studied. These patients were selected from an ongoing follow-up study. MAIN OUTCOME MEASURES: Eye movements were recorded by electro-oculography; an extensive battery of quantitative tests was used. RESULTS: A proven CAG repeat expansion on chromosome 6 or 14 was significantly associated with reduced saccadic eye velocity and vertical gaze palsy (P<.001, Mann-Whitney U test). All 6 patients with OPCA and slow saccades had an autosomal-dominant inheritance; 4 of them were proved to have spinocerebellar atrophy type 1. In 9 of these patients (4 with FA, 1 with CA, and 4 with OPCA), the genetic defect could not be identified. Saccadic dysmetria, impairment of smooth pursuit and optokinetic nystagmus, deficient suppression of the vestibulo-ocular reflex by either visual or otolith input, and pathological nystagmus were attributed to degenerative lesions in different parts of the cerebellum. However, these symptoms failed to clearly distinguish between the different groups of patients, whereas decreased vestibulo-ocular reflex gain, slow saccades, and vertical gaze palsy pointed to an extracerebellar manifestation of the degenerative disease, occurring only in patients with OPCA and FA. CONCLUSIONS: In this prospective study, oculomotor disturbances were mainly related to cerebellar dysfunction. Only a few of them were caused by extracerebellar manifestations of the disease, such as slowing of saccades, which was characteristic for patients with OPCA of autosomal-dominant inheritance.  相似文献   

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Psychoneuroimmunology (PNI) is a field of medicine which joins immunology and neurobiology. It focuses on the relationship of stress upon the hypothalamic-adrenal-pituitary (HPA) axis. Depletion of hormones and neurotransmitters within the HPA-axis, as a result of stress, can lead to a multitude of diseases and disorders. Therefore, it is necessary for the dentist to be familiar with PNI and the HPA-axis in order to make an accurate diagnosis of TMD.  相似文献   

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Familial and epidemiologic studies of inflammatory bowel disease indicate a strong genetic predisposition that is modified by certain environmental factors. Abnormal submucosal immune activation may be important in the etiology of the disease. Yersinia enterocolitica infection, various "gay bowel syndromes" and other recently described enteric infections often mimic Crohn's disease. An initial barium study is useful in documenting the extent of disease and complications. Endoscopic biopsy confirms the surface appearance and histologic features of inflammatory bowel disease. Newer photodocumentation techniques are expected to improve the comparability of endoscopic observations. Complications of inflammatory bowel disease occur frequently, may involve any organ system and may precede the onset of bowel symptoms.  相似文献   

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Three major types of amnesia, i.e. selective deficit of memory formation without disturbance of immediate memory have been recognized clinically. The hippocampal type is characterized by relatively short retrograde amnesia and preserved insight into his own amnesic trouble. Persistent amnesia is always associated with bilateral lesion. The diencephalon type usually shows longer retrograde amnesia and poor insight. Unilateral lesion is usually modal in deficit, i.e. verbal in the left and non-verbal in the right, and lacks clear evidence of retrograde amnesia. Responsible locus within the thalamus is still controversial. Our experience point to the mammilothalamic tract. The basal forebrain type is characterized by disorganized and confused recollection of the memorized items. Cued recall is fair compared to voluntary recall. Two special types of amnesic syndrome, i.e. transient global amnesia and isolated focal retrograde amnesia are also important clinical entities, although their etiologies and responsible lesions are not clear yet.  相似文献   

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In the differential diagnosis of primary and secondary thrombocytosis, platelet function test can be used. We have examined the possible role of O'Brien's filter test in the differentiation of primary and secondary thrombocytosis in 53 patients with myeloproliferative diseases with primary thrombocytosis and in 21 patients with other disorders complicated by secondary thrombocytosis. By using heparin as an anticoagulant, the sensitivity of O'Brien's filter test proved to be 75%, and it's specificity was 85.7%. In blood samples anticoagulated with citrate, the sensitivity was 100% and specificity 83.3%. Based on these studies we suggest the use of O'Brien's filterometer as a screening test in the differential diagnosis in patients with elevated (> 400 x 10(9)/L) platelet count. In case of normal results, the causes of reactive thrombocytosis should be cleared first, while with pathologic results, haematological examination of the patients should be performed.  相似文献   

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BACKGROUND: The purpose of this prospectively randomized study was to evaluate intraoperative as well as long-term performance of different coating materials for knitted Dacron aortobifemoral prostheses. PATIENTS AND METHODS: Between 1989 and 1992 a total of 150 consecutive patients who underwent aortobifemoral bypass were randomized for three different coating materials: gelatine (Unigraft; n = 49), collagen (Hemashield; n = 50) and human albumin (USCI; n = 51). Intra- and perioperative data such as duration of operation, clamping time, blood loss, and early complications were obtained as well as yearly follow-up examinations up to five years. Frequency of late complications, graft patency, and patient survival were observed. RESULTS: No statistically significant difference of intraoperative data could be obtained. In every group 6% of patients presented with anastomotic aneurysm in the groin. Primary patency rates were Unigraft 92%, Hemashield 91%, USCI 92% (no significant difference, n.s.), secondary patency rates after 5 years were Unigraft 98%, Hemashield 95%, USCI 94% (n.s.). CONCLUSIONS: Overall superiority of one particular type of prosthesis could not be stated. In order to prevent sudden graft failure associated with progressive arteriosclerotic disease or from late anastomotic aneurysm regular follow-up examinations should follow aorto-bifemoral bypass.  相似文献   

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OBJECTIVE: The aim of this study was to characterize the clinical and motility findings in 62 patients with systemic sclerosis or related disorders referred for evaluation of upper gastrointestinal (GI) symptoms. METHODS: Methods included retrospective clinical record review and quantitation of esophageal, LES antral, and duodenal motility (3 h fasting, 2 h fed) were compared with results of 10 symptomatic patients with normal gastric emptying. RESULTS: A total of 46 patients had systemic sclerosis, eight mixed connective tissue disease, and eight polymyositis-systemic sclerosis overlap; systemic manifestations were almost invariably present. GI symptoms were: heartburn (77%), nausea/vomiting (58%), dysphagia (61%), diarrhea (53%), constipation (31%), and fecal incontinence (13%). Anatomical studies showed esophageal erosions or GERD (53%), aperistalsis (34%), stricture (29%), and Barrett's metaplasia (16%); megaduodenum, small bowel dilation, or diverticulae (42%); and pneumatosis intestinalis (8%). A total of 36 patients underwent esophageal and 26 esophagogastrointestinal manometry. Postprandial antral motility index was abnormal in 22 of 26; amplitudes and frequency in the antrum (34 +/- 3 mm Hg and 0.6 +/- 0.1/min, respectively) and duodenum (7.3 +/- 0.9 mm Hg and 1.8 +/- 0.5/min) were significantly lower than controls (p < 0.05). CONCLUSION: In patients with GI symptoms associated with systemic sclerosis and related disorders, the amplitude and frequency of intestinal contractions are typically <10 mm Hg and <2/min. Antral amplitude is low (<40 mm Hg) when antral hypomotility is observed.  相似文献   

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Difficulties in differential diagnosis of acute impairement in mesenterial circulation (AIMC) and acute pancreatitis (AP) were noted in 39 patients. At laparoscopy, AP was diagnosed in 21 patient, AIMC--in 11, acute appendicitis--in 3, perforative gastric ulcer--in 2. In 2 patients, no pathologic changes were revealed. The diagnosis established by means of laparoscopy, in 9 patients was confirmed at operation, in 10--at autopsy, in the remaining patients--at dynamic follow-up and use of other methods of investigation. Use of therapeutic laparoscopy contributed to improved of the results of treatment of the patients.  相似文献   

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OBJECTIVE: This analysis examines 1-year transition probabilities and baseline predictors for suicidal behaviors in young adolescents. METHOD: Adolescents from a two-stage, community-based longitudinal study were classified into suicidal behavior categories (attempt, plan, ideation, and none) for baseline and follow-up years. Transition probabilities for movement among categories were calculated, and polytomous logistic regression analysis was used to examine predictors of suicidal behaviors. RESULTS: Among those with no suicidal behaviors at baseline, 1-year incidence rates were 1.3% for attempts and 1.7% each for plans and ideation. Increasing family cohesion was protective for suicide attempts (odds ratio [OR] = 0.9). Female subjects were more likely than males to report plans (OR = 8.9) and ideation (OR = 4.1). Increasing impulsivity (OR = 2.3), prior suicidal behavior (OR = 10.6), and undesirable life events (OR = 1.1) were significant predictors of plans. CONCLUSIONS: While there are a number of predictors of suicidal behaviors, the false-positive rate is high. Focusing on proximal risk factors, particularly stressors in adolescent development, may overlook the fundamental role of underlying mental disorder and familial factors--both biological and environmental. Suicide and suicidal behaviors are the result of a constellation of adverse factors requiring a range of interventions for prevention.  相似文献   

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Clinicians today face difficulties in appropriately assisting children with mood disorders, whose parents may challenge diagnostic and treatment decisions based on potentially faulty information obtained from unregulated sources (e.g., the Internet, commercial books, other media). In light of this problem, as well as the U.S. Surgeon General's recent call for increases in evidence-based diagnosis and treatment of childhood disorders, it is important that psychologists educate themselves and their clients about evidence-based practices. Evidence-based assessment and psychosocial and psychopharmacological treatment procedures for childhood unipolar and bipolar mood disorders are reviewed, and specific practice recommendations are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)  相似文献   

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High resolution magnetic resonance imaging (HR-MRI) and computed tomography (HR-CT) of the inner ear are becoming more important for the diagnosis of peripheral vestibular lesions. Modern HR-MRI techniques allow visualization of detailed anatomic features of the vestibulo-cochlear regions as well as pathologic findings in the inner ear such as, neoplastic lesions (e.g., small intracanalicular acoustic neuromas), anomalies causing vertigo and hearing loss (e.g. Mondini's-malformation, perilymph fistula, vestibular paroxysmia), and inflammatory diseases (e.g., Cogan's syndrome, labyrinthitis, zoster neuritis). HR-CT is still the first examination that should be performed in patients with middle ear diseases (e.g., tumor, infection), trauma (e.g. temporal bone fractures), or fibro-osseous diseases. Although the imaging of the vestibulo-cochlear system has dramatically improved, there are still several peripheral vestibular disorders that cannot be visualized so far, e.g., benign paroxysmal positioning vertigo, idopathic vestibular neuritis or Menière's disease.  相似文献   

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35 anginal patients with the disease functional class II-III were treated with metoprolol given in conventional regimen (100 mg twice a day) and adjusted to chronosensitivity to metoprolol (100 mg in a single dose). 23 patients were aged 50-72 years. Chronosensitivity was determined at acute pharmacological tests with control of blood pressure, stroke volume. It was found that the highest chronosensitivity to metoprolol in middle-aged and elderly anginal patients occurs with maximum for the stroke volume index in 15.32 and for ejection in 21.04.  相似文献   

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A dramatic increase in the number of children who are diagnosed with an autistic disorder has given rise to a deluge of articles on autism in the professional as well as the popular literature. This review of the current literature summarizes and synthesizes recent information on the causes and manifestations of autism; the trends in screening, diagnosis, and assessment; and the salient features of different treatment programs. It provides an overview of the advances and controversial issues that are of special interest to practicing clinical psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)  相似文献   

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