Nutrition of the fetus and premature infant

Nutrition in the fetus and the premature infant is a rapidly changing field, not solely due to the acquisition of new knowledge but also because there have been major conceptual advances that have altered our approach to nutrition during early stages of development. This special report will highlight some of these conceptual advances in this area.     

Cardiac tamponade in Taiwan

We describe two sibs with chorioretinal dystrophy, hypogonadotrophic hypogonadism, and cerebellar ataxia, Boucher-Neuh?user syndrome, a rare but distinct pleiotropic single gene disorder with an autosomal recessive pattern of inheritance. The cases presented illustrate that this syndrome is still poorly recognised. We provide a review and analysis of previously reported cases and the differential diagnosis, which might aid in the identification of additional cases.     

Topographic diagnosis of hearing loss in patients with ischemic heart disease. Use of high-rate brain stem evoked response audiometry

Hearing loss in patients with ischemic heart disease traditionally has been attributed to atheromatous cerebral vascular disease. In this study, the site of the auditory lesion was sought in patients with ischemic heart disease and perceptive hearing loss. Standard brainstem evoked response audiometry (BSER) with increased stimulation rate (ISR) were performed. Sixty-seven patients admitted for coronary artery disease were examined. Fifty-seven recordings were complete and evaluable. All the cases of hearing loss were endocochlear. In 4 patients. BSER and ISR detected subclinical retrocochlear lesions that were compatible with ischemic disease. The results suggest that selective early cochlear ischemia can occur in young persons with heart disease. The sensitivity of BSER with ISR for detecting ischemic brainstem lesions was confirmed.     

Etiology of Posttraumatic Stress Disorder in Vietnam veterans: Analysis of premilitary, military, and combat exposure influences.

43 Vietnam veterans seeking psychological services at a VA medical center were assigned to positive and negative groups of posttraumatic stress disorder (PTSD) based on the DSM-III. The average S was a 33-yr-old White male with 13 yrs of education. Ss were extensively assessed to examine the relative contributions of premilitary adjustment, military adjustment, and extent of combat exposure to the development of combat-related, chronic PTSD. In addition, groups were compared on profiles from the MMPI and a psychological problem checklist. Results of multiple regression analyses demonstrated that combat exposure and, to a lesser degree, military adjustment were significantly related to PTSD symptomatology, whereas premilitary adjustment was not. Discriminant function analyses showed that the MMPI had moderate ability to correctly classify Ss on the basis of PTSD diagnosis. However, problem checklist items indicative of anxiety-based disorders, particularly generalized anxiety and pervasive disgust, formed a discriminant function that correctly classified more than 90% of Ss. Results are discussed in terms of complications for an empirically derived conceptualization of PTSD. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors associated with child mental health service use in the community

OBJECTIVE: To determine the association of parent, family, and child factors with mental health services need and utilization. METHOD: Possible determinants of services need and utilization were assessed in a general population sample of 2,227 children aged 4 to 18 years. RESULTS: 3.5% of the total sample had been referred for mental health services within the past year. The most potent factors associated with service need and utilization were the child's problem behaviors (both internalizing and externalizing) and academic problems and family stress. Socioeconomic factors and the child's sex were not in itself associated with help-seeking factors. Parental psychopathology, life events, and family psychopathology lowered the parents' threshold for evaluating the child's behavior as problematic but did not increase the likelihood of referral. CONCLUSION: Referred children are more likely to live in families under stress than are children with the same level of problems who live in well-functioning families. Clinicians and researchers who make inferences from findings in clinical samples should realize, therefore, that children from problem families are overrepresented in their samples.     

Acquired tracheomalacia--a case report

Divalproex sodium is an effective drug for the treatment of migraine. Most adverse drug events are transient and not of great clinical concern. Although rare, well-documented examples of liver toxicity have been reported in children under 2 years of age on polypharmacy. Additional cases occur in children under 10 who are receiving polypharmacy, particularly those who have intractable seizures and degenerative central nervous system disease. Clinicians who treat migraineurs with divalproex sodium do not need to be overly preoccupied with monitoring of drug levels and liver function tests. The most valuable test is clinical observation of the patient.     

A new approach to psychopathology

A new approach to psychopathology based on the psychology of integration as applied to psychological states is outlined. Because all raw behavior occurs only in the form of psychological states, all formulations of psychopathology must refer to integrative disorders that are postulated to underlie all pathological or defective behaviors. Disintegration is the one common factor found in all mental disorders. Lack of integration underlies most inadaptability. The classical field of psychopathology, which formerly was limited to the consideration of formal psychiatric disorders, now is expanded to include deficits, imbalances and disintegrations of acute or chornic nature that result in erroneous or less than perfect judgments. Judgment is considered to reflect the quality of underlying integrative processes. Judgmental defects that lead to maladaptive decisions inevitably must result in maladjustment and/or less than perfect performance. It is necessary to differentiate between (a) integrative disorders per se, and (b) the personal-social effects of positive or negative integrations organized by healthy or unhealthy factors. Criminals may be well integrated in their asocial activities, but socially undesirable because organized about the criminal ethic. Postulates are presented that outline the theoretical assumptions upon which integrative psychopathology is based. This approach utilizes classic theories such as the Freudian psychopathology of everyday life when valid and relevant within the larger framework of integrative psychology. A differentiation is made between hierarchical levels of increasingly complex factors that may organize integration.     

Angiotensin-converting enzyme and angiotensinogen gene polymorphisms and heart rate variability in twins

Decreased heart rate variability (HRV) is associated with congestive heart failure, post-myocardial infarction, ventricular arrhythmias, sudden cardiac death, and advancing age. A deletion/insertion polymorphism in the angiotensin-converting enzyme (ACE) gene and a substitution (M235T) in the angiotensinogen gene have been associated with risk for heart disease. The aim of this study was to determine the heritability of HRV and related parameters in monozygotic and dizygotic twins and to assess the influence of ACE and angiotensinogen polymorphisms. We studied 95 MZ pairs and 46 DZ pairs. We measured HRV and related parameters, ACE and angiotensinogen levels, plasma norepinephrine, ACE, and angiotensinogen genotypes. We found that HRV and related parameters were significantly influenced by genetic variability, although nonshared genetic effects were also important. Angiotensinogen and plasma norepinephrine were generally correlated with decreased HRV, whereas ACE was correlated with perturbances of normal rhythmic HRV. Nevertheless, the DD ACE genotype was associated with increased HRV (p <0.05), whereas angiotensinogen polymorphisms had no effect. We conclude that HRV and related parameters are in part heritable. Interestingly, the DD ACE genotype is associated with increased HRV.     

Genetics in hypertension research. What can we learn from it regarding common essential hypertension?

Essential hypertension is a polygenic disease. Various genes responsible for rare monogenic forms of hypertension have been identified in the recent years. These are glucocorticoid remediable aldosteronism (GRA), Liddle's syndrome and apparent mineralocorticoid excess (AME). A fourth form, the Bilginturan syndrome is associated with brachydactyly and resembles essential hypertension. The investigations of the pathomechanisms in these rare diseases can help us to understand common hypertension.