Referenz 988a Neurologie, 11. Auflage ; Vossler DG, Wyler AR, Wilkus RJ, Gardner-Walker G, Vlcek BW.: Cataplexy and monoamine oxidase deficiency in Norrie disease. Neurology 46, 1258-1261 1996 ; . Epilepsy Center, Swedish Health Services, Seattle, WA 98122, USA. Norrie disease ND ; is an X-linked recessive disorder causing ocular atrophy, mental retardation, deafness, and dysmorphic features. Virtually absent monoamine oxidase MAO ; type-A and -B activity has been found in some boys with chromosome deletions. We report the coexistence of cataplexy and abnormal REM sleep organization with ND. Three related boys, referred for treatment of medically refractory atonic spells and apneas, underwent extended EEG-video-polysomnographic monitoring. They demonstrated attacks of cataplexy and inappropriate periods of REM sleep during which they were unarousable. One boy also had generalized tonic-clonic seizures. Previous testing revealed that all three have complete ND gene deletions. In all subjects, platelet MAO-B activity was absent, serum serotonin levels were markedly increased, and plasma catecholamine levels were normal. Data from the canine narcolepsy syndrome model implicate abnormal catecholaminergic and cholinergic activities in the pathogenesis of cataplexy. Our findings suggest that abnormal MAO activity or an imbalance between serotonin and other neurotransmitter levels may be involved in the pathogenesis of human cataplexy.
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Cognitive-behavioral therapy was the most favored approach, recommended by 66.2% of the sample, followed by family 37.6% ; , support 34.5% ; , interpersonal 33.7% ; and dynamic 32.4% ; psychotherapies. Overall, the most recommended drugs were antidepressants 58.5% ; , followed by anxiolytics 32.6% ; , antipsychotics 24% ; , stimulants 19.6% ; , beta-blockers 19.3% ; , mood stabilizers 10.4% ; and alpha-adrenergics 3.8, because plaviix mechanism.
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NABIL HAGAG, 1 JUAN CARLOS LACAL, 2 MARK GRABER, 1 STUART AARONSON, 2 AND MICHAEL V. VIOLA' * Departments of Medicine and Microbiology, State University of New York at Stony Brook, Stony Brook, New York 11794, 1 and Laboratory of Cellular and Molecular Biology, National Cancer Institute, Bethesda, Maryland 208922 and prilosec.
Recent research in New Zealand identified significant rates of iron deficiency in female teenagers. This qualitative study aimed to research why this may be occurring by exploring female teenagers' beliefs, attitudes and behaviours towards iron. This study also investigated effective ways of communicating iron education messages to this target group. Focus groups were conducted with female fifth formers from three schools in West Auckland. The results showed that iron messages should be targeted at female teenagers. The difficulty of targeting this group was acknowledged and confirmed the need to involve the target group in future educational developments to ensure effectiveness. Television was identified as an important media for reaching this target group. A revised iron education pamphlet that relates to the identified needs of female teenagers was recommended to be a reference for teenagers and to assist health professionals working with this group. It could be distributed through schools and in the magazines read by teenagers. Female adolescents appeared to be more concerned about current health and appearance, therefore good nutrition should be emphasised in relation to these factors. Eating habits may be difficult to influence in this group, but the period while they are at school offers an opportunity to educate females and their parents who provide most of their food, on female iron needs.
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Acceptance, side effects, and safety. Arch Gen 45: 423-428 Kaplan HI, Sadock BJ eds ; : Comprehensive Textbook of Psychiatry, 4th ed, vol 2. Baltimore, Williams & Wilkins, 1985 Fyer AJ, Manuzza 5, Endicott J: Differential diagnosis and assessments of anxiety: recent developments, in Psychopharmacology: The Third Generation of Progress. Edited by Meltzer HY. New York, Raven Press, 1987.
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2. The effectiveness of mitral valve repair or replacement is not established for severe secondary mitral regurgitation in refractory end-stage HF. Level of Evidence: C ; 3. Continuous intravenous infusion of a positive inotropic agent may be considered for palliation of symptoms in patients with refractory end-stage HF. Level of Evidence: C ; Class III 1. Partial left ventriculectomy is not recommended in patients with nonischemic cardiomyopathy and refractory end-stage HF. Level of Evidence: C ; 2. Routine intermittent infusions of positive inotropic agents are not recommended for patients with refractory end-stage HF. Level of Evidence: B ; Most patients with HF due to reduced LVEF respond favorably to pharmacological and nonpharmacological treatments and enjoy a good quality of life and enhanced survival; however, some patients do not improve or experience rapid recurrence of symptoms despite optimal medical therapy. Such patients characteristically have symptoms at rest or on minimal exertion, including profound fatigue; cannot perform most activities of daily living; frequently have evidence of cardiac cachexia; and typically require repeated and or prolonged hospitalizations for intensive management. These individuals represent the most advanced stage of HF and should be considered for specialized treatment strategies, such as mechanical circulatory support, continuous intravenous positive inotropic therapy, referral for cardiac transplantation, or hospice care. Before a patient is considered to have refractory HF, physicians should confirm the accuracy of the diagnosis, identify any contributing conditions, and ensure that all conventional medical strategies have been optimally employed. Measures listed as Class I recommendations for patients in stages A, B, and C are also appropriate for patients in end-stage HF also see Section 5 ; . When no further therapies are appropriate, careful discussion of the prognosis and options for end-oflife care should be initiated see Section 7 and plendil.
Most people with asthma may adjust their inhaled medication from time to time, for example using your reliever inhaler when you feel breathless. It is now thought that when given the correct information, people with asthma can achieve better control by adjusting their own treatment. The British Guidelines for Asthma, recommend individual Action Plans for people with asthma. Action Plans An Action Plan these used to be called self-management plans ; is a written guide explaining what to do if your asthma becomes more of a problem than usual. This may involve an increase in your treatment, or advise you to start a `rescue' course of steroid tablets. It should also include instructions on when to seek medical help urgently. You should be involved in the making of your Action Plan with your doctor or nurse. If you are worried or unsure about your treatment in any way see your doctor or asthma nurse. Once your Action Plan has been decided on, it is important that you follow it if your asthma worsens. The National Asthma Campaign provide a plan which can be downloaded from their website asthma - or by phone on 08457 010203.
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