Absence Of Organic Cause Research Articles

Assessment of cardiac function in syncopal children without organic causes.

Background Syncope is a common problem in children and adolescents. However, a large proportion of syncope cases have no underlying cause.Purpose This study aimed to identify the factors affecting the severity of syncope using tissue Doppler imaging (TDI).Methods This retrospective study included 61 children and adolescents with syncope who underwent echocardiography. The head-up-tilt test (HUT) was performed when there was a more severe syncopal event. We compared the echocardiographic findings between the execute HUT and nonexecute HUT, negative HUT result and positive HUT result, and normal electrocardiogram (ECG) and abnormal ECG groups. Data were analyzed using an unpaired t test post hoc analysis.Results In the execute and nonexecute HUT groups, the odds ratios were 0.55 for medial E/E′ (P=0.040) and 0.64 for lateral E/E′ (P=0.049). Comparison of the results of the decreased, normal, and increased groups for lateral E/E′ revealed a significant difference in the execution HUT and nonexecute HUT groups (overall, P=0.004; decreased vs. increased, P= 0.003; normal vs. increased, P=0.050).Conclusion Medial E/E′ and lateral E/E′ were decreased in patients with severe syncopal events. These findings suggest that the presence of left ventricular diastolic deterioration may cause hypoperfusion even in the absence of organic causes and, consequently, increase syncope severity and frequency. The TDI measured by echocardiography can be used as an index to predict syncope recurrence and/or severity.

Functional Constipation and the Gut Microbiome in Children: Preclinical and Clinical Evidence.

Functional constipation is a common condition in childhood with significant impact on patients' quality of life and on health care resources. Functional constipation is characterized by decreased bowel movements and/or hard stools, which cause significant distress for children and their caregivers. While the term “functional” may imply the absence of organic causes with a focus on behavioral aspects, 40% of children continue to have symptoms beyond conventional management with one in four children continuing to experience constipation into adulthood. The refractory and chronic nature of constipation highlights the importance of considering a range of pathophysiological mechanisms, including the potential role of the gut microbiome. In this review, we provide an overview of preclinical and clinical studies that focus on the potential mechanisms through which the gut microbiome might contribute to the clinical presentation of functional constipation in pediatrics.

Puberphonia: From classic to modern approach

<p>Voice is a significant component of communication that allows us to express information and emotions, so it is the foundation of verbal communication. Maturation of the body involves dilation of the larynx and lower positioning of the larynx in the neck, resulting in multiple changes in voice quality. The rapid changes in the human larynx during puberty are more evident in males. Such changes can result in voice mutation - puberphonia. Puberphonia, also called mutational dysphonia or mutational falsetto, is the failure of a natural decrease in fundamental frequency or pitch. We can also defined puberphonia as persistent adolescent voice even after puberty in the absence of organic cause. This functional voice disorder can have multiple consequences on the personality and quality of life of an individual that often encounters problems that include psychological, emotional, social, and professional difficulties. This article aims to review the relevant and accessible literature on puberphonia in a comprehensive concise manner, highlighting the etiology, prevalence, clinical manifestation, consequences on quality of life, as well as evolution of the approach and attitude to its treatment.</p>

Effect of Otilonium Bromide in the Treatment of Irritable Bowel Syndrome: A Meta-Analysis

Introduction: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits in the absence of organic causes. Antispasmodics have been studied in the management of IBS. The aim of our study is to update previous overviews of placebo controlled randomized trials assessing the efficacy and tolerance of otilonium bromide in irritable bowel syndrome. Methods: A systematic search of PubMed/Medline, CINAHL, Scopus, Cochrane data base of systematic reviews, and clinical trials.gov registry was performed. Two independent reviewers systematically identified prospective randomized controlled trials (RCTs) that compared the effect of otilonium bromide versus placebo in adults with IBS. Studies had to report either a global assessment of cure or improvement in symptoms, or improvement in abdominal pain after treatment. Meta-analysis was performed using a fixed effect model to assess the primary outcome (global improvement of symptoms) and secondary outcomes (improvement in abdominal pain and frequency of adverse events). Review Manager 5.2 software program was utilized for statistical analysis. Results: Seven RCTs met the inclusion criteria. A total of 1,188 patients were included in the meta-analysis. The mean percentage of patients with global improvement was 39% in the placebo group (n=522) and 53% in the OB group (n=521), in favor of otilonium bromide with an odds ratio of 1.84 (95% CI: 1.42-2.40; p<0.01). The percentage of patients with improvement of abdominal pain was 47% in the placebo group (n=350) and 62% in the otilonium bromide group (n=354) with an odds ratio of 1.94 (95% CI: 1.42-2.63; p<0.01). There was no significant difference for adverse events. Conclusion: Otilonium bromide was superior to placebo in the management of IBS, without any significant adverse effects. Disclosure - Dr. Bechtold - Consultant: Nestle Nutrition Institute.

Idiopathic adult colo-colonic intussusception: Case report and review of the literature

INTRODUCTIONAcute colonic intussusception occurring in the absence of organic cause is uncommon in adults. PRESENTATION OF CASEWe report acute colonic intussusception in a 46-year-old female; clinical evidence of a palpable mass, abdominal pain and bloody mucoid stools appeared a few hours after hospital admission. Multislice CT-scan confirmed the clinical diagnosis and surgical exploration revealed right colonic obstruction caused by intussusception of the cecum into the ascending colon. Right hemicolectomy was performed and histopathological examination did not reveal any causative pathology. DISCUSSIONIntussusception remains a rare condition in adults, representing 1–5% of bowel obstruction and accounting for 0.003–0.02% of all hospital admissions. Intussusception occurs more frequently in the small (50–80%) than in the large bowel (12–50%). It is estimated that approximately 90% of intussusceptions in adults are secondary to an anatomical or pathological condition, of which more than half are malignant. Idiopathic cases are the exception in adults. The clinical presentation of adult intussusception differs considerably from the classic pediatric presentation of abdominal pain, palpable mass, and blood per rectum, which is rarely seen in adults. A pre-operative CT-scan showed a 10cm intussuscepted segment of right colon. Surgical resection was considered mandatory because of severe bowel obstruction, and the theoretical possibility of occult malignancy. This approach was vindicated by the presence of widespread ischemic lesions in the wall of the resected bowel, without any obvious lead point. CONCLUSIONThere are few reports in the medical literature of acute colonic intussusception occurring in the absence of organic cause in adults.

Characterisation and growth outcomes of children with Insulin-like Growth Factor-1 deficiency in idiopathic short stature

Background/aimsChildren with idiopathic short stature (ISS) constitute a heterogenous group. Recombinant IGF-I (rhIGF-I) have been licensed for the treatment of severe short stature (height <−3 standard deviation scores (SDS)) in...

Psychiatric diagnoses in patients with burning mouth syndrome and atypical odontalgia referred from psychiatric to dental facilities.

BackgroundBurning mouth syndrome (BMS) and atypical odontalgia (AO) are two conditions involving chronic oral pain in the absence of any organic cause. Psychiatrically they can both be considered as “somatoform disorder”. From the dental point of view, however, the two disorders are quite distinct. BMS is a burning or stinging sensation in the mouth in association with a normal mucosa whereas AO is most frequently associated with a continuous pain in the teeth or in a tooth socket after extraction in the absence of any identifiable cause. Because of the absence of organic causes, BMS and AO are often regarded as psychogenic conditions, although the relationship between oral pain and psychologic factors is still unclear. Some studies have analyzed the psychiatric diagnoses of patients with chronic oral pain who have been referred from dental facilities to psychiatric facilities. No study to date has investigated patients referred from psychiatric facilities to dental facilities.ObjectiveTo analyze the psychiatric diagnoses of chronic oral pain patients, diagnosed with BMS and AO, and referred from psychiatric facilities to dental facilities.Study designPsychiatric diagnoses and disease conditions of BMS or AO were investigated in 162 patients by reviewing patients’ medical records and referral forms. Psychiatric diagnoses were categorized according to the International Statistical Classification of Disease and Related Health Problems, Tenth Revision.ResultsThe proportion of F4 classification (neurotic, stress-related, and somatoform disorders) in AO patients was significantly higher than in BMS patients. BMS patients were more frequently given a F3 classification (mood/affective disorders). However, 50.8% of BMS patients and 33.3% of AO patients had no specific psychiatric diagnoses.ConclusionAlthough BMS and AO are both chronic pain disorders occurring in the absence of any organic cause, the psychiatric diagnoses of patients with BMS and AO differ substantially.

Behavioural treatment of severe food refusal in five toddlers with developmental disabilities

Young children with developmental disabilities are at risk of food refusal. In case of severe food refusal, children are being fed by nasal or gastrostomy tube. Behavioural treatment may be effective in establishing oral food intake. A behavioural treatment package was implemented in an outpatient setting for the treatment of severe food refusal in five toddlers with developmental disabilities. During the course of treatment, treatment principles were generalized to parents in the home setting. Treatment resulted in oral acceptance of a variety of food items in each child and was successfully generalized. Treatment effects were maintained during follow-up between 3 and 12 months. Tube feeding was discontinued in each child and health status of each child improved. Behavioural treatment may be highly effective in establishing oral food intake in children with developmental disabilities (in the absence of organic causes). As a side-effect of this treatment, tube-feeding may be discontinued and general heath status improved.

Probing the causes of visual acuity loss in patients diagnosed with functional amblyopia

Although amblyopia is normally defined as a deficit invisual acuity despite full optical correction and theabsence of observable pathology, the association be-tween ocular pathology in early life and amblyopicvisual loss is well established. For example, the presenceof monocular congenital cataract (von Noorden andMaumenee, 1968; von Noorden, 1981), unilateral ptosis(Anderson and Baumgartner, 1980; Harrad et al., 1988)or a wide variety of unilateral ocular pathologies presentduring early childhood (Kushner, 1981, 1984) canprecipitate often severe (deep) cases of amblyopia. Thesestudies provide strong support for the view that aunilateral decrease in the signal emerging from one eyebecause of patching or pathology during a sensitiveperiod early in life will precipitate a functional ambly-opia (Hardesty, 1959; Awaya et al., 1973; von Noorden,1981). In cases where the pathology cannot be resolvedthe total visual deficit reflects the combination of theprimary (organic) visual loss together with a super-imposed functional amblyopia. Recently, it has beensuggested that the visual deficit in many cases of themuch milder and more common forms of amblyopiamay also represent the sum of functional and organiccomponents (Lempert, 2000, 2003, 2004). That is, theamblyopia typically associated with strabismus and/oranisometropia, and considered to exist in the absence oforganic causes, may, in fact, be superimposed upon theloss which is due to a subtle organic defect. Thishypothesis clearly contradicts the generally held viewthat almost all amblyopias are caused by either strabis-mus or anisometropia in the absence of ocular patho-logy. This controversial hypothesis has prompted us tore-examine the traditional view of the causal agents formost amblyopias, and the implications for remediationof this condition.The vast majority of the 2–2.5% (von Noorden, 1996)ofhumansdiagnosedwithamblyopiaeitherhave,orhavepreviously had, strabismus and/or anisometropia. Theabsenceofclinically-detectedpathology,coupledwiththefact that experimentally induced anisometropia andstrabismusinanimalscausebroadlysimilarvisualdeficits(e.g. Harwerth et al., 1983; Smith et al., 1985), has led tothe ubiquitous terms anisometropic and strabismicamblyopia – with the resultant implication of a directcausalrelationship.Thatis,currentclinicaldogmaassertsthat chronic abnormal sensory input because of strabis-mus or anisometropia precipitates a neural deficit that ismanifest clinically as reduced monocular visual acuity.Improvement in visual acuity after treatment consistingonly of manipulation of sensory input (e.g. spectaclesand/or occlusion therapy) can be viewed as a formalconfirmation of the functional amblyopia diagnosis.Although the association between amblyopia andanisometropia and/or strabismus is clear, there has longbeen uncertainty regarding the causal relationshipsbetween anisometropia and strabismus and amblyopiain humans. The causal relationship is self-evident inlongitudinal animal studies in which either strabismus oranisometropia have been shown to precipitate ambly-opia (e.g. Kiorpes and Boothe, 1980; Harwerth et al.,1983; Smith et al., 1985). Furthermore, studies ofhuman infantile esotropia show that esotropia precedesthe development of amblyopia (Birch and Stager, 1985).Unfortunately, such longitudinal studies are rare in thehuman amblyopia literature. In addition to the absenceof definitive longitudinal data from human amblyopes,there are many experimental results that suggest a quitedifferent causal relationship between amblyopia andstrabismus or anisometropia. For example, althoughanimal investigations show that sustained, unilateralblurring is required to precipitate amblyopia (Smithet al., 1985), longitudinal refractive studies of human

Defining Amblyopia: The Need for a Joint Classification

Recent years have shown an impressive rise in high quality research on amblyopia. Unfortunately, the condition itself is not sufficiently defined, and consequently different studies have been used different definitions of amblyopia. Aspects in need of consideration include the degree of visual acuity reduction, magnitude of interocular difference in acuity, method of visual acuity testing used, the effect of refractive adaption, the presence of amblyogenic factors, the absence of organic cause and the treat ability of the deficit. Vision scientists worldwide are encouraged to jointly decide on what is, and what is not, amblyopia.

Patterns of psychiatric consultations in Kuwait general hospitals

Two hundred and nineteen consecutive referrals to psychiatric consultation services from all general hospitals in Kuwait over a 3-month period were studied and compared with a control group of 100 patients who were not referred for psychiatric consultation. The two groups differed significantly in age, sex, marital status, employment, and past psychiatric treatment. Inpatients were more often referred than outpatients with an overall low referral rate of 0.3%. The department of general medicine referred 74.4% of patients in contrast to 11.4% referred by the department of general surgery. The most common reason for referral was for assessment of a suicide attempt in the inpatient group, and the absence of organic cause for patients' physical symptoms in the outpatient group. Acute situational disturbance that resulted in a suicide attempt was the most common psychiatric diagnosis (26%), followed by depressive illness (19.5%) and organic psychotic disorders (8.2%). Our findings are similar to those reported in the literature, and the present study suggests a national underutilization of psychiatric consultation services in general hospitals.

Infants who fail to thrive: An intervention for poor feeding practices

Abstract Although failure to thrive in the absence of organic cause was originally regarded as an outcome of emotional deprivation, the consensus among practioners now is that it results directly from inadequate nutrition, though the causes of poor feeding practices may well have origins in psychological difficulties of the parents and/or the child. An intervention of a scale which could be provided in a community setting was devised and applied to six mothers whose children were non-organically failing to thrive. The intervention was designed to enable the mothers to provide their child with adequate nutrition and resulted in a significant improvement on all measures after the very short treatment programme.

Parental Visiting of Sick Infants: The Effect of Living at Home Prior to Hospitalization

Several studies have suggested the importance of keeping mother and infant together during the early post-partum period for the development of the mother-infant bond.1,2 Mother-infant contact soon after birth has been shown to have far-reaching consequences with effects demonstrable in mother-to-child speech at 2 years3 and affecting IQ in premature infants at 42 months.4 Prematurity and neonatal illness may separate the mother and infant and change the quality of their contact. After these separations there is a significant increase in the incidence of child abuse and failure to thrive in the absence of organic cause.5,6 The frequency of parental visiting was studied to determine the effects of a short period of care at home and the presence of a visible congenital anomaly on parent-to-infant attachment.

Diocytyl sodium sulfosuccinate (colace) following proctologic operations.

Introduction The proctologic aspects of constipation were presented from a broad biologic standpoint at a symposium on the normal and abnormal physiology and therapeutics of the colon held by the Section of Biology of the New York Academy of Sciences on May 8 and 9, 1953. 1 Lesions such as diverticulitis, complete and incomplete colonic obstruction, megacolon and other congenital colonic and anorectal malformations, anal fissure, so-called pectinosis, hemorrhoids, prolapse, and megarectum were discussed briefly. It was then stated that laxatives have no place the therapy of constipation caused by organic etiologic factors. Although functional constipation, or constipation on a habit basis, hardly belongs the realm of the proctologist, I nevertheless stated that with Ogilvie I believe that in the absence of organic causes, normal defecation usually 'comes from equanimity and common sense.' Hardly ever do I find a need for cathartic drugs the management of the