Severe Bouts Research Articles

The prevention of depression in children and adolescents

Depression is a common mental health problem, which is increasing in people born in the latter half of this century. It is also becoming more common to experience a first episode of depression in adolescence, a factor that is a significant risk for recurrent and more severe bouts of the disorder. This paper makes a case for universal prevention programs and suggests that efforts should begin in late childhood. In making this case, risk and protective factors for depression are reviewed, along with the efficacy research on early interventions to prevent depression in young people.

Thomas Addison

Thomas Addison found a coveted place in medical history—not merely one, but two clinical conditions are named after him. His clinical description of pernicious (Addison) anemia first appeared in 1849. In 1855 came his famous review of adrenal insufficiency (Addison disease).Addison’s exact date of birth is obscure, probably 1793. He graduated in medicine in 1815, with a thesis entitled “De Syphilide et Hydrargyro.” He joined Guy’s Hospital as a “perpetual Physician’s Pupil.” He rose quickly through the ranks, as lecturer on Materia Medica in 1827 and full physician in 1837. He was associated with other luminaries of Guy’s Hospital, such as Hodgkin and Bright.Addison gave classical descriptions of many conditions, including vitiligoidea, keloid, pneumonia, phthisis, and acute appendicitis. An accomplished auscultator, he enumerated 42 difficulties and fallacies in physical diagnosis of the chest.On March 15, 1849, at a meeting of the South London Medical Society, Addison read a paper on a “remarkable form of anemia.” Calling this “idiopathic” anemia, Addison described languor and restlessness, a resemblance to a bad wax figure and a fatal outcome. Initially, he felt the condition was related to the suprarenals, as 3 cases showed postmortem abnormalities of this structure. The association of adrenal disease and anemia in 3 of Addison’s initial patients is one of the most fortuitous coincidences in medical history, as it focused his attention on the suprarenals and ushered in the dawn of endocrinology.Addison believed the suprarenals were essential to life. In 1855, he published his famous work, “On the Constitutional and Local Effects of Diseases of the Supra-renal Capsules,” in which he provided a clinical description of what is now known as Addison disease, including darkening of the skin. Six of his 11 cases had tuberculosis. A statement in this second monograph suggests that he no longer regarded adrenal disease as the likely cause of “idiopathic” anemia.Unfortunately, Addison suffered from severe bouts of depression. He retired from medical practice in March 1860 and died on June 29, 1860.

Features of eating disorders in patients with irritable bowel syndrome

The relationship between characteristics of irritable bowel syndrome (IBS) and eating disorders (ED) was investigated in a clinical sample of 43 female and 17 male IBS patients who completed the Eating Disorder Inventory (EDI). A diagnosis of IBS was generally unrelated to the Body Dissatisfaction, Perfectionism, and Ineffectiveness subscales of the EDI, but symptom severity was correlated with Perfectionism and Ineffectiveness. Severe bouts of vomiting were significantly associated with desires for lower body weight and reported binge–purge behaviors and cognitions measured by the Bulimia subscale of the EDI. Results suggest the need for a more comprehensive understanding of both types of illness as well as a possible framework for future empirical work.

Nautilus and the art of metabolic maintenance

THE cephalopod mollusc Nautilus is often called a living fossil because its multichambered shell resembles that of extinct forms from the early Palaeozoic era. Living at depths of 100–300 m, the animals not only encounter zones of low oxygen concentration, but also exploit them for refuge or feeding1,2. Despite some modest recruitment of anaerobic sources of energy, Nautilus is able to survive severe bouts of hypoxia, mainly through its prodigious capacity for aerobic metabolic rate suppression. Here we show that the hypometabolic, hypoxic animal conserves energy further by means of prolonged ventilatory and circulatory pauses, during which time the blood, having a comparatively high oxygen affinity, is apparently loaded at the venous side, across the superficially located and voluminous vena cava. Under these highly arrested conditions, a significant fraction of the animal's aerobic metabolic rate can be accounted for by a slow 'metering out' of the O2 store contained in the shell, indicating that the buoyancy chambers of Nautilus may occasionally subserve the role of a 'SCUBA tank'. The internal shell morphology and siphuncular arrangement seen in the fossilized remains of ammonites suggest that similar processes may have occurred.

A Patient with Autoimmune Thrombocytopenic Purpura Demonstrating Serum Antibodies Reactive with Mouse Cross-Reactive Idiotypes

Autoimmune thrombocytopenic purpura (ATP) is a syndrome of destructive thrombocytopenia due to platelet-binding antibodies. We report the case of a young woman (C.V.) who has a history of chronic ATP with severe but transient bouts of thrombocytopenia. Using the classic monoclonal antibody (MAb) immobilization of platelet antigens (MAIPA) assay to screen serum antibody specificity, results were strongly positive with MAbs to glycoproteins (GPs) Ib-IX, Ia-IIa, IV, and p24, but weakly positive or negative for GP IIb-IIIa. In contrast, a two-step incubation assay (MAIPA II), in which platelets were incubated sequentially with C.V. serum and the murine MAb, gave negative results for all GPs. Affinity chromatography performed using Bx-1, a MAb to GP Ib, showed that the patient's serum contained antibodies to determinants expressed by mouse immunoglobulins. These were present on Fab fragments of Bx-1. A survey of sera from other patients with thrombocytopenia of immune origin revealed that antibodies reactive with selected idiotypes of mouse MAbs were not infrequent and raises the question of their role in the thrombocytopenia.

Edward Lear: A Biography

Edward Lear, Victorian author of nonsense verse, was also a water-colourist and a traveller. Lear's sense of humour was contrasted with his severe bouts of depression. Gregarious and popular, he had a wide circle of friends including Alfred Tennyson, yet was often lonely. As well as descriptions of some of Lear's sketches and watercolours (of which he painted some 10,000 in the course of his career), Levi also provides critical analysis of classic poems, such as The Jumblies, The Owl and the Pussycat and The Yonghy-Bonghy-Bo, setting them in the wider context of traditional nursery rhymes. Lear belonged to the great traditon of adventurous British travellers, undertaking extensive journeys in Italy and Greece, in Albania, Turkey, and Egypt, in Palestine, and in India. Many of his travels took him through wild and rugged terrain and led to encounters with unusual characters. Extensive quotation from Lear's letters and detailed diaries complement this book.

Ascaris Lumbricoides in air passage

An unusual living foreign body (Ascaris Lumbricoides) in trachea is documented for its rarity. Awareness of the condition is of paramount importance for proper diagnosis and treatment. Severe bouts of paroxysmal cough, dyspnoea or stridor in children, specially of sudden onset, must arouse the suspicion of an endobronchial or endotracheal foreign body.

Cerebral Arteriovenous Malformation and Cluster‐like Headache

Cluster headache is considered a clinically distinct entity with no underlying gross pathology. However, in rare cases this kind of headache may be mimicked by an arteriovenous malformation. A 49-year-old male is described who had severe bouts of unilateral headache resembling those of cluster headache. The usual accompanying autonomic manifestations were minor and the headache attacks were prolonged. Treatment with ergotamine tartrate and pizotifen failed. A large ipsilateral arteriovenous malformation was diagnosed. Prospectively, true clustering of the headache attacks could not be documented.

Bronchial cast — An endogenous foreign body

Bronchial cast is an infrequently reported endogenous type of foreign body. Awareness of the condition is of paramount importance for treatment. Severe bouts of paroxysmal cough, dyspnoea, non-resolving pneumonic consolidation should arouse the suspicion of an endobronchial obstruction. Prompt removal of the casts by rigid bronchoscopy using powerful suction is rewarding.

Immuntherapie des chronischen Guillain-Barré-Syndroms mit Hochdosis-IgG und Ciclosporin A

We report about the three-year treatment of a patient with chronic relapsing Guillain-Barré syndrome (GBS), who, simultaneously, suffered from benign gammopathy. A casual relationship between the two diseases could not be proven, since specific antimyeline antibodies could not be found. Five severe bouts of the disease occurred during the observation period, only the first two relapses, however, showed improvement with cortisone treatment, while the latter did not so. High dosages of 7S-immunoglobuline, by contrast, led to a rapid improvement during each of the subsequent relapses. The additional therapy with ciclosporine A kept the patient free from neurological deficits for more than six months now. The mechanisms of various immunological therapeutic approaches are discussed, particularly as an alternative to plasmapheresis. Our observation, as well as theoretical considerations, suggest the aforementioned immunological treatment being promising in chronic GBS.

Serious Migraine: A Study of Some Epidemiological Aspects

Data are scant concerning some epidemiological aspects of those severe headaches which cause serious personal and economic morbidity. Our purpose was to study the incidence and other epidemiological features of patients suffering from severe migraine exacerbations, in an unselected population. The 64 patients who suffered from severe migraine bouts represented 10.5% of all the new walk-in neurological consultations in the area covered in this study. 70% of these patients were between 10 and 39 years old. Although females clearly predominated in all ages after fifteen, below this age there was a slight male predominance. The calculated incidence of serious migraine exacerbations was 90 per 100,000 people per year, the corrected incidence for females being 143/100,000 and for males 37/100,000. The highest incidence for females was in 15-19 year-olds (377/100,000) and for males in 10-14 year-olds (166/100,000). Our data seem to confirm the periodic nature of this condition since in 80% of patients the migraine bouts (ie: groups of attacks) lasted between two and nine months. Also they support the reported existence of genetic and hormonal factors in the susceptibility to migraine exacerbations. Our results may help in planning the public health aspect of migraine and add some light to the natural history of this common condition.

Woodrow Wilson: A Medical and Psychological Biography

The personality of Woodrow Wilson has always been a controversial subject, one that prompted a psychological study by Freud himself. Edwin Weinstein, professor of neurology at Mt Sinai Medical School and a fellow of the William Alanson White Institute of Psychoanalysis, has written a superb book analyzing the influence of Wilson's neurological and psychological health on his political life. Weinstein presents persuasive evidence that Wilson suffered from mixed cerebral dominance, with consequent childhood dyslexia and lifelong difficulties with reading and factual recall, in marked contrast to his mastery of rhetoric and imagery. Wilson's early career as an academic was interrupted by severe bouts of "the blues," headaches, and gastrointestinal disturbances at times of psychic stress. Wilson also suffered from hypertension and cerebral arteriolosclerosis, and experienced his first stroke at age 39, which left his right hand partially paralyzed. Another, larger stroke while president of Princeton University left him blind in

An in vitro study of depressed cell-mediated immunity and of T and B lymphocytes in atopic dermatitis

Lymphocyte transformation tests, E binding(T) rosette assay and immunofluorescent preparations of B cells were studied in patients with atopic dermatitis, and also in healthy controls. Most of the patients were found to have high levels of IgE in serum. The patients were studied both during severe bouts of dermatitis and also when the dermatitis was almost healed. Lymphocyte transformation tests showed that patients were hyporeactive to PPD and herpes simplex antigen in vitro, both during periods of severe dermatitis and also when the dermatitis was in remission. The response to PHA in the patients was normal in vitro. No factors which could reduce cell-mediated immunity in vitro were found in patients' sera. A decreased number of T lymphocytes and a slight increase in the number of immunoglobulin-bearing lymphocytes (B cells) were demonstrated in the patients, both during remission and during recurrence of severe dermatitis. In 3 of 8 patients, increased numbers of IgE-bearing lymphocytes were found to be present when the patients had severe dermatitis. A possible correlation between high serum levels of IgE and depressed cell-mediated immunity in patients with atopic dermatitis is discussed.

Generalized pustular psoriasis. A report on thirteen patients

Generalized pustular psoriasis shows a fluctuating pattern, its course varying with time and from patient to patient. The prognosis and results of treatment are therefore extremely difficult to assess. The patients in this series have been followed up by us with regard to the natural course of the illness including complications and precipitating factors. Oral drug therapy has suprisingly often provoked acute pustular eruptions, and these patients have also strikingly often and rapidly developed contact allergy to topical applications. The undesirable effects of long-term systemic corticosteroid therapy have been confirmed in this series, chiefly by severe rebound phenomena, notwithstanding that such treatment has proved the only means of rapidly reversing life-threatening states. The effects of methotrexate and hydroxyurea were at times good but, not uncommonly, mediocre and occasionally even useless. Large doses of antibiotics have also failed to achieve the results described by others. On the contrary, secondary infection with beta-hemolytic streptococci has caused serious problems in several cases. Apart from careful protection from infection and precipitating factors, little can be done to influence the course of generalized pustular psoriasis, but trial with cytostatics is justified during severe bouts, pending the appearance of new lines of therapy.

Management of increased lead absorption and lead poisoning in children.

THE primary aim of treatment for plumbism in children is the prevention of injury to the nervous system. In the long run, societal steps to minimize adventitious lead absorption will be needed to obtain this goal. In practice today, therapeutic intervention at the subclinical stage of lead poisoning and close follow-up observation during the preschool years can do much to prevent the severe forms of residual nervous-system injury. At least 25 per cent of young children with acute lead encephalopathy or recurrent but less severe clinical bouts of plumbism sustain permanent injury to the nervous system.1 2 3 Current chelation therapy started . . .

Occlusive disease of intracranial main arteries with collateral networks in children.

Six children with occlusion of main intracranial arteries and collateral networks are described. The diagnosis was made by carotid angiography at the age of 3 to 10 years. In one case there were symptoms already from the first months of life (spastic tetraplegia and later epilepsy), four children had acute hemiplegia at the age of 6 months, four, five and seven years respectively and one had severe bouts of headache since the age of three years. One child died of intracranial haemorrhage 10 months after the first symptoms had developed, the other ones have been followed up for one to five years and have not shown progression of the disease. Two are severely mentally retarded, the other three are mentally normal or bright. Of the mentally retarded cases one had also congenital cataracts, microcephaly and dwarfism and the other one signs of neurofibromatosis. Three of the other children had mild arterial hypertension but no other evidence of systemic disease such as diabetes, homocystinuria, collagen disease or autoimmune disorder. At autopsy of the only fatal case intimal proliferation of the arterial wall was seen in cerebral arteries and the same abnormality was also found in a renal and a coronary artery. After a review of the literature it is concluded that this syndrome is not very uncommon, that the causes seem to be manifold and that the diagnosis can usually be made by unilateral carotid angiography which will reveal the bilateral disease.

Long-term postoperative results following selective section of the vestibular nerve in Ménière's disease.

A material, consisting of 15 patients, who had preoperatively suffered from severe bouts of vertigo, and from tinnitus and loss of hearing, was investigated from 3 to 7 years after selective vestibular nerve section in Meniere' disease. Vertigo bouts disappeared in all patients; tinnitus improved in 73%, and remained unchanged in 27%. In 80% there was no change as regards hearing, and in 20% it deteriorated. This demonstrated that a selective nerve section gives better long-term results than other operative methods. Moreover, it indicates that although the operation may not bring about a cure, in most cases it will prevent the disease from progressing.

A Spectrum of Myopathy Associated with Alcoholism

Article1 September 1967A Spectrum of Myopathy Associated with AlcoholismI. Clinical and Laboratory FeaturesGERALD T. PERKOFF, M.D., F.A.C.P., MARCONI M. DIOSO, M.D., VIRGIL BLEISCH, M.D., GEORGE KLINKERFUSS, M.D.GERALD T. PERKOFF, M.D., F.A.C.P.Search for more papers by this author, MARCONI M. DIOSO, M.D.Search for more papers by this author, VIRGIL BLEISCH, M.D.Search for more papers by this author, GEORGE KLINKERFUSS, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-67-3-481 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptHepatic, neurologic, cardiac, hematologic, and metabolic abnormalities are generally accepted as frequent occurrences in people who drink alcoholic beverages (1-5) to excess. That muscle disease may occur in alcoholism is not as widely known. However, myoglobinuria with severe muscle tenderness and swelling, fever, increased levels of serum glutamic-oxalo-acetic transaminase (SGOT) and other enzymes, and, often, acute renal failure has been reported in several alcoholic patients after severe drinking bouts (6-11).More recently, we reported studies (12) of a similar but less severe syndrome characterized by muscle tenderness and cramps, increased serum creatine phosphokinase (CPK), and a diminished ability to increase...

Small-Bowel Ulcers With Thiazide and Potassium

ABSTRACT To the Editor:— After reading Small Bowel Ulceration Apparently Associated with Thiazide and Potassium Therapy by Baker et al (JAMA190:586 [Nov 16] 1964), I remembered that I had treated a patient with a similar course in 1963 and 1964.This 65-year-old white male had had numerous hospital admissions since 1956 for the treatment of hypertensive cardiovascular disease associated with angina pectoris, paroxysmal atrial fibrillation, and, in 1958, an acute posterior myocardial infarction, after which he was treated with bishydroxycoumarin (Dicumarol). On April 20, 1963, he visited my office, complaining of severe bouts of angina pectoris. Blood pressure was 180/110 mm Hg. He had been taking nitroglycerin, 0.4 mg sublingually, and bishydroxycoumarin, 75-100 mg daily.I started him on a regimen of Esidrix-K (hydrochlorothiazide with potassium chloride), 50-1,000 mg, one tablet daily, and papaverine hydrochloride, 30 mg four times a day. He continued the use of nitroglycerin and bishydroxycoumarin as

THE BOERHAAVE SYNDROME.

Construed literally, the designation Mallory-Weiss syndrome refers to massive painless hematemesis from lacerations which traverse the gastroesophageal junction. The lacerations extend into the submucosa but do not rupture through the entire thickness of the wall. They usually follow forced vomiting but may occur after prolonged severe coughing bouts or a variety of other antecedents. Although it may be necessary to repair such lacerations surgically, there is time to treat patients for loss of blood and fluid and for shock. It is almost impossible to diagnose the Mallory type of laceration without esophagoscopy or surgical incision. A proportion of undiagnosed cases of hematemesis probably can be ascribed to such lacerations. With blood replacement, pressor agents, and supportive measures, the majority of patients recover from the acute episode. Though dangerous, Mallory-Weiss lacerations need not be accompanied by high mortality. In contrast, rupture of the esophagus is a surgical emergency. Though the pathogenesis