ABSTRACT
BACKGROUND: Major depressive disorder (MDD) is a common disorder during adolescence and it is associated with an increased risk of suicide, poor school performance, impaired social skills, social withdrawal and substance abuse. Further, as many depressive episode in adolescents do not reach the diagnostic threshold for MDD, the disorder remains undetected. AIM: This review aims to provide an update of clinical features of adolescent MDD and to focus on the most appropriate therapeutic strategies to adopt in clinical practice. MATERIALS AND METHODS: We reviewed the international literature to identify studies focusing on clinical features and therapeutic options in adolescents affected by MDD. PubMed, Medline and Cochrane Library databases were searched for English language papers. RESULTS: The clinical picture of depression is variable with sex and age. Somatic complaints, particularly headache and fatigue, are a common presentation in adolescent MDD. Irritability is present most frequently in female and it is related to the severity of MDD. Adolescent MDD is also characterized by a high rates of suicides. The therapeutic strategy in adolescent depression includes psychotropic medications, psychotherapy or a combination of both treatments, with selection of the most appropriate strategy depending on symptom severity. As first-line treatment the traditional cognitive behavioural therapy (CBT), as well as the cognitive Post-Rationalist (PR) approach, are so far considered the goal standard. CONCLUSIONS: The therapeutic approach to the adolescent affected by MMD should respect the person in his/her psycho-physical entirety. The intervention may help the subject in seeking a more stable and adaptable identity. It is relevant to have a good knowledge of the peculiar clinical picture of adolescent MDD in order to make an early identification of the disorder and to define an appropriate personalized therapeutic program.
Subject(s)
Depressive Disorder, Major/therapy , Adolescent , Cognitive Behavioral Therapy , Fluoxetine/therapeutic use , HumansABSTRACT
BACKGROUND: There are a few studies on the treatment of sporotrichosis. The standard drug used is itraconazole. However, the use of itraconazole is limited by its interaction with other drugs. OBJECTIVE: To evaluate the effectiveness and safety of 250 mg terbinafine for the treatment of cutaneous sporotrichosis in patients in whom itraconazole use is not possible. METHODS: We performed a descriptive study of cutaneous sporotrichosis cases treated with 250 mg terbinafine for which itraconazole was contraindicated or resulted in severe or moderate pharmacological interactions. Sporotrichosis was diagnosed based on the isolation of S. schenckii. RESULTS: Fifty patients seen between July 2005 and September 2007 were included. Forty-five (92%) patients reported contact with a sick cat and 47 (94%) presented comorbidities (high blood pressure: 64.0%; diabetes mellitus: 30.0%; dyslipidemia: 16.7%; depression: 10.0%; migraine: 2.1%; Parkinsonís disease: 2.1%; peptic ulcer disease: 2.1%; heart failure: 2.1%, and arrhythmia: 2.1%). All patients used some medication interacting with itraconazole (psycholeptics: 36.0%; antidiabetic agents: 28.0%; hypolipemiant agents: 18.0%; calcium-channel blockers: 16.0%; anticonvulsants: 8.0%; cardiotropic drugs: 6.3%; antacids: 6.3%, and antiparkinsonian agent: 2.1%). Most patients (96%) were cured within a mean period of 14 weeks. The drug was discontinued due to a skin rash in one patient. There were no cases of recurrence of the mycosis within a mean follow-up period of 37 weeks. CONCLUSIONS: This study suggests that 250 mg/day terbinafine is an effective and well-tolerated alternative to drug therapy of cutaneous sporotrichosis in a population in which itraconazole use is not possible.
Subject(s)
Antifungal Agents/therapeutic use , Naphthalenes/therapeutic use , Sporotrichosis/drug therapy , Humans , TerbinafineSubject(s)
Physician Self-Referral/legislation & jurisprudence , Centers for Medicare and Medicaid Services, U.S. , Group Practice/legislation & jurisprudence , Guideline Adherence , Health Services/legislation & jurisprudence , Home Care Services/legislation & jurisprudence , Liability, Legal , Ownership/legislation & jurisprudence , Physician-Patient Relations , Salaries and Fringe Benefits/legislation & jurisprudence , United StatesABSTRACT
BACKGROUND: The authors evaluated the chronic post-mastectomy lymphoedematous tissue and the effects of manual lymphatic drainage (Leduc method) with and without compressive bandage. METHODS: The arms were measured before and after physical therapy and the results were expressed as a percentage decrease. Physical therapy was performed first by manual lymphatic drainage only and after by manual lymphatic drainage plus compressive bandage. RESULTS: We observed that during manual lymphatic drainage plus compressive bandage the total percentage decrease of whole limb was the highest: 41.1 +/- 12.2% versus 30.4 +/- 15.8% (p < 0.05). Clinical and physiopathological implication are discussed.
Subject(s)
Drainage/methods , Lymphedema/etiology , Lymphedema/therapy , Mastectomy/adverse effects , Adult , Aged , Arm , Bandages , Chronic Disease , Evaluation Studies as Topic , Female , Humans , Middle Aged , PressureSubject(s)
Scalp/surgery , Surgical Flaps , Female , Humans , Male , Scalp/injuries , Skull Fractures/surgeryABSTRACT
The treatment of cleft lips is a complex problem that need an interdisciplinary approach, involving the effort of many specialists. The constant improvement of plastic surgery has today reached highly qualified techniques that permit satisfactory results in most cases. We report our long experience, including more than 500 cases of cleft lips, stressing the right sequence and the basilar principles of their correction.
