ABSTRACT
Within the new DSM-5, the currently differentiated subgroups of "Autistic Disorder" (299.0), "Asperger's Disorder" (299.80) and "Pervasive Developmental Disorder" (299.80) are replaced by the more general "Autism Spectrum Disorder". With regard to a patient-oriented and expedient advising therapy planning, however, the issue of an empirically reproducible and clinically feasible differentiation into subgroups must still be raised. Based on two Autism-rating-scales (ASDS and FSK), an exploratory two-step cluster analysis was conducted with N=103 children (age: 5-18) seen in our social-pediatric health care centre to examine potentially autistic symptoms. In the two-cluster solution of both rating scales, mainly the problems in social communication grouped the children into a cluster "with communication problems" (51 % and 41 %), and a cluster "without communication problems". Within the three-cluster solution of the ASDS, sensory hypersensitivity, cleaving to routines and social-communicative problems generated an "autistic" subgroup (22%). The children of the second cluster ("communication problems", 35%) were only described by social-communicative problems, and the third group did not show any problems (38%). In the three-cluster solution of the FSK, the "autistic cluster" of the two-cluster solution differentiated in a subgroup with mainly social-communicative problems (cluster 1) and a second subgroup described by restrictive, repetitive behavior. The different cluster solutions will be discussed with a view to the new DSM-5 diagnostic criteria, for following studies a further specification of some of the ASDS and FSK items could be helpful.
Subject(s)
Child Development Disorders, Pervasive/diagnosis , Child Development Disorders, Pervasive/psychology , Diagnostic and Statistical Manual of Mental Disorders , Adolescent , Asperger Syndrome/classification , Asperger Syndrome/diagnosis , Asperger Syndrome/psychology , Asperger Syndrome/therapy , Child , Child Development Disorders, Pervasive/classification , Child Development Disorders, Pervasive/therapy , Cluster Analysis , Communication Disorders/classification , Communication Disorders/diagnosis , Communication Disorders/psychology , Communication Disorders/therapy , Developmental Disabilities/classification , Developmental Disabilities/diagnosis , Developmental Disabilities/psychology , Developmental Disabilities/therapy , Diagnosis, Differential , Female , Humans , Male , Personality Assessment/statistics & numerical data , Personality Disorders/classification , Personality Disorders/diagnosis , Personality Disorders/psychology , Personality Disorders/therapy , Prognosis , Psychometrics/statistics & numerical data , Social AdjustmentSubject(s)
Neoplasms/prevention & control , Neoplasms/rehabilitation , Sports , Female , Humans , Life Style , Male , Neoplasms/mortality , Overweight/rehabilitation , Quality of Life , Risk Factors , Survival RateSubject(s)
Eligibility Determination , Myocarditis/pathology , Soccer , Sports Medicine , Adolescent , Fibrosis , Humans , Magnetic Resonance Imaging , Male , RiskABSTRACT
Recurrent focal segmental glomerulosclerosis (FSGS) after renal transplantation with nephrotic syndrome is a serious problem with a high risk of graft loss. The therapeutic role of renin-angiotensin-system (RAS) blockers in recurrent FSGS is not clear. We present the safety and efficacy of an intensified triple RAS blockade with an ACE-inhibitor, an AT 1 receptor blocker and the direct renin inhibitor aliskiren in a 29-year-old renal transplant recipient with biopsy proven recurrence of FSGS and relapsing severe nephrotic syndrome. We subsequently used full dose ramipril, candesartan and aliskiren under a close monitoring of kidney function and electrolytes and examined the effect on proteinuria, clinical course and tolerability over 12 months. We found a significant and sustained antiproteinuric effect under triple RAS blockade. RAS blockade was generally well tolerated. This can offer a new therapeutic approach in selected hypertensive patients with recurrent FSGS.
