ABSTRACT
Four children, ages 5 1/2 to 7 years, diagnosed with selective mutism and successfully treated with phenelzine are presented. All four children were anxious and extremely shy and had family histories of anxiety and shyness. The first three children were treated with phenelzine prior to reports that fluoxetine was helpful in some cases. The fourth child was treated initially with fluoxetine and had shown only minimal improvement after 10 months of doses up to 16 mg daily. Phenelzine doses ranged from 30 to 60 mg/day and treatment, including medication taper, lasted from 24 to 60 weeks. The phenelzine was generally well-tolerated and weight gain was the most common side effect. No hypertensive reactions or serotonin syndromes occurred. There was no recurrence of mutism after medication discontinuation. The authors conclude that phenelzine can be an effective treatment for selective mutism, but because of the possibility of serious food and drug interactions and the necessary dietary restrictions, it should be reserved for cases that do not respond to behavior therapy and fluoxetine or other specific serotonin reuptake inhibitors.
Subject(s)
Monoamine Oxidase Inhibitors/therapeutic use , Mutism/drug therapy , Phenelzine/therapeutic use , Child , Child, Preschool , Female , Humans , Male , Phenelzine/adverse effects , Weight Gain/drug effectsSubject(s)
Antidepressive Agents/therapeutic use , Controlled Clinical Trials as Topic/standards , Fluoxetine/therapeutic use , Obsessive-Compulsive Disorder/drug therapy , Phenelzine/therapeutic use , Selective Serotonin Reuptake Inhibitors/therapeutic use , Drug Administration Schedule , Humans , Obsessive-Compulsive Disorder/psychology , Placebos , Research Design/standards , Treatment OutcomeABSTRACT
PURPOSE: Retrospective review of authors' experience with percutaneous transcatheter renal ablation in patients with uncontrolled hypertension and/or nephrotic syndrome. MATERIALS AND METHODS: Between April 1987 and September 1995, renal ablation was performed on 11 patients aged 10 months to 21 years. All patients had end-stage renal disease (ESRD) with uncontrolled hypertension (10 patients) and/or nephrotic syndrome (four patients). Uncontrolled hypertension was defined as diastolic pressure greater than 90 mm Hg despite multidrug antihypertensive therapy. Nephrotic syndrome was defined as proteinuria exceeding 960 mg/m2 per day, serum albumin level less than 3 g/dL, and generalized edema. Embolization was performed with absolute ethanol from a common femoral artery approach. In most cases, a balloon catheter was used to prevent alcohol reflux into the aorta or nontarget renal artery branches, such as the adrenal arteries. Angiographic stasis of contrast material in the renal arteries was the endpoint. RESULTS: All patients experienced a postembolization syndrome of 3-5 days duration, clinically manifested by variable degrees of nausea, vomiting, fever, and pain. Long-term improvement in hypertension was observed in nine patients. Improvement in hypertension was defined as diastolic blood pressure below 90 mm Hg while the patient received the same or fewer antihypertensive medications. The four patients with nephrotic syndrome were cured of their proteinuria and edema. CONCLUSIONS: Transarterial renal ablation with alcohol is efficacious for treatment of uncontrolled hypertension and nephrotic syndrome in patients with ESRD. The morbidity and mortality in our series were less than those reported for surgical nephrectomy.
Subject(s)
Catheter Ablation/methods , Embolization, Therapeutic/methods , Ethanol/therapeutic use , Hypertension, Renal/therapy , Kidney Failure, Chronic/complications , Nephrotic Syndrome/therapy , Solvents/therapeutic use , Adolescent , Adult , Child , Child, Preschool , Embolization, Therapeutic/adverse effects , Female , Follow-Up Studies , Humans , Hypertension, Renal/diagnostic imaging , Hypertension, Renal/etiology , Infant , Kidney Failure, Chronic/diagnostic imaging , Kidney Failure, Chronic/therapy , Male , Nephrotic Syndrome/diagnostic imaging , Nephrotic Syndrome/etiology , Radiography , Recurrence , Renal Artery/diagnostic imaging , Retrospective Studies , Treatment OutcomeSubject(s)
Depressive Disorder/drug therapy , Headache/chemically induced , Hypertension, Malignant/chemically induced , Hypotension, Orthostatic/chemically induced , Monoamine Oxidase Inhibitors/adverse effects , Administration, Sublingual , Headache/drug therapy , Humans , Hypertension, Malignant/drug therapy , Hypotension, Orthostatic/drug therapy , Monoamine Oxidase Inhibitors/therapeutic use , Nifedipine/administration & dosage , Phenelzine/adverse effects , Phenelzine/therapeutic use , Risk FactorsABSTRACT
A cervical location for an extradural cavernous hemangioma is exceedingly rare. We present the MRI findings of such a case in a 19-year-old female.
Subject(s)
Epidural Neoplasms/diagnosis , Hemangioma, Cavernous/diagnosis , Adult , Female , Humans , Magnetic Resonance ImagingABSTRACT
A 7-year-old girl with a 2-year history of elective mutism was successfully treated with phenelzine. The only side effects of treatment were mild constipation and weight gain. Talkativeness as a dopaminergic behavioral effect of phenelzine is described. On the basis of the case report and the literature, the authors raise nosologic questions concerning elective mutism and social phobia.
Subject(s)
Mutism/drug therapy , Phenelzine/therapeutic use , Child, Preschool , Constipation/chemically induced , Diagnosis, Differential , Drug Administration Schedule , Female , Humans , Mutism/diagnosis , Mutism/psychology , Phenelzine/administration & dosage , Phenelzine/adverse effects , Phobic Disorders/diagnosis , Phobic Disorders/psychology , Weight GainABSTRACT
Cocaine abuse, a destructive and deadly worldwide problem, can be controlled effectively and inexpensively. Highly successful results in treating 26 cocaine-abusing patients, most of whom failed other treatment modalities, were achieved with the use of phenelzine (Nardil, Parke-Davis). Phenelzine was chosen because cocaine is contraindicated in patients taking the medication and also because it reduces the craving for cocaine. Phenelzine is thought to correct the biochemical defects caused by chronic cocaine use, namely the depletion of brain dopamine, norepinephrine, and serotonin. Failure of treatment of cocaine abuse with other pharmacological agents is also presented.
