Does pharmacological treatment of ADHD in adults enhance parenting performance? Results of a double-blind randomized trial.

OBJECTIVE: This study examines the effects of parental lisdexamfetamine (LDX) treatment on parent-child interactions. METHODS: Participants were 30 parents (27% were male) and their children aged 5-12 years, both diagnosed with DSM-IV attention-deficit/hyperactivity disorder (ADHD). Optimal LDX dose (30, 50, or 70 mg/day) was determined for parents during a 3-week open-label titration, followed by a within-subjects trial of the acute impact of LDX and placebo on observable parent-child interactions. Two laboratory-based, parent-child interactions simulating typical family tasks (e.g., homework, joint play) were conducted within 2 weeks, once with the adult on a blinded optimal dose of LDX and once on placebo (phase I). Parents were then randomly assigned to continue blinded treatment with LDX or placebo for another month followed by a third interaction task (phase II) to assess the ongoing effects of LDX on parent-child interactions. The primary outcome was the change in rate of parenting behaviors coded during the parent-child interaction tasks. Secondary outcomes included observed rates of children's inappropriate behaviors during the laboratory tasks and changes in parental ADHD symptom severity (ADHD-Rating Scale). RESULTS: Twenty parents (67%) completed the trial. In phase I, medication was associated with a significant reduction in negative talk by parents (p = 0.0066, d = -0.47). There was a Medication × Task interaction (p = 0.0235) with a reduction in children's negative behaviors in the homework phase only (p = 0.0154, d = -0.58). In phase II, LDX was associated with significant increases in praise by parents (d = 0.81) and reductions in parental commands (d = -0.88) and children's inappropriate behaviors (d = -0.84) (all p-values < 0.05). While not reaching statistical significance, LDX was also associated with large reductions in parental verbalizations (d = -0.82), moderate increases in parental responsiveness (d = 0.55), and large reductions in the ratio of commands to verbalizations during the non-homework task (d = -1.05) (all p-values < 0.10). Significant reductions in parental ADHD symptoms vs. placebo were observed (p < 0.005). Loss of appetite, dry mouth, headaches, and delayed sleep onset were the most common adverse events. CONCLUSIONS: Improvements in parent-child interactions emerged over time with LDX treatment of parental ADHD. Results suggest that pharmacological treatment of parental ADHD may improve outcomes in parents and their children.

[Nasal dermoid cysts and sinuses]. / Przetoki i torbiele skórzaste nosa.

The authors discuss problems of the nasal dermoids treatment. They point at difficulties with settlement of right term of operation, and they stress that X-ray diagnosis before operation should be taken into consideration to exclude the contact of the dermal cyst or sinuses with cranial cavity. They confirm necessities of radical removal of the cyst or/and the sinus to gain the recovery. They analyse the material of 6 patients with dermal cysts or sinuses who were operated since 1988 to 1997 in the ENT Department of Municipal Hospital, Gdynia. They were 4 boys and 2 girls. In each case a cyst with fistulas was observed. All children were treated surgically, and their ages were 2-14 years (mean 6 1/2). In 2 cases there was self-existent destruction of the nasal bones, other 2 patients had median rhinotomy made, in 2 cases only simple excision of the cyst and sinuses was performed. In any case it was no recurrence of the disease (time of follow-up is 1-10 years). The analysis is illustrated with two case reports. The first case was a 2-year-old boy who had a dermal cyst with sinus penetrating into the cranial cavity. CT imaging did not reveal obvious evidences of that. During operation, a momentary CSF leak was observed but it was stopped using oxycel and tissucol. The second case, a 7-year-old boy, was treated by curettage of the dermoid, with recurrence after 6 months. This patient was cured after total resection of the cyst and sinuses. In conclusion, the authors present in detail signs that can attest that contact of the cyst with the cranial cavity exists. They stress the necessity of right surgical treatment in cases of dermal cysts of the nose to avoid recurrence or complications.

[Adenolymphoma (Warthin's tumor) of the larynx: coexistence with the bilateral laryngocele. Contribution to differential diagnosis with oncocytic papillary cystadenoma]. / Gruczolak limfatyczny (guz Warthina) krtani wspólistniejacy z obustronna torbiela kieszonki krtaniowej. Przyczynek do róznicowania z onkocytarnym brodawczakowatym gruczolakotorbielakiem.

Adenolymphoma is a benign monomorphic lesion composed of epithelial tissue. Usually it is found in parotid gland; however, its laryngeal occurrence was rarely described. Extraparotid Warthin's tumour as scanty lymphatic tissue. In cases when there is no lymphatic tissue in subepithelial layer it is called oncocytic cystadenoma. The authors describe the case of bifocal adenolymphoma in bilateral laryngocoele and indicate classification difficulties of oncocytic lesions in the larynx.

[Histiocytosis X (Langerhans cell histiocytosis) of temporal bone. Role of scintigraphy in disease progress evaluation]. / Histiocytosis X (Langerhans cell histiocytosis) kosci skroniowej. Znaczenie scyntygrafii w ocenie zaawansowania choroby.

The authors present a case report of a 7-year-old girl with Langerhans cell histiocytosis of temporal bone. Edema and bone destruction involved zygomatic process of temporal bone and temporal fossa without ear occupation. The role of picturing diagnosis in evaluation of lesion extent with special importance of scintigraphy is discussed. Treatment methods of Langerhans cell histiocytosis lesions in temporal bone are presented. In our case locally Depo-Medrol injection was given and radiation was left as last resort management.

[Thyroid neoplasm with symptoms of carotid body tumor]. / Nowotwór tarczycy z objawami guza klebka szyjnego.

The authors present a case of thyroid cancer manifestating itself as carotid body tumor. Fine needle biopsy performed twice and an arteriography suggested this diagnosis.

[Rhinologic changes in cystic fibrosis and hypogammaglobulinemia]. / Zmiany rynologiczne w mukowiscydozie i hipogammaglobulinemii.

Nasal and paranasal findings in cystic fibrosis and hypogammaglobulinaemia are presented. Two cases are discussed. Case one that is 20 year old man with oedemato-polypoid changes of nasal mucosa and diagnosis of cystic fibrosis was made during his staying in hospital. Case 2 that is 12 year old boy with previously diagnosed hypogammaglobulinaemia also presented oedemato-polypoid changes of nasal mucosa. Both pharmacological and surgical treatments were brought. Authors' observations are compared with the literature and necessity of detailed diagnosis of oedemato-polypoid changes of nasal and paranasal sinus' mucosa is stressed.