Sleep, chronotype, and behavior in adolescents with attention-deficit/hyperactivity disorder.

Sleep problems are highly prevalent in patients with attention-deficit/hyperactivity disorder (ADHD). Although chronotype has been linked to behavioral problems, its specific contribution to ADHD symptoms remains unclear. We assessed the association between chronotype and sleep and behavioral problems in adolescents with ADHD between 12 and 18 years of age using questionnaires (Morningness-Eveningness Scale for Children [MESC], Strengths and Difficulties Questionnaire [SDQ], and Pediatric Sleep Questionnaire [PSQ]). Overall, 84 families (parents and adolescents) were enrolled. The intermediate chronotype was the most common in the study sample. No sex differences were detected in the proportion of morning, intermediate, and evening types. No correlation was found between MESC score and body mass index nor total PSQ score. Regarding SDQ, a significant negative correlation was found between the MESC score and hyperactivity/inattention score. We conclude that adolescents with ADHD tend to have an intermediate chronotype and eveningness is related to hyperactivity/inattention problems.

[Breath-holding spell or epileptic seizure? A description of three girls with epileptic seizures triggered by anoxia]. / ¿Espasmo del sollozo prolongado o crisis epiléptica?: descripción de tres niñas con crisis epilépticas desencadenadas por anoxia.

TITLE: ¿Espasmo del sollozo prolongado o crisis epiléptica?: descripción de tres niñas con crisis epilépticas desencadenadas por anoxia.

[A consensus on Helicobacter pylori and gastroduodenal pathology]. / Consenso sobre Helicobacter pylori y patología gastroduodenal.

The current debate involving Helicobacter pylori (H.p.) and its potential role as an etiological factor for some digestive diseases, as well as the recent discussion through different mass media of this bacterium, including the American N.I.H. Consensus, have lead to the discussion of the H.p. problem, in order to clarify its real importance in acid-related diseases. Thus we want, as gastroenterologists, to give an overview of the current status, so as to facilitate the general practitioner work when confronted with gastrointestinal diseases, particularly related to H.p. Our purpose is to provide a critical and objective view regarding the implications of H.p. infection, and explain when treatment is needed and how this treatment should be accomplished.

[Retrospective study of Crohn disease at a hospital in Andalucía (1978-1988)]. / Estudio retrospectivo de la enfermedad de Crohn en un hospital de Andalucía (1978-1988).

We reviewed 46 cases of Crohn's disease diagnosed during the period between 1978-1988, with the intention to analyse the age, sex, presentation, evolution, complications and diagnosis. The majority of patients were women, with a mean age of 39. In the last years we have seen an increment in our number of cases. The mean time to diagnosis was about 3.5 years. The main symptoms were abdominal pain, diarrhoea and loss of weight. The complications was of 40% in colonic disease and 75% when the affection was in ileum and colon. During the evolution 4 patients died, 2 of them from their Crohn's disease. One patient had a colonic carcinoma. In 15% of the cases there was a previous appendectomy. The most frequent radiological findings were in the small intestine: lack of haustration and cobblestone appearance. In the colon: lack of haustration and ulceration. The most frequent endoscopical findings were ulcers and a cobblestone appearance.

[Immunosuppression therapy with cyclosporin in inflammatory bowel disease: preliminary experience]. / Tratamiento inmunosupresor con ciclosporina en la enfermedad inflamatoria intestinal (EII): experiencia preliminar.

Three patients afflicted with inflammatory bowel disease (1 UC, 1 Crohn's disease, 1 non-filiated colitis), who did not respond to the aggressive treatment from Oxford (3) were treated with immunosuppression therapy with cyclosporin. The dosage was 5-7 mg/day, to obtain seric levels (RIA) between 100-125 ng/ml during 3 months. All patients showed complete remission which was maintained for 6 months after the halt in treatment in the cases of the UC and non-filiated colitis. Parameters of cholestasis appeared with a transient increase of transaminase levels in 1 patient. Another patient suffered a pericarditis sicca which may not necessarily be related to the treatment.

Zinc and liver cirrhosis.

We have measured zinc levels in serum and urine of healthy controls, patients with liver cirrhosis and patients with cirrhosis and hepatic cancer. In patients with ascitic fluid, we also measured zinc, total protein, albumin and alpha 2-globulin. Basal measurements were performed in blood drawn at 8.00, before the intravenous administration of 8 mg zinc in the form of zinc sulphate. Serum levels were measured at various intervals to a total time of 24 h after overload, and total urine was collected for zinc determinations 24 h before and 24 h after overload. Under basal conditions, cirrhotic patients had lower serum levels and higher rates of urinary excretion of zinc than controls. After overload, blood levels of zinc fell more rapidly in cirrhotic patients than in controls, the former group showing no concomitant rise in urinary zinc excretion, thus suggesting an organic deficit in this trace element. In ascitic fluid, the concentration of zinc was positively correlated with protein content.

[Retrospective study of ulcerative colitis at an Andalusian hospital]. / Estudio retrospectivo de la colitis ulcerosa en un hospital andaluz.

We reviewed 96 cases of ulcerative colitis diagnosed during the period between 1970 and 1988, with the intention of analysing the presentation, complications, evolution and diagnosis aspects. The most frequent presentation symptoms were mucoid and bloody diarrhea (91.3%) and abdominal pain (84%), isolated rectal bleeding being predominated in distal type. The frequency of complications were 17.14%. X-ray findings were the lack of haustration and ulcers, the rate of normal barium enema being of 27.27% (without double contrast). Rectum was not affected in 6.8%. The endoscopy showed an edematous and congestive mucosa, ulcer with normal barium enema. The most significant anatomopathological findings were the lymphoplasmocyte and polynuclear infiltration of the proper lamina and epithelial ulcer, with a lack of cripta and absence of metaplasia of Paneth's cells. In our area, we have to use colonoscopy to diagnose the disease, because the double contrast barium enema is not performed as a routine. Only a few (5) of our patients needed surgical treatment.

[Pneumatosis coli vs. deep cystic colitis]. / Pneumatosis coli vs. colitis quística profunda.

We present the case of a 63-year-old female who with no previous history presented with episodes of self-limited diarrhea without fever, general repercussions, abnormal elements or tenesmus. Biochemistry: no abnormality. Parasite and feces culture: negative. Colonoscopy: at 20 to 40 cm from the anal margin were found polypoid lesions covered with normal mucosa. Barium enema confirmed the presence of multiple lacunar defects and possible parietal gas. Biopsy: submucous cysts with foreign body type giant cells. Mixed infiltrate. The differential diagnosis was made between intestinal enterogenous cyst, lymphangioma, retractable mesenteritis and deep cystic colitis, concluding with pneumatosis coli that evolved favorably.

[Esophageal pseudomotor]. / Pseudomotor esofágico.

A patient was referred by Zone Cardiology due to the absence of heart disease in spite of a history suggestive of coronary ischemia and occasional dysphagia. We performed EDA and encountered a submucous mass that was depressible by the endoscope and pulsatile. Biopsy was not performed, but PA-lateral X-ray disclosed a large aortic aneurysm that was later confirmed by CAT.