Unanticipated discovery of vascular anomalies by hemodialysis catheter placement. Case report.

This case report describes an unexpected finding post hemodialysis catheter placement in a child scheduled for living-relation renal transplant. Moreover, the unusual appearance of the catheter on a chest X-ray prompted further investigation of the patient's vascular anatomy, resulting in the discovery of an aberrant iliac artery course that significantly affected the surgical approach to this planned procedure.

Efficacy of interventional radiology procedures for the treatment of early ureteral complications after kidney transplantation.

UNLABELLED: Ureteral stricture and ureteral leakage are the most common early urological complications after kidney transplantation causing decreased urine output and increased serum creatinine and blood urea nitrogen. We report our experience with internal-external ureteral stent placement and ureteroplasty. MATERIALS AND METHODS: From August 1999 to January 2005, we treated nine patients presenting with stricture or leak. After an anterograde pyelogram, an internal-external nephrostomy catheter was inserted in all patients; in four patients we also performed ureteroplasty. RESULTS: The stricture and leak appeared from 12 to 93 days after kidney transplantation (mean = 39 +/- 29 days). After a mean of 80 +/- 43 days (range 25-141 days), the stent was successfully removed in seven patients (77%); no patient had a recurrence. The success was confirmed by a decline in serum creatinine (from 3.7 +/- 1.4 to 1.6 +/- 0.7 mg/dL) and blood urea nitrogen (from 54 +/- 24 to 28 +/- 7 mg/dL) with resolution of hydronephrosis on sonography. No procedure-related complications were observed. Surgical correction was necessary in two patients due to the persistence of a stricture. At long-term follow-up (50 +/- 17 months), seven kidneys were still functioning and two had failed due to chronic rejection. CONCLUSION: Nephrostomy catheter placement and ureteroplasty are safe, effective alternatives to surgery to treat early ureteral complications after kidney transplantation. Interventional radiology procedures reducing the morbidity and the likelihood of loss of graft function may improve graft and patient survival.

Suicide attempts in major affective disorder patients with comorbid substance use disorders.

BACKGROUND: The widely accepted impression that substance abuse and dependence are associated with increased suicidal risk was evaluated by literature review and with new data. METHOD: Previous research on this association was reviewed, and clinical data on suicide attempts and substance use in 504 mood disorder patients hospitalized in 4 psychiatric units in Sardinia affiliated with the Italian mental health system were analyzed. RESULTS: The literature supports associations of alcohol and drug use comorbidity with major affective disorders, and of some substances (polyabuse, alcohol, heroin, cocaine, and even tobacco, but perhaps not marijuana or hallucinogens) with suicidal behavior. Our new findings generally supported these 2-way associations. Suicidal risks were similar in hospitalized men and women but were associated with bipolar II, bipolar I (mainly mixed), and unipolar depressive disorders as well as substance abuse, with little effect of type of agent. Substance abuse was more common in nonmixed bipolar disorders, men, and age below 30. CONCLUSION: The tendency for bipolar I, mainly nonmixed patients, to have a relatively high risk of substance abuse and low risk of suicide attempts indicates that mainly depressive or dysphoric (bipolar II, nonbipolar, and bipolar I, mainly mixed) mood disorders may be especially lethal. Differences in risks of substance abuse and suicidal behavior in men and in bipolar I patients further suggest that substance abuse and mood disorders may contribute to suicidal risk with at least partial independence or additivity.

Sleep-related erections: absence of change following presleep sexual arousal.

We examined the effects of a brief period of sexual arousal before sleep on sleep-related erections (SREs) to add to our knowledge concerning those factors that affect SREs. Twelve subjects watched a 5 minute sexually explicit video before sleep. On other evenings they watched a dysphoric arousal video or a lecture (neutral) video. Sleep and SREs were recorded throughout the following night. Although the brief sexual arousal video produced a full or near full erection in all subjects, no significant effect on subsequent SREs occurred. We conclude that the control of SREs in young healthy subjects is insulated against the effect of a brief period of sexual arousal before sleep.

[Clinical course and social outcome in schizophrenia. Results from a retrospective study]. / Decorso clinico e disabilità sociale nella schizofrenia. Risultati di uno studio catamnestico.

OBJECTIVE: The aim of the present study is to investigate the possible clinical and symptomatological determinants of social outcome in schizophrenic patients. METHOD: 40 schizophrenic patients (DSMIII-R), 21 males and 19 females, mean age 4 +/- 5 years, have been evaluated in the present retrospective study. All of them had first undergone psychiatric hospitalization between 1978 and 1981. The following data have been collected: socio-anagraphic features and course of the illness (AMDP), contacts with community health centre and pharmacological compliance. Social disability has been investigated by means of a semi-structured interview developed from the "Disability Assessment Schedule" named "Accertamento Disabilità e Carico Familiare" (ADC), which has been administered to the main carer, usually a cohabitant relative. Presence and level of social support have also been evaluated. One Way Analysis of Variance (ANOVA), "t" test with Bonferroni correction and Pearson Correlation test have been used for data analysis. RESULTS: Patients with less severe social disability (lower scores at ADC) were mainly those with recurrent course of illness without residual symptoms or remitted ones (p = 0.0001), better pharmacological compliance (p = 0.004), more frequent and regular contacts with community health centres (p = 0.0001) and better social support (p = 0.01). On the contrary, score at ADC resulted positively correlated with number of hospitalizations (r = 0.57, p = 0.01), number of compulsory admission (r = 0.32, p = 0.01) and length of illness (r = 0.40, p = 0.01). CONCLUSIONS: Although in our study the influence of severity of illness on social disability has been confirmed, suggestive evidence about importance of other factors, such as compliance or social support, may be drawn.

Erectile dysfunction in hypertensive men: sleep-related erections, penile blood flow and musculovascular events.

To explore how hypertension affects penile erection, we studied erectile hemodynamics during nocturnal penile tumescence in 3 groups of middle-aged men: hypertensive patients with and without erectile dysfunction, and normotensive controls without erectile problems. The hypertensive patients were not taking antihypertensive medication. Evaluations included standard monitoring of penile circumference change as well as noninvasive monitoring of penile segmental pulsatile blood flow and activity in the bulbocavernosus-ischiocavernosus muscles. Variables differed in how they discriminated among groups. Median amplitude of penile blood flow during rapid eye movement sleep differed significantly among all 3 study groups: controls had the highest amplitudes, patients without erectile problems had lower values and patients with erectile complaints had the lowest values. By contrast, standard measures of nocturnal penile tumescence (that is based on penile circumference change during sleep) only distinguished the patients with erectile problems from the 2 other groups. Density of musculovascular event clusters during rapid eye movement sleep (nearly simultaneous muscle activity burst, blood flow burst and circumference pulsation) distinguished the 2 groups of hypertensive men from controls. The sensitivity of the blood flow measure to changes in the hypertensive men without erectile complaints may indicate that the measure can reveal subclinical signs of developing vasculogenic erectile dysfunction.

Penile blood flow and musculovascular events during sleep-related erections of middle-aged men.

The relationships among penile segmental pulsatile blood flow, pelvic musculovascular events, phases of nocturnal penile tumescence, and sleep stages were studied by all-night polysomnography in 23 healthy middle-aged men. Penile blood flow peaked during maximal tumescence. Bursts of phasic musculovascular activity were more frequent during ascending and maximal tumescence than during detumescence and baseline. Both penile blood flow and the number of musculovascular events increased during REM sleep. These data describe important local aspects of penile erectile mechanisms in normal men. The findings on musculovascular events support the notion that the bulbocavernosus-ischiocavernosus muscles have a role in human penile erection.

Sleep-related electrodermal activity patterns in impotent patients.

The etiology of erectile failure is not always clear despite the fact that recordings of nocturnal penile tumescence (NPT) are used to detect patients with a significant organic component to their complaint. We recorded electrodermal activity in addition to NPT in 60 impotent patients. Normally more electrodermal activity occurs in stage 2 than in stage REM sleep. Despite a similar total amount of electrodermal activity, organically impotent patients tended to have less electrodermal activity in stage 2 and more in stage REM sleep than those with normal NPT. This difference was due to a subgroup of 15 organically impotent patients with less electrodermal activity in stage 2 than in stage REM sleep. Because of this difference in the pattern of electrodermal activity in relation to sleep stages, the results suggest a central nervous system change is related to impaired erectile capability and abnormal NPT in these cases.

Disulfiram and nocturnal penile tumescence in the chronic alcoholic.

Thirty male sober alcoholic inpatients received placebo or disulfiram in a random double-blind design in order to evaluate the effects of disulfiram on nocturnal penile tumescence. The amount and frequency of full erections were decreased in the cohort receiving disulfiram. Implications of these results for the role of norepinephrine in penile tumescence are discussed.

Effects of disulfiram on the sleep of chronic alcoholics.

Thirty male alcoholic inpatients received in a random double-blind design placebo (P) or disulfiram 250 mg. (D) at bedtime in order to evaluate the effects of the latter on EEG-EOG sleep patterns. Subjects (S's) had no major medical illness and required no medication for 3 weeks prior to the study. There were 13 disulfiram S's and 17 placebo S's. The total REM time decreased significantly (p less than 0.05) in the D group. Total number of REM episodes decreased and latency to stage 1 REM increased in the disulfiram group. These results are characteristic of sleep patterns induced by the administration of catecholaminergics and opposite to those induced by catecholamine inhibiting agents.

Narcolepsy and automatic behavior: a case report.

Narcolepsy is characterized by excessive daytime sleepiness and cataplexy, which may be accompanied by hypnogogic or hypnopompic hallucinations and sleep paralysis. Automatic behavior is a relatively newly recognized symptom of the narcolepsy syndrome. This case report describes a particularly troublesome sort of automatic behavior--shoplifting--in a narcoleptic patient. It illustrates how a sleep-laboratory evaluation was used to confirm the diagnosis of narcolepsy and considers aspects of the treatment of the problem.

Effects of temazepam, flurazepam and quinalbarbitone on sleep: psychomotor and cognitive function.

1 The effect of temazepam 15 and 30 mg, flurazepam 15 and 30 mg, quinalbarbitone 100 and 200 mg and placebo were studied in 14 healthy male volunteers according to a Latin-square design. At 14-d intervals subjects received capsules 30 min before bedtime on 2 consecutive nights and were evaluated for objective sleep characteristics, for morning estimates of sleep characteristics, and for cognitive and psychomotive performance and subjective state at 3.5, 10.0 and 22.5 h after ingestion. 2 Changes in sleep induction and sleep maintenance were observed with temazepam 30 mg and flurazepam 30 mg had the greater effect on cognitive performance, whereas quinalbarbitone 20 mg had the greater effect on psychomotive performance. Subjective assessments of alertness were most affected by flurazepam, and by quinalbarbitone 200 mg. 4 The results suggest that temazepam produces less residual effects and is shorter acting than quinalbarbitone and flurazepam.

Nocturnal penile tumescence and diagnosis in diabetic impotence.

The authors conducted a study of nocturnal penile tumescence (NPT) in 35 diabetic men, aged 33 to 70, who complained of impotence and in 35 age-matched control subjects. EEGs and other measurements showed that the diabetic men as a group exhibited significant reductions in the total amount of NPT and in the amount and frequency of full erection, thus suggesting that impotence in this cohort was organogenic. Although NPT monitoring represents an advance over the less precise traditional procedures for the differential diagnosis of impotence, the authors stress the need for more research in this area.

Nocturnal erections, differential diagnosis of impotence, and diabetes.

In this study it is shown that monitoring of nocturnal penile tumescence (NPT) is an objective method for determining the erectile status of patients who complain of impotence. The characteristics of 11 diabetic patients with abnormal NPT, 11 patients with normal NPT and no medical disorders, and 11 normal men are presented. Also described are several sociodemographic characteristics of the first 100 patients undergoing an NPT evaluation as part of a screen for patients seeking implantation of a penile prosthesis. It is suggested that NPT monitoring should be a component of the differential diagnosis procedure for every patient who complains of impotence and that it provides a tool for the concentrated study of the mechanisms of erection and impotence.

Dose-related sleep disturbances induced by coffee and caffeine.

In a 13-night sleep laboratory study, each of 18 normal young adult males twice received 1 cup of warm water, 1-, 2-, and 4-cup equivalents of regular coffee, a 4-cup equivalent of decaffeinated coffee, and a 4-cup equivalent of caffeine. All beverages were administered 30 min before bedtime according to a balanced Latin-square design. Regular coffee produced dose-related changes in most standard electroencephalogram-electrooculogram (EEG-EOG) sleep parameters, and the 4-cup equivalents of regular coffee and caffeine produced equivalent effects. Decaffeinated coffee had no effect. Regular coffee and caffeine caused rapid eye movement (REM) sleep to shift to the early part of the night and stages 3 and 4 sleep to shift to the later part. Coffee also produced dose-related changes in several subjects estimates of sleep characteristics. These results suggest that coffee and caffeine may be used in normal subjects to induce symptoms mimicking those of insomnia. Such a tool should promote further understanding of insomnia.