Manic-depressive conditions in adolescents. Epidemiological and clinical aspects

EPIDEMIOLOGY CONTEXT: The prevalence of maniac depressive disorders is similar in adolescents and adults, i.e. about 1% with a 1:1 sex-ratio. Risk is higher in families with a diseased member and early episodes of mood disorders are probably correlated with the genotypic severity or the presence of a unique susceptibility gene. HIGHLY VARIABLE CLINICAL SIGNS: Until recent years, the highly variable clinical expression with rapid changes in mood, bipolar states, variable somatic, behavioral or addictive symptomatology, cognition disorders, and disturbed ideation or hallucinations, probably contributed to our poor understanding of juvenile forms of the disease. EARLY MANAGEMENT: Early diagnosis and psychiatric care is crucial due to the short-, mid- and long-term risk of unfavorable or even fatal consequences. Indeed, while still in the process of structuralization, the predisposed personality is particularly reactive to positive or negative events. It is most difficult to achieve flexibility once a restrictive organization of the personality has been installed. In addition, these families often have a painful past and lack sufficient capacity to successfully deal with the stress of emotions and conflicts occurring in the future adult during the self-identification and independence-seeking processes. This familial situation points out the importance of implicating the family and close friends in the treatment strategy as a complement to drug therapy and psychotherapy proposed to the adolescent.     

Primary correction of scoliosis with the Wilmington corset]

QUESTION: As part of our study, the effectiveness and patient's acceptance of the Wilmington-brace is to be evaluated. The effectiveness can be documented with the help of the primary correction achieved, especially in light of the fact, that the primary correction and the long-term results are directly dependant upon one another. MATERIAL AND METHOD: We examined a total of 52 patients with an idiopathic scoliosis treated in a thermoplast brace. The group consisted of 38 female and 14 male patients (average age 11.6 years). The angulation was measured with the help of the Cobb-angle and the rotation with the method described by Nash and Moe. The skeletal age was classified according to Risser's-sign. The angle determinations were carried out at three separate points in time--at first presentation, prior to bracing and four to six weeks following bracing. RESULTS: The patients presented with an average angulation of 31 degrees. The average correction achieved in the Wilmington-brace was 41%. This corresponds to a correction of 13 degrees. The best primary correction (45%) was obtained in the thoracolumbar spine. Those patients with the smallest deformity at the onset of treatment showed the best results. The scoliosis with a large primary deformity and a marked rotation of the vertebral bodies responded poorly to correction. Advanced age or skeletal maturity were also limiting factors. Physical therapy had a positive influence on the amount of primary correction obtained. CLINICAL RELEVANCE: The Wilmington-brace (thermoplast) allows for a good primary correction of idiopathic scoliosis. The simplicity of application and the low production costs are also positive attributes.     

Treatment of Scheuermann's disease with the active-passive Gschwend erection corset

In a retrospective study of 31 patients we give a report about the experience with the Geschwend-brace in the therapy of acute M. Scheuermann. The indication for therapy with this brace was given if there was no possibility to stop the progression of the kyphosis by intensive physiotherapy. During the whole time of therapy the brace could not be removed by the patients. Within a follow-up of 24 month in average after the end of brace treatment, we saw a permanent correction of kyphosis of 18 degrees in 22 patients (71%). In 2 patients there was no change of kyphosis and in 7 patients (22%) we saw a progression of 7 degrees. An erection of the wedge-shaped vertebrae we couldn't see in our patients. Permanent correction of kyphosis by Gschwend-brace could be achieved by starting the therapy early, long enough time of treatment about 1,5-2 years and a good compliance.     

New aspects in the treatment of priapism

Recent advances in the understanding of erectile physiology have improved the prompt diagnosis and treatment of priapism. During initial assessment, the physician must distinguish between veno-occlusive low flow (ischemic) and arterial high flow (nonischemic) in order to choose the correct treatment option for each type of priapism. Patient history, physical examination, penile haemodynamics and corporeal metabolic blood quality assist the distinction between static and dynamic priapism. Normally, priapism is effectively treated with intracavernous vasoconstrictive agents or surgical shunting. However, when these two methods fail, subsequent treatment procedures are a matter for debate. Alternative options, such as intracavernous injection of methylene blue or selective penile arterial embolization, for the management of high and low flow priapism are described and a survey of current treatment modalities is presented.