Physical comorbidity and medical care use in children with emotional problems.

As family disruption, violence, and the decline of community become more common, an ever-growing number of children are exposed to psychological and social stressors that can lead to serious emotional problems. For many children emotional problems can interfere with normal psychological and social development and can have serious long-term effects. In this study data from a large national survey are used to examine patterns of emotional and physical comorbidity and the uses of general medical and mental health services by children ages 4 to 11. Results indicate that emotional problems are common among children with physical illnesses and that emotional problems increase general medical care use. Emotional problems are clearly exacerbated by factors associated with poverty. The data also show that a larger proportion of children in single-parent than in two-parent families experience emotional problems and use mental health services. We discuss the implications of these findings for general pediatric practice.     

Prevalence, awareness, treatment, and control of hypertension in a Spanish population

A cross-sectional population survey using a random, stratified sample into phases was conducted in order to assess the prevalence, awareness, treatment, and control of hypertension in Albacete (a south-eastern province in Spain) with 248 000 inhabitants over 18 years of age. The sample size was of 1322 people. Both systolic and diastolic BP were higher in men than in women and showed an increasing trend with age independently of gender. Assuming a cut-off for hypertension of <140/90 mm Hg and <160/95 mm Hg, we found a prevalence of hypertension of 32.7% and 23.1%, respectively. Overall, 56.5% of hypertensive subjects were aware of their condition. The degree of this awareness was significantly higher in women and in the elderly. The percentage of patients who were receiving antihypertensive treatment was 49.1%. This proportion was also higher among women, elderly people, and subjects living in urban areas. High BP was successfully controlled in 10.9% of the total hypertensive population which accounted for 24.4% of the treated patients. The corresponding figures for the <160/95 mm Hg cut-off were 38.5% and 60.6%, respectively. In the logistic regression model, male gender and size of the local community were significantly associated with a better pharmacological control of hypertension. We found a high prevalence of hypertension with low degree of awareness and control, despite the general progress made in the diagnosis and treatment of hypertension in Spain. Specific intervention programs are necessary to increase the extent of control of hypertension in our country.     

Migration within the island of Korcula, Yugoslavia

For several centuries the village populations on the Yugoslav island of Korcula have remained essentially isolated from each other and from the mainland. Historical, linguistic and biological data indicate that systematic population pressure predominantly came from the coastal area of the Balkan peninsula westward onto the island. To examine short and long range migration on the island, data on the place of birth of parents of adult inhabitants (1168 subjects) were presented and migration matrices analysed applying a gamma function. Most examinees were born in the same village as their parents (86.39%); only 6.33% of the parents migrated between villages on the island; and village endogamy is quite high for the past four generations (75%). When inter-village migration has occurred, migration density is greatest at a distance of 8-12 km, rather than from the immediate neighbourhood. Short range migration occurs up to a mean distance of 33.98 km, long range migration over distances greater than 28 km.     

Wyburn-Mason Syndrome

Wyburn-Mason syndrome is an uncommon condition in which arteriovenous malformations coexist in the visual brain area, in the retina, and in some cases, in the face. As a consequence, it has recently been defined as a brain-retino-facial angiomatosis. The syndrome results from an embryonary insult in the development of the optic nerve path and the related vessels from its origin in the mesencephalon all the way to the projection to the retina where it usually causes unilateral manifestations. Here the authors present an interesting case of this ailment and a review of the literature.     

5-HT1B receptor binding in degenerative movement disorders

Using [³H]sumatriptan as a radioligand, 5-hydroxytryptamine (5-HT)_1B receptors were examined in posterior striatum and midbrain post-mortem tissue sections of 12 patients who had died from representative degenerative movement disorders as compared to nine controls. In the control human basal ganglia, the highest densities of [³H]sumatriptan binding were observed in the globus pallidus and substantia nigra. No significant change in the density of [³H]sumatriptan binding sites was found in the striatum and substantia nigra of the six Parkinson's disease brains. In the two brains from patients with progressive supranuclear palsy an increase was found in the densities of [³H]sumatriptan binding sites, most marked in the substantia nigra. In contrast, [³H]sumatriptan labelling was almost absent in the striatonigral degeneration brain and was markedly reduced in the three Huntington's disease brains. This study indicates that the status of 5-HT_1B receptors is different in each degenerative movement disorder and suggests that human 5-HT_1B receptors are located somatodendritically on GABAergic and peptidergic caudate-putamen neurons which project to the substantia nigra and globus pallidus, where these receptors are presynaptic.     

Daclizumab induction and maintenance steroid-free immunosuppression with mycophenolate mofetil and tacrolimus to prevent acute rejection of hepatic allografts

Steroid-free immunosuppressive regimens reduce corticosteroid-related side effects in liver transplant recipients although their efficacy is very variable. We evaluated the efficacy and safety of a steroid-free regimen in a 6-month, open-label, multicenter, pilot study, which involved 102 liver transplant patients treated with daclizumab (2 mg/kg within 6 h following transplant and 1 mg/kg on day 7), mycophenolate mofetil (MMF, 1 g b.i.d) and tacrolimus (trough levels of 5-15 ng/ml in the first month and 5-10 ng/ml thereafter). One intra-operative dose of methylprednisolone was administered. At 6 months, the acute rejection rate was 9.8%, and patient and graft survival rates were 96% and 95%, respectively. Acute rejection rates were similar for hepatitis C-positive patients (8.6%) and hepatitis C-negative patients (10.4%). Infections occurred in 22% of patients; most cases were considered mild or moderate. Post-transplantation hypertension and diabetes mellitus developed in 37% and 14% of patients, respectively, during the study period, but were markedly less frequent (8% and 6%, respectively) at 6 months. Hypercholesterolemia was observed in only 2% of patients. In conclusion, the steroid-free immunosuppressive regimen of daclizumab, MMF, and tacrolimus effectively prevents acute rejection after liver transplantation without decreasing safety.     

Cerebellar grafting in the oculomotor system as a model to study target influence on adult neurons

In the last decades, there have been many efforts directed to gain a better understanding on adult neuron–target cell relationships. Embryonic grafts have been used for the study of neural circuit rewiring. Thus, using several donor neuronal tissues, such as cerebellum or striatum, developing grafted cells have been shown to have the capability of substituting neural cell populations and establishing reciprocal connections with the host. In addition, different lesion paradigms have also led to a better understanding of target dependence in neuronal cells. Thus, for example, axotomy induces profound morphofunctional changes in adult neurons, including the loss of synaptic inputs and discharge alterations. These alterations are probably due to trophic factor loss in response to target disconnection. In this review, we summarize the different strategies performed to disconnect neurons from their targets, and the effects of target substitution, performed by tissue grafting, upon neural properties. Using the oculomotor system—and more precisely the abducens internuclear neurons—as a model, we describe herein the effects of disconnecting a population of central neurons from its natural target (i.e., the medial rectus motoneurons at the mesencephalic oculomotor nucleus). We also analyze target-derived influences in the structure and physiology of these neurons by using cerebellar embryonic grafts as a new target for the axotomized abducens internuclear neurons.