Sleep Disorders

A 48-year-old woman complains of finger and knuckle pain in her right hand of 1 year's duration. She is right-handed. The pain is located over the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the index and middle fingers. The pain has recently become more intense and now makes it difficult to sleep and to grasp objects.

THECASE:An 84-year-old man with a history of stable angina, type 2 diabetes, hyperlipidemia, and hypertension presents to the emergency department with worsening dyspnea and peripheral edema. Congestive heart failure is diagnosed, and the patient is admitted to the care of a hospitalist. A standard therapeutic regimen, including diuretics, angiotensin-converting enzyme inhibitors, and oxygen, is instituted, in addition to the patient's home regimen of isosorbide mononitrate, glipizide, and amlodipine. The hospitalsubstitutes pravastatin for the patient's atorvastatin. A Foley catheter is inserted by a urologist because of the patient's benign prostatic hypertrophy. The patient complains of insomnia and is given diphenhydramine. His hospital course is otherwise uneventful.

An 84-year-old man with a history of stable angina, type 2 diabetes, hyperlipidemia, and hypertension presents to the emergency department with worsening dyspnea and peripheral edema.

SEATTLE -- Surgery to correct obstructive sleep apnea (uvulopalatopharyngoplasty) is more likely to have complications if the condition is severe, a concurrent retrolingual procedure is done, BMI is high, or there are medical comorbidities, found a VA study.

CHICAGO -- Vivid ghost stories recounted by apparently healthy patients may be a sign of somatic neuropathology, researchers reported here.

CHICAGO -- Parkinson's patients were able to control symptoms of early-stage disease for at least 85 weeks using a once-daily transdermal patch delivering investigational rotigotine, investigators reported here.

SAN ANTONIO -- Children with high blood pressure are more likely to snore and have other sleep disordered breathing problems than normotensive peers, researchers reported here.

ABSTRACT: Signs that strongly suggest Parkinson disease (PD) include unilateral hand tremor, slowed or decreased movement, and gait changes. Postural alterations include leaning forward or asymmetric shoulder height; the arm may not swing when the patient walks, or it may be held flexed at the elbow. Patients may report increasing difficulties in occupational and social functioning. Mimics of PD include essential tremor, normal pressure hydrocephalus, other neurodegenerative diseases, and drug-induced parkinsonism. Most patients report such nonmotor symptoms as sleep disturbances, visual difficulties, bowel and bladder problems, fatigue, depression, and anxiety. Cognitive impairment in many patients takes the form of slowing of memory and difficulty with visual spatial tasks and executive function. A more realistic treatment goal than tremor eradication is improved overall mobility.

An 80-year-old man has had an asymptomatic, flesh-colored swelling on his right ear for 4 to 5 months. In the center is a 1-mm white scab pointing downward from the helix. At times, the patient shaves a white spicule that grows in this crusted area. He sleeps on his right side and does not use a cell phone.

ABSTRACT: Although levodopa and the dopamine agonists remain the mainstays of treatment, the number of therapeutic options has increased, and trials of new medications are ongoing. Some trials are evaluating ways to alter disease progression. Medical management of the symptoms of Parkinson disease is generally successful but requires familiarity with the agents to avoid troublesome side effects. Deep brain stimulation surgery is an option for some patients whose symptoms are not adequately managed with medication.

Because the manifestations of Parkinson disease are protean and complex, the diagnosis can be difficult and treatment challenging. However, an awareness of the key clinical features and familiarity with 2 or 3 of the dopaminergic medications can facilitate management.

CHICAGO -- For "super-obese" patients, biliopancreatic diversion with duodenal switch appears to achieve better weight loss than Roux-en-Y gastric bypass, researchers said.

CHICAGO -- Patients with type 2 diabetes who are chronically sleep deprived may have impaired glucose control and more serious complications of type 2 diabetes, researchers here found.

CHICAGO -- Patients with type 2 diabetes who are chronically sleep deprived may have impaired glucose control and more serious complications of type 2 diabetes, researchers here found.

CAMBRIDGE, England -- A woman thought to be in a persistent vegetative state showed evidence of awareness of herself and her environment in response to verbal commands, said researchers here.

ROCHESTER, Minn. -- When medical residents make major errors, as many of them believe they do, their emotional suffering and guilt may require counseling to avoid burnout, according to Mayo investigators.

ABSTRACT: The number of medical therapies for patients with erectile dysfunction (ED) has increased in recent years because of our expanded understanding of the physiologic and neurologic causes of ED. Oral agents range from testosterone to antidepressants to phosphodiesterase inhibitors. Nitroglycerin and minoxidil have shown some effectiveness as topical agents. Alprostadil, which can be applied intraurethrally, is also effective as intracavernosal injection therapy. Prostaglandin E1 and papaverine are effective as intracavernosal injection agents. Some studies have shown that combined use of intracavernosal injection and oral therapy produces satisfactory erections.

An up-to-the-minute review of the array of oral and topical agents as well as those used intraurethrally or for intracavernosal injection.

BALTIMORE -- Children with obstructive sleep apnea may suffer hypoxic damage to areas of the brain governing learning, memory, and executive function, according to a study here.

IWATE, Japan -- Ischemic strokes are more likely to occur in the morning and hemorrhagic strokes in the early evening, according to investigators here.

PHILADELPHIA -- Nearly one out of five commercial truck drivers may be at risk for driving impairment because of poor sleep quality, the results of a study here suggested.

ROYAL OAK, Mich. -- Morbidly obese patients with poor cardiorespiratory fitness are more likely to suffer major complications after bariatric surgery, according to researchers here.

LONDON -- For some patients with cardiovascular disease risk factors, the root cause may be the loneliness of childhood, according to a study that followed more than 1,000 adults from birth.

PAMPLONA, Spain -- Severe obstructive sleep apnea more than doubled the risk of a first ischemic stroke in persons over age 70, researchers here reported.

Abstract: A significant advance in CT imaging is the use of 3-dimensional (3D) reconstruction techniques. A 3D reconstruction, for example, permits a volumetric evaluation of the contours of the airways and displays areas of stricture, or narrowing, more effectively than do routine axial images. External 3D rendering, also called CT bronchography, helps reveal complex airway abnormalities and improves the detection of subtle airway stenoses. Although it is primarily an investigational tool, internal 3D rendering (virtual bronchoscopy) has several potential applications, including assessing airway stenoses, guiding transbronchial biopsy procedures, and screening for lung cancer. Multiplanar reformation imaging methods can aid in the assessment of airway stenoses, airway stents, tracheomalacia, and extrinsic airway compression. A review of multiplanar images can also aid in the planning of stent placement or surgery. (J Respir Dis. 2006;27(8):348-352)

ABSTRACT: The number of medical therapies for patients with erectile dysfunction (ED) has increased in recent years because of our expanded understanding of the physiologic and neurologic causes of ED. Oral agents range from testosterone to antidepressants to phosphodiesterase inhibitors. Nitroglycerin and minoxidil have shown some effectiveness as topical agents. Alprostadil, which can be applied intraurethrally, is also effective as intracavernosal injection therapy. Prostaglandin E1 and papaverine are effective as intracavernosal injection agents. Some studies have shown that combined use of intracavernosal injection and oral therapy produces satisfactory erections.

ABSTRACT: The number of medical therapies for patients with erectile dysfunction (ED) has increased in recent years because of our expanded understanding of the physiologic and neurologic causes of ED. Oral agents range from testosterone to antidepressants to phosphodiesterase inhibitors. Nitroglycerin and minoxidil have shown some effectiveness as topical agents. Alprostadil, which can be applied intraurethrally, is also effective as intracavernosal injection therapy. Prostaglandin E1 and papaverine are effective as intracavernosal injection agents. Some studies have shown that combined use of intracavernosal injection and oral therapy produces satisfactory erections.

How can I control elevated blood pressure (BP) in an older patient who is already taking 4 antihypertensive agents?

A middle-aged woman is experiencing episodes of chest pain and fatigue. Although stress test results are positive for ischemia, coronary angiography reveals open arteries. What next step would you take?

LEICESTERSHIRE, England -- The energy boost provided by a sugary drink is only a temporary respite for an afternoon's torpor and, in the end, is counterproductive, said researchers here.