Sleep Disorders

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.

NEW YORK -- For super morbidly obese patients, Roux-en-Y gastric bypass surgery is a better approach than gastric banding, according to researchers here.

PHILADELPHIA -- Extremely overweight teens lost an average of 14 pounds in one year with a combination of behavioral therapy and the weight-loss drug Meridia (sibutramine), researchers reported.

SAN FRANCISCO -- Unopposed transdermal estradiol at an ultra-low dose over two years did not affect cognitive function or health-related quality of life in post-menopausal women, researchers here reported.

BETHESDA, Md. -- Expending energy by walking, climbing stairs, doing household chores, or even washing windows may enhance survival in healthy older adults, according to investigators here.

BALTIMORE -- Despite anecdotal evidence, a dose of the antihistamine Benadryl (diphenhydramine) at bedtime won't help infants sleep, reported investigators here.

Abstract: Although excessive daytime sleepiness is most often simply the result of inadequate sleep, other causes must be considered as well. Common causes of daytime sleepiness include obstructive sleep apnea/hypopnea syndrome (OSAHS) and medication side effects. The differential diagnosis also includes narcolepsy and restless legs syndrome (RLS). In many cases, the answers to a few simple questions can provide the necessary clues to the diagnosis. Loud snoring is associated with OSAHS, while sudden muscle weakness triggered by intense emotion is consistent with narcolepsy. Referral for sleep evaluation is indicated to evaluate for OSAHS, narcolepsy, RLS, and idiopathic hypersomnia. Methods of measuring daytime sleepiness include the Multiple Sleep Latency Test and the Epworth Sleepiness Scale. (J Respir Dis. 2005;26(6):253-259)

Two days before an eye examination, a 56-year-old man started to have difficulty in focusing his right eye. The morning of the examination, the patient noted a dark spot in his vision in this eye.

SALT LAKE CITY - Drivers chatting on cell phones are as impaired as drivers who are legally drunk, researchers here said.