Sleep Disorders

Premenstrual disorders affect many women in the United States. These disorders range in severity from the mild, bothersome symptoms that occur in more than 75% of women with regular menstrual cycles, to premenstrual syndrome (PMS) and, finally, to the most severe and disabling, premenstrual dysphoric disorder (PMDD). Nearly 5 million American women have PMDD.

In the past 15 years, there has been an increasing awareness of the syndromal persistence of attention-deficit/ hyperactivity disorder (ADHD) into adulthood.

It can be difficult to determine whether unusual, paroxysmal behavior represents a seizure or a nonepileptic event. Patients with sudden flailing movements or unresponsive staring may, in fact, be experiencing psychogenic events. Other types of pathological spells, such as syncope and migraine, can also be mistaken for epileptic seizures.

A 25-year-old woman presents for a prenatal visit. She has an unremarkable medical history except for hypermobility of the joints and a tendency to bruise easily. Her mother and sister also have very lax joints.

My patient is a middle-aged white man who has had an itchy rash on his upper body for the past 16 months. It consists of red raised bumps and resembles “prickly heat.”

The numerous symptom domains of fibromyalgia syndrome (FMS) include pain, fatigue, sleep disturbance, mood disturbance, function impairment, irritable bowel syndrome, tension and migraine headache, and cognitive dysfunction. Its pathophysiology is rooted in neural dysregulation in the spinal cord and brain.

Establishing the cause of chronic pain is crucial because treatment based on the mechanism of the pain is most likely to be successful.

Pain is a significant public health concern. In a prevalence study conducted in Australia, 17% of men and 20% of women reported chronic daily pain. A US study found that 13% of the total workforce had lost productive time during a 2-week period because of a pain condition. Headache, back pain, and arthritis pain headed the list of causes.

An 8-week-old boy is brought for evaluation of gradually worsening yellow skin discoloration of about 1 week's duration. His parents report that he has had constipation for the past several days; before that, he had green diarrhea and occasionally spit up after breast-feeding.

How effective is upper airway surgery in treating obstructive sleep apnea? The fallout from the growing obesity epidemic includes obstructive sleep apnea (OSA) syndrome. Although OSA may be considered a "specialty disease" (managed by pulmonologists, sleep specialists, otolaryngologists, and bariatric surgeons), the primary care physician bears the brunt of providing ongoing care.

Parents of young children know that colds are extremely common, especially from fall until spring. Colds account for a large number of pediatric office visits and telephone calls-particularly during "cold season."

Systolic hypertension is an independent risk factor for coronary artery disease, stroke, and end-stage renal disease. Nonpharmacological interventions for systolic hypertension include limitation of dietary sodium and alcohol intake along with weight reduction and aerobic exercise.

The differential diagnosis of generalized weakness is enormous; it includes disorders at all levels of the neur-axis. A variety of electrophysiological, pathological, radiographic, and other laboratory studies may be indicated depending on the specific diagnostic possibilities; costs can be controlled if such investigations are selected judiciously.

PHILADELPHIA -- Half of all patients with nighttime symptoms of gastroesophageal reflux disease have sleep problems and such patients also score lower on quality of life measures, including mental and physical function, according to studies reported here.

KANSAS CITY, Kan. -- Adenotonsillectomy for kids who snore may improve not only their quality of sleep but their behavior, as well, researchers here found.

BALTIMORE -- Television watching at a young age may be a set-up for behavioral problems later on, but not if early TV-watching habits are curtailed before age six, reported investigators here.

HELSINKI, Finland -- Sleep excesses one way or the other can carry a roughly 20% greater mortality risk over two decades, investigators here found.

For 2 weeks, a 31-year-old man has had a nonhealing, painful abscess on his left shoulder. A week before presentation, he sought treatment at a walk-in clinic; the abscess was incised and drained, and he was given gatifloxacin.

SAO PAULO, Brazil -- Treatment of obstructive sleep apnea with continuous positive airway pressure reverses early signs of atherosclerosis, according to researchers here.

WEST CHESTER, Pa. -- Hormone therapy had no significant effects on the memory or concentration complaints of women shortly after menopause, according to investigators here.

ST. LOUIS -- The value of bumper pads on baby cribs as a cushion against bumps and bruises may be outweighed by the small risk of death, researchers said.

AMSTERDAM -- Type 2 diabetes may be linked to mental health disorders, but age and gender may be contributing factors, according to two separate studies.

CALGARY, Alberta -- Nocturnal dialysis at home six times a week markedly reduced left ventricular hypertrophy in patients with end-stage renal disease compared with conventional treatment, according to a preliminary study.

INDIANAPOLIS, Ind. -- The investigational schizophrenia drug LY2140023 may effectively reduce the symptoms of schizophrenia without causing any of the side effects seen with older therapies.

GENEVA, Switzerland -- No individual chronic disease - not angina, not arthritis, not asthma, not diabetes -- is more disabling than depression, according to a World Health Organization study.

MONTREAL -- Vivid dreams of babies in peril are common to pregnant women and newly delivered mothers, often inspiring wakefulness and a postpartum need to check on the infant.

TOKYO -- Second-hand cigarette smoke can exacerbate the sleep disturbances of pregnant women, investigators here found in two surveys of nearly 36,000 women.

LEUVEN, Belgium -- Just because adolescents go to bed, that doesn't mean they stop calling and texting their friends, and that may leave them bleary-eyed in the morning, researchers here reported.

abstract: While the risk factors for aspiration pneumonia are similar to those for aspiration pneumonitis, the 2 syndromes have different presentations. Aspiration pneumonia tends to occur in older patients or in those with neurological diseases, and the aspiration is not usually witnessed. Aspiration pneumonitis is more likely to occur in patients undergoing anesthesia or in those with acute drug and alcohol overdoses, and the aspiration is often witnessed. The workup may include bedside assessment of the cough and gag reflexes, chest radiography, videofluoroscopic imaging, or fiberoptic endoscopy. Empiric antibiotic therapy should be avoided in most patients with pneumonitis; however, antibiotics may be indicated for those at high risk for bacterial colonization of oropharyngeal and gastric contents who have fever, increasing sputum production, or new infiltrates or for those who fail to improve within 48 hours. (J Respir Dis. 2007;28(9):370-385)

Current evidence suggests that out-of-office blood pressure measurements and 24-hour ambulatory blood pressure monitoring are better predictors of cardiovascular risk than routine office measurements. Is it time to make greater use of automated devices in my practice?