1/122. Weight change of infants, age birth to 12 months, born to abused women. Abuse to pregnant women can affect maternal health and infant birthweight. To examine the rate of weight change among infants, ages birth to 12 months, born to women abused by the male intimate, an ethnically stratified cohort of 121 infants and their mothers were followed. Infants were weighed on a beam balance scale at birth, 6, and 12 months of age. At the same time, abused mothers were asked if the abuse had ended. Rate of change in infant weight was calculated for birth to 6 months and 6 months to 1 year. The rate of change in infant weight from birth to 6 months did not differ significantly based on whether or not the mother reported that the abuse had ended by 6 months or 12 months. However, the rate of change in infant weight from 6 to 12 months was significantly greater (p = .046) for those infants whose mothers reported the abuse had ended by 12 months and even greater (p = .019) if the mother reported that the abuse had ended by 6 months. When controlling for ethnicity and parity, abuse ending at 6 months was a significant (p = .029, r2 = .102) predictor of the rate of infant weight change from 6 to 12 months. To maximize infant growth and the health and wellbeing of mother and child, routine screening and intervention for abuse of women is recommended during child health visits. ( info) |
2/122. phenelzine treatment of selective mutism in four prepubertal children. Four children, ages 5 1/2 to 7 years, diagnosed with selective mutism and successfully treated with phenelzine are presented. All four children were anxious and extremely shy and had family histories of anxiety and shyness. The first three children were treated with phenelzine prior to reports that fluoxetine was helpful in some cases. The fourth child was treated initially with fluoxetine and had shown only minimal improvement after 10 months of doses up to 16 mg daily. phenelzine doses ranged from 30 to 60 mg/day and treatment, including medication taper, lasted from 24 to 60 weeks. The phenelzine was generally well-tolerated and weight gain was the most common side effect. No hypertensive reactions or serotonin syndromes occurred. There was no recurrence of mutism after medication discontinuation. The authors conclude that phenelzine can be an effective treatment for selective mutism, but because of the possibility of serious food and drug interactions and the necessary dietary restrictions, it should be reserved for cases that do not respond to behavior therapy and fluoxetine or other specific serotonin reuptake inhibitors. ( info) |
3/122. Prescription medications: a modifiable contributor to obesity. BACKGROUND: While usually not the only factor in obese patients, prescription medications, which may increase appetite or body weight, can be important in some individuals. The cause of weight gain in such cases may go unrecognized or lead to cessation of medication with or without the practitioner's knowledge or approval. methods: We found illustrative cases among patients treated at the Johns Hopkins Weight Management Center, searched medline and the Micromedex Drug Information database, and organized this information by drug mechanism and indications for use. RESULTS: Most reports of medication-induced weight gain are anecdotal or gleaned from clinical trials. Notable offenders include hormones (especially corticosteroids and insulinotropic agents), and psychoactive medications (especially tricyclic antidepressants, lithium, and some antipsychotics). CONCLUSIONS: Medication-related increases in appetite and body weight are under-recognized and cause noncompliance with pharmacotherapy. A high index of awareness of the known mechanisms by which medications can lead to weight gain has the potential to prevent most medication-related contributions to weight gain and obesity. ( info) |
4/122. Bilateral fracture of the sacrum associated with pregnancy: a case report. We describe a 33-year-old woman with a bilateral fracture of the sacrum associated with pregnancy. Dual-energy X-ray absorptiometry of the lumbar spine and femoral neck showed normal bone mineral density, whereas bilateral osteopenic areas in the massae laterales were demonstrated by the initial CT-scan. The question remains whether the correct diagnosis is so-called insufficiency fracture due to transient osteoporosis of the sacrum associated with pregnancy or so-called fatigue fracture due to unaccustomed stress related to rapid and excessive weight gain in the last trimester of pregnancy. ( info) |
5/122. Adverse events during use of intranasal desmopressin acetate for haemophilia A and von Willebrand disease: a case report and review of 40 patients. We report our experience with the incidence of adverse events during the use of Stimate brand intranasal desmopressin acetate (IN DDAVP) for patients with haemophilia A (HA) or von Willebrand disease (vWD) after noting two severe adverse events in one adult patient. All patients with documented vWD (type 1 or 2 A) or haemophilia A (mild, moderate or symptomatic carrier) from the Emory Comprehensive Hemophilia Center who had IN DDAVP challenge testing or were using Stimate for treatment of bleeding were evaluated for adverse events by patient report or nursing observation of clinical signs and symptoms. Forty patients were studied. Sixty-eight per cent (27/40) experienced clinical signs and/or symptoms. The majority of these symptoms were mild, however several patients reported moderate to severe side-effects and one adult patient required medical intervention for symptomatic hyponatraemia. In our experience, two-thirds of patients tested experienced adverse signs and/or symptoms with the use of Stimate; considerably higher than that reported from preliminary results in the literature. Young age did not correlate positively with adverse reactions. Severe adverse events requiring medical intervention were rare, however symptoms such as moderate to severe headache, nausea, vomiting and weakness may necessitate evaluation for hyponatraemia. This is the first report of symptomatic hyponatraemia in an adult patient with recommended dosing of Stimate. Side-effects may be minimized if patients adhere to instructions regarding fluid intake and composition while using IN DDAVP. ( info) |
6/122. leptin deficiency due to lipid apheresis: a possible reason for ravenous hunger and weight gain. OBJECTIVE: To investigate how extracorporal cholesterol lowering therapy affects circulating leptin levels in patients with ravenous hunger after treatment and permanent weight gain. DESIGN: A case report. SUBJECT: 51 y old caucasian male patient with moderate chronic renal failure. MEASUREMENTS: serum leptin concentration (RIA, Linco research Inc, St. Louis, MO, USA), total cholesterol, low density lipoprotein cholesterol, blood glucose levels, calorie intake by food records. RESULTS: During treatment total cholesterol was reduced by 50%. serum leptin levels showed a 42% reduction at the end of treatment, that by far exceeds the physiological diurnal variation. Calorie intake was significantly increased on days of treatment. CONCLUSION: We conclude that this artificial reduction in circulating leptin plays an important role in the pathogenesis of ravenous hunger and weight gain under extracorporal cholesterol lowering therapy in this case. ( info) |
| A young girl developed extensive striae while on Depo Provera injections. She had gained some weight during the treatment. Endocrinal investigations were negative. The development of striae was attributed to her weight gain. ( info) |
8/122. Self perception affecting adherence to drug regimen following renal transplantation. The patient, a chronic cannabis user, found it increasingly difficult to tolerate the side effects of the medication on her appearance. Rejection in the early post-transplant period meant that immunosuppression could not be further reduced. We were able to avoid a catastrophic self-initiated cut in immunosuppression, and withdrawal of steroids was carried out according to a schedule supervised by the clinic. Cellular rejection resulted and was treated with i.v. methyl prednisolone and conversion from cyclosporin micro-emulsion (Neoral, Novartis) to tacrolimus (Prograf, Fujisawa) and from azathioprine to mycophenolate mofetil (CellCept, Roche). ( info) |
9/122. Progressive muscle pain, weight gain, fatique and unusual body shape change. Multiple symmetrical lipomatosis (MSL) is a rare syndrome characterized by symmetric unencapsulated lipomas around the axial region and frequently associated with neurological involvement, particularly myopathy and neuropathy (Klopstock et al., 1994). Here we present a typical image of a patient with MSL, explaining this disease for neurologists who might care for these patients in an average day at the neuromuscular consultation unit. ( info) |
10/122. Successful chemotherapeutic treatment of diencephalic syndrome with continued tumor presence. A 7-month-old infant with typical features of diencephalic syndrome (DES) associated with a hypothalamic mass, most probably a glioma, was treated with chemotherapy. The tumor showed clear shrinkage, but after more than 2 years regrowth was noted. During the treatment period the child regained normal growth and became free of symptoms. As radiation therapy, especially at a young age, has significant adverse effects and a neurosurgical approach to the diencephalic region also has the potential to cause significant sequelae, a chemotherapeutic option, when it exists, is preferred. Thus, in an infant in whom a glioma is suspected to be the cause of the DES, based on the clinical picture and the neuroimaging appearance, chemotherapy should be considered the primary therapeutic modality. Even if its effect is temporary, its use is well justified. The most appropriate treatment protocol still needs to be determined. ( info) |