Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0917801 (insomnia)
 10,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A preliminary report is presented on the sleep patterns of three combat fatigued patients with recurrent nightmares, insomnia, low frustration thresholds and impotence. All the patients had undergone acute partial sleep deprivation prior to their breakdown. The results show severe deficiency in REM sleep and absence of stage 4 sleep. EMG was usually high with numerous body movements and bursts of tachycardia throughout the night. Nightmares occurred in stage 2. Total effective sleep time was between 129' and 250'. Most of the sleep was in stage 2, and patients woke up with the feeling that "they had not slept at all." It is hypothesized that acute partial sleep deprivation prior to breakdown was an important predisposing factor, and that chronic partial sleep deprivation was a constant aggravating factor of combat fatigue. Replacement therapy for the specific deficient sleep states is proposed.
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PMID:Sleep patterns in three acute combat fatigue cases. 20 80

In a prospective study of 144 consecutive male patients with psychosexual disorders, comprising 93 with Dhat syndrome with or without impotence or premature ejaculation, 21 with premature ejaculation, and 30 suffering only impotence, the commonest associated psychiatric illness was neurotic depression (39%) followed by anxiety neurosis (21%), while 31% did not receive a psychiatric diagnosis. The common presenting a symptoms of Dhat syndrome were weakness (71%), fatigue (69%), palpitations (69%), and sleeplessness (62%). After random allocation into groups, four types of treatment were given: an anti-anxiety drug, an antidepressant, a placebo, or counselling. The best response was seen with the anti-anxiety and antidepressant drugs. Twenty-one patients dropped out of treatment; 15 of whom were from the counselling group.
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PMID:Dhat syndrome--a useful diagnostic entity in Indian culture. 161 79

Raynaud's phenomenon has been considered to be due to activation of the central sympathetic vasoconstrictor reflex, and may represent part of a larger dysfunction of higher autonomic centers. Symptoms, such as sweating disturbances, orthostatic hypotension, insomnia and impotence have been reported to be more common among vibration exposed workers. We studied 217 male forest workers and selected samples of this population for electromyographic (N = 80), autonomic nervous system function, controlled breathing, tilting bed and valsalva manoeuvre (N = 88) tests, and a full clinical neurological examination. Mean alcohol consumption was estimated to be 3.0 kg absolute alcohol/year. The total mean vibration exposure time was 14,100 hours. The prevalence of Raynaud's phenomenon was 5%. The variations in heart rate (HRV) at rest and during deep breathing were observed. The traditional indexes of HRV (CV, CVS, MEAN) were computerized and calculated. There was a significant difference (p less than 0.001) between the HRV indexes during the deep breathing test in those with the shortest and the longest exposure to vibration. The values of HRV indexes were age dependent; and in multiple regression analysis, the total exposure time to vibration had an independent negative association to HRV. Also association of sensory neural hearing loss to Raynaud's phenomenon among vibration exposed workers indicates that there is an involvement of the central nervous system in the pathogenesis of vibration syndrome. The question, does vibration cause permanent changes in autonomic centers of the brain or do these centers only mediate vibration stress to end organs, remains unsettled.
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PMID:Vibration stress and the autonomic nervous system. 238 Nov 49

48 consecutive male patients of potency disorders were examined and classified as 'Dhat' syndrome, impotence or premature ejaculation. The age range of these cases was found as 20-38 years (mean 23.5 +/- 3.3 years) while age of onset was 16-24 years (mean 20.6 +/- 4.5 years). Majority of cases were unmarried (54.2%) and educated 5th class or above (79.1%). 31 cases (64.6%) had Dhat syndrome with or without impotency and/or premature ejaculation while 7 cases (14.6%) had only premature ejaculation and 10 cases (20.8%) only impotence. The cases with 'Dhat' syndrome or with impotence scored maximally on neuroticism and depression scales. Neurotic depression was the commonest associated psychiatric illness (39.5%) followed by anxiety neurosis (20.8%) while 31.3% did not have any possible diagnosis. The common presenting symptoms of 'Dhat' syndrome include weakness (70.8%), fatigue (68.7%), palpitations (68.7%), sleeplessness (62.4%) etc. Among the four groups on the basis of type of treatment (antianxiety drug, antidepressant, placebo, psychotherapy), the best response was seen in those receiving antianxiety or antidepressant drugs while those receiving psychotherapy showed minimal response. 7 cases (14.6%) dropped out of treatment and the maximum dropout (40.6%) was seen in psychotherapy group.
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PMID:'Dhat' syndrome--a useful clinical entity. 263 75

It is estimated that there are approximately six million patient-years of clinical experience with fenofibrate among physicians outside of the United States. A review of the European literature and unpublished studies supplied by the manufacturer (Laboratoires Fournier, Dijon, France) has been compiled with the data recently reported from a double-blind, placebo-controlled study completed in the United States. In general, fenofibrate has been found to reduce serum triglyceride levels by 30 to 60 percent in patients with type II B and IV hyperlipoproteinemia. Serum cholesterol levels were also reduced by 20 to 25 percent in this group of hypertriglyceridemic patients. A similar reduction in serum cholesterol levels was also found in type II A patients (normal triglyceride levels). Low-density lipoprotein levels were usually reduced in those patients with elevated levels and high-density lipoprotein levels increased when baseline levels were low. Fenofibrate also produced a 10 to 28 percent reduction in uric acid that was sustained for years. The incidence of unwanted effects ranged from 2 to 15 percent in the open trials lasting from a few months up to six years. Gastrointestinal problems (abdominal discomfort, diarrhea, and constipation) are most common, occurring in approximately 5 percent of patients. Reports including fatigue, headache, loss of libido, impotence, dizziness, and insomnia were grouped as neurologic and occurred with a total incidence of 3 to 4 percent. In about 1 percent of patients, muscle tenderness developed, often accompanied by elevated creatine phosphokinase levels. These and the gastrointestinal problems occurred with a similar frequency in the placebo-treated cohort in controlled studies. In approximately 2 percent of patients, a skin rash developed, an incidence that appears significantly higher than that of placebo control groups. Liver changes in rodents have included marked peroxisome proliferation and increased hepatic carcinomas with very high doses. In humans, only a small increase in incidence of elevated levels of serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase seems to be present and is not clearly different from that of the control groups. Alkaline phosphatase, gamma-glutamyl transferase, and bilirubin levels are often decreased with no known undesirable effects. Investigations into the lithogenicity of bile indicated a significant increase in five studies. However, there has been no evidence of a significant rise in the incidence of cholelithiasis in the clinical trials completed to date.
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PMID:Comparative toxicity and safety profile of fenofibrate and other fibric acid derivatives. 331 50

Vasectomy is a rapid, inexpensive, 1-time method of birth control that has been chosen by 50 million men, 3/4 of whom live in the US, India, and South Korea. Although the operation has found little favor in Mediterranean countries, it is gaining interest in some countries of Latin America and the Middle East. Vasectomy can be performed on an ambulatory basis using local anesthesia and is associated with a very low rate of morbidity and almost no mortality. At present it is reversible in only about 25-35% of cases. A dialogue between the urologist and the patient is of the utmost importance to rule out any possible medical contraindication and to insure that the patient understands the permanence of the procedure and has chosen it voluntarily. The rate of complications of all types in different series varies from 1-122/1000 operations, with hematoma, infection, and epididymitis the most common. Spontaneous reanastomosis occurs in .1-.3% of cases. Some studies have minimized the probability of negative psychosocial consequences such as impotence or loss of libido resulting from the operation, stating that many couples have improved sexual relationships and that fewer than 1% of men express regret at not being able to father additional children, while other studies suggest more widespread reactions of insomnia, depression, hypochondriacal troubles, or sexual symptoms. Negative reactions occur most frequently in men who have not been adequately prepared psychologically for the procedure. Several prospective studies in men undergoing vasectomy have failed to demonstrate changes in testicular volume or in histologic status of the testicular parenchyma several years after operation, although changes at the epididymal level may occur. Although no absolute proof exists, it is likely that the presence of antisperm antibodies in the serum or seminal fluid after vasectomy plays a role in the persistent infertility of men undergoing sterilization reversal operations. The immunological effect of vasectomy on other organs and systems is a subject of controversy. The possible relationship between vasectomy and atherosclerotic disease also remains to be elucidated.
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PMID:[Vasectomy. Advantages, complications and consequences]. 685 68

More than 1200 patients who received pindolol for the treatment of hypertension, angina pectoris, and various arrhythmias in studies conducted in the United States were included in the New Drug Application submitted to the FDA. Nearly 1000 of these patients received pindolol as monotherapy. The side effects reported were generally transient and of mild or moderate severity. The most frequently reported side effects seen after pindolol administration, compared to those seen after placebo, were in decreasing order of incidence: headache, dizziness, insomnia, muscle pain, fatigue, weakness, nervousness, joint pain, edema, nausea, and muscle cramps. Other side effects that occurred more frequently with pindolol than with placebo but at a rather low incidence induced weight gain, bizarre dreams, visual disturbances, lethargy, and diarrhea. Nasal congestion, throat discomfort, nocturia, impotence, pruritus, anxiety, hypotension, bradycardia, and heart failure occurred only rarely. Of the 323 patients who received pindolol alone for the treatment of mild to moderate hypertension, only 20 (6.2%) were withdrawn from the study because of side effects. Overall, 3.4% of the patients treated with pindolol were withdrawn because of side effects, most of which involved the central nervous system, that is, insomnia, anxiety, dizziness, and headache. However, a few patients manifested some edema and weight gain while receiving pindolol alone. Review of the side effects data did not reveal a tendency for the incidence of side effects to be dose related. One placebo-controlled, double-blind study designed to evaluate the fixed dosages of 15, 30, and 60 mg in the treatment of mild to moderate hypertension suggested that only the incidences of insomnia and nervousness increased with increasing doses. However, these side effects were generally transient and of mild or moderate severity. The evidence indicates that pindolol has an acceptable safety profile and that any side effects that appear are generally well tolerated and disappear with continued treatment.
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PMID:Adverse reactions to pindolol administration. 704 82

The presenting symptom complex, diagnostic features, and therapeutic alternatives for obstructive and central sleep apnea are discussed in relation to two illustrative patients. Heavy snoring and restlessness during sleep in an obese individual, usually a male, may indicate obstructive apnea. Daytime hypersomnolence, intellectual deterioration, mental depression, impotence, cardiac arrhythmias, cor pulmonale, systemic hypertension, and erythrocytosis are the most common complications. Tracheostomy, the classic form of therapy, can be replaced by pharmacologic intervention in most patients. The clinical presentation of central apnea is less dramatic, but neurological and cardiac complications can occur. Therapy is less well established for this entity. Knowledge of the increased incidence of these disorders and awareness of more subtle complications indicate that sleep apnea should be placed in the differential diagnosis of pulmonary and systemic hypertension, hypersomnolence states, mental deterioration, psychiatric illness, and even insomnia.
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PMID:Diagnosis and therapy of sleep apnea. 722 83

A 67-year-old man with SIADH complicated by slowly progressing autonomic failure was described. The patient noticed constipation at the age of 57. In the following years, he suffered from urinary incontinence, depletion of sweating, impotence, sleeplessness with snore, and dizziness while walking. Physical examination revealed a masked oily face with slight cerebellar disturbance. Abnormality of autonomic function tests was recognized and he was diagnosed as Shy-Drager syndrome with gradually progressing, diffuse autonomic failure accompanied by slight cerebellar ataxia and Parkinsonism. Both serum sodium level and plasma osmotic pressure were reduced, whereas daily sodium excretion was more than 100mEq and urinary osmolality was about 500mOsm/kgH2O. His renal function was intact, and the adrenocortical and thyroid hormone levels were normal, then criteria of SIADH was fulfilled. SIADH was thought to have occurred on the basis of Shy-Drager syndrome. Water load test showed failure of adequate water diuresis, but intravenous phenytoin administration following the water load test ameliorated the diuresis to normal. The relationship between plasma osmolality and the ADH response indicates that ADH was adequately secreted in response to the increase in plasma osmolality but not suppressed in response to the decrease in plasma osmolality below 280mOsm/kgH2O. These results suggest that ADH synthesis in the hypothalamus and its secretion from the pituitary gland were both intact. The response of ADH secretion to the orthostatic hypotension induced by head-up tilt was quite blunted, being compatible with Shy-Drager Syndrome. Sleep disturbance was studied by polysomnography and laryngoscopy, and was revealed to be based upon severe sleep apnea due to incomplete paralysis of the bilateral vocal cords. Sleep apnea due to vocal cord paralysis is sometimes found to be complicated in patients with multiple system atrophy (MSA) including Shy-Drager syndrome, and is known as Gerhardt syndrome. This is the first report on a case of Shy-Drager syndrome complicated with SIADH and bilateral vocal cord paralysis. In this case, SIADH is caused by impaired afferent pathways from baroreceptors to the hypothalamus, which transfer inhibitory stimuli on ADH secretion. It is suggested that Shy-Drager syndrome should be considered one of the causes of SIADH.
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PMID:[A case of Shy-Drager syndrome complicated with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and incomplete paralysis of bilateral vocal cords]. 795 87

Chemical dependence is a leading cause of morbidity and death in the United States. At least 20% of patients seen by primary care physicians in both the outpatient and inpatient setting are chemically dependent. Up to 90% of these patients go undiagnosed by their primary physicians. Chemical dependence is defined as a chronic, progressive illness characterized by the repeated and persistent use of alcohol or drugs despite negative health, family, work, financial, or legal consequences. Primary care physicians are in an ideal position to detect chemical dependence at its earliest stages, when irreversible medical consequences and death are most likely preventable. Alcohol is the most common drug of abuse. Improving the rate of recognition of chemical dependence depends on being familiar with the constellation of physical, mental, and social indicators. Early medical manifestations of alcoholism common in the primary care setting include: gastric complaints, elevated blood pressure, palpitations, traumatic injuries, headaches, impotence, and gout. Early psychosocial manifestations common in both alcohol and drug dependence include anxiety, depression, insomnia, persistent relationship conflicts, work or school problems, and financial or legal problems. Particularly useful laboratory indicators of alcoholism include elevated levels of GGT and MCV, both displaying high specificity, with the GGT level being the most sensitive. Similarly specific laboratory tests for drug dependence are not available. Any patient presenting with any of the above medical, psychosocial, or laboratory manifestations should be screened for chemical dependence. The CAGE questionnaire for alcoholism, a four-question test, is particularly well suited to the primary care setting, where it can be administered in fewer than 60 seconds. The CAGE has demonstrated high sensitivity (in the 80% range) and specificity (approximately 85%) for alcoholism. Comparably convenient instruments do not yet exist for drug dependence, although a 28-item instrument, the DAST (Drug Abuse Screening Test), has demonstrated high sensitivity and specificity for drug abuse.
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PMID:Early recognition of chemical dependence. 846 47


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