Sleep Disorders

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.

LOS ANGELES - Sleeping well, plus behavioral modification techniques, may be a start toward relieving the chronic, daily headaches called transformed migraine, researchers said here.

LOS ANGELES ? Children with headaches are more likely to be overweight or obese, researchers said here.

LOS ANGELES - During the last three months of their tours of duty in Iraq, U.S. soldiers were prone to twice as many migraines as the general population, according to army researchers.

UPPSALA, Sweden - A nighttime increase in diastolic blood pressure, or blood pressure that fails to dip at night, are significant independent predictors of congestive heart failure, researchers here reported.

SALT LAKE CITY - Don't change your alarm clock for the weekend, recommends an Australian researcher. Sleeping late on Saturday and Sunday mornings may make you more tired and cranky on Monday and Tuesday.

SALT LAKE CITY - A restless leg syndrome diagnosis can be ruled out by a single question, a researcher said here.

SALT LAKE CITY - Adherence to treatment with continuous positive airway pressure (CPAP) by patients with obstructive sleep apnea may be considerably less than believed.

SALT LAKE CITY - The sedative Ambien (zolpidem) appears to reduce the symptoms of central sleep apnea, according to a small open-label study reported here.

SALT LAKE CITY - A 200-mg jolt of caffeine every two hours can keep sleepless people functioning at about 100% of normal for 48 hours, according to researchers here.

SALT LAKE CITY - Rozerem (ramelteon), a melatonin agonist, was found both safe and effective in a laboratory model of transient insomnia.

SALT LAKE CITY - Americans aren't having nightmares-or dreams of any kind-that replay the 9/11 attack on New York, according to sleep researchers.