RESUMEN

Measurement of cerebrospinal fluid (CSF) levels of the minor dopamine metabolite 3,4-dihydroxyphenylacetic acid in neonates and children indicates that a rapid decline (approximately 90%) occurs in the first 2 years of life. The much less rapid ontogenetic decline seen for the predominant dopamine metabolite, homovanillic acid (HVA), indicates that differing factors affect CSF levels of the two acid metabolites. Further study is required to determine which compound more closely reflects ontogenetic changes in dopamine functioning.

Asunto(s)

RESUMEN

Whole blood serotonin and tryptophan were measured in 87 normal subjects and in 40 autistic subjects. Whole blood serotonin concentrations (mean +/- SE) were significantly higher in drug-free (N = 21) autistics (205 +/- 16 ng/ml) than in normals (136 +/- 5.4 ng/ml). The Gaussian distribution of serotonin levels in the unmedicated autistic group suggests the elevation was not due to a subgroup of autistic subjects. Autistics medicated with anticonvulsants or neuroleptics had significantly lower serotonin levels than did drug-free autistic subjects. Whole blood tryptophan levels and platelet counts were similar in the autistic and normal groups. The possible causes of the hyperserotonemia of autism are discussed.

Asunto(s)

RESUMEN

Nineteen autistic individuals were observed in their familiar residential environment using a time-sample technique. Rates of stereotyped and self-injurious behaviors, the direction of the subject's gaze (at staff, task or elsewhere) and the number of requests made to a subject by staff were a function of treatment structure, as defined by the staff: child ratio. While patterns of compliance in response to different types of requests were observed, subjects were generally compliant. The data do not support the notion that autistic children are unusually 'negativistic'. The utility of ecologically valid observations and the need for normative data are discussed.

Asunto(s)

RESUMEN

The amino-acid precursors tryptophan and tyrosine, and the major metabolites 5-hydroxyindoleacetic acid, indoleacetic acid, homovanillic acid and 3-methoxy-4-hydroxyphenethyleneglycol, related to the central neurotransmitters serotonin, dopamine and norepinephrine, were measured in 62 samples of cerebrospinal fluid from human neonates. Means are reported for the samples from 17 medically uncomplicated infants and for the larger group (42 to 45) of infants with medical complications. The latter group was divided according to diagnosis and medication. All groups had significantly higher levels of all compounds in comparison with older children and adults. There were few significant subgroup differences in the group with complications. In both the normal and complicated groups a number of significant correlations were observed between the compounds themselves and with other physiological measures.

Asunto(s)

RESUMEN

The utility of stimulant medications in the treatment of attention deficit disorder (ADD) has been demonstrated repeatedly. Over 500,000 children receive these medications in the United States each year. The drugs, however, may be used inappropriately in cases where a presumptive diagnosis of "hyperactivity" is mistakenly made on the basis of nonspecific increases in activity levels or when an initial sedative response is taken as diagnostic confirmation of ADD. In this series of six cases, stimulant medications had been used inappropriately to manage a range of developmental problems. The importance of a careful diagnostic evaluation before instituting stimulants, careful monitoring, and a consideration of their risks are emphasized.

Asunto(s)

RESUMEN

Whole blood serotonin (WB5HT) and tryptophan (WBTRP) levels were studied in 20 patients (aged 8 to 45 years) with Tourette's disorder under medication-free baseline conditions and following acute and chronic clonidine treatment. Compared to 87 normal controls, Tourette's disorder patients had lower mean baseline WBTRP levels (mean +/- SEM: Tourette's, 5993 +/- 304 ng/ml vs. 6822 +/- 169 ng/ml; p less than .03). No significant differences in mean baseline WB5HT levels were found. Three hours after an acute dose of clonidine (2.5 - 5.1 micrograms/kg, p.o. at 9:00 A.M.), no mean differences were observed (baseline vs. post 3 hours) in WB5HT or WBTRP levels. However, following chronic treatment (greater than 3 weeks) with clonidine (3-8 micrograms/kg/day, p.o.), WB5HT levels were increased in 9 of 14 Tourette's disorder patients. The mean increases in WB5HT levels following chronic clonidine treatment were significant when WB5HT levels were expressed per 10(9) platelets. (mean +/- SEM: baseline, 471 +/- 45 ng/10(9) platelets vs. chronic, 697 +/- 82 ng/10(9) platelets, p = .02). No mean differences in WBTRP levels were observed after chronic clonidine treatment. These findings are discussed in light of a proposed intermediary role of 5HT systems in the mode of action of clonidine in the treatment of Tourette's disorder.

Asunto(s)

RESUMEN

Clonidine hydrochloride, an alpha 2-adrenergic agonists, was used to treat seven infants who were passively addicted to narcotics because of maternal methadone maintenance. In six of seven infants, the major symptoms of narcotic withdrawal were ameliorated after a total daily oral dose of 3-4 micrograms/kg/day was achieved. One infant failed to respond. No toxic side effects of clonidine were observed at the dosage level used. The results of this pilot study suggest that clonidine may be a safe therapeutic agent for the treatment of neonatal narcotic abstinence syndrome (NNAS). Clonidine treatment of NNAS remains strictly investigational at this time. The relative efficacy and safety of clonidine versus other currently used drug regimens for NNAS also remains to be determined.

Asunto(s)

RESUMEN

The results of a management protocol for women with premature rupture of the membranes (PROM) between 27 and 36 weeks' gestation is presented. Prior to 33 weeks' gestation patients were hospitalized and observed for signs of infection; labor was induced if amnionitis was diagnosed. After 33 weeks patients with vertex presentations underwent elective induction of labor after 16 hours of PROM. Amniocentesis was not performed, corticosteroids were not administered, and tocolysis was not used. The overall perinatal mortality rate was 2.8%. There was only 1 death in the group of 44 patients between 33 and 36 weeks' gestation with PROM for more than 16 hours. This neonate had moderate respiratory distress syndrome and a severe intracranial hemorrhage. The cesarean section rate in the group that underwent labor induction after 16 hours of PROM was 22.7% but only 1 of the 10 operations performed might possibly have been avoided if induction had not been a part of the protocol. In the group of 41 patients managed expectantly but delivered after 16 hours of PROM prior to 33 weeks' gestation, 21.9% were clinically believed to have amnionitis but only 12 neonate had documented sepsis. The implications of these results are discussed.

Asunto(s)

Asunto(s)