Autism Spectrum Disorder (ASD) is characterized by persistent deficits in social communication and restricted, repetitive patterns of behavior and interest. Sleep problems are not uncommon in children with autism spectrum disorders. Symptoms of insomnia are the most frequent sleep problems in individuals with ASD. Sleep problems can cause significant difficulties in the daily life of children with ASD and their families. Genetic factor, deregulations of melatonin synthesis, extraneous environmental stimuli and psychiatric and medical conditions may cause sleep problems. The first line treatment of sleep problems in ASD includes managements for potential contributing factors and parent education about sleep hygiene care for child and behavioral therapy. Supplementation with melatonin may be effective before considering other medications, such as risperidone, clonidine, and mirtazapine.
Autistic Disorder* ; Child ; Autism Spectrum Disorder* ; Clonidine ; Education ; Genetics ; Humans ; Hygiene ; Melatonin ; Parents ; Risperidone ; Sleep Initiation and Maintenance Disorders

Alcohol has been used as sedatives historically. The effect of alcohol on sleep is different according to its dose, timing of ingestion, and drinking frequency. Sleep problems may play a role in the development and course of alcohol-related disorders. Insomnia in alcohol-dependent patients is common and early treatment of insomnia may reduce the rate of relapse. Sleep apnea, restless legs syndrome, periodic limbs movement disorder, and altered circadian rhythm may be more frequent in this patients. Management of sleep and alcohol problems is important in treating alcohol-related disorder and sleep disorders, respectively.
Alcohol-Related Disorders ; Circadian Rhythm ; Drinking ; Eating ; Extremities ; Humans ; Hypnotics and Sedatives ; Movement Disorders ; Recurrence ; Restless Legs Syndrome ; Sleep Apnea Syndromes ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders

PURPOSE: We evaluated the degree of femoral and tibial torsion in, and the efficacy of two operative procedures for, resistant idiopathic clubfoot with toe-in gait. MATERIALS AND METHODS: Thirty one feet in 23 patients (average age at the time of revision surgery 4.3 years) were studied. CT was used to determine femoral anteversion and tibial torsion. Two different operative procedures were applied, depending on the degree of toe-in gait: group 1 (10 feet whose toe-in gait was not severe) - soft tissue release, anterior tibial tendon transfer and mid-foot (cuboid closing and cuneiform opening) osteotomy; group 2 (21 feet which had relatively severe toe-in gait) - supramalleolar external rotation osteotomy of the distal tibia (SEROT), along with the same procedure as group 1. Mean follow-up period after revision surgery was 6.3 years. Results were assessed radiologically and clinically with the Dimeglio classification and Clubfoot Assessment Protocol. RESULTS: The mean femoral anteversion and external-tibial torsion of the affected side were increased. Twenty eight of 31 feet (90.3%) demonstrated excellent or good results. In group 2, we obtained 19 excellent (90.5%) and 2 good (9.5%) results. Group 1 had 6 excellent (60%), one good (10%) and 3 fair (30%) results. CONCLUSION: Surgical treatment of the relapsed clubfoot with toe-in gait including soft-tissue release, tendon transfer and mid-foot osteotomy, along with SEROT in cases of severe toe-in gait, is effective in correcting residual clubfoot deformities.
Clubfoot ; Congenital Abnormalities ; Follow-Up Studies ; Foot ; Gait ; Humans ; Osteotomy ; Surgical Procedures, Operative ; Tendon Transfer ; Tenotomy ; Tibia

A 44-year-old man with chronic alcoholism presented with seizure and loss of consciousness. He was diagnosed with alcoholic hepatic encephalopathy, and his neurologic symptoms recovered after lactulose enema treatment. His initial serum sodium level was 141 mEq/L. However, his mental state became confused after treatment with lactulose enema for five days, and his serum sodium level increased to 178 mEq/L. After five days of gradual correction of serum sodium level from 178 mEq/L to 140 mEq/L, the patient’s mental state recovered, but motor weakness in both limbs remained. Therefore, magnetic resonance imaging of the brain was performed. T2-weighted brain images showed bilateral symmetrical hyperintensities in the central pons, basal ganglia, thalami, hippocampi and unci, which were consistent with central pontine and extrapontine myelinolysis. We report a rare case of osmotic demyelination syndrome that occurred as a result of a rapid increase from a normal sodium level to hypernatremia caused by lactulose enema administered to treat alcoholic hepatic encephalopathy.

No abstract available.
Morphine* ; Respiration, Artificial* ; Weaning*

BACKGROUND: A randomized, multicenter, open-label, parallel group study was performed to compare the effects of remifentanil and morphine as analgesic drugs on the duration of weaning time from mechanical ventilation (MV). METHODS: A total of 96 patients with MV in 6 medical and surgical intensive care units were randomly assigned to either, remifentanil (0.1-0.2 mcg/kg/min, n = 49) or morphine (0.8-35 mg/hr, n = 47) from the weaning start. The weaning time was defined as the total ventilation time minus the sum of controlled mode duration. RESULTS: Compared with the morphine group, the remifentanil-based analgesic group showed a tendency of shorter weaning time (mean 143.9 hr, 89.7 hr, respectively: p = 0.069). Secondary outcomes such as total ventilation time, successful weaning rate at the 7th of MV day was similar in both groups. There was also no difference in the mortality rate at the 7th and 28th hospital day. Kaplan-Meyer curve for weaning was not different between the two groups. CONCLUSIONS: Remifentanil usage during the weaning phase tended to decrease weaning time compared with morphine usage.
Analgesics ; Humans ; Critical Care ; Morphine* ; Mortality ; Respiration, Artificial* ; Ventilation ; Ventilator Weaning ; Weaning*

Klippel-Trenaunay syndrome (KTS) is a rare congenital disorder and is essentially a disorder of capillary, venous, and lymphatic malformations. Hematochezia is the most common symptom associated with intestinal hemangiomatosis and remains one of the life-threatening emergencies in KTS. We reported one patient of KTS presented with rectal bleeding and severe anemia who was successfully managed by sphincter-saving operation.
Anemia ; Capillaries ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Emergencies ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Klippel-Trenaunay-Weber Syndrome

INTRODUCTION: Although it is well known that medical students are not getting an adequate amount of sleep, there have been only a few studies on the sleep patterns of medical students and the related factors. Therefore, the present study aimed to investigate the medical students' sleep patterns and the related factors. METHODS: A questionnaire package was administered to the 1st to 4th year medical students at one medical school. It consisted of questions asking about their lifestyles as well as Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), global assessment of recent stress scale (GASS), the center for epidemiologic studies-depression scale (CES-D), and Moudsley obsessive-compulsive inventory (MOCI). A total of 352 students (206 males and 146 females) responded to the survey and the result was analyzed using the independent t-test, the chi-square test, the paired t-test, Pearson's correlation and ANOVA. p-values of less than 0.05 were considered statistically significant in analyses. RESULTS: The weekend bedtime was significantly delayed (0 : 49 on weekday ; 1 : 34 on weekend ; t=-5.23, p<0.001), the weekend rise time was delayed (6 : 58 on weekday ; 9 : 30 on weekend ; t=-24.48, p<0.001) and the total sleep time was increased on weekends (5 : 36 on weekday ; 7 : 39 on weekend ; t=15.94, p<0.001). The PSQI score of all subjects was 6.43+/-2.64. PSQI was positively correlated with ESS (r=0.383, p<0.001), GASS (r=0.326, p<0.001), CES-D (r=0.393, p<0.001), and MOCI (r=0.247, p<0.001), but not with GPA (r=0.072, p=0.228. The more senior students had lower PSQI, GASS, CES-D, and MOCI score (p<0.05). CONCLUSION: Medical students were experiencing a lack of sleep during weekdays as they have a later bedtime and earlier rise time, and consequently had more hours of sleep on weekends. Overall, the medical students were experiencing poor sleep quality and sleep deprivation. Poor sleep quality is associated with psychological problems (daytime sleepiness, stress, depression, and obsessive tendency).
Depression ; Humans ; Life Style ; Male ; Surveys and Questionnaires ; Schools, Medical ; Sleep Deprivation ; Students, Medical*

BACKGROUND: We assessed the state of diabetes control in Korean adults from the 2001 Korean National Health and Nutrition Survey. METHODS: A total of 271 adult diabetes patients (125 males, 146 females) were identified from the health interview survey. Diabetes control status was assessed by the American Diabetic Association (ADA) recommendations. Socioeconomic characteristics and the health status were assessed by an interview and the health- related behavior was assessed by self-questionnaire. A one-day 24-hour recall was used for the dietary assessment. Blood pressure and anthropometric measurements were done. Fasting blood was drawn for glucose, HbA1c, and lipids profile. RESULTS: The proportions of patients reaching the recommended goals for fasting plasma glucose (< or =130 mg/dl), HbA1c (<7%), blood pressure (<130/80 mmHg), low density lipoprotein cholesterol (<100 mg/dl), triglyceride (<200 mg/dl), and high density lipoprotein cholesterol (>45 mg/dl for males, >55 mg/dl for females) were 57.2%, 19.9%, 24.4%, 27.8%, 64.5% and 20.7%, respectively. Body mass index, and smoking in males and age, and diabetes duration in females were associated with HbA1c level. CONCLUSION: This study shows that diabetes in Korean adult is not adequately controlled. National effort is needed to achieve the recommended treatment goals and to manage modifiable risk factors such as obesity and smoking.
Adult ; Blood Pressure ; Body Mass Index ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Diabetes Mellitus ; Fasting ; Female ; Glucose ; Humans ; Lipoproteins ; Male ; Obesity ; Plasma ; Risk Factors ; Smoke ; Smoking