Progressive disseminated histoplasmosis presenting as cellulitis in a renal transplant recipient.

With the advent of potent immunosuppressive therapies used in solid organ transplantation, patients are more susceptible to a variety of infectious organisms. Infections may result from atypical pathogens and present in an unusual manner. We describe a case of progressive disseminated histoplasmosis presenting as cellulitis in a renal transplant recipient and review this disease.

Parental and self-report of sleep in children with attention-deficit/hyperactivity disorder.

OBJECTIVE: To determine the prevalence of parent-reported and self-reported sleep disturbances in a sample of school-aged children with attention-deficit/ hyperactivity disorder (ADHD). DESIGN: Cross-sectional survey questionnaire. SETTING: A multidisciplinary ADHD evaluation clinic in a children's teaching hospital (ADHD sample) and 3 elementary schools in southern New England (control sample). PARTICIPANTS: Forty-six unmedicated, school-aged children (mean age, 89.4 +/- 18.7 months; 74% male) diagnosed as having ADHD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria who had been screened for marked symptoms of sleep-disordered breathing, and 46 normal control children (mean age, 86.5 +/- 16.9 months; 70% male). INTERVENTION: None. MAIN OUTCOME MEASURE: Sleep habits and sleep disturbances reported by parents and children. RESULTS: Children with ADHD had significantly higher (more sleep-disturbed) scores on all sleep subscales of the Children's Sleep Habits Questionnaire (parent measure) than did controls; average sleep duration as reported by parents was also significantly shorter in the ADHD group. Children with ADHD also reported their own sleep to be more disturbed than controls did on the Sleep Self-report, particularly on items relating to bedtime struggles (P range, .05-.001). There was a much higher correlation between parent and child sleep report items for the children with ADHD (mean correlation, 0.55) than for the control children. CONCLUSIONS: Sleep disturbances, particularly at bedtime, are frequently reported by both parents and children with ADHD. Children undergoing evaluation for ADHD should be routinely screened for sleep disturbances, especially symptoms of sleep-disordered breathing. The causes of sleep-onset delay in children with ADHD should be considered in designing intervention strategies for children with difficulty falling and staying asleep.

Sleep habits and sleep disturbance in elementary school-aged children.

Relatively little is known about sleep habits, sleep disturbances, and the consequences of disordered sleep in school-aged children. This descriptive study examined a variety of common sleep behaviors in a group of 494 elementary school children, grades kindergarten through fourth, using a battery of sleep questionnaires that included parent, teacher, and self-report surveys. The prevalence of parent-defined sleep problems ranged from 3.7% (Sleep-Disordered Breathing) to 15.1% (Bedtime Resistance), with 37% of the overall sample described as having significant sleep problems in at least one sleep domain. Younger children were more likely than older children to have sleep problems noted by parents (particularly bedtime struggles and night wakings), as well as by teacher and self-report. Children tended to identify more sleep problems by self-report, particularly sleep-onset delay and night wakings, than did their parents. Overall, approximately 10% of the sample was identified by all three measures as having significant problems with daytime sleepiness. The results of this study emphasize the importance of screening for sleep disorders in this age group in the clinical setting. The need for consensus regarding the use of sleep screening instruments and the definition of "problem" sleep in school-aged children is also discussed.

The Children's Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children.

STUDY OBJECTIVES: To present psychometric data on a comprehensive, parent-report sleep screening instrument designed for school-aged children, the Children's Sleep Habits Questionnaire (CSHQ). The CSHQ yields both a total score and eight subscale scores, reflecting key sleep domains that encompass the major medical and behavioral sleep disorders in this age group. DESIGN: Cross-sectional survey. SETTING: Three elementary schools in New England, a pediatric sleep disorders clinic in a children's teaching hospital. PARTICIPANTS: Parents of 469 school-aged children, aged 4 through 10 years (community sample), and parents of 154 patients diagnosed with sleep disorders in a pediatric sleep clinic completed the CSHQ. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The CSHQ showed adequate internal consistency for both the community sample (p=0.68) and the clinical sample (p=0.78); alpha coefficients for the various subscales of the CSHQ ranged from 0.36 (Parasomnias) to 0.70 (Bedtime Resistance) for the community sample, and from 0.56 (Parasomnias) to 0.93 (Sleep-Disordered Breathing) for the sleep clinic group. Test-retest reliability was acceptable (range 0.62 to 0.79). CSHQ individual items, as well as the subscale and total scores were able to consistently differentiate the community group from the sleep-disordered group, demonstrating validity. A cut-off total CSHQ score of 41 generated by analysis of the Receiver Operator Characteristic Curve (ROC) correctly yielded a sensitivity of 0.80 and specificity of 0.72. CONCLUSIONS: The CSHQ appears to be a useful sleep screening instrument to identify both behaviorally based and medically-based sleep problems in school-aged children.

Trimethylamine oxide transport across plasma membranes of elasmobranch erythrocytes.

The aim of this study was to characterize the erythrocyte cell membrane transport of trimethylamine oxide (TMAO) in the little skate, Raja erincea. Uptake of TMAO occurs by two processes, Na(+)-dependent and Na(+)-independent. 2,4 dinitrophenol (2,4 DNP), a known ATP synthesis inhibitor, inhibited TMAO uptake, suggesting the involvement of the Na(+)/K(+)-ATP pump in Na(+)-dependent TMAO transport. Na(+)-independent TMAO uptake was stimulated by cell swelling when erythrocytes were incubated in hypotonic elasmobranch incubation medium. Swelling-activated, Na(+)-independent TMAO uptake was inhibited by the anion transport inhibitors quinine and 4, 4'-diisthiocyanostilbene-2,2'-disulfonic acid (DIDS), two blockers of the swelling-activated osmolyte channel in skate erythrocytes. TMAO efflux was stimulated by hypotonic stress in the erythrocytes of the spiny dogfish, Squalus acanthias. DIDS also inhibited this efflux, indicating that TMAO is transported by the organic osmolyte channel in the erythrocytes of this elasmobranch as well. J. Exp. Zool. 284:605-609, 1999.

Television-viewing habits and sleep disturbance in school children.

OBJECTIVE: To investigate the relationship between specific television-viewing habits and both sleep habits and sleep disturbances in school children. METHODS: The parents of 495 children in grades kindergarten through fourth grade in three public elementary schools completed two retrospective survey questionnaires, one assessing their children's sleep behaviors and the other examining television-viewing habits of both the child and the family. Sleep domains assessed included bedtime resistance, sleep onset delay, sleep duration, anxiety around sleep, parasomnias, night wakings, and daytime sleepiness. Teachers from all three schools also completed daytime sleepiness questionnaires (N = 402) for the sample. RESULTS: Most of the television-viewing practices examined in this study were associated with at least one type of sleep disturbance. Despite overall close monitoring of television-viewing habits, one quarter of the parents reported the presence of a television set in the child's bedroom. The television-viewing habits associated most significantly with sleep disturbance were increased daily television viewing amounts and increased television viewing at bedtime, especially in the context of having a television set in the child's bedroom. The sleep domains that appeared to be affected most consistently by television were bedtime resistance, sleep onset delay, and anxiety around sleep, followed by shortened sleep duration. The parent's threshold for defining "problem sleep behavior" in their child was also important in determining the significance of the association between sleep disturbance and television-viewing habits. CONCLUSION: Health care practitioners should be aware of the potential negative impact of television viewing at bedtime. Parents should be questioned about their children's television-viewing habits as part of general screening for sleep disturbances and as part of anticipatory guidance in regards to healthy sleep habits in children. In particular, the presence of a television set in the child's bedroom may be a relatively underrecognized, but important, contributor to sleep problems in school children.

Unpublished letters from Prosper Menière: a personal silhouette.

It is ironic that, while the term "Menière's disease" is becoming more and more well known today, published accounts of a biographic nature are scarce for the man for whom the eponym was devised: Prosper Menière. As we are obliged to turn to only a few avenues for this sort of information, we are fortunate to discover new sources of original materials to augment the published account of the life and character of Menière the man. One such unpublished source that has recently come to light is a cache of letters from the pen of Menière that was preserved for the period extending from the early 1850s up to the time shortly preceding the author's death a decade later; and it is these letters that form the basis of this inquiry into the mind and character of Menière, the brilliant otologist and man of letters. This particular body of letters, while being for the most part of an admittedly social nature, is of particular interest not only for the occasional references Menière makes to the ear or to his deaf-mute patients, but also because of Menière's epistolary style, and because of their content in general. For this reason the letters have been analyzed primarily with an eye to three categories of interest. The first category is the professional life of Menière, which for the purpose of this paper will be understood to comprise his professional work as a physician, his mention of his patients, of deaf-mutes and their treatment, of his writings in general, and of other pertinent aspects of his medical involvement.(ABSTRACT TRUNCATED AT 250 WORDS)