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Although it is a rare disorder (1 in 10 60caps pilex visa,000 to the self-injurious behavior (30) generic pilex 60caps amex. These authors documented 15 purchase pilex 60 caps without a prescription,000), its behavioral phenotype has assumed prominence reductions in dopamine transporter density of 68% in puta- in genetics because of its relationship with AS, which has men and 42% in caudate in six patients with classic LNS a different behavioral phenotype, although both disorders and self-injurious behavior. To clarify the relationship be- involve genomic imprinting of the same region of chromo- tween presynaptic dopamine transporter binding in the stri- some 15. In UPD, two copies of the maternal chromo- 630 Neuropsychopharmacology: The Fifth Generation of Progress some are inherited with no paternal contribution (32). Pipes evaluated food-related behavior in the PWS (36). Without the presence of the chromosome donated by the They found that behavioral problems were most commonly father, the normal imprinting of the two maternally donated related to food and included food stealing, foraging for food, chromosomes leads to absence of gene expression in this gorging, and indiscriminate eating with little food selectiv- interval. This results in a functional abnormality that is ity. No special circumstances that resulted in food stealing essentially equivalent to the structural abnormality found or gorging were identified. Moreover, in about 5% of cases, abnormalities with temper tantrums, stubbornness, negativism, skin pick- in the mechanism of imprinting may occur when the im- ing and scratching, and non–food-related obsessions have printing control center itself has a mutation. A questionnaire survey involving 369 cases Several genes are included in the most commonly deleted identified compulsive and impulsive aggressive behavior region in PWS. These authors used the Overt Aggression Scale, the are maternally imprinted (33). Among these, ZNF 127, Yale-Brown Obsessive-Compulsive Disorder Scale, a clini- NDN, SNURF-SMRPN, IPW are paternally imprinted. An- cal global rating, and DSM-III-R criteria to diagnose self- other gene, UBE3A (E6-AP ubiquitin lipase), is maternally stimulation and self-injury, compulsive behavior, and obses- imprinted. Others genes in this region that are expressed sive behaviors. These investigators found that skin picking from both maternal and paternal chromosomes include was the most common form of self-injury, observed in three -aminobutyric acid (GABA) receptor subunits 19. Other types of self-injury with lower (GABRB3, GABRA5, GABRG3) (33). Because similar phe- frequency were nose picking, nail biting, lip biting, and hair notypes result from deletions and from imprinting in PWS, pulling. The second behavioral problem area was compul- it is less likely that nonimprinted genes play a role in PWS sive behavior; food hoarding was the most severe manifesta- or AS. Among these genes, a specific gene for PWS has not tion and occurred in 17. Other compulsive behaviors been established, so several of these genes may contribute included counting, symmetric arrangements of objects, to the phenotype. For example, the SMRPN gene is involved checking, and hand washing, but they were less common. The NCD (necdin) gene does lead to concerns about contamination. Thus, the disorder is most likely havioral problems identified in the preschool years persist linked to the loss of more than one gene in this region. Etiologic Factors Behavioral Phenotype Investigators have proposed that the genetic abnormality in The extent of cognitive impairment is variable in PWS. PWS leads to hypothalamic dysfunction that results in as- Some patients test in the normal range of intelligence, pects of the clinical phenotype, such as dysregulation of but most test in the mild to moderate range of mental re- feeding, delay in sexual development, sleep disorder, and tardation. Others may test in the severe range of mental abnormality of thermoregulation. The behavioral phenotype includes unusual lamic dysfunction, Swaab et al. However, other brain regions and neu- tolerance, and stubbornness.

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Edited by W ilm ore DW purchase pilex 60caps on line, Brennan M F buy 60caps pilex with visa, H arken AH purchase pilex 60caps with visa, transplants. Gittes RF, W aters W B: Sexual im potence: the overlooked com plication during cadaver kidney transplantation. Barry JM , Fuchs EF: Right renal vein extension in cadaver kidney Laboratory; 1993:267–284. Cecka JM : The UN O S Scientific Renal Transplant Registry. Corry RJ, Kelly SE: Technique for lengthening the right renal vein of Transplants 1996. Sollinger n the United States, diabetes m ellitus is the third m ost com m on disease and fourth leading cause of death from disease. Diabetes is Ithe leading cause of blindness, the number one cause of amputa- tions and impotence, and one of the most frequently occurring chron- ic childhood diseases. Diabetes is also the leading cause of end-stage renal disease in the United States, with a prevalence rate of 31% com- pared with other renal diseases. Diabetes is also the most frequent indication for kidney transplantation, accounting for 22% of all transplantation operations. Increasingly, pancreas transplantation is being offered to patients who would benefit from kidney transplantation (called simultaneous pancreas-kidney transplantation) or who have had a previously suc- cessful kidney transplantation (called sequential pancreas after kidney transplantation). Relatively few transplantation centers are performing pancreas transplantation alone in patients with severe life-threatening complications of diabetes. Pancreas transplantation has been criticized because of the increased morbidity associated with the procedure and lack of controlled trials demonstrating significant benefit to the secondary complications of diabetes. H owever, many of these criticisms have been overcome with improvement in surgical techniques and pancreas transplantation preservation and with more potent immunosuppressive regimens. The relative frequency of pancreas transplantation, common surgical procedures, and outcomes of patients undergoing pancreas C H A P T ER transplantation are discussed. Approxim ately 10,000 patients receive kidney continental United States at the end of 1995, 257,266 patients had transplantations in a given year. Diabetes mellitus (DM ) accounts for nearly one third of all requiring transplantation, diabetes accounted for 22% of all kidney patients newly diagnosed with ESRD who require kidney trans- transplantations perform ed in the United States. GN — glom erulonephritis; H TN — hypertensive lonephritis; H TN — hypertensive nephropathy; PCKD— polycystic nephropathy; PCKD— polycystic kidney disease. Total n=9012 130 115 1200 1027 1022 US n=6640 NonUS n=2372 167 157 842 1000 774 201 200 800 181 557 528 530 201 417 600 213 249 218 400 147 146 170 111 112 112 85 51 200 32 36 50 66 19 30 6 11 24 38 8 20 9 0 Pre- 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 78 Year FIGURE 15-3 Pancreas transplantations per year. The number of pancreas transplantations performed per year in the United States has been increasing. In 1995 and 1996, over 1000 pancreas transplantations were performed in the United States. A smaller number were performed outside of the United States. Patients usually have 1988 1989 1990 1991 1992 1993 1994 1995 type I diabetes mellitus and must have the Year physical stamina to undergo a major abdomi- nal operation. FIGURE 15-4 In some transplantation centers, the cutoff Relative proportion of simultaneous pancreas-kidney (SPK) transplantations versus cadaveric age is 50 years. The patient should demon- kidney transplantations in the United States. Despite an increasing number of SPK transplan- strate emotional and psychological stability, tations over the past 7 years, pancreas transplantation is a less com m on procedure than is and significant secondary complications of cadaveric kidney transplantation alone. Because M edicare does not pay for pancreas transplantations, recipients must use either private insurance or personal funds.

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Rossini PM buy discount pilex 60caps on-line, Caltagirone C pilex 60caps amex, Castriota-Scanderbeg A discount pilex 60 caps with amex, et al. Hand and oxidative defects in neurodegenerative illness using magnetic motor cortical area reorganization in stroke: a study with fMRI, resonance techniques. The role of the basal ganglia in motor control: contri- 52. Motor disturbance and brain functional imaging in 30:749–754. DAVIDSON Virtually all forms of psychopathology are associated with CIRCUITRY OF AFFECT AND COGNITION IN disturbances in various aspects of affect and cognition. Al- MOOD AND ANXIETY DISORDERS though most clinical research has relied on relatively coarse phenomenologic descriptions of symptoms, recent work in The review presented in this section of the key components neuroimaging with behavioral activation paradigms offers of the circuitry underlying aspects of emotion and cognition a new and more penetrating look at specific cognitive and that are most relevant to mood and anxiety disorders is affective processes in psychopathology. This new trend is gleaned mostly from studies of lesions experimentally pro- predicated on the view that we must go beyond phenome- duced in animals, the human lesion literature, and neuroim- nology to understand the brain circuitry that is associated aging studies in normal humans. The review focuses on with complex mood and anxiety disorders. Advances in our various territories of the prefrontal cortex, amygdala, hippo- understanding of these conditions will emerge from research campus, and anterior cingulate cortex. Collectively, these that is designed to examine more specific cognitive and af- studies provide important clues regarding the types of acti- fective processing abnormalities. This work holds promise vation paradigms that are most promising for use in patients in revealing additional targets for therapeutic intervention, with mood and anxiety disorders to probe the underlying both behavioral and pharmacologic. It also will be impor- circuitry of affect and cognition. Research in which activa- tant in helping to expose the heterogeneity of these disorders tion paradigms with neuroimaging are applied in patients and in offering more meaningful ways in which to parse with mood and anxiety disorders is reviewed in a subsequent various subtypes. Finally, by examining the impact of partic- section. The PFC is not a homogene- is most relevant to understanding mood and anxiety disor- ous zone of tissue; rather, it has been differentiated on the ders are first reviewed. The role of individual differences in basis of both cytoarchitectonic and functional considera- the functional activity of this circuitry is then considered. The three subdivisions of the primate PFC that have The next section reviews key approaches and findings of been consistently distinguished are the dorsolateral, ventro- activation paradigms that have been used in this area. In addition, chapter concludes with a summary and a discussion of fu- it appears that important functional differences exist be- ture trends in this rapidly developing area. The role of the PFC in cognitive control has recently been reviewed (1), so it is not extensively considered here Richard J. Davidson: Laboratory for Affective Neuroscience, University other than to underscore that a major function of the PFC of Wisconsin, Madison, Wisconsin. One of the principal roles tive and negative affective states shift the asymmetry in pre- of the PFC is to represent goal-relevant information, a key frontal brain electrical activity in lawful ways. For example, component of both complex thought and emotion. As many film-induced negative affect increases relative right-sided studies at the nonhuman primate level have now docu- prefrontal and anterior temporal activation (15), whereas mented, reward-related information plays a key role in mod- induced positive affect elicits an opposite pattern of asym- ulating the activity of PFC neurons. This general pattern has been replicated and ventromedial zones of the PFC is associated with the by others using similar measures (16,17).

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