bluuebunny/crossref_metadata_2025 huggingface dataset:
Posttraumatic Embitterment Disorder
Authors: Linden Michael
Published: June 2003

Background: Adjustment and reactive disorders are a heterogeneous group of mental disorders. Diagnostic criteria are vague and scientific research is limited despite the fact that these disorders play a major role in clinical practice. Methods: The ‘posttraumatic embitterment disorder’ (PTED) is introduced as a new concept for a subgroup of adjustment disorders. A case vignette and diagnostic criteria are presented. Results: Core criteria of PTED are: (1) a single exceptional negative life event precipitates the onset of the illness; (2) the present negative state developped in the direct context of this event; (3) the emotional response is embitterment and feelings of injustice; (4) repeated intrusive memories of the event; (5) emotional modulation is unimpaired, patients can even smile when engaged in thoughts of revenge, and (6) no obvious other mental disorder that can explain the reaction. Additional symptoms are feelings of helplessness, self-blame, rejection of help, suicidal ideation, dysphoria, aggression, down-heartedness, seemingly melancholic depression, unspecific somatic complaints, loss of appetite, sleep disturbances, pain, phobic symptoms in respect to the place or to persons related to the event, reduced drive. Duration is longer than 3 months. Performance in daily activities and roles is impaired. Conclusions: PTED is a frequent disorder. The diagnosis of PTED can lead to specific therapeutic interventions. PTED can be discriminated from PTSD, depression, anxiety disorders, and other adjustment disorders.
Dropout from Brief Psychotherapy within a Combination Treatment in Bulimia nervosa: Role of Personality and Anger
Authors: Fassino Secondo , Abbate-Daga Giovanni , Pierò Andrea , Leombruni Paolo , Rovera Giovanni Giacomo
Published: June 2003

Background: To explore the personality, psychopathology, and clinical features of bulimic patients who do not complete psychotherapy, within a combined treatment. Methods: 86 patients with bulimia nervosa (BN; DSM-IV) were evaluated before beginning treatment. The Eating Disorder Inventory II (EDI-II), State-Trait Anger Expression Inventory (STAXI), and the Temperament and Character Inventory (TCI) were administered to all patients. Results: 3 subjects failed to engage in psychotherapy. Comparing patients who dropped out (n = 28) with those who did not drop out from psychotherapy (n = 55), significant differences were found in some psychopathologic (EDI-II, STAXI) and personality (TCI) variables. In particular, patients who dropped out from the treatment were more impulsive and more likely to feel anger; they were also less cooperative and less self-directive. No significant differences in sociodemographic, clinical variables and in response to fluoxetine were found between the two groups (dropout and completers). Conclusions: We found a characteristic profile in the bulimic patients who dropped out from brief psychotherapy, i.e., they are less cooperative and more predisposed to anger. These data suggest that dropping out in a subgroup of BN patients could be related to borderline personality traits and to difficulties in making and maintaining a therapeutic relationship. Implications for treatment are discussed.
Cognitive-Behavioral Group Therapy in Obsessive-Compulsive Disorder: A Randomized Clinical Trial
Authors: Volpato Cordioli Aristides , Heldt Elizeth , Braga Bochi Daniela , Margis Regina , Basso de Sousa Marcelo , Fonseca Tonello Juliano , Gus Manfro Gisele , Kapczinski Flavio
Published: June 2003

Background: The present study was designed to verify the efficacy of cognitive-behavioral group therapy (CBGT) in reducing obsessive-compulsive symptoms and the intensity of overvalued ideas, as well as in improving the patient’s quality of life. Methods: Forty-seven patients meeting DSM-IV criteria for obsessive-compulsive disorder (OCD) were randomly assigned to either 12 weekly CBGT sessions or a waiting list (control group). Treated patients were followed for three months. Results: There was a significant reduction in the Yale-Brown Obsessive-Compulsive Scale (p < 0.001), in the National Institute of Mental Health Obsessive-Compulsive Scale (p < 0.001), in the Overvalued Ideas Scale (p < 0.001), and a significant improvement in the quality of life in the four domains of the World Health Organization Quality of Life Assessment Scale: physical (p < 0.001), psychological (p < 0.017), social (p < 0.018) and environmental (p < 0.04). No significant reduction was found in the Hamilton Rating Scale for Anxiety (p = 0.111) and the Hamilton Rating Scale for Depression (p = 0.271). The concomitant use of anti-obsessional medications did not influence the results. The rate of improved patients was 69.6% in the treated group and 4.2% in the control group (p < 0.001). The therapeutic gains were maintained and an additional reduction in symptoms was observed during the 3-month follow-up period. Conclusions: The results suggest that CBGT is effective in reducing the intensity of OCD symptoms and of overvalued ideas, and that it improves the OCD patient’s quality of life in a short period of time.
Assessing Short-Statured Children for Growth Hormone Deficiency
Authors: Chemaitilly W. , Trivin C. , Souberbielle J.-C. , Brauner R.
Published: June 2003

Aim: To optimize the workup of short-statured children by defining the most appropriate tools for diagnosing growth hormone (GH) deficiency. Methods: Patients were assigned to prepubertal (n = 113) or pubertal (n = 112, including 25 boys primed with testosterone) age groups. Mean plasma GH concentration during sleep, GH peak after provocative test, and insulin-like growth factor I (IGF-I) were measured in a single evaluation. Results: The mean GH concentration during sleep was more often normal (n = 155) than the GH peak after provocative tests (n = 105) or the IGF-I concentration (n = 88). Prepubertal patients with a normal body mass index (BMI) had mean GH concentrations during sleep that correlated positively with height, growth rate, GH peak after provocative tests, and IGF-I (p < 0.0005 for all) and negatively with the difference between target and patient heights (p = 0.01) and BMI (p < 0.05). Pubertal patients with a normal BMI had a mean GH concentration during sleep that correlated positively with GH after provocative tests (p < 0.0001) and IGF-I (p < 0.005). Mean GH concentration during sleep and IGF-I concentration for boys primed with testosterone were more often normal (n = 23) than the GH peak after provocative tests (n = 14). All 9 patients with pituitary stalk interruption had low IGF-I concentrations; 1 patient had a normal GH peak after provocative test, and 2 patients had normal mean GH concentrations during sleep. Conclusions: Measuring the GH concentration during sleep and priming boys with pubertal delay can help to exclude idiopathic GH deficiency. Magnetic resonance imaging is needed to exclude anatomic abnormalities when GH and/or IGF-I concentrations are low.
Empty Sella following Spontaneous Resolution of a Pituitary Macroadenoma
Authors: Weiss Roy E.
Published: June 2003

Background/Aim: Empty sella is a radiological finding characterized by the presence of arachnoid herniation into the sella, resulting in compression of the pituitary against the sella wall. The objective of this case presentation is to discuss secondary empty sella in a patient with spontaneous resolution of a pituitary macroadenoma. Methods: A case of empty sella syndrome is presented. Static and dynamic testing was performed. Etiology, pituitary function, and imaging are discussed. Results: A 69-year-old African-American woman was referred by her primary care physician for evaluation and treatment of ‘hypothyroidisim’. Thyroid tests were performed because of muscle and joint tenderness and revealed low free thyroxine and normal thyroid-stimulating hormone levels. The diagnosis of secondary hypothyroidism was made, and magnetic resonance imaging (MRI) of the pituitary revealed an empty sella turcica. In retrospect, the patient had presented 11 years earlier with tinnitus, and an MRI of her auditory canals demonstrated an ‘incidental’ 1.5-cm pituitary tumor. No endocrine evaluation was done at that time, and neurosurgical follow-up of the pituitary tumor by serial MRIs demonstrated the genesis into empty sella. Conclusions: In our patient the natural history of her pituitary tumor was that it involuted and resulted in an empty sella. Although oftentimes speculated as a cause of empty sella, tumor involution has rarely been shown to be causative. In this instance, empty sella was associated with hypopituitarism. This case illustrates the importance of endocrine evaluation of patients with this radiological finding.
Attenuation of Axon Reflexes to Compound 48/80 after Repeated Iontophoresis of Compound 48/80 in Skin of the Human Forearm
Authors: Drummond P.D.
Published: June 2003

The aim of this study was to determine whether the iontophoretic administration of the mast cell degranulator compound 48/80 influences axon reflex vasodilatation in the skin of the human forearm. In stage 1, compound 48/80 was administered by iontophoresis to a circular site in the forearm of 9 healthy men and 8 healthy women on four occasions spread over 24 h. Two control sites were also prepared by passing the iontophoretic current through 0.9% saline. Large wheals initially developed at the compound 48/80 site in 8 of the males and in 2 of the females, but wheals were minimal in all subjects by the fourth administration. In stage 2, compound 48/80 iontophoresis provoked substantial flaring at the first control site, whereas saline iontophoresis induced only minor flaring at the second control site, indicating that compound 48/80 induced axon reflex vasodilatation. However, prior treatment with compound 48/80 inhibited flaring to compound 48/80 in subjects who initially developed wheals, consistent with mast cell degranulation. In stage 3, flaring after iontophoresis of histamine was investigated at the site of compound 48/80 pretreatment and at the second control site in 12 subjects. Flaring was impaired only slightly in 6 subjects who initially developed wheals to compound 48/80. The persistence of flaring indicates that repeated administrations of compound 48/80 did not abolish neurogenic inflammation. Transcutaneous iontophoresis of compound 48/80 may be an attractive alternative to intradermal injection in studies that aim at clarifying the function of mast cells in healthy and diseased skin.
Variability in Brain Death Declaration Practices in Pediatric Head Trauma Patients
Authors: Chang Matthew Y. , McBride Lori A. , Ferguson Margaret A.
Published: June 2003

The American Academy of Pediatrics’ ‘Guidelines for the determination of brain death in children’ [Pediatrics 1987;80: 298–300] has been cited since its publication as the definitive reference for all cases of pediatric brain death. As these guidelines appear to have been designed for use in patients where the etiology of coma is unclear, they often seem inappropriate in cases of severe head trauma. We questioned whether these guidelines were truly the national standard of practice, particularly in instances of brain death secondary to head trauma. We conducted a survey of pediatric hospitals and pediatric neurosurgeons across the country regarding this matter, and found that their brain death declaration practices varied widely. The majority of hospitals and neurosurgeons in our survey do not follow the guidelines exactly. We feel that these guidelines should be reevaluated and perhaps revised, especially in the setting of severe head trauma.
Epilepsy Surgery in Infancy
Authors: Olavarria Greg , Petronio Joseph A.
Published: June 2003

It has been demonstrated that intractable seizures in children can be eliminated or become more responsive to anticonvulsant medication after surgical resection of the epileptogenic focus or dysfunctional hemisphere. We describe our surgical experience with 4 infants treated at Children’s Healthcare of Atlanta Egleston Hospital between 1994 and 2002. All infants, ranging in age from 5 to 9 months, presented with severe seizure disorders and failed trials of anticonvulsants. All had preoperative EEG monitoring and MRI studies; 2 had PET functional imaging. One infant underwent a temporal resection for a low-grade glioma. The rest had cortical resections for malformations and dysplasia. All had improvement, with 2 infants free of seizures off medication. We argue for early intervention in severe cases, as the potential for recovery can be dramatic.
Cortical Ependymoma
Authors: Lehman Norman L. , Jorden Michelle A. , Huhn Stephen L. , Barnes Patrick D. , Nelson Gregg B. , Fisher Paul G. , Horoupian Dikran S.
Published: June 2003

The authors report a rare case of a cortical ependymoma in a 10-year-old boy. The patient presented with complex partial seizures and a well-circumscribed, right frontal cortical mass. Routine microscopy showed a glial tumor with diverse histologic features. Immunohistochemistry and electron microscopy were required to establish the definitive diagnosis of cortical ependymoma. Cortical-based pediatric brain tumors range from World Health Organization grade I to III lesions and require significantly different treatment and follow-up. This case illustrates the importance of establishing an accurate neuropathologic tissue diagnosis of all pediatric cortical tumors.
Regulation of Follicle-Stimulating Hormone Secretion by the Interactions of Activin-A, Dexamethasone and Testosterone in Anterior Pituitary Cell Cultures of Male Rats
Authors: Leal Angela M.O. , Blount Amy L. , Donaldson Cynthia J. , Bilezikjian Louise M. , Vale Wylie W.
Published: June 2003

This study was designed to evaluate the effects of glucocorticoids and gonadal steroids on the expression of inhibin/activin subunits and follistatin of the anterior pituitary and test the hypothesis that resulting changes in the local activin/inhibin/follistatin tone contribute to steroid effects on follicle stimulating hormone (FSH) production from gonadotropes. In primary cell cultures of male rat anterior pituitaries, dexamethasone (DEX) or testosterone (T) stimulated FSH secretion and FSHβ mRNA and their effects were additive with activin-A. Follistatin (FS288) and inhibin-A antagonized the rise in FSH secretion both in the absence and presence of exogenous activin-A. Despite the similarity in their action on FSH production, DEX and T had opposite effects on follistatin mRNA levels. Follistatin mRNA levels of cultured rat anterior pituitary cells were elevated upon the addition of DEX but attenuated by T. On the other hand, both DEX and T suppressed inhibin/activin βB mRNA levels while only DEX affected βA mRNA. In these cells, activin-A stimulated follistatin and inhibin/activin βB mRNA levels but had no effect on βA. Together, DEX and activin-A caused a further increase in follistatin mRNA levels while T attenuated the effect of activin-A alone. Both steroids attenuated the effect of activin-A on βB mRNA accumulation. These results support the possibility that DEX and T, possibly acting on different subsets of anterior pituitary cells, use distinct mechanisms to modify the local activin/inhibin/follistatin circuitry and thereby upregulate FSH production from the anterior pituitary gonadotropes.
Morphological Studies of Prolactin-Secreting Cells in Estrogen Receptor α and Estrogen Receptor β Knockout Mice
Authors: Pelletier Georges , Li Songyun , Phaneuf Daniel , Martel Céline , Labrie Fernand
Published: June 2003

Estrogens play a major role in the regulation of prolactin (PRL) secretion through activation of pituitary and hypothalamic estrogen receptors (ERs). In order to evaluate the relative role of ERα and ERβ in the control of PRL density in the pituitary gland, we performed immunocytochemical localization of PRL and ERs in pituitaries of wild-type (WT), ERα knockout (KO) and ERβKO mice. In WT and ERβKO anterior pituitaries, the vast majority of secretory cells contained ERα immunoreactivity, while no ERα immunostaining could be found in ERαKO pituitaries. No ERβ immunoreactivity could be detected in pituitaries of WT, ERαKO or ERβKO mice. At the light microscopic level, a large number of cells staining for PRL were present in pituitaries of female WT, while in female ERαKO pituitaries, the density of PRL cells was much lower. In WT male pituitaries, the density of PRL cells was lower than observed in female WT, while PRL staining was markedly decreased in male ERαKO as compared to male WT. In ERβKO mice of both sexes, the results were identical to those observed in WT animals. At the electron microscopic level, in WT mice of both sexes, type 1 PRL cells exhibited a well-developed Golgi apparatus and a large number of strongly stained large mature and immature secretory granules. Type 2 PRL cells were also present in the pituitary. Type 2 PRL cells contain small poorly labelled granules. In ERαKO mice of both sexes, type 1 PRL cells were atrophied with poorly developed Golgi apparatus, and no type 2 PRL cells could be observed. In ERαKO pituitaries, typical gonadectomy cells were found. No ultrastructural changes were observed in PRL cells of ERβKO mice. The present data strongly suggest that the positive regulation of PRL expression at the pituitary level by estrogens is mediated by ERα and does not involve ERβ activation.
Hypothesis of Whiplike Motion as a Possible Traumatizing Mechanism in Vocal Fold Vibration
Authors: Sonninen Aatto , Laukkanen Anne-Maria
Published: June 2003

The mucosal waves on the vibrating vocal folds may move in anterior-posterior, mediolateral and in caudal-cranial direction. This article discusses the possible significance of the vertical movement from the point of view of mechanical stress in phonation and the formation of vocal fold traumas. It is hypothesized that in certain conditions the vocal folds may behave in cranial direction like a quasi-free end of a long lash producing very rapid vibratory waves (e.g. the waves in a whiplash). This could be detrimental to the tissue structure. The role of phonation type in enhancing/diminishing this effect will also be discussed.
In vivo Studies of the Genetically Modified Mouse Kidney
Authors: Vallon Volker
Published: June 2003

Gene-targeted mice provide a powerful approach to study the physiological and pathophysiological role of a given protein in kidney function and can give insights on the functional importance of these proteins under in vivo conditions as well as on the potential compensating mechanisms in their absence. Full utilisation of these animal models requires adaptation of the respective methods to the size of the mouse. This applies especially to in vivo studies in mice which have to deal with rather small structures and volumes, e.g. vessels for cannulation, plasma volumes or urinary flow rates. Here some aspects which can help to study kidney function in the mouse in vivo are outlined. The applicability of these in vivo methods are stressed by reviewing their very recent application in mice being deficient for either ROMK or SGK1.
Effect of Tetrahydrobiopterin on Blood Pressure in Rats after Subtotal Nephrectomy
Authors: Podjarny Eduardo , Benchetrit Sidney , Rathaus Mauro , Pomeranz Avishalom , Rashid Gloria , Shapira Janice , Bernheim Jacques
Published: June 2003

Background: Previous studies have shown that endothelial dysfunction after 5/6 nephrectomy (5/6 Nx) in rats is associated with decreased nitric oxide (NO) bioavailability and increased vascular superoxide production. Blood pressure is significantly increased by day 10 after surgery. Tetrahydrobiopterin (BH4) is a key cofactor of NO synthase. Suboptimal levels of BH4 result in uncoupling of NO synthase, low NO synthesis and augmented production of superoxide anions. The aim of this study was to evaluate whether BH4 supplementation may improve NO production and prevent the increase of blood pressure after 5/6 Nx. Methods: Three groups were evaluated: 5/6 Nx (untreated rats), BH4 (5/6 Nx rats treated with BH4, 10 mg/day i.p. for 10 days) and L-ARG (5/6 Nx rats treated with L-arginine, 260 mg/kg BW, p.o for 10 days). Systolic blood pressure (SBP), urinary nitrate excretion (UNO3) and creatinine clearance (CCR) were measured before surgery and on days 3 and 10 after surgery. Endothelial NO synthase (eNOS) protein content of mesenteric resistance vessels was measured at the end of the study. Results: SBP increased from 107 ± 2 to 127 ± 4 mm Hg in untreated 5/6 Nx rats (p < 0.01). By contrast, rats treated with BH4 or L-ARG remained normotensive. Ten days after 5/6 Nx, creatinine clearance decreased similarly in all groups. Both BH4 and L-ARG supplementation markedly increased UNO3 excretion. The mesenteric vascular expression of eNOs protein was significantly higher in BH4 but not in L-ARG, compared with Nx rats. Conclusions: BH4 supplementation prevents the earlier increase in blood pressure observed in rats after 5/6 Nx, possibly by upregulating eNOS in resistance vessels.
Are Some Cases of Infected Pancreatic Necrosis Treatable without Intervention?
Authors: Ramesh H. , Prakash K. , Lekha V. , Jacob G. , Venugopal A.
Published: June 2003

Background: Infected pancreatic necrosis is considered an absolute indication for interventional management such as percutaneous drainage or surgery. The presence of retroperitoneal air is a sign of anaerobic sepsis. Method: A retrospective review of case records of patients presenting with severe acute pancreatitis and pancreatic necrosis was performed to identify cases in whom conservative treatment was followed by a satisfactory outcome. Results: Four patients were identified over a 3-year period who had pancreatic necrosis and retroperitoneal air; they were treated with antibiotics and intensive care, and they improved without any interventional treatment. Conclusions: Some patients with infected pancreatic necrosis are treatable medically. The clinical status of the patients may well be a more important factor governing the choice of the treatment approach than bacteriological findings of infection alone.
Mortality after Colon Surgery: The Value of a Mortality Registration System
Authors: Maartense S. , Vrancken Peeters M.-P.F.M. , Spaander P.J. , Breslau P.J.
Published: June 2003

Background/Aims: Postoperative mortality after colon surgery is relatively infrequent. In order to evaluate the quality of colon surgery, post-mortem evaluation is useful. This study was performed to determine the value of a mortality register used at the Department of Surgery of the Red Cross Hospital. Methods: From 1991 to 2000, 882 colon resections were performed for both malignant and benign disorders, including elective and emergency surgery. Permission for autopsy was asked routinely. All cases were reviewed and categorized in a multidisciplinary meeting. Any discrepancy between the clinical and post-mortem diagnosis was determined by a pathologist. Results: The mortality rate of colon surgery was 8.0% (n = 71), 23% for emergency surgery and 6% for elective surgery (p < 0.001). For patients under 70 years of age the mortality rate was 4.3%, for patients over 70 years of age 11.2% (p < 0.001). Autopsy was performed in 62% (n = 44) of the patients. Discrepancy between clinical and post-mortem findings was documented in 14%. Conclusion: Postoperative mortality after colon surgery is influenced by the timing of surgery (elective or emergency procedure) and the age of the patient. A discrepancy of 14% between clinical cause of death and post-mortem cause of death justifies the need for obtaining autopsy in this type of surgery.
Efficacy of SPIO-MR Imaging in the Diagnosis of Liver Metastases from Colorectal Carcinomas
Authors: Furuhata Tomohisa , Okita Kenji , Tsuruma Tetsuhiro , Hata Fumitake , Kimura Yasutoshi , Katsuramaki Tadashi , Mukaiya Mitsuhiro , Hirokawa Naoki , Ichimura Takeshi , Yama Naoya , Koito Kazumitsu , Sasaki Kazuaki , Hirata Koichi
Published: June 2003

Aim: To determine whether superparamagnetic iron oxide-enhanced magnetic resonance imaging (SPIO-MRI) could replace intravenous contrast-enhanced spiral CT (iv-CT) and spiral CT during arterial portography (CTAP) combined with spiral CT hepatic angiography (CTHA) in the diagnosis of liver metastases from colorectal carcinomas. Methods: Twenty-six adult patients with liver metastases were studied preoperatively by means of iv-CT, CTAP/CTHA, and SPIO-MRI. Preoperative diagnoses using iv-CT, CTAP/CTHA, and SPIO-MRI were compared with intraoperative and pathological findings in resected specimens. The gold standard for the lesions that were resected was histological examination. Intraoperative findings represented the gold standard for lesions that were not resected. Results: Twenty-six patients were found to have a total number of 43 liver metastases. The sensitivities of iv-CT, CTAP/CTHA, and SPIO-MRI were 74.4, 100, and 90.7%, respectively. SPIO-MRI was significantly superior to iv-CT (p < 0.05). The positive predictive values of iv-CT, CTAP/CTHA, and SPIO-MRI were 97.0, 91.5, and 100%, respectively. CTAP/CTHA yielded four false-positive lesions. In contrast, we detected no false-positive findings using SPIO-MRI. Conclusions: These results suggest that SPIO-MRI might not completely replace CTAP/CTHA, but could replace iv-CT in the diagnosis of liver metastases from colorectal carcinomas. It is thought that SPIO-MRI is a promising imaging modality for diagnosing liver metastases in patients with colorectal carcinoma because of its relatively high sensitivity and extremely high specificity.
Bile Duct Cancer Developing 21 Years after Choledochoduodenostomy
Authors: Maeda Atsuyuki , Yokoi Shumpei , Kunou Takao , Saeki Satomi , Murata Tohru , Niinomi Noriji , Uesaka Katsuhiko
Published: June 2003

Background: Cholangiocarcinoma in patients with choledochoenterostomy has been a rare condition with few cases reported in the literature written in English, and there have been few pathological descriptions of this disease. However, it has recently been documented as a late complication of choledochoenteric anastomosis, and has become a serious issue today since choledochoenterostomy and sphincteroplasty for benign biliary lesions were frequently resorted to in the 1970s and 1980s. The authors here present a case of a 67-year-old woman who developed a cholangiocarcinoma 21 years after choledochoduodenostomy. Methods: The patient underwent a curative resection of the tumor with a hepatopancreatoduodenectomy after a detailed preoperative assessment, including cholangiography and cholangioscopy. Results: Although this tumor has been reported to have a poor prognosis, a precise preoperative evaluation and aggressive surgery may contribute to better survival. Pathologically, the tumor originated in the bile duct mucosa of the choledochoduodenostomy, and was accompanied by intestinal and pyloric gland-like metaplasia. Conclusion: These epithelial changes presumably induced by chronic inflammation due to the reflux of intestinal contents and bile stasis may be responsible for the carcinogenesis.
Pneumoperitoneum without Perforation of the Gastrointestinal Tract
Authors: Omori Hiroaki , Asahi Hiroshi , Inoue Yoshihiro , Irinoda Takashi , Saito Kazuyoshi
Published: June 2003

Pneumoperitoneum (PP) is usually the result of perforation of the gastrointestinal (GI) tract with associated peritonitis. However, other rare causes, including spontaneous PP incidental to intrathoracic, intra-abdominal, gynecologic, and miscellaneous other origins not associated with a perforated GI tract have been described in the literature. Six cases of PP without any perforated GI tract are reported. Three patients with generalized peritonitis underwent exploratory laparotomy or laparoscopy when clinical examinations suggested an acute abdomen. At surgical procedure, perforated pyometra, perforated liver abscess and a ruptured necrotic lesion of a liver metastasis were documented in these patients, respectively. We also saw 3 PP patients not associated with peritonitis. Two patients with PP caused by pneumatosis cystoides intestinalis were encountered, 1 was managed conservatively and the other received diagnostic laparoscopy. A patient in whom pneumomediastinum and pneumoretroperitoneum were accompanied by PP caused by an alveolar rupture based on decreased pulmonary compliance due to malnutrition was managed conservatively. The history of the patient and knowledge of the less frequent causes of PP can possibly contribute towards refraining from exploratory laparotomy in the absence of peritonitis.
Systematic Usability Evaluation and Design Issues for Collaborative Virtual Environments
Authors: Tromp Jolanda G. , Steed Anthony , Wilson John R.
Published: June 2003

This paper presents results of the longitudinal usability and network trials that took place throughout the COVEN (COllaborative Virtual ENvironments) Project. To address the lack of understanding about usability design and evaluation for collaborative virtual environments (CVEs), a deductive analysis was used to systematically identify areas of inquiry. We present a summary of the analysis and the resulting framework through which various complementary methods were utilized during our studies. The objective of these studies was to gain a better understanding about design, usability, and utility for CVEs in a multidisciplinary setting.

During the studies, which span four years, we undertook longitudinal studies of user behavior and computational demands during network trials, usability inspections of each iteration of the project demonstrators, consumer evaluations to assess social acceptability and utility of our demonstrators, and continuous preparations of design guidelines for future developers of CVEs.

In this paper, we discuss the need for such activities, give an overview of our development of methods and adaptation of existing methods, give a number of explanatory examples, and review the future requirements in this area.
Six-Degree-of-Freedom Haptic Rendering Using Incremental and Localized Computations
Authors: Kim Young J. , Otaduy Miguel A. , Lin Ming C. , Manocha Dinesh
Published: June 2003

We present a novel six-degree-of-freedom haptic rendering algorithm using incremental and localized contact computations. It uses an incremental approach for contact and force computations and takes advantage of spatial and temporal coherence between successive frames. As part of a preprocess, we decompose the surface of each polyhedron into convex pieces and construct bounding volume hierarchies to perform fast proximity queries. Once the objects have intersected, we compute the penetration depth (PD) in the neighborhood of the contact between each pair of decomposed convex pieces using a new incremental algorithm. Moreover, we cluster different contacts based on their spatial proximity to speed up the force computation. We have implemented this algorithm and applied it to complex contact scenarios consisting of multiple contacts. We demonstrate its effectiveness on electronic prototyping of complex mechanical structures and virtual exploration of a digestive system.
Virtual Reality Serves as a Support Technology in Cardiopulmonary Exercise Testing
Authors: Chuang Tien-Yow , Chen Chih-Hung , Chang Hwa-Ann , Lee Hui-Chen , Chou Cheng-Lian , Doong Ji-Liang
Published: June 2003

The purpose of this study was to develop a virtual cycling system and examine the influence of virtual reality (VR) on test performance during clinical exercise testing. We aimed to compare the physiological responses of the cardiovascular and ventilatory systems during incremental exercise testing with or without VR, and to measure VR effects on the ratings of perceived exertion (RPE) and cycling duration throughout the test.

Twelve healthy senior citizens (ten men and two women) with a mean age of 74.5-4.7 years participated in the study. The codes of behavior for this study included a maximum graded exercise tolerance test, a submaximal endurance VR exercise, and a submaximal endurance non-VR exercise. A friction-braked cycle ergometer was used to conduct the exercise tests. For the subject's movement speed to create an appropriate environment flow on the display screen, the bike was connected to a personal computer. The cardiorespiratory and hemodynamic parameters were evaluated at both peak and submaximal exertion.

The results show that the VR versus non-VR programs did not differ on submaximal and peak exercise responses during the cycling test. However, significant differences were observed between the mean values for cycling duration, distance, and energy consumption. The difference between RPE curves for VR and non-VR protocols revealed promising results within 45 min. of cycling (Breslow test, p = .06); however, no statistical significance was achieved at the test termination (log rank test, p =.17).

In conclusion, this study found that the maintenance of endurance, the increase in target intensity, and total energy consumption in exercise programs may be assisted by introducing VR technology. In addition, the activities taking place in virtual environments can be performed in complete safety.
Keepin' it Real
Authors: Clay Andreana
Published: June 2003

The relationship between Black youth and hip-hop culture is the focus of this article. The author considers how African American youth use hip-hop as a form of cultural capital in everyday settings. By focusing on how Black youth interact with one another at the City Youth Center, the article examines how this particular form of cultural capital may be used to authenticate a Black identity. Finally, how the articulation of this identity is based on traditional gender roles is explored. Bourdieu's theory of cultural capital is heavily relied on to investigate how Black youth construct legitimate racial boundaries in predominately Black settings. The intention is to provide an extension of Bourdieu's theory by examining how Black youth identity is formed and renegotiated in everyday interactions with other Black youth and how this negotiation is mediated through hip-hop culture.
Bailouts, Budget Constraints, and Leviathans
Authors: Wibbels Erik
Published: June 2003

Recent research on federations, particularly in the developing world, emphasizes the importance of hard budget constraints and a strong central government to attenuate intergovernmental economic conflicts. Such research fails on two counts. First, it does not explain how hard budget constraints emerge or become self-enforcing. Second, it does not take into account the insight of the market-preserving federalism literature that central governments strong enough to impose restraint on regions are likely too powerful to be checked in a manner consistent with the longterm health of markets. Unfortunately, the market-preserving federalism literature itself provides little insight into how to move from a market-distorting to a market-preserving equilibrium. This article answers these theoretical shortcomings with reference to the evolution of political competition at the regional level and the representation of those regions at the national level. More specifically, whereas regional competition determines the subnational demand for soft budget constraints, the coalition of those regions at the national level determines the likelihood of their provision. Empirically, the research relies on a case study of the state debt crisis of the 1840s when the United States made a definitive movement toward market-preserving federalism.
Social Justice: A Long-Term Challenge for Counseling Psychology
Authors: Ivey Allen E. , Collins Noah M.
Published: June 2003

Counseling psychology has a long history of interest and commitment to social justice and multicultural issues. This article discusses some of that history and, in addition, speaks to specifics of implementing a liberation psychology frame of reference into clinical practice along with the issues of implementation and challenges faced by those of a social justice orientation. The authors support the position of Vera and Speight (2003 [this issue]) but point to (a) the need to avoid ahistoricism as practitioners work with social justice and (b) the need for awareness that the multicultural competencies themselves represent a major social justice organizational intervention.
A Pragmatic View of Social Justice
Authors: Helms Janet E.
Published: June 2003

Vera and Speight's (2003 [this issue]) use of the current Multicultural Competencies (Sue et al., 1998) to criticize all multicultural cultural social justice interventions may be unfair. The author offers some perspectives on shifting the focus of counseling psychology to marginalized groups but advises that minority status and economic realities may impede the shift.
Nearby Nature
Authors: Wells Nancy M. , Evans Gary W.
Published: June 2003

Identifying mechanisms that buffer children from life's stress and adversity is an important empirical and practical concern. This study focuses on nature as a buffer of life stress among rural children. To examine whether vegetation near the residential environment might buffer or moderate the impact of stressful life events on children's psychological well-being, data were collected from 337 rural children in Grades 3 through 5 (mean age=9.2 years). Dependent variables include a standard parent-reported measure of children's psychological distress and children's own ratings of global self-worth. In a rural setting, levels of nearby nature moderate the impact of stressful life events on the psychological well-being of children. Specifically, the impact of life stress was lower among children with high levels of nearby nature than among those with little nearby nature. Implications of these finding are discussed with respect to our understanding of resilience and protective mechanisms.
Differentiating Active and Passive Littering
Authors: Sibley Chris G. , Liu James H.
Published: June 2003

A two-stage model of littering behavior in public places differentiated two types of littering: active and passive. The distinction between active littering (e.g., someone drops litter on the ground and continues walking) and passive littering (e.g., someone drops litter on a bench while seated and fails to remove it when leaving) depends on the latency between (a) when the litter is placed in the environment and (b) failure to remove that litter when vacating the territory. Results suggested passive littering was more resistant to change than active littering. Posted feedback significantly reduced cigarette littering by 17% (20% reduction in active littering, 6% increase in passive littering) and noncigarette littering by 19% (0% change in active littering due to minimal baseline levels, 25% reduction in passive littering). The probability of littering also increased with the latency between when litter was placed in the area and when the individual vacated the area.
Rap and Race
Authors: Sullivan Rachel E.
Published: June 2003

This article examines adolescents' attitudes toward rap music, specifically racial differences in Black and White adolescents' perceptions of rap. Rap critics have long touted the allegedly deleterious effects of rap, but few researchers have asked fans themselves how rap has affected them. This study uses a survey of 51 adolescents in a Midwestern city to examine racial differences in preferences for and interpretations of rap music. Survey results indicate that racial differences in the popularity of rap music are limited. However, further questions reveal that African American youth are more committed to rap music and are more likely to see rap music as life affirming. Although both groups appear to have favorable opinions of rap, their commitment to it and its significance in their lives varies by race.
Cultural Identity and Learning to Teach in a Diverse Community
Authors: Au Kathryn H. , Blake Karen M.
Published: June 2003

Teacher educators face the challenge not only of recruiting candidates of diverse backgrounds but of preparing these candidates to be effective teachers. This study looks at the influence of cultural identity (ethnicity, social class, and community membership) on the learning of three preservice teachers. One of the preservice teachers was a Japanese American, an outsider to the low-income Hawaiian community served by the teacher education program. The other two were of Hawaiian ancestry and insiders to the community. The findings suggest that preservice teachers who differ in terms of cultural identity may gain different benefits from participation in a program designed to prepare them to teach in a diverse community. For outsiders, critical understandings may develop as a result of field experiences. For insiders, critical understandings may evolve as a result of course readings, class discussions, and written reflections.
Summative Evaluation of Student Teachers
Authors: Raths James , Lyman Frank
Published: June 2003

This article proposes that teacher education faculty are not taking sufficient care in preventing weak, incompetent student teachers from attaining state licenses. Several factors that contribute to this problem are cited and discussed. One explanation accounting for the difficulty in withholding licensure from weak students is that the concept of incompetence is not sufficiently clear. Responding to this explanation, the authors make the following two distinct contributions: (a) They place incompetence in a continuum of teaching behaviors from criminality and malpractice through best practice; and (b) teaching acts in specific settings are pronounced as indicators of teacher incompetence. The article concludes with significant caveats that need to be taken into account as the definitions of incompetence are shared or adopted.
From Teacher to Student
Authors: Kunzman Robert
Published: June 2003

This study considers the usefulness of formal teacher preparation for those with prior teaching experience. We examine the experiences of STEP (Stanford Teacher Education Program) graduates who had significant classroom teaching experience prior to entering STEP. Five themes emerge as central to the learning of these experienced teachers during their STEP year: a greater awareness of the students in their classes who are struggling academically and how to help them; a broader and more complex understanding of curriculum planning; the importance of collegiality and collaboration in professional life; the value of feedback and structured reflection; and theoretical frameworks of education that enhanced both pedagogy and appreciation for broader educational issues outside the classroom. The comments of these STEP graduates reveal their strong support of a comprehensive training experience that recognizes the value of classroom experience but situates it in an intellectually rigorous context of reflection, feedback, and collaboration.
Representations of Substitute Teachers and the Paradoxes of Professionalism
Authors: Weems Lisa
Published: June 2003

This article explores both dominant and counternarratives about the work of teachers (and teaching) articulated through representations of substitute teachers. Using the notion of deviant historiography, the author uses the representation of substitute teachers to render visible the assumptions that govern the boundaries of professionalism. The author's exploration begins with a brief discussion of the professional teacher as constructed in educational reform. The author then presents three images of substitute teachers—the incompetent, unqualified teacher; the deviant outsider; and the guerilla superhero—that proliferate in popular cultural and educational practitioner discourses on teaching. Finally, the author discusses the significance of these images through an analysis of how other teachers function in the context of teacher shortage, educational reform, and school practice.
County Jail Suicides in a Midwestern State: Moving Beyond the Use of Profiles
Authors: Winter Melinda M.
Published: June 2003

As part of a larger research project that evaluated individual and organizational units of analysis as related to jail suicides and suicide rates, this study addresses the problem of jail suicide and the current utilization of profiles as screening devices. Traditional profiles either overgeneralize to too broad of a population, are too small to offer conclusions beyond a case study, or lack distinction from the general jail population. This study examines inmate characteristics in relation to county jail suicides in a Midwestern state from 1980 through mid-1998. The concepts behind current profile application are refuted and yield to characteristics elicited through comparisons to the general, county-jail inmate populations. These factors distinguish inmates who committed suicide from inmates in the general jail population. The results demonstrate the need for local assessments and more stringent methods when developing screening tools. Implications for jail administrators, policies, and future research are discussed further.
Parenting Attitudes of Drug-Involved Women Inmates
Authors: Surratt Hilary L.
Published: June 2003

Of the 93,000 women incarcerated in 2001, nearly 80% were mothers of approximately 130,000 minor children. Many correctional institutions have implemented programs to teach the growing number of incarcerated women effective parenting skills. However, there are few evaluations of such programs. This study examined changes in parenting attitudes as a function of program participation for drug-involved women at a correctional institution in Delaware. The attitudes of 59 women were assessed along five dimensions predictive of abusive parenting practices. Mean scores revealed no statistically significant differences between those who had completed the program, those enrolled, and those not participating. Significantly, however, standardized scores were well within average range of normed scores developed on nonabusive adult parents. Findings indicate these women did not express overly controlling or punitive attitudes with regard to children. The study lends support to other investigations documenting similarly positive parenting attitudes among substance-abusing women. Thus, the intense focus of programs on disciplinary alternatives to spanking might be misplaced.
A Simulink-Based Scheme for Simulation of Irrigation Canal Control Systems
Authors: Mantecón Juan A. , Gómez Manuel , Rodellar José
Published: June 2003

Computer simulation is the main tool in the design and analysis of control systems for irrigation canal automation, which involves several disciplines and backgrounds. While hydraulic engineers are more familiar with equation-oriented, highly nonlinear, distributed parameter models, control engineers are usually comfortable with linear models and block-oriented descriptions of systems. This article presents a Simulink-based scheme for the simulation of irrigation control systems, which combines library blocks with user-custom blocks, fitting different user preferences and reducing implementation complexity.
A Rapid Prototyping Environment for Designing and Simulating Multilevel Computer Architectures
Authors: Pizzutilo Sebastiano , Tangorra Filippo
Published: June 2003

This paper describes a software environment that allows the rapid development and simulation of computer architectures. The system, called the Architecture Prototyping Environment (APE), is based on an object-oriented approach for hardware component description. This approach allows the formation of a class definition that does not require the writing of special-purpose simulators. In this way, computer architecture hardware components are effectively and conveniently expressed as a class library, representing basic elements of the processor. APE allows the user to define the computer architecture at the instruction set level and then to switch automatically to the lower level of the corresponding microarchitecture. APE supports the design of a computer architecture (definition phase), which is used as a starting point for the next phase for evaluating prototype behavior (test phase). APE accepts modifications of the architecture design and repeats the simulation process until architectural features match user requirements.